Oral Manifestations and Maxillo-Facial Features in the Acromegalic Patient: A Literature Review

Abstract

Background: Acromegaly is a chronic disease caused by an abnormal secretion of growth hormone (GH) by a pituitary adenoma, resulting in an increased circulating concentration of insulin-like growth factor 1 (IGF-1). The main characteristics are a slow progression of signs and symptoms, with multisystemic involvement, leading to acral overgrowth, progressive somatic changes, and a complex range of comorbidities. Most of these comorbidities can be controlled with treatment. The literature reveals that the most evident and early signs are those related to soft tissue thickening and skeletal growth, especially in the head and neck region. Methods: The authors reviewed the available literature on the clinical oro-dental features of acromegaly, selecting articles from PubMed and Google Scholar. The aim of this review was to summarize all the reported clinical oro-dental features of acromegalic patients. Results: The most common facial dimorphisms involved the maxillo-facial district, with hypertrophy of the paranasal sinuses, thickening of the frontal bones, and protruding glabella, which may be associated with joint pain and clicks. Regarding the oro-dental signs, the most frequent are dental diastema (40-43%), mandibular overgrowth (22-24%), mandibular prognathism (20-22%), and macroglossia (54-58%). These signs of acromegaly can be significantly reduced with adequate treatment, which is more effective when initiated early. Conclusions: Increased awareness of acromegaly among dentists and maxillo-facial surgeons, along with the early identification of oro-facial changes, could lead to an earlier diagnosis and treatment, thereby improving patients' quality of life and prognosis.

Keywords: acromegalic features; acromegaly; acromegaly oro-dental diagnosis; dental manifestations acromegaly; dentist acromegaly; oral manifestations acromegaly; oro-dental acromegaly.

Figure 1

Oro-maxillo-facial features of acromegaly.

Figure 2

Oro-maxillo-facial features of acromegaly. Panel (A) Mandibular growth, prognathism, and class III dental and skeletal pattern; panel (B) macroglossia, hypertrophic uvula, and elongation of the soft palate; panel (C) dental occlusion; panel (D) inclined frontal elements, over-erupted molar teeth; panel (E) diastemas; panel (F) thickening of the gingival tissues; panel (G) palatine and/or mandibular torus and vestibular exostoses.

Figure 3

Cephalometric characteristics of a patient affected by acromegaly. Note the significant enlargement of sella turcica.