Use of High Condylectomy and Abdominal Dermis Fat Grafting for an Acromegaly Induced Bilateral Condylar Hyperplasia: A Case Report

Acromegaly is a disorder characterized by hypersecretion of growth hormone, resulting in morbidities associated with multiple systems. Although most of the morbidities are reversed following control of the underlying disease, it may take several weeks to months for the symptoms to subside. One of the most noticeable effects of acromegaly is changes in facial features and jawbone growth, which can lead to severe pain and discomfort. This report describes a case of a 31-year-old patient with acromegaly induced bilateral condylar hyperplasia who presented with severe temporomandibular joint (TMJ), facial pain, and degenerative changes in TMJ. The patient was treated by trans-sphenoidal excision of pituitary adenoma, medications, and radiotherapy, but his hormonal levels were persistently high. Considering the refractory nature of the disease, the patient underwent bilateral high condylectomy, right articular disc removal, and abdominal dermis fat grafting. The surgery arrested the progressive mandibular enlargement and prevented further degenerative changes of TMJ. Although there was some reduction in TMJ pain, the myogenous pain and headache persisted after surgery. TMJ surgery may be selectively used for refractory cases of acromegaly and those requiring discectomy or total joint replacement. This case report describes the role of TMJ surgery in the management of morbidities and symptoms associated with TMJ in acromegaly until biochemical normalcy is achieved.