先端巨大症による下顎前突症に顎矯正手術を行った2例

Abstract

Acromegaly is caused by growth hormone excess owing to a pituitary adenoma after completion of growth and tends to lead to mandibular prognathism. In this paper, two patients with mandibular prognathism caused by acromegaly and treated by surgical-orthodontic treatment are reported. The first case was a 36-year-old male who was referred to our hospital to correct mandibular prognathism and malocclusion after resection of the tumor in the pituitary gland. The second case was a 26-year-old male who was referred from an orthodontic clinic for orthognathic surgery. He had not been diagnosed as acromegaly but a typical double-floor of the Turkish saddle was found in the lateral cephalogram. Blood tests revealed acromegaly. Surgical-orthodontic treatments were performed after resection of the pituitary adenoma and confirmation of normal level of blood growth hormone (GH) and somatomedin C. In both cases, multi-bracket appliances were worn and bimaxillary osteotomy (Le Fort I osteotomy for maxillary advancement and bilateral sagittal splitting ramus osteotomies for mandibular setback) was carried out to secure the intraoral space for the enlarged tongue. After post-surgical orthodontic treatment, the treatment results were good and stable in both cases. These cases showed that surgical-orthodontic treatment for patients with acromegaly after pituitary adenoma resection is reliable. The importance of careful examination of the craniofacial shape in patients with mandibular prognathism to detect acromegaly is emphasized.