Thomas Klit Pedersen

Objective: Unilateral craniofacial microsomia (UCM) presents varying unilateral deficiencies of the temporomandibular joint, mandibular ramus, masticatory muscles, and adjacent soft tissues and ear. Reduced mandibular and maxillary dimensions may decrease upper airway volume and may increase the risk of sleep‐disordered breathing (SDB). This retrospective pilot study aimed to evaluate a novel three‐dimensional (3D) method for assessing nasal cavity (NC) and pharyngeal airway (PA) dimensions in growing patients with UCM compared with healthy controls, and to explore the potential associations between airway dimensions and SDB risk using the pediatric Sleep Questionnaire (PSQ). Material and Methods: This retrospective case–control pilot study analysed Cone‐beam computed tomography (CBCT) scans from 11 patients with UCM (mean age 12.7 ± 4.4 years) and 11 age‐matched controls (mean age 12.1 ± 1.1 years). Two calibrated investigators performed airway measurements, including total and partial NC and PA volumes, minimal cross‐sectional area (MCS), and hydraulic diameter. SDB risk in the UCM group was assessed using PSQ scores. Reliability was evaluated with intra‐class correlation coefficients and Dahlberg's formula. Group differences were tested using unpaired t ‐tests. Results: Patients with UCM showed significantly smaller NC volume (9714.9 ± 3032 mm ³ ) than controls (12773.9 ± 1963 mm ³ ; p < 0.0001). PA volume and MCS did not differ significantly. Four of the eleven patients with UCM showed a high PSQ‐based risk of SDB and tended to have smaller airway dimensions. Measurement reliability was acceptable. Conclusions: CBCT‐based 3D assessment of upper airway morphology was feasible in patients with UCM. Patients with UCM demonstrated significantly reduced nasal cavity volume compared with controls. Exploratory analysis suggested that some patients may be at increased risk of SDB; however, these findings require confirmation in larger studies.

Continuous advancements in technology have made it possible to integrate clear aligner therapy (CAT) with orthognathic surgery. This case report presents a novel, individually-planned workflow, combining CAT with a surgery-first orthognathic approach (SFOA) in collaborating with engineers for an in-house production of surgical guides and customized titanium plates. The patient was evaluated subjectively, using the Oral Health-Related Quality of Life-14 (OHIP-14) questionnaire and Orthognathic Quality of Life questionnaire (OQLQ), and objectively with the Peer Assessment Rating (PAR) index. The patient displayed the planned occlusal relationship with no report of discomfort in the temporomandibular joint (TMJ) or post-surgical complications. The surgical and occlusal outcomes have remained consistent and stable after debonding. A decreased score was reported in both questionnaires and the PAR after treatment, thereby indicating improvements in both subjective and objective evaluations. This case report demonstrates that with proper individual planning, satisfactory subjective and objective outcomes can be achieved when combining SFOA with CAT.

To assess the agreement between child- and parent-reported orofacial symptoms in the Danish version of the patient questionnaire Assessment of Orofacial Symptoms in Juvenile Idiopathic Arthritis. This cross-sectional study was conducted at Aarhus University in March 2023. Eligible candidates were consecutive subjects with juvenile idiopathic arthritis (JIA) and temporomandibular joint involvement accompanied by a parental proxy for examination in the Craniofacial Clinic. After obtaining written informed consent, the questionnaire was completed individually and separately by the child and the parent without any communication between them. The level of agreement was analysed using Cohen's (weighted) kappa for nominal and ordinal outcome variables (orofacial pain frequency, pain location, jaw function, orofacial symptoms, and changes since last visit) and the intraclass correlation coefficient for linear outcome variables (orofacial pain intensity and functional disability of the jaw). The 34 included dyads had an overall 'poor' to 'moderate' child-proxy reporting agreement on the questionnaire for the assessment of JIA-related orofacial symptoms. After dividing the children into two age groups, < 13 and ≥ 13 years old, we found substantial agreement on pain frequency and moderate to excellent agreement on pain intensity for the older group. The child-proxy agreement for children aged < 13 years was slight on pain frequency and poor to moderate on pain intensity. The child-proxy reporting agreement on JIA-related orofacial symptoms is inconsistent. We suggest collecting information from both children and parents, especially when assessing orofacial pain and symptoms in children < 13 years of age.

Aim of the study: This article introduces an in-house workflow implementing patient-specific surgical cutting guides and spacers combined with pre-adapted osteosynthesis in two Surgery First Orthognathic Approach (SFOA) scenarios. Background: The integration of three-dimensional virtual surgical planning (VSP) in combination with computer aided design and computer aided manufacturing (CAD/CAM) has advanced the field of orthognathic surgery. With the use of surgical guides and patient specific implants (PSI) the accuracy of the surgical outcome could potentially increase. While PSI approaches offer advantages, commercial PSIs are characterized by a prolonged turnaround time and high costs.These drawbacks linked with commercial PSIs might restrict their utilization and acceptance. Technical note: The VSP was completed in Dolphin Imaging software. 3-Matic software was used to design the cutting guides and spacers. The anterior spacers where specifically designed to utilize the wedge-technique during positioning of the anterior segment in segmented Le Fort I osteotomy. The surgical guides and spacers were manufactured in Form 3B 3D printer with BioMed Clear V1 Resin with 0.100 mm layer thickness. Titanium plates 2.0 from Biomet were customized based on a 3D-model of the planned postsurgical outcome based on the VSP. Conclusion: The in-house methodology for developing and employing personalized surgical guides, spacers and pre-adapted titanium plates offers a viable workflow for SFOA, with the potential to enhance the reliability and precision of maxillary repositioning.

Background: Physiotherapy appears as a promising therapy option for patients with Juvenile Idiopathic Arthritis (JIA) [1, 2], but the effects of physiotherapy and jaw exercises on JIA-related orofacial symptoms remain unknown [3]. The aim of this proof-of-concept study was to assess the impact of orofacial physiotherapy and home-exercise programs in patients with JIA and temporomandibular joint (TMJ) involvement. Methods: Twelve patients with JIA and TMJ involvement received a treatment of physiotherapy, complemented by prescribed home exercises spanning over eight weeks. Orofacial symptoms and dysfunction were monitored pre-treatment, during treatment, after treatment, and at a three-months follow-up. Results: Orofacial pain frequency and intensity significantly decreased during the course of the treatment (p = 0.009 and p = 0.006), with further reductions observed at the three-month follow-up (p = 0.007 and p = 0.002). During treatment, the mandibular function improved significantly in terms of maximal mouth opening capacity, laterotrusion, and protrusion. Conclusions: This proof-of-concept study shows favourable effects of physiotherapy and home excercises in the management of JIA-related orofacial symptoms and dysfunctions.

Objective: To develop, validate, and test the performance of patient-reported outcomes (PROs) in a short patient questionnaire (< 5 minutes in length) in order to assess the multidimensional aspects of orofacial symptoms related to juvenile idiopathic arthritis (JIA) among patients aged ≥ 10 years.Methods: The study was conducted by an interdisciplinary task force from the Temporomandibular Joint Juvenile Arthritis Working Group. The project consisted of a multiphased approach including the following: (1) conceptual phase with online international survey of 167 healthcare workers, (2) item generation and drafting of preliminary questionnaire(s) (ie, face validity), (3) cognitive script interview and probing (ie, content validity; 16 patients with JIA), (4) assessment of construct validity (ie, convergence and divergence; 53 patients with JIA), (5) test of reliability, and (6) test of clinical performance and psychometric characteristics (95 patients with JIA).Results: In total, 7 PROs were included in the final patient questionnaire: (1) pain frequency, (2) pain intensity, (3) pain location, (4) jaw function, (5) specific questions related to symptoms and dysfunction, (6) changes in face and jaw pain since last visit, and (7) changes in jaw function since last visit. In total, 80% of the patients were able to complete the questionnaire in less than 5 minutes.Conclusion: We have developed and validated a short patient questionnaire to assess the multidimensional aspects of JIA-related orofacial symptoms. The PROs included in our questionnaire show acceptable validity and reliability. The questionnaire is applicable to routine monitoring of subjects with JIA, as well as future research studies.

Little is known about the chronicity of orofacial symptoms and how this influences the oral health-related quality of life in juvenile idiopathic arthritis (JIA). Therefore, our objectives were to study the long-term changes in self-reported orofacial symptoms, and to define the impact of orofacial symptoms on oral health-related quality of life in JIA. At baseline (T0), 157 consecutive JIA patients ≤20 years completed a patient pain questionnaire that incorporates domains related to the orofacial area. At the 2 year follow-up (T1), 113 patients completed the same questionnaire (response rate 72%) in addition to the Child Perception’s Questionnaire; a validated 31-item questionnaire addressing oral health-related quality of life. At T0, 53% (60/113) of patients reported the presence of orofacial pain, and 36% (41/113) of patients reported compromised orofacial function. At T1, 77% (46/60) of patients with pain at T0 reported persistent pain, and 66% (27/41) of patients with functional disability at T0 reported persistent disability. Patients with orofacial symptoms reported a significantly greater prevalence of negative impact of orofacial conditions on general quality of life and within the domains of emotional and social well-being compared to asymptomatic patients. Self-reported orofacial pain and functional disability were common findings in a cohort of JIA patients followed over 2 years. These symptoms seem to persist over time in most patients, and have a significant negative impact on oral health-related quality of life.

In patients with juvenile idiopathic arthritis (JIA) temporomandibular joint (TMJ) involvement is a common cause of severe growth disturbances. Extent of growth deviation depends on age of onset and duration of arthritis in the TMJ. TMJ arthritis is difficult to diagnose at an early stage since relatively few symptoms and clinical findings are related to this joint. The pathologic process can affect growth long before radiographic changes are seen. We investigated the relationship between TMJ arthritis and symptoms and clinical findings to suggest a clinical routine for diagnosing TMJ arthritis. We also describe the course of TMJ arthritis in relation to a commonly used radiographic method versus MRI. Fifteen children with JIA were examined 4 times at 6 month intervals for TMJ involvement by clinical examination, MRI-scanning, and orthopantomograms (OPG). At baseline, 10 healthy children served as a control group. Patients reported more inability to chew and open their mouth than the control group. Translation of the condyle and range of mandibular movements were diminished in the arthritis group. Decreased translation was correlated to condylar changes seen on both OPG and MRI. MRI was superior to OPG in following changes of the condyle over time, and inflammation was detected in nearly all joints. OPG cannot be recommended for diagnosis or to follow the course of changes in the TMJ. We advocate recording condylar translation and mandibular range of motion as a current clinical routine to find early TMJ arthritis in contrast to the often used OPG performed in our study, which was an uncertain method.