Three dimensional facial analyses in acromegaly: A study to investigate craniofacial characteristics after long-term remission

Program: Abstracts - Orals, Featured Poster Presentations, and Posters
Session: SUN 88-129-Acromegaly & Prolactinoma
Sunday, June 16, 2013: 1:45 PM-3:45 PM
Expo Halls ABC (Moscone Center)

Poster Board SUN-124
Sean H.P.P. Roerink*1, Margreet A.E.M. Wagenmakers1, Thomas J.J. Maal1, Roel H. Pelleboer1, Tong Xi1, Johannes W.A. Smit1, Stefaan J. Berge1, Ad R.M.M. Hermus2 and Romana T. Netea-Maier1
1Radboud University Nijmegen Medical Center, Nijmegen, Netherlands, 2Radboud University Nijmegen Medical Centre, Nijmegen
Context:Craniofacial disproportions due to soft tissue swelling and new bone formation are highly prevalent in patients with active acromegaly. It is unclear to what extent these disproportions persist after long-term remission. Therefore we are not able to adequately inform our patients about what to expect regarding alterations in their appearance after successful treatment. It is now possible to accurately investigate craniofacial characteristics with an innovative technique of facial analysis via a 3D fusion model of a 3D stereophotograph of the face combined with a cone beam computed tomography (CBCT)-scan of the skull. This technique enables us to generate a full 3D fusion reconstruction of the acromegalic head.  

Objective:To investigate the 3-dimensional characteristics of both soft tissue and bony parts of the face in patients in long-term remission of acromegaly.

Patients and methods: Sixteen patients in remission of acromegaly for at least 24 months (mean  ± SD 105 ± 104) after successful transsphenoidal pituitary surgery  (50% male, age 55.9 ± 10.7 years, BMI 29.3 ± 5.5 kg/m2) were compared to 16 age-, gender-, ethnicity-, and BMI-matched control subjects. A CBCT scan and 3D photograph of each individual were acquired and analyzed with the aid of 3D cephalometry according to the method of Swennen et al. (1).

Results:  Compared to the matched control subjects, patients in long-term remission of  acromegaly still showed striking differences in appearance. The following differences were the most impressive: Analysis of the bony tissue showed that   patients have a longer mandible (median difference 4.80 mm, p=0.02), a longer maxilla (4.05 mm, p<0.01), increased anterior facial height (13.10 mm, p<0.01) and an increased face width (6.80 mm, p<0.01). Analysis of the soft tissues showed that patients have  increased nose length (3.65 mm, p<0.01), an increased width of the nasal bridge (6.70 mm, p=0.02), an increased width of the mouth (3.45 mm, p=0.04) and  an increased nasal tip protrusion (2.70 mm, p=0.01).

Conclusion:The 3-D fusion model is an attractive method to investigate craniofacial disproportions in patients with acromegaly. Significant craniofacial changes persist even after long-term remission. These data enable us to quantitatively study long term sequela of acromegaly and help to inform patients at the time of diagnosis. Longitudinal research is needed to establish to what extent craniofacial changes are reversible after remission and to what extent these changes are dependent upon the different treatment modalities.

(1) Swennen GRJ, Schutyser, F., Hausamen, J.E. 2006 Three-dimensional cephalometry: A color atlas and manual: Springer


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Sources of Research Support: Ipsen