Addressing Acromegaly-Related Malocclusion With Surgery-First Orthognathic Surgery: A Clinical Case Report

Angle's class III malocclusions are characterized by the anterior positioning of the mandible in relation to the maxilla. The discrepancy can be caused by an anterior deficiency of the maxilla, excessive mandibular prognathism, or a combination of both. Acromegaly is a dysfunction caused by the excessive production of growth hormone (GH), which leads to systemic changes and orofacial manifestations. In acromegaly caused by a pituitary adenoma, which secretes an excessive amount of GH, disproportionate mandibular growth may occur, leading to skeletal class III malocclusion in adulthood. Excessive growth stops when the tumor is removed, but the skeletal deformity persists, requiring orthognathic surgery to reposition the mandible. This article reports the case of a 31-year-old man referred to the maxillofacial surgery consultation due to severe Angle's class III malocclusion, with prognathism, mandibular asymmetry, and maxillary retrusion. He had a history of disproportionate soft tissue growth (hands and feet) up to 18 years old, less evident after that age. Considering the possibility of acromegaly due to a pituitary adenoma, imaging studies (CT scan and magnetic resonance imaging (MRI)) and directed analytical studies were requested. When the diagnosis was confirmed, the patient was referred to endocrinology and neurosurgery consultations. After undergoing endoscopic resection of the pituitary adenoma, the patient underwent surgery-first orthognathic surgery to correct the dental malocclusion.

Rehabilitation of Occlusal Vertical Dimension in a Patient with Acromegaly: A Clinical Report

Acromegaly is a rare acquired disorder caused by excessive growth hormone production. Dentists play an important role in the diagnosis of this disorder because of intraoral and extraoral symptoms such as extreme growth of the mandible, enlargement of the maxilla, diastema between teeth, a tendency toward malocclusion, a wide and thick nose, a marked malar bone, and thick lips. The prosthetic treatment of these patients is challenging because growth in the condyles and rami can lead to the development of a severe class III jaw relationship. This case report describes the prosthetic treatment of a patient with acromegaly. A decreased occlusal vertical dimension and class III jaw relationship were determined by intraoral and extraoral examinations and cephalometric radiography. The occlusal vertical dimension was reestablished by increasing it approximately 10 mm, as per the esthetic and functional needs of the patient. Four years after treatment, the patient was functioning well, and neither occlusal disharmony nor temporomandibular disorder was observed.