Typical changes in the viscerocranium in acromegaly.

31 patients (mean age 52.7 years) suffering from persistent symptoms of a growth hormone-producing pituitary adenoma underwent both clinical and radiological examination at least one year after transnasal extirpation of the tumour. The results of standardized X-ray analysis of the viscerocranium were compared with a group of 21 healthy subjects (mean age 42.1 years): Although several remarkable changes of the facial skeleton were observed, statistically significant changes could be found in the lower jaw only. The ascending ramus as well as the mandibular body were found to be elongated. The main contribution to the elongation was made by the chin prominence and the condyle. Two different growth patterns of the mandible could be determined; neither of them was pathognomonic for acromegaly. Due to overgrowth of the septal cartilage in 7 patients we found a so-called "hanging columella". In 16 patients the mandibular canal was widened and showed marked deviations in its diameter or a funnel-shaped mandibular foramen.