Acromegaly: A Cross-Sectional Analysis of the Oral and Maxillofacial Pathologies

Abstract

Context: It is well established that clinical features of acromegaly concern the teeth and the jaw, but less is known about the degree of oral and maxillofacial pathologies.

Patients: 28 acromegalics (13 females, 15 males) with a mean age 49±11 (mean±SD) years (range 31–70) were included in the study. 32% had active disease, 68% were well-controlled under the somatostatin analogue octreotide, the dopamine agonist cabergoline, and the GH receptor antagonist pegvisomant, or were cured after pituitary surgery and/or radiation.

Methods: All subjects undergone intensive and complex examinations of a plaster model and facial arch with articulator, an intra-oral bracket-pen registration, analysis of a digital picture, panoramic and lateral radiographs with cephalometry in comparison with a reference group (n=201).

Results: 42% had a diastema mediale (0.9±1.1 mm). Overbite and overjet (vertical overbite) correlated with the disease duration (r²=0.2237; p=0.011 respectively r²=0.3364; p=0.015). 96% had an asymmetric movement of the mandible. 57% had a prognathism. The protrusion of the mandible correlated significantly with the disease duration (r²=0.1784; p=0.028). The degree of the mandibular prognathism (SNB-angle) was higher in the acromegalic group (84°±7° vs. 81°±3°, p<0.05). The ANB-angle indicates the relation between maxilla and mandible and was negative in the acromegalic group and positive in the controls (−0.3°±5.0° vs. 1.6°±2.1°, p=<0.05) and correlated negative with the disease duration (r²=0.2553; p=0.0061). The mandibular angle was significantly greater in the acromegalic group (126°±9° acromegalic group vs. 121°±7°control group, p=0.003). The length of the mandible correlated with the disease duration (r²=0.2801; p=0.0038). 86% had an asymmetric face. The high of the midface was in the acromegalic group higher (6.1±0.7 vs. 5.5±0.4 cm, p=0.0009) as well as the lower bony high of the face (9.5±1.0 acromegalics vs. 6.9±0.5 cm controls, p=0.0009). The high of the lower bony face correlated with as well with the disease duration (r²=0.3224; p=0.0016).

Conclusions: Patients with acromegaly suffer not only from cardiovascular, metabolic and neoplastic complications, but also from dental and jaw disorders. The high incidence of these manifestations and its relation to the disease duration requires a carefully work-up of oral and maxillofacial examinations in close collaboration with endocrinologists, dentists and dental surgeons.

acromegaly - bite - jaw - denture - disease activity

References

• 1 Colao A, Ferone D, Marzullo P. et al . Systemic complications of acromegaly: epidemiology, pathogenesis, and management.  Endocr Rev. 2004;  25 102-152
• 2 Melmed S. Acromegaly.  N Engl J Med. 1990;  322 966-977
• 3 Nabarro JD. Acromegaly.  Clin Endocrinol (Oxf). 1987;  26 481-512
• 4 Ezzat S, Forster MJ, Berchtold P. et al . Acromegaly. Clinical and biochemical features in 500 patients.  Medicine (Baltimore). 1994;  73 233-240
• 5 Herrmann BL, Severing M, Schmermund A. et al . Impact of Disease Duration on Coronary Calcification in Patients with Acromegaly.  Exp Clin Endocrinol Diabetes. 2009; 
• 6 Clayton RN. Cardiovascular function in acromegaly.  Endocr Rev. 2003;  24 272-277
• 7 Melmed S. Acromegaly and cancer: not a problem?.  J Clin Endocrinol Metab. 2001;  86 2929-2934
• 8 Kunzler A, Farmand M. Typical changes in the viscerocranium in acromegaly.  J Craniomaxillofac Surg. 1991;  19 332-340
• 9 Serra Payro JM, Vinals Vinals JM, Palacin Porte JA. et al . Surgical management of the acromegalic face.  J Craniofac Surg. 1994;  5 336-338
• 10 Morarasu C, Burlui V, Zbranca E. [Cephalometric changes in acromegaly].  Rev Med Chir Soc Med Nat Iasi. 1997;  101 120-124
• 11 Brennan MD, Jackson IT, Keller EE. et al . Multidisciplinary management of acromegaly and its deformities.  JAMA. 1985;  253 682-683
• 12 Eganova TD. [Maxillodental function in acromegaly patients].  Stomatologiia (Mosk). 1985;  64 53-54
• 13 Goodkind RJ. Prosthetic management of an acromegaly patient.  J Am Dent Assoc. 1968;  77 1327-1330
• 14 Korkhaus G. [Proliferating and destructive processes at the dental root in acromegaly].  Zahnarztl Welt. 1955;  10 286-291
• 15 Herrmann BL, Wessendorf TE, Ajaj W. et al . Effects of octreotide on sleep apnoea and tongue volume (magnetic resonance imaging) in patients with acromegaly.  Eur J Endocrinol. 2004;  151 309-315
• 16 Dostalova S, Sonka K, Smahel Z. et al . Craniofacial abnormalities and their relevance for sleep apnoea syndrome aetiopathogenesis in acromegaly.  Eur J Endocrinol. 2001;  144 491-497
• 17 Dostalova S, Sonka K, Smahel Z. et al . Cephalometric assessment of cranial abnormalities in patients with acromegaly.  J Craniomaxillofac Surg. 2003;  31 80-87
• 18 Giustina A, Barkan A, Casanueva FF. et al . Criteria for cure of acromegaly: a consensus statement.  J Clin Endocrinol Metab. 2000;  85 526-529
• 19 Segner D. Floating norms as a means to describe individual skeletal patterns.  Eur J Orthod. 1989;  11 214-220
• 20 Schwarz AM. [Lessons in anatomy of face and cranium for the beginning orthodontist].  Osterr Z Stomatol. 1955;  52 188-221 ; contd
• 21 Schwarz AM. [Lessons in face and cranium anatomy for the beginning orthodontist].  Osterr Z Stomatol. 1955;  52 132-155 ; contd
• 22 Schwarz AM. [What every doctor should know about the orthopedics of the jaw in childhood].  Munch Med Wochenschr. 1961;  103 601-605
• 23 Brabant G, von zur Muhlen A, Wuster C. et al . Serum insulin-like growth factor I reference values for an automated chemiluminescence immunoassay system: results from a multicenter study.  Horm Res. 2003;  60 53-60
• 24 Iikubo M, Kobayashi A, Kojima I. et al . Excessive lateral dental arch expansion in experimentally developed acromegaly-like rats.  Arch Oral Biol. 2008;  53 924-927
• 25 Pelttari L, Polo O, Rauhala E. et al . Nocturnal breathing abnormalities in acromegaly after adenomectomy.  Clin Endocrinol (Oxf). 1995;  43 175-182
• 26 Kojima I, Iikubo M, Kobayashi A. et al . High serum levels of IGF-I contribute to promotion of endochondral ossification in mandibular condyle and cause its specific elongation in acromegaly-like rats.  Horm Metab Res. 2008;  40 533-538
• 27 Colao A, Marzullo P, Vallone G. et al . Reversibility of joint thickening in acromegalic patients: an ultrasonography study.  J Clin Endocrinol Metab. 1998;  83 2121-2125
• 28 Rodrigues MP, Naves LA, Casulari LA. et al . Craniofacial abnormalities, obesity, and hormonal alterations have similar effects in magnitude on the development of nocturnal hypoxemia in patients with acromegaly.  J Endocrinol Invest. 2008;  31 1052-1057
• 29 Zucconi M, Ferini-Strambi L, Palazzi S. et al . Craniofacial cephalometric evaluation in habitual snorers with and without obstructive sleep apnea.  Otolaryngol Head Neck Surg. 1993;  109 1007-1013
• 30 Berg C, Wessendorf TE, Mortsch F. et al . Influence of disease control with pegvisomant on sleep apnoea and tongue volume in patients with active acromegaly.  Eur J Endocrinol. 2009;  161 829-835
• 31 Berlin R, Dessner L, Aberg S. Chronic headache and dysfunction of the temporo-mandibular joint.  Acta Med Scand. 1956;  154 167-176
• 32 Lorber CG. Pathology of the temporo-mandibular joint and its treatment in the first half of the 19^th century. 1.  Dent Hist. 1991;  16-29
• 33 Levy MJ, Matharu M, Goadsby PJ. Chronic headache and pituitary tumors.  Curr Pain Headache Rep. 2008;  12 74-78
• 34 Takakura M, Kuroda T. Morphologic analysis of dentofacial structure in patients with acromegaly.  Int J Adult Orthodon Orthognath Surg. 1998;  13 277-288
• 35 Ionescu O, Sonnet E, Roudaut N. et al . [Oral manifestations of endocrine dysfunction].  Ann Endocrinol (Paris). 2004;  65 459-465
• 36 Chanson P, Salenave S. Acromegaly.  Orphanet J Rare Dis. 2008;  3 17
• 37 Feelders RA, Delwel EJ, de Baat C. [Acromegaly Treatment of the causal factor and the oral sequelae].  Ned Tijdschr Tandheelkd. 2004;  111 20-22
• 38 Sugata T, Myoken Y, Tanaka S. Acromegaly identified in a patient with a complaint of malocclusion.  Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 1998;  85 44-46

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