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Resnick CM. Pediatric Temporomandibular Joint Pathology. Oral Maxillofac Surg Clin North Am 2024; 36:303-315. [PMID: 38462395 DOI: 10.1016/j.coms.2024.01.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/12/2024]
Abstract
Pediatric temporomandibular joint (TMJ) disorders represent a broad range of congenital and acquired diagnoses. Dentofacial deformities, including facial asymmetry, retrognathism, and malocclusion, commonly develop. Compared with adult TMJ conditions, pain and articular disc pathology are less common. Accurate diagnosis is paramount in planning and prognostication. Several specific considerations apply in preparation for skeletal correction, including timing in relation to disease progression and growth trajectory, expectation for postcorrection stability, reconstructive technique as it applies to expected durability and need for future revision, management of occlusion, and need for ancillary procedures to optimize correction. This article reviews common conditions and treatment considerations.
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Affiliation(s)
- Cory M Resnick
- Department of Oral and Maxillofacial Surgery, Harvard Medical School, Boston, MA, USA; Department of Plastic and Oral Surgery, Boston Children's Hospital, 300 Longwood Avenue, Boston, MA 02115, USA.
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Krarup H, Pedersen TK, Frid P, Nørholt SE. Long-term follow-up of corrective jaw surgery including distraction osteogenesis in 32 patients with juvenile idiopathic arthritis. Int J Oral Maxillofac Surg 2024:S0901-5027(24)00182-6. [PMID: 38945734 DOI: 10.1016/j.ijom.2024.06.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2023] [Revised: 06/02/2024] [Accepted: 06/04/2024] [Indexed: 07/02/2024]
Abstract
Dentofacial deformity following juvenile idiopathic arthritis (JIA) with temporomandibular joint (TMJ) involvement is associated with functional, aesthetic, and psychosocial impairment. Corrective surgical treatment includes combinations of orthognathic surgeries (OS). The aims of this study were to assess orofacial symptoms, functional and aesthetic status, and stability after OS including mandibular distraction osteogenesis (MDO). A prospective study was conducted of 32 patients with JIA of the TMJ and dentofacial deformities who underwent MDO as the only surgery or in combination with bilateral sagittal split osteotomy, Le Fort I, and/or genioplastybetween 2003 and 2018. Data from clinical examinations and cephalograms performed pre- and postoperative and at long-term (mean 4 years) were analysed. Patients experienced unchanged orofacial symptoms (all P > 0.05), short-term TMJ functional impairment (all P < 0.001), and long-term morphological improvements in SNB angle (P < 0.001), anterior facial height (P < 0.001), mandibular length (P = 0.049), overjet (P < 0.001 and P = 0.005), and posterior facial symmetry (P = 0.046). MDO as the only surgery or with secondary adjunctive OS improved dentofacial morphology in terms of mandibular advancement, anterior facial height, posterior facial symmetry, and incisal relationships without long-term deterioration in TMJ function or orofacial symptoms.
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Affiliation(s)
- H Krarup
- Department of Oral and Maxillofacial Surgery, Aarhus University Hospital, Aarhus, Denmark.
| | - T K Pedersen
- Department of Oral and Maxillofacial Surgery, Aarhus University Hospital, Aarhus, Denmark; Section for Orthodontics, Department of Dentistry and Oral Health, Aarhus University, Aarhus, Denmark
| | - P Frid
- Department of Otorhinolaryngology, Division of Oral and Maxillofacial Surgery, University Hospital North Norway, Tromsø, Norway; Public Dental Service Competence Centre of North Norway, Tromsø, Norway; Department of Clinical Dentistry, UiT the Arctic University of Norway, Tromsø, Norway
| | - S E Nørholt
- Department of Oral and Maxillofacial Surgery, Aarhus University Hospital, Aarhus, Denmark; Section for Maxillofacial Surgery and Oral Pathology, Department of Dentistry and Oral Health, Aarhus University, Aarhus, Denmark
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Rongo R, Michelotti A, Pedersen TK, Resnick CM, Stoustrup P. Management of temporomandibular joint arthritis in children and adolescents: An introduction for orthodontists. Orthod Craniofac Res 2023; 26 Suppl 1:151-163. [PMID: 37226648 DOI: 10.1111/ocr.12676] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Accepted: 05/02/2023] [Indexed: 05/26/2023]
Abstract
Juvenile idiopathic arthritis (JIA) is the most common inflammatory rheumatic disease of childhood. JIA can affect any joint and the temporomandibular joint (TMJ) is one of the joints most frequently involved. TMJ arthritis impacts mandibular growth and development and can result in skeletal deformity (convex profile and facial asymmetry), and malocclusion. Furthermore, when TMJs are affected, patients may present with pain at joint and masticatory muscles and dysfunction with crepitus and limited jaw movement. This review aims to describe the role of orthodontists in the management of patients with JIA and TMJ involvement. This article is an overview of evidence for the diagnosis and treatment of patients with JIA and TMJ involvement. Screening for the orofacial manifestation of JIA is important for orthodontists to identify TMJ involvement and related dentofacial deformity. The treatment protocol of JIA with TMJ involvement requires an interdisciplinary collaboration including orthopaedic/orthodontic treatment and surgical interventions for the management of growth disturbances. Orthodontists are also involved in the management of orofacial signs and symptoms; behavioural therapy, physiotherapy and occlusal splints are the suggested treatments. Patients with TMJ arthritis require specific expertise from an interdisciplinary team with members knowledgeable in JIA care. Since disorders of mandibular growth often appear during childhood, the orthodontist could be the first clinician to see the patient and can play a crucial role in the diagnosis and management of JIA patients with TMJ involvement.
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Affiliation(s)
- Roberto Rongo
- Department of Neurosciences, Reproductive sciences and Oral Sciences, School of Orthodontics, University of Naples "Federico II", Naples, Italy
| | - Ambrosina Michelotti
- Department of Neurosciences, Reproductive sciences and Oral Sciences, School of Orthodontics, University of Naples "Federico II", Naples, Italy
| | - Thomas Klit Pedersen
- Department of Dentistry and Oral Health, Section of Orthodontics, Aarhus University, Aarhus, Denmark
- Department of Maxillofacial Surgery, Aarhus University Hospital, Aarhus, Denmark
| | - Cory M Resnick
- Department of Oral and Maxillofacial Surgery, Harvard School of Dental Medicine and Harvard Medical School, Boston, MA, USA
- Department of Plastic and Oral Surgery, Boston Children's Hospital, Boston, MA, USA
| | - Peter Stoustrup
- Department of Dentistry and Oral Health, Section of Orthodontics, Aarhus University, Aarhus, Denmark
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Kotaniemi KVM, Suojanen J, Palotie T. Complications and Associated Risk Factors for Bimaxillary Osteotomies: A 15-Year Single-center Retrospective Study. J Craniofac Surg 2023; 34:2356-2362. [PMID: 37747239 DOI: 10.1097/scs.0000000000009736] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2023] [Accepted: 07/31/2023] [Indexed: 09/26/2023] Open
Abstract
AIM The aim of this study was to retrospectively investigate the risk factors and their association on bimaxillary osteotomies to be able to improve patient selection and bimaxillary osteotomy planning. MATERIAL AND METHODS Patients treated with a bimaxillary osteotomy were included in the study. The complications were collected retrospectively from the patient data records. The effects of certain predictor variables on complication rates were also studied. RESULTS Sixty-one patients (48.0%) suffered from peri- or postoperative complications, or both. Twenty-five various perioperative complications were reported on 25 patients (19.6%) and 63 postoperative complications on 46 patients (36.2%). Ten patients (7.8%) suffered from both perioperative and postoperative complications. The effect of various predictor variables (sex, age, general health, type of malocclusion, surgery planning, use of bone grafts, and type of maxillary or mandibular movement) on complications was investigated, but we could not find any single factor to affect significantly on complication rate. CONCLUSION Both perioperative and postoperative complications are common in bimaxillary surgery, which must be noted in patient preoperative information. However, life-threatening complications are rare. Patient profile, bone grafting, type of osteosynthesis, or segmentation of the maxilla do not seem to affect the complication risk.
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Affiliation(s)
- Karoliina V M Kotaniemi
- Department of Oral and Maxillofacial Diseases, Head and Neck Center Helsinki University Hospital, Helsinki
- Department of Oral and Maxillofacial Diseases, Clinicum, Faculty of Medicine, University of Helsinki
| | - Juho Suojanen
- Cleft Palate and Craniofacial Center, Department of Plastic Surgery, Helsinki University Hospital, Helsinki
- Päijät-Häme Joint Authority for Health and Wellbeing, Department of Oral and Maxillo-Facial Surgery, Lahti, Finland
| | - Tuula Palotie
- Department of Oral and Maxillofacial Diseases, Head and Neck Center Helsinki University Hospital, Helsinki
- Department of Oral and Maxillofacial Diseases, Clinicum, Faculty of Medicine, University of Helsinki
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Krarup H, Pedersen TK, Frid P, Nørholt SE. Long-Term Follow-Up of Orthognathic Surgery in 19 Patients with Juvenile Idiopathic Arthritis. J Oral Maxillofac Res 2023; 14:e4. [PMID: 38222878 PMCID: PMC10783879 DOI: 10.5037/jomr.2023.14404] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2023] [Accepted: 12/30/2023] [Indexed: 01/16/2024]
Abstract
Objectives Dentofacial deformity following juvenile idiopathic arthritis with temporomandibular joint involvement is associated with functional, aesthetic, and psychosocial impairment. Surgical treatment may involve combinations of orthognathic surgery. The aims of this retrospective study were to assess orofacial symptoms, functional and aesthetic status, and stability after orthognathic surgery. Material and Methods Nineteen patients with juvenile idiopathic arthritis of the temporomandibular joint (TMJ) and dentofacial deformities were included. All patients were treated with combinations of bilateral sagittal split osteotomy, Le Fort I and/or genioplasty, between September 10, 2007 and October 17, 2017. Analysis of patient symptoms and clinical registrations, and frontal/lateral cephalograms was performed pre- and postoperative and long-term (mean: 3.8 and 2.6 years, respectively). Results Patients experienced no changes in orofacial symptoms or TMJ function, and stable normalisation of horizontal and vertical incisal relations at long-term (horizontal overbite; vertical overbite: P < 0.05). Mandibular lengthening was achieved postoperatively (from mean 79.7 to 87.2 mm; P = 0.004) and was stable. Sella-nasion to A point (SNA) and sella-nasion to B point (SNB) angles increased postoperatively (SNA, mean 79.9° to 82.8°; P = 0.022 and SNB, mean 73.9° to 77.8°; P = 0.003), however, largely reverted to preoperative status at long-term. Conclusions Orthognathic surgery normalized incisal relations while providing stable mandibular lengthening without long-term deterioration of temporomandibular joint function or orofacial symptoms. No long-term effect on jaw advancements was observed.
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Affiliation(s)
- Henrik Krarup
- Department of Oral and Maxillofacial Surgery, Aarhus University Hospital, AarhusDenmark.
| | - Thomas Klit Pedersen
- Department of Oral and Maxillofacial Surgery, Aarhus University Hospital, AarhusDenmark.
- Section for Orthodontics, Department of Dentistry and Oral Health, Aarhus University, AarhusDenmark.
| | - Paula Frid
- Department of Otorhinolaryngology, Division of Oral and Maxillofacial Surgery, University Hospital North Norway, TromsøNorway.
- Public Dental Service Competence Centre of North Norway, TromsøNorway.
- Department of Clinical Dentistry, UiT the Arctic University of Norway, Tromsø
Norway.
| | - Sven Erik Nørholt
- Department of Oral and Maxillofacial Surgery, Aarhus University Hospital, AarhusDenmark.
- Section for Maxillofacial Surgery and Oral Pathology, Department of Dentistry and Oral Health, Aarhus University, AarhusDenmark.
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Wroclawski C, Mediratta JK, Fillmore WJ. Recent Advances in Temporomandibular Joint Surgery. MEDICINA (KAUNAS, LITHUANIA) 2023; 59:1409. [PMID: 37629699 PMCID: PMC10456345 DOI: 10.3390/medicina59081409] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/01/2023] [Revised: 07/28/2023] [Accepted: 07/29/2023] [Indexed: 08/27/2023]
Abstract
Temporomandibular disorders (TMDs) affect a high percentage of children and adults worldwide. Surgery may be indicated in severe or recalcitrant cases. Several recent advancements in TMD and temporomandibular joint (TMJ) surgery have elevated understanding and the ability to treat affected patients. We discuss recent advances in TMD epidemiology, juvenile idiopathic arthritis (JIA) of the TMJ, and surgical techniques and technologies. Technical advancements have been identified in TMJ arthroscopy, the treatment of TMJ subluxation and dislocation, and extended prosthetic total TMJ reconstruction (eTMJR). Overall, this review provides valuable insights into significant recent advancements in TMJ disorders and their surgical management.
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Affiliation(s)
| | - Jai Kumar Mediratta
- Resident, Oral and Maxillofacial Surgery, Mayo Clinic, Rochester, MN 55905, USA
| | - W. Jonathan Fillmore
- Consultant, Oral and Maxillofacial Surgery, Mayo Clinic, Rochester, MN 55905, USA
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