Surgical facial corrections in acromegaly

Acromegaly is an acquired disorder characterized by overproduction of growth hormone in adults. It results in enlargement of the neurocranium and orofacial skeleton with exception of the maxilla. Obstructive sleep apnea is also common.

Objective: The aim of this presentation is to show the possibilities of facial corrections to treat the disfigurements characteristic for acromegaly.

Case: A case of a 44-year old male will be described. After two transsphenoidal resections he was cured from his pituitary adenoma. His major wish was to have the prominent forehead and mandible reduced. Besides this he had prominent cheekbones, brow-ptosis, and pseudo-temporal hollowing and a negative overjet of 17 mm. After psychological, clinical, and 3D radiologic examination and planning a treatment plan was made. After presurgical orthodontics facial surgery was undertaken. A Le Fort I osteotomy was carried out with advancement and dorsal impaction of the maxilla combined with a bilateral sagittal split osteotomy with dorsal rotation and setback of the mandible with a vertical reduction genioplasty. The anterior wall of the frontal sinus was osteotomized and removed, the supra orbital rim trimmed back to a normal contour after which the frontal wall was repositioned in a new contour. The temporal muscles were partially released to allow recontouring of the temporal fossa using calcium phosphate cementum. This material was also used to smoothen the new forehead. Simultaneously a foreheadlift was performed.

The procedure was uneventful and the final outcome very satisfying.

Conclusion: Disfigurements caused by acromegaly can very well be corrected with facial surgery.

Conflict of interest: None declared.

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Jan 27, 2018 | Posted by in Oral and Maxillofacial Surgery | Comments Off on Surgical facial corrections in acromegaly
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