若年性特発性関節炎による著しい下顎頭吸収を伴う下顎後退症患者に上下顎移動術を施行した1例

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  • A Case of Two-jaw Surgery in a Retrognathia Patient with Marked Resorption of Mandibular Condyle Due to Juvenile Idiopathic Arthritis

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Juvenile idiopathic arthritis （JIA）, one of the most common chronic diseases in childhood, causes significant limitation in sagittal and vertical mandibular growth, resulting in severe retrognathia and anterior open bite with strong esthetic and functional restriction. We present a case of two-jaw surgery in a retrognathia patient with marked resorption of mandibular condyle due to JIA. The patient was a 12-year-old female at the first presentation. She showed a severe retrognathia and anterior open bite. The condyle of the mandible was remarkably resorbed and located anteriorly. The condition of JIA was well controlled by medication. Under the diagnosis of retrognathia and open bite due to JIA, surgical orthodontic treatment started at the age of 13 years old. The first premolars and the third molars were extracted during preoperative orthodontic treatment. Two-jaw surgery by Le Fort I osteotomy and sagittal split ramus osteotomy was performed under general anesthesia at the age of 19 years old. The maxilla was rotated counterclockwise and moved 6mm upward at the incisors. The mandible was advanced 7 mm and rotated accordingly. Genioplasty was performed with the advance of 5mm. The postoperative course was uneventful without infection or delayed wound healing. Active orthodontic treatment ended 10 months after surgery and the fixation plates in the mandible were removed 1 year and 7 months after surgery. No remarkable relapse or further resorption of the condyles was observed. Her profile and occlusion have greatly improved and been maintained in the condition as planned for 2 years and 2 months after surgery.

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