Orthognatic surgery and acromegaly, important considerations before surgery

Acromegaly is an infrequent, chronic and progressive disorder caused by hypersecretion of growth hormone by tumorous pituitary somatotroph cells that leads to disproportionate skeletal, tissue, and organ growth. Diagnosis is usually preceded by long-time of active but un-detected disease. Management comprises transsphenoidal surgery as first-line option. Pharmacological therapy is mainly indicated when surgery fails to achieve remission and, in patients with recurrent tumors after surgery radiotherapy is described as an option. Usually orofacial soft tissue changes are reversed following successful treatment for acromegaly but facial skeletal changes remain. Thus, correction of the facial deformity needs to be solved subsequently to treatment of acromegaly. This issue had been described rarely in oral and maxillofacial literature, and association with multisystem comorbidities due to acromegaly, including sleep apnea syndrome, cardiovascular disease, colon polyposis, arthropathy, hypertension, and metabolic complications including glucose intolerance and type 2 diabetes mellitus are described. We present a case of a 52-years-old male with acromegaly consecutive to a pituitary tumor resected 12 years before surgery. He remained stable at substitution therapy with hydrocortisone and sodium levothyroxine daily. The clinical features found were mandibular prognathism with left mandibular deviation and prominent supraorbital ridges. The surgical correction treatment was segmentary LeFort-I osteotomy and BSSO with midline alignment. A special pharmacological scheme prior, during and after surgery was carried out. In the postoperative course, the patient developed a bradycardic episode managed and controlled with atropine administration, showing the cardiovascular risk to which these patients are exposed. A complete surgical-endocrine management is shown.

Conflict of interest: None declared.

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Feb 5, 2018 | Posted by in Oral and Maxillofacial Surgery | Comments Off on Orthognatic surgery and acromegaly, important considerations before surgery
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