Craniofacial growth in juvenile chronic arthritis

The craniofacial growth in children with juvenile chronic arthritis (JCA), especially that of the mandible, and the degree of destruction of the mandibular condyles vary depending on the heterogeneity in duration and intensity of the disease. In JCA children showing destruction of the temporomandibular joint, the dentofacial morphology is characterized by overall smaller dimensions of the mandible, mandibular retrognathia, a steep mandibular plane, Class II malocclusion, dental crowding, and frontal open bite. In children with unilateral condylar destruction, asymmetries will develop, with the chin deviating to the affected side. The facial morphology of JCA children with condylar lesions becomes more abnormal during growth, reflecting a decelerated mandibular development and a backward-rotating growth pattern. The main single cause of the deviating craniofacial growth is mandibular condylar destruction. Other factors that may influence the craniofacial growth are head posture, soft tissue stretching, disease activity and drug therapy, type of onset of the disease, muscle weakness, decreased functional ability, and orthodontic treatment.