Abstract
In this paper, we report the application of bimaxillary surgery for mandibular prognathism in an acromegalic patient with obstructive sleep apnea syndrome (OSAS).
The patient, a 21-year-old male, was referred to our clinic for the treatment of malocclusion with open bite and mandibular protrusion. He was 187cm tall and weighed 68kg. The serum growth hormone (GH) and insulin like growth factor I (IGF-I) showed high scores of 5.86ng/ml and 604ng/ml, respectively. His apnea and hypopnea index was also out of the normal range (16.5). MRI revealed a tumor in the sella turcica. Under the diagnosis of acromegaly caused by pituitary adenoma, he underwent removal of the pituitary tumor by neurosurgeons. Ten months later, IGF-I reduced to the normal range. GH and AHI also decreased. Morphological analysis of the pharynx by using lateral cephalograms revealed widening of his upper airway tract after removal of the pituitary adenoma. Le Fort I and bilateral sagittal splitting ramus osteotomy along with tracheotomy was successfully performed at the age of 24 years. The postoperative course was uneventful. He was followed up for 2 years without skeletal relapse, deterioration of OSAS, or recurrence of pituitary adenoma.
