A Case of Growth Hormone Deficiency with Severe Mandibular Protrusion and Masseter Hypertrophy

Abstract

Growth hormone deficiency (GHD) is the deficiency of growth hormone produced by the pituitary gland to stimulate the body to grow. We report a case of GHD with severe mandibular protrusion and masseter hypertrophy. A 28-year-old male patient with GHD treated with administration of human growth hormone between the ages of 11 to 20 visited our hospital because of severe mandibular protrusion and malocclusion. The patient had a history of orthodontic treatment for skeletal Class III malocclusion from 9 to 14 years old. Clinical evaluation revealed a concave profile with severe mandibular protrusion and a prominent mandibular angle. After preoperative orthodontic treatment, a combination of Le Fort I osteotomy, anterior mandibular segmental osteotomy, and bilateral sagittal split ramus osteotomy was performed. Eight months after the first surgery, the lower and inner portions of the bilateral masseter muscles were resected and the expanded portions of the mandibular angles were trimmed away by an intraoral approach. After orthognathic surgery, the facial profile and malocclusion were improved remarkably.
Untreated patients with GHD have typical somatic features, including short stature, acromicria, and distinctive craniofacial features including small head circumference and retrognathism. It is reported that GH therapy partially corrects craniofacial defects but long-term GH therapy might be associated with acromegalic features. In the present case, it is suggested that GH therapy accelerated mandibular growth and aggravated mandibular protrusion.