Cases reported "Acromegaly"

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1/8. Treatment of mandibular prognathism in an acromegalic patient.

    A 41-year-old man with acromegaly underwent cryosurgery for a pituitary adenoma. Although soft tissue regression is possible after pituitary ablation, bony changes are permanent. Thus, bilateral vertical osteotomies and bilateral coronoidotomies were performed for correction of the mandibular prognathism. The postoperative occlusion and facial profile were very acceptable. Unfortunately, the patient died of a myocardial infarction eight days postoperatively.
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2/8. A case of acromegaly.

    A fifty years old woman hailing from Purbadhala of Netrokona district complaining of gradual enlargement of hands, feet, nose and other acral parts of the body for about last eight years. She noticed coarsening of the skin and gradual protrusion of her lower jaw. She complained of headache, vertigo, frequent passage of urine, increased thirst, weight loss and fatiguability. She was found hypertensive having blood pressure 200/110 mm of Hg. Her appearance was coarse with rough skin. There were enlargement of hands, feet, nose, lower jaw with prognathism and enlargement of other acral parts. Investigations revealed high plasma glucose level, both fasting and 2 hrs. after glucose, high level of growth hormone, failure of suppression of growth hormone during OGTT. thyroid function tests of the patient were found normal with increased heel pad size and enlarged sella turcica in all diameters. She was diagnosed as a case of acromegaly due to growth hormone hypersecretion.
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3/8. Surgical orthodontic correction of acromegaly with mandibular prognathism.

    A male (30 years five months) who complained of mandibular prominence and masticatory dysfunction was diagnosed as a mandibular prognathic with acromegaly after cephalometric and endocrine examinations. The level of growth hormone (GH) subsequent to a transsphenoidal hypophysectomy had been controlled by medicines for about five years. Surgical orthodontic correction improved his occlusion and profile, but magnetic resonance imaging detected a recurrent adenoma in the cranial base during the retention period. The recurrence resulted in slight prognathic changes of the patient with a high level of GH. This is a case report of the treatment of an acromegalic patient discussing growth considerations that could influence the orthodontic treatment plan and long-term stability.
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keywords = prognathism
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4/8. An enlarged sella turcica on cephalometric radiograph.

    A 28-year-old male presented to the Orthodontic clinic for correction of his anterior crossbite due to mandibular prognathism as a result of pituitary adenoma with acromegaly. A radiographic cephalometric analysis and clinical orthodontic examination were made. This article describes in detail the methods of correcting the magnification of cephalometric linear measurements in sellar dimensions (length, depth and width) from lateral and posteroanterior cephalograms. Cephalometric findings revealed that the sella enlarged in all its dimensions with a deepening of the floor in this acromegalic case. We discuss the radiographic diagnosis of an enlarged sella turcica in intrasellar tumours and also emphasise the dentist's important role in the initial diagnosis of pituitary adenoma cases.
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keywords = prognathism
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5/8. acromegaly in an orthodontic patient.

    A 32-year-old white man presented for orthodontic treatment with the chief complaint of mandibular prognathism; he was later found to have acromegaly. General information about pituitary adenomas, specifically growth hormone adenomas, is given, and treatment options are discussed.
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6/8. Surgery in active acromegaly with prognathism and a lateral open bite.

    The case of a 33-year-old Caucasian with acromegaly is presented. The maxillo-facial deformity with the rare combination of unilateral open bite is demonstrated. The patient underwent surgical treatment of the pituitary gland three times. In the last operative procedure the sella was found to be empty, but despite this the growth hormone level appeared to be too high. Nevertheless, it was decided to correct the mandibular deformity. Risks during and after mandibular osteotomy are discussed, and the results are shown.
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keywords = prognathism
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7/8. The medical and anaesthetic management of acromegalic patients undergoing maxillo-facial surgery.

    Three acromegalic patients are described in whom successful surgical correction of the prognathism was performed. No immediate post-operative upper respiratory tract obstruction nor cardiac dysrrhythmias occurred as have been reported in previously recorded cases. It is suggested that particular attention be paid to the recognition and prevention of these complications. In addition we believe that initial treatment should be directed to the achievement of as near normal growth hormone levels as possible for at least a year before maxillo-facial surgery so that there may be maximal soft tissue regression and reduction of airway hazards and cardiac embarrassment.
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keywords = prognathism
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8/8. Use of modern craniofacial techniques for comprehensive reconstruction of the acromegalic face.

    The severe acromegalic patient poses a difficult reconstructive dilemma to the craniofacial surgeon. Significant facial deformities can include frontal bossing, prominent supraorbital ridges, malar flatness, maxillary hypoplasia, mandibular prognathism with class III malocclusion, and macrogenia. Reports on the correction of these deformities are rare. Prior publications describe long hospital stays, weeks of intermaxillary fixation, requirement for a tracheostomy, as well as the need for multiple, staged procedures and interdisciplinary teams. In an effort to extend the advances of modern craniofacial techniques to this group of patients, we performed an extensive reconstruction on a 28-year-old acromegalic patient using a one-stage procedure without the use of intermaxillary fixation and without the added morbidity of a tracheostomy. The procedure addressed the skeletal deformities of the upper face, the midface, and the lower face. The operation was performed by a single plastic surgery team and the patient was extubated in 36 hours and discharged in 6 days. We believe that the use of rigid fixation and the judicious application of modern craniofacial principles can allow a complex yet safe one-stage procedure to reconstruct the acromegalic face. Such an approach showed decreased perioperative morbidity and provided an excellent functional and aesthetic result.
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keywords = prognathism
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