A Man With Acromegaly

Providing Optimal Dental Care

Janet Hatcher Rice, DDS


February 16, 2011

A Man With Mandibular Changes, Tongue Enlargement, and Sleep Apnea

Clinical Presentation

A 65-year-old white man with symptoms of acromegaly, including mandibular changes, tongue enlargement, and sleep apnea, presented for dental care. The definitive diagnosis was made by a neurologist, who confirmed a pituitary tumor. The tumor caused increased growth hormone production and subsequent dental problems (Figure 1). The patient wanted dental treatment for his condition.

Figure 1. Preoperative view of acromegaly.

History and Dental Examination

History. The patient had presented 6 years earlier complaining of enlarged tongue and recent misaligned occlusion. The malocclusion was a recently developed class 3 with open bite (Figure 2). His primary concern at that time was movement of lower posterior bridgework out toward the buccal mucosa (Figure 3). His tongue had become enlarged, causing sleep apnea, which was being treated by his primary care physician. There was no contact between the maxillary posterior teeth and the mandibular posterior teeth.

At that time, study models were taken, and a telephone call made to the patient to request consultation with his physician. Once permission was given, his dentist referred him back to his physician for workup for acromegaly, with subsequent loss of contact with the patient.

Figure 2. Initial view of acromegaly.

Figure 3. Prognathic class 3, classic presentation of acromegaly.

Dental examination. The class 3 malocclusion and enlarged tongue remained. From this change in occlusion, the patient's buccal mucosa was abraded and 2 lower anterior mandibular bridges, replacing tooth numbers 18-21 and numbers 28-31, were displaced. Occlusion was not optimal for chewing.


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