Adolescent Scoliosis and the Use of an Oral Appliance. A Case Report. Karen Rappoport, DDS, Cert Ortho, Rosa Wurgaft DDS, Susan Armijo Olivo, BScPT, MSc, PhD Cand. U. Alberta INTRODUCTION Scoliosis is a common cause of spinal deformity in children and adolescents. Some researchers have shown that craniocervical posture is related to the position of the facial structures, and any modification to the craniocervical system can have an effect on the stomatognathic system and vice versa. 1 However, the effect of the use of oral appliances in patients with scoliosis has not been established in the literature. The objective of this study is to report the case of a girl with severe adolescent thoracolumbar scoliosis associated to unilateral craneosynostosis, treated with an oral appliance to improve her facial asymmetry, that changed the evolution of the curves. METHODS This study is a case report of an eight year old girl with severe thoracolumbar scoliosis who was treated with an oral appliance for four months to improve her facial asymmetry. The appliance only had a single unilateral and posterior occlusal contact. Complete spinal radiographs, orthopantomography and craniocervical lateral teleradiographs were taken before and after the treatment with the oral appliance. The evolution of the spinal curves was determined by measuring the Cobb angle in the thoracic and lumbar spine. The mandibular ramus height was measured to determine mandibular changes. 2 1 Figure 1 and 2: Frontal picture and teleradiograph showing facial asymmetry. The cranium is more developed in the right side and in compensation, the jaw is deviated to the left. RESULTS Cobb angles and mandibular ramus height discrepancy improved before and after the treatment with oral appliance. The use of the oral appliance caused a significant correction of the thoracolumbar curves and the mandibular asymmetry. This prevented the patient to undergo surgery for her scoliosis 65 57 3 4 11 12 Figure 11 and 12: Initial panorex and lateral teleradiograph. It is noted a ramus height discrepancy and a big ramus posterior border separation, suggesting a mandibular deviation. 7 8 9 10 5 6 Figure 3: Patient’s frontal occlusion view. Figure 4, 5 and 6: Patient wearing the appliance. The appliance has only one posterior and unilateral contact. CONCLUSIONS This finding suggest a biomechanic relationship between the stomatognathic system and the trunk alignment which has only been demonstrated previously by animal experimental data.2   This case report highlights the importance of the biomechanical chains in the human body. Clinicians and researchers should take this information into consideration when designing treatments for treating the stomatognathic system. 62 61 14 13 Figure 13 and 14: Panorex and lateral teleradiograph after six months of treatment. After treatment, both ramus had even heights (the right ramus height decreased and the left ramus height increased). In the lateral teleradiograph, it is noted that the distance between both ramus posterior borders decreased, suggesting the mandible is more centred. CONTACTS: Karen Rappoport karenrapo@gmail.com Figure 7 and 9: Initial lateral and frontal spinal radiographs (yellow line) (Before treatment with appliance) Figure 8 and 10: Lateral and frontal spinal radiographs (red line) after four and half months of treatment with oral appliance. Figures 8 and 10 show the improvement of the curves in the sagital and frontal planes (red line) respectively after the treatment with the oral appliance. REFERENCES Rocabado M. Biomechanical relationship of the cranial, cervical, and hyoid regions. The Journal Of Cranio-Mandibular Practice. 1983;1(3):61-66. D'Attilio M, Filippi MR, Femminella B, Festa F, Tecco S. The influence of an experimentally-induced malocclusion on vertebral alignment in rats: A controlled pilot study. Cranio. 2005;23(2):119-129. ACKNOWLEDGEMENTS Susan Armijo Olivo is supported by a full-time Canada Graduate Scholarship from Canadian Institutes of Health Research (CIHR), the Alberta Provincial CIHR Training Program in Bone and Joint Health and the Physiotherapy Foundation of Canada through an Ann Collins Whitmore Memorial Award.