Orthognathic Treatment for Prognathism in a Patient with Acromegaly

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  • MIYAMOTO SAYA
    Department of Oral and Maxillofacial Surgery, Showa University, School of Dentistry
  • SATO HITOSHI
    Department of Oral and Maxillofacial Surgery, Division of oral oncology, Showa University, School of Dentistry
  • KURIHARA YUJI
    Department of Oral Maxillofacial Surgery, School of Dentistry, Matsumoto Dental University
  • TANAKA MOTOHIRO
    Department of Oral and Maxillofacial Surgery, Showa University, School of Dentistry
  • INADA TAKANOBU
    Department of Oral and Maxillofacial Surgery, Showa University, School of Dentistry
  • KATADA RYOGO
    Department of Oral and Maxillofacial Surgery, Showa University, School of Dentistry
  • MORIYA TAKASHI
    Department of Oral and Maxillofacial Surgery, Showa University, School of Dentistry
  • YASUDA ARISA
    Department of Oral and Maxillofacial Surgery, Showa University, School of Dentistry
  • SHIROTA TATSUO
    Department of Oral and Maxillofacial Surgery, Showa University, School of Dentistry

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Other Title
  • 先端巨大症に伴う骨格性下顎前突症に外科的矯正治療を行った1例
  • センタン キョダイショウ ニ トモナウ コッカクセイ カガク ゼントツショウ ニ ゲカテキ キョウセイ チリョウ オ オコナッタ 1レイ

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Abstract

Acromegaly is an endocrine disease caused by excessive secretion of growth hormone （GH） after the end of the growth period, due to a pituitary adenoma. Mandibular prognathism, tongue hypertrophy, and bulging of the eyebrow arch are observed in the maxillofacial region. We describe a case with acromegaly for which surgical orthodontic treatment was performed after excision of the pituitary adenoma. A 47-year-old woman who became aware of enlargement of the size of the hands and feet from 35 years old was diagnosed with acromegaly by the Department of Neurosurgery because of a high GH level and a pituitary tumor on MRI. In September 2014, chemotherapy was performed after tumor resection via the nasal cavity. In March 2016, she was referred to the Department of Orthodontics of our hospital for further examination and treatment of malocclusion. Overjet and overbite were −5.0mm and ＋2.5mm, respectively. The occlusal relationship of the molars was Angle class Ⅲ. Angular analysis of lateral cephalometric analysis showed SNA: 80.0°, SNB: 77.0°, ANB: 3.0°, and FMA: 37.9°. Mandibular prognathism was diagnosed based on a Wits appraisal of −7.1. Since there was no clinical activity of acromegaly and hypertrophy of the hard and soft tissues due to acromegaly had stopped, and serum insulin-like growth factor-1 was well controlled by chemotherapy, orthognathic treatment was started in April 2016 and bimaxillary surgery was performed in January 2019. The occlusal relationship was stable and there was no recurrence at 2 years after the surgery. Since acromegaly has various complications, it is necessary to create a treatment plan considering the complications, and to perform extended follow-up due to the potential for recurrence of the disease.

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