Cirurgia ortognática como modalidade terapêutica para deformidade dentofacial em paciente acometida por artrite reumatoide: um relato de caso
DOI:
https://doi.org/10.34119/bjhrv8n6-094Keywords:
artrite reumatoide, cirurgia ortognática, osteotomia sagital da mandíbulaAbstract
As deformidades dentofaciais (DFDs) envolvem alterações no crescimento e desenvolvimento dos ossos faciais, comprometendo estética, oclusão dentária e função estomatognática. A correção geralmente requer abordagem ortodôntico-cirúrgica, sendo a identificação precoce essencial para melhores desfechos. A artrite reumatoide (AR) é uma doença autoimune que pode afetar a articulação temporomandibular (ATM), levando à reabsorção condilar, perda de altura mandibular e desenvolvimento de DFDs. Em jovens com artrite idiopática juvenil, o comprometimento condilar pode resultar em severas assimetrias faciais. A cirurgia ortognática é indicada para corrigir discrepâncias esqueléticas não solucionáveis apenas com ortodontia, utilizando técnicas como osteotomias Le Fort I, BSSO e mentoplastia. Contudo, em pacientes com AR, o envolvimento da ATM representa um desafio, podendo causar instabilidade pós-operatória e recidiva se a articulação estiver comprometida. O presente trabalho tem como objetivo relatar um caso de deformidade dentofacial secundária a artrite reumatoide, onde foi realizado o tratamento orto-cirúrgico, sendo dado ênfase ao tratamento cirúrgico por cirurgia ortognática, após realização de analise facial e planejamento cirúrgico virtual minucioso, assim como proservação do caso para mensuração da estabilidade clínica.
References
ACAR, Yasemin Bahar et al. Is Counterclockwise Rotation With Double Jaw Orthognathic Surgery Stable in the Long-Term in Hyperdivergent Class III Patients? Journal of Oral and Maxillofacial Surgery, v. 76, n. 9, p. 1983–1990, 1 set. 2018.
ALKHAYER, Ali et al. Accuracy of virtual planning in orthognathic surgery: a systematic review. Head and Face Medicine, v. 16, n. 1, 1 dez. 2020.
AL-MORAISSI, Essam Ahmed; WOLFORD, Larry M. Is Counterclockwise Rotation of the Maxillomandibular Complex Stable Compared With Clockwise Rotation in the Correction of Dentofacial Deformities? A Systematic Review and Meta-Analysis. Journal of Oral and Maxillofacial SurgeryW.B. Saunders, , 1 out. 2016.
BENNETT, Mark A.; RAGERTY, Christopher G. Modification of the mandibular ramus sagittal split osteotomy. [S.l.: S.n.].
DE AGUIAR TRENCH, Janayna; PAULO CORREIA DE ARAÚJO, Roberto. DENTOFACIAL DEFORMITIES: OROFACIAL MYOFUNCTIONAL CHARACTERISTICS Deformidades Dentofaciais: características miofuncionais orofaciaisJul-Ago. [S.l.: S.n.].
ESTEVES, Lucas Senhorinho et al. Assessment of skeletal stability after counterclockwise rotation of the maxillomandibular complex in patients with long-face pattern subjected to orthognathic surgery. Journal of Craniofacial Surgery, v. 25, n. 2, p. 432–436, 2014.
FARRELL, Brian B.; FRANCO, Peter B.; TUCKER, Myron R. Virtual surgical planning in orthognathic surgery. Oral and Maxillofacial Surgery Clinics of North AmericaW.B. Saunders, , 2014.
FATTAHI, Tirbod. Aesthetic Surgery to Augment Orthognathic Surgery. Oral and Maxillofacial Surgery Clinics of North AmericaW.B. Saunders, , 2007.
FRID, P. et al. Surgical correction of dentofacial deformities in juvenile idiopathic arthritis: a systematic literature review. International Journal of Oral and Maxillofacial SurgeryChurchill Livingstone, , 1 ago. 2019.
HSIEH, Yuh Jia et al. Facial morphology in children and adolescents with juvenile idiopathic arthritis and moderate to severe temporomandibular joint involvement. American Journal of Orthodontics and Dentofacial Orthopedics, v. 149, n. 2, p. 182–191, 1 fev. 2016.
JÜNGER, Thies Hendrik; KRENKEL, Christian; HOWALDT, Hans Peter. Le Fort I sliding osteotomy - A procedure for stable inferior repositioning of the maxilla. Journal of Cranio-Maxillofacial Surgery, v. 31, n. 2, p. 92–96, 2003.
KAMINISHI, Ronald M. et al. Improved Maxillary Stability with Modified LeFort I TechniqueJ Oral Maxillofac Surg. [S.l.: S.n.].
KROESE, Johanna M. et al. Temporomandibular disorders in patients with early rheumatoid arthritis and at-risk individuals in the Dutch population: A cross-sectional study. RMD Open, v. 7, n. 1, 4 jan. 2021.
MEHRA, Pushkar et al. Single-Stage Comprehensive Surgical Treatment of the Rheumatoid Arthritis Temporomandibular Joint Patient. Journal of Oral and Maxillofacial Surgery, v. 67, n. 9, p. 1859–1872, set. 2009.
MERCURI, Louis G. et al. Long-term follow-up of the CAD/CAM patient fitted total temporomandibular joint reconstruction system. Journal of Oral and Maxillofacial Surgery, v. 60, n. 12, p. 1440–1448, 1 dez. 2002.
MOHAMED, Waheed V.; PERENACK, Jon D. Aesthetic adjuncts with orthognathic surgery. Oral and Maxillofacial Surgery Clinics of North AmericaW.B. Saunders, , 2014.
ØYE, F.; BJØRNLAND, Tore; STØRE, G. Mandibular osteotomies in patients with juvenile rheumatoid arthritic disease. Scandinavian Journal of Rheumatology, v. 32, n. 3, p. 168–173, 2003.
PAGNONI, Mario et al. Juvenile idiopathic/rheumatoid arthritis and orthognatic surgery without mandibular osteotomies in the remittent phase. Journal of Craniofacial Surgery, v. 24, n. 6, p. 1940–1945, nov. 2013.
RUSLIN, Muhammad et al. One-year stability of the mandibular advancement and counterclockwise rotation for correction of the skeletal class II malocclusion and high mandibular plane angle: Dental and skeletal aspect. Biomedical Journal, v. 45, n. 1, p. 206–214, 1 fev. 2022.
SAEED, N. R.; MCLEOD, N. M. H.; HENSHER, R. Temporomandibular joint replacement in rheumatoid-induced disease. British Journal of Oral and Maxillofacial Surgery, v. 39, n. 1, p. 71–75, 2001.
SARVER, David; JACOBSON, Ronald S. The Aesthetic Dentofacial Analysis. Clinics in Plastic Surgery, jul. 2007.
SATO, Fábio Ricardo Loureiro et al. Prevalence and treatment of dentofacial deformities on a multiethnic population: A retrospective study. Oral and Maxillofacial Surgery, v. 18, n. 2, p. 173–179, 2014.
SCHMIDT, Christopher et al. The Diagnosis and Treatment of Rheumatoid and Juvenile Idiopathic Arthritis of the Temporomandibular Joint. Deutsches Arzteblatt International, v. 119, n. 4, p. 47–54, 28 jan. 2022.
SCHNEIDER, Daniel et al. Customized virtual surgical planning in bimaxillary orthognathic surgery: a prospective randomized trial. Clinical Oral Investigations, v. 23, n. 7, p. 3115–3122, 1 jul. 2019.
SEMERCI, Zeliha Merve; GÜNEN YILMAZ, Sevcihan. Evaluation of Rheumatic Diseases Affecting the Temporomandibular Joint: A Cone Beam Computed Tomography Study and Literature Review. Diagnostics, v. 14, n. 1, 1 jan. 2024.
SHAMS, Mohammad Ghasem; MOTAMEDI, Mohammad Hosein Kalantar. A simple technique to facilitate the Le Fort I osteotomy downfracture. Oral Surgery, Oral Medicine, Oral Pathology, Oral Radiology and Endodontology, v. 99, n. 6, jun. 2005.
TRAUNER, Richard et al. Operative Oral Surgery THE SURGICAL CORRECTION OF MANDIBULAR PROGNATHISM AND RETROGNATHIA WITH CONSIDERATION OF GENIOPLASTY PART L SURGICAL PROCEDURES TO CORRECT MANDIBULAR PROGNATHISM AND RESHAPING OF THE CHIN. [S.l.: S.n.].
WOLFORD, Larry M. The Mandibular Inferior Border Split: A Modification in the Sagittal Split OsteotomyJ Oral Maxillofac Surg. [S.l.: S.n.].
WOLFORD, Larry M.; REICHE-FISCHEL, Oscar; MEHRA, Pushkar. Changes in temporomandibular joint dysfunction after orthognathic surgery. Journal of Oral and Maxillofacial Surgery, v. 61, n. 6, p. 655–660, 1 jun. 2003.
