Facial deformity of juvenile rheumatoid arthritis.

Arthritis of the temporomandibular joint and resulting deficient mandibular growth are seen in as many as 25 percent of patients with juvenile rheumatoid arthritis. The magnitude of joint involvement and resulting growth deficiency varies significantly. These patients typically develop a "birdface" deformity with retruding mandible, alteration of the cervicofacial angle, and class II occlusion with limitation of the bite opening. A multidisciplinary approach, including the surgeon, a dentist, an orthodontist, and a rheumatologist, is necessary to ensure a safe and successful surgical outcome. The side effects of pharmacologic agents used to control the disease on coagulation, healing, and bone density should be considered seriously.