Case Study 2: Micrognathia/Retrognathia

Chief Complaint

A sixteen year old female with a known diagnosis of rheumatoid arthritis was referred with a chief complaint of a painful underdeveloped jaw. Several other joints were involved in this process.

Regional Examination

Clinical examination revealed a patient with a severe micrognathia. Her maxilla demonstrated a steep occulsal plane secondary to posterior vertical deficiency. The dentition was significantly compensated in a class II position. The chin was quite small.

Radiographic Evaluation

Cephalometric and panoramic radiographs of the jaw demonstrated rheumatoid arthritis of the tempromandibular joints bilaterally and significant micrognathia.

Treatment Plan

A team conference with the patient’s orthodontist and rheumatologist developed the following treatment sequence:

1. Systemic management of JRA and intra-articular TMJ steroid injection.
2. Pre-surgical orthodontics to align, level, and decompensate the dentition.
3. Surgical Phase

a. Le Fort I Osteotomy. (To level occlusal plane) b. Bilateral Sagital Splitting of Mandible for Advancement. c. Advancement Geneoplasty.

Outcome

The patient subsequently underwent her treatment without complication. Fortunately, her rheumatoid arthritis went into remission, enabling her to be comfortable and to enjoy a new outlook on life.