The facial skeleton in children affected by rheumatoid arthritis--a roentgen-cephalometric study

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Abstract
This study is a characterization of the facial frame in profile of children with rheumatoid arthritis. Cephalometric roentgenograms were taken of 18 girls (mean age 15 years 4 months) and 10 boys (mean age 15 years 3 months), who had had destructive changes in the regions of both mandibular condyles for at least 5 years. Similar roentgenograms of presumably healthy children, 20 girls and 20 boys (mean age 15 years 5 months) were available as controls. A number of distances and angles were measured from tracings on acetate films. The facial height of the affected children was on average smaller than that of the controls, the difference being significant posteriorly in both sexes and showing a similar tendency anteriorly in the boys. The maxilla was also smaller vertically in the children with rheumatoid arthritis. The mandible was short and the reduced descent of its posterior part seemed to be only partly compensated for by the exostosis in the gonion region. The lack of any anterior open bite appeared to be related to over-eruption of the lower incisors and a posteriorly elevated occlusal plane associated with subnormally erupted maxillary molars. While the inter-incisal angle and the angle between the mandibular incisors and the nasion-sella line were small, the inclination of the mandibular incisors to the mandibular body seemed virtually normal. The elevation of the mandible at its posterior part evidently results from muscle traction diminishing the gap between the adjoining bones following condylar destruction. The reduced vertical dimension of the maxilla may be an expression of a secondary reaction to the subnormal growth of the mandible.

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