A Case Report of Skeletal Mandibular Prognathism Associated with Acromegaly Treated by Orthognathic Surgery with a Glossectomy

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The patient was a 52 years, 11 month old male, who came to our hospital with a chief complaint of an occlusion anomaly on the left side. There was previous medical history of excess secretion of growth hormone due to a pituitary gland tumor that caused acromegaly. The patient was in follow up after a lumpectomy. Molar relationships were Angle Class III. Overjet was -4.0mm and an overbite was -2.0mm. Dental arches were spaced in association with macroglossia. Lateral cephalometric analysis showed skeletal mandibular protrusion and an open bite of the left side. Based on these findings the patient was diagnosed as having a skeletal mandibular protrusion with a left sided open bite associated with acromegaly. Glossectomy, Le Fort I osteotomy and sagittal split ramus osteotomy (SSRO) were planned. Le Fort I osteotomy and SSRO were performed after the lower molar width was reduced with a semi-fixed constriction appliance. Postoperative orthodontic treatment and myofunctional therapy were performed for detailing. The treatment period was 2 years and 2 months. The results showed that the spaces caused by macroglossia were closed efficiently. Maxillary and mandibular dental arch widths were coordinated well and a good occlusion with molar relation of Angle Class I was acquired.