Juvenile rheumatoid arthritis: cases from the coalfields

Juvenile rheumatoid arthritis can result in destruction of the temporomandibular joints producing a characteristic facial growth deficiency. Features include loss of vertical ramus height, marked antegonial notching and a Class II malocclusion frequently with an anterior open bite. Two cases are presented, both treated surgically utilizing bilateral autologous costochondral grafts to replace the temporomandibular joints and increase the vertical ramus height. Postoperative orthodontic therapy was employed to close the surgically created posterior open bite in each case. Autologous dermis was used in the most recently treated case as an interpositional soft tissue layer between the glenoid fossa and the costochondral graft.