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

TL;DR

A 31-year-old man with acromegaly-related malocclusion underwent surgery-first orthognathic surgery after tumor removal to correct his skeletal deformity.

Contribution

This case report presents a successful surgical-first approach for correcting malocclusion caused by acromegaly.

Findings

The patient had a confirmed diagnosis of acromegaly due to a pituitary adenoma.

Endoscopic resection of the tumor was followed by orthognathic surgery to correct the malocclusion.

The surgery-first approach effectively repositioned the mandible and improved the patient's occlusion.

Abstract

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.

Figures