Cephalometric assessment of soft tissue morphology of patients with acromegaly


Share / Export Citation / Email / Print / Text size:

Australasian Orthodontic Journal

Australian Society of Orthodontists

Subject: Dentistry, Orthodontics & Medicine


ISSN: 2207-7472
eISSN: 2207-7480





Volume / Issue / page

Volume 38 (2022)
Volume 37 (2021)
Volume 36 (2020)
Volume 35 (2019)
Volume 34 (2018)
Volume 33 (2017)
Volume 32 (2016)
Volume 31 (2015)
Related articles

VOLUME 32 , ISSUE 1 (May 2016) > List of articles

Cephalometric assessment of soft tissue morphology of patients with acromegaly

Nehir Canigur Bavbek * / Burcu Balos Tuncer * / Cumhur Tuncer * / Kahraman Gungor * / Cigdem Ozkan * / Emre Arslan * / Alev Eroglu Altinova * / Mujde Akturk * / Fusun Balos Toruner *

Citation Information : Australasian Orthodontic Journal. Volume 32, Issue 1, Pages 48-54, DOI: https://doi.org/10.21307/aoj-2020-112

License : (CC BY 4.0)

Published Online: 30-July-2021



Aim: To assess the sagittal soft tissue morphology of patients with acromegaly in comparison with a healthy control group.

Methods: Twenty-seven patients with acromegaly (11 male, 16 female; mean age 47.3 ± 11.5 years) and 30 healthy subjects (15 male, 15 female; mean age 42.2 ± 17.4 years) were included in the study. Linear and angular measurements were made on lateral cephalograms to evaluate soft tissue and skeletal characteristics. The intergroup comparisons were analysed with the Student’s t-test.

Results: Facial convexity (p < 0.01) and the nasolabial angle (p < 0.001) were reduced in patients with acromegaly, whereas nose prominence (p < 0.01), upper lip sulcus depth (p < 0.01), upper lip thickness (p < 0.01), basic upper lip thickness (p < 0.01), lower lip protrusion (p < 0.05), mentolabial sulcus depth (p < 0.05) and soft tissue chin thickness (p < 0.001) were increased. Anterior cranial base length (p < 0.05), the supraorbital ridge (p < 0.01), the length of the maxilla and mandible (p < 0.001, p < 0.01, respectively) were significantly increased, and mandibular prognathism was an acromegalic feature (p < 0.05).

Conclusion: Acromegalic coarsening and thickening of the craniofacial soft tissues was identified from lateral cephalograms, which may therefore contribute to early diagnosis when evaluated together with other changes caused by the disease.

Content not available PDF Share



1. Holdaway IM, Rajasoorya C. Epidemiology of acromegaly. Pituitary 1999;2:29-41.

2. Mestron A, Webb SM, Astorga R, Benito P, Catala M, Gaztambide S et al. Epidemiology, clinical characteristics, outcome, morbidity and mortality in acromegaly based on the Spanish Acromegaly Registry (Registro Espanol de Acromegalia, REA). Eur J Endocrinol 2004;151:439-46.

3. Jane JA Jr, Thapar K, Laws ER Jr. Acromegaly: historical perspectives and current therapy. J Neurooncol 2001;54:129-37.

4. Fukuda I, Hizuka N, Muraoka T, Kurimoto M, Yamakado Y, Takano K et al. Clinical features and therapeutic outcomes of acromegaly during the recent 10 years in a single institution in Japan. Pituitary 2014;17:90-5.

5. Reid TJ, Post KD, Bruce JN, Nabi Kanibir M, Reyes-Vidal CM, Freda PU. Features at diagnosis of 324 patients with acromegaly did not change from 1981 to 2006: acromegaly remains under-recognized and under-diagnosed. Clin Endocrinol (Oxf) 2010;72:203-8.

6. Dekkers OM, Biermasz NR, Pereira AM, Romijn JA, Vandenbroucke JP. Mortality in acromegaly: a metaanalysis. J Clin Endocrinol Metab 2008;93:61-7.

7. Iuliano SL, Laws ER Jr. Recognizing the clinical manifestations of acromegaly: case studies. J Am Assoc Nurse Pract 2014;26:136-42.

8. 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;85:44-6.

9. Vitral RW, Tanaka OM, Fraga MR, Rosa EA. Acromegaly in an orthodontic patient. Am J Orthod Dentofacial Orthop 2006;130:388-90.

10. Karakis D, Aktas-Yilmaz B, Dogan A, Yetkin I, Bek B. The bite force and craniofacial morphology in patients with acromegaly: a pilot study. Med Oral Patol Oral Cir Bucal 2014;19:e1-7.

11. Kashyap RR, Babu GS, Shetty SR. Dental patient with acromegaly: a case report. J Oral Sci 2011;53:133-6.

12. Nakano H, Mishima K, Matsushita A, Suga H, Miyawaki Y, Mano T et al. Orthognathic surgery in an acromegalic patient with obstructive sleep apnea syndrome. Sleep Breath 2013;17:29-32.

13. Balos Tuncer B, Canigur Bavbek N, Ozkan C, Tuncer C, Eroglu Altinova A, Gungor K et al. Craniofacial and pharyngeal airway morphology in patients with acromegaly. Acta Odontol Scand 2015;73:433-40.

14. Legan HL, Burstone CJ. Soft tissue cephalometric analysis for orthognathic surgery. J Oral Surg 1980;38:744-51.

15. Gelgör IE, Karaman AI, Zekiç E. The use of parental data to evaluate soft tissues in an Anatolian Turkish population according to Holdaway soft tissue norms. Am J Orthod Dentofacial Orthop 2006;129:330 e1-9.

16. Dostálová S, Sonka K, Smahel Z, Weiss V, Marek J. Cephalometric assessment of cranial abnormalities in patients with acromegaly. J Craniomaxillofac Surg 2003;31:80-7.

17. Wagenmakers MA, Roerink SH, Maal TJ, Pelleboer RH, Smith JW, Hermus AR et al. Three-dimensional facial analysis in acromegaly: a novel tool to quantify craniofacial characteristics after long-term remission. Pituitary 2015;18:126-34.

18. Künzler A, Farmand M. Typical changes in the viscerocranium in acromegaly. J Craniomaxillofac Surg 1991;19:332-40.

19. De Greef S, Vandermeulen D, Claes P, Suetens P, Willems G. The influence of sex, age and body mass index on facial soft tissue depths. Forensic Sci Med Pathol 2009;5:60-5.

20. Learned-Miller E, Lu Q, Paisley A, Trainer P, Blanz V, Dedden K et al. Detecting acromegaly: screening for disease with a morphable model. Med Image Comput Comput Assist Interv 2006;9:495-503.

21. Miller RE, Learned-Miller EG, Trainer P, Paisley A, Blanz V. Early diagnosis of acromegaly: computers vs clinicians. Clin Endocrinol (Oxf) 2011;75:226-31.

22. Schneider HJ, Kosilek RP, Günther M, Roemmler J, Stalla GK, Sievers C et al. A novel approach to the detection of acromegaly: accuracy of diagnosis by automatic face classification. J Clin Endocrinol Metab 2011;96:2074-80.

23. Ludlow JB, Ivanovic M. Comparative dosimetry of dental CBCT devices and 64-slice CT for oral and maxillofacial radiology. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2008;106:106-14.

24. Gijbels F, Sanderink G, Wyatt J, Van Dam J, Nowak B, Jacobs R. Radiation doses of indirect and direct digital cephalometric radiography. Br Dent J 2004;197:149-52.

25. Ferguson JK, Donald RA, Weston TS, Espiner EA. Skin thickness in patients with acromegaly and Cushing’s syndrome and response to treatment. Clin Endocrinol (Oxf) 1983;18:347-53.

26. Chang HP, Tseng YC, Chou TM. An enlarged sella turcica on cephalometric radiograph. Dentomaxillofac Radiol 2005;34:308-12.

27. Dostalova S, Sonka K, Smahel Z, Weiss V, Marek J, Horinek D. Craniofacial abnormalities and their relevance for sleep apnoea syndrome aetiopathogenesis in acromegaly. Eur J Endocrinol 2001;144:491-7.