Facial reconstruction consideration in rheumatic diseases

Area of Science:

• Rheumatology
• Plastic Surgery
• Orthodontics

Background:

• Facial involvement is a significant concern in Juvenile Rheumatoid Arthritis (JRA), Romberg disease, and scleroderma.
• These conditions can lead to functional occlusal abnormalities and aesthetic deformities.
• Current management strategies require careful consideration of disease activity and patient-specific factors.

Purpose of the Study:

• To outline the principles for managing facial disfigurement in JRA, Romberg disease, and scleroderma.
• To discuss the role of a multidisciplinary team in addressing functional occlusal abnormalities.
• To provide guidance on the timing and techniques for surgical facial reconstruction.

Main Methods:

• Review of management strategies for facial involvement in JRA, Romberg disease, and scleroderma.
• Emphasis on a team-based approach involving orthodontics and orthognathic surgery.
• Discussion of surgical reconstruction timing and techniques, including grafts, flaps, and implants.

Main Results:

• Management is tailored to disease severity, age of onset, and disease duration.
• Orthodontics and orthognathic surgery are key for functional occlusal issues.
• Surgical reconstruction in scleroderma is recommended only after at least one year of disease quiescence.

Conclusions:

• A multidisciplinary approach is crucial for optimizing functional and aesthetic outcomes in facial JRA, Romberg disease, and scleroderma.
• Delayed surgical intervention until disease quiescence is vital, particularly in scleroderma.
• Further research is needed to identify ideal methods for facial skeletal and soft-tissue augmentation.