Skip to main content

A comparative study on cephalometric differences in maxillofacial morphology between skeletal Class III cases with and without acromegaly: a pilot study



The most typical maxillofacial feature of patients with acromegaly is mandibular protrusion. This study aimed to determine differences in maxillofacial morphology between skeletal Class III patients with and without acromegaly using cephalometric analysis.


Cephalograms of 37 patients with acromegaly (Acro), 37 age-matched non-acromegalic patients with skeletal Class III malocclusion (C-III), and 37 age-matched Class I malocclusion patients (C-I; control) were retrospectively collected. The skeletal and dental morphology of each group was analyzed using cephalometric analysis, which included linear and angular measurements and facial profilograms. In addition, we analyzed diagnostic performance and cutoff values for discriminating acromegaly from skeletal Class III malocclusion using receiver operating characteristic (ROC) curve analysis.


The mandibular ramus height was larger in the Acro group than in the other groups. The increase in L1/MP in the Acro group, which represented labial inclination of the mandibular central incisors, was the most characteristic feature in this study. ROC curve analysis indicated that a cutoff value of 88.4° for L1/MP had the highest diagnostic performance in discriminating acromegaly from non-acromegalic Class III malocclusion.


Acromegaly was characterized by a greater degree of bimaxillary prognathism than was non-acromegalic Class III malocclusion. Focusing on labial inclination of the mandibular central incisors would be the most useful way to differentiate acromegaly from non-acromegalic Class III malocclusion.

This is a preview of subscription content, access via your institution.

Fig. 1
Fig. 2
Fig. 3
Fig. 4


  1. Melmed S. Acromegaly. N Engl J Med. 1990;322:966–77.

    Article  Google Scholar 

  2. Künzler A, Farmand M. Typical changes in the viscerocranium in acromegaly. J Cranio-Maxillofac Surg. 1991;19:332–40.

    Article  Google Scholar 

  3. Wright AD, Hill DM, Lowy C, Fraser TR. Mortality in acromegaly. Q J Med. 1970;39:1–16.

    PubMed  Google Scholar 

  4. Zahr R, Fleseriu M. Updates in diagnosis and treatment of acromegaly. Eur Endocrinol. 2018;14:57–61.

    Article  Google Scholar 

  5. Kashyap RR, Babu GS, Shetty SR. Dental patient with acromegaly: a case report. J Oral Sci. 2011;53:133–6.

    Article  Google Scholar 

  6. Dostálová S, Sonka K, Smahel Z, Weiss V, Marek J. Cephalometric assessment of cranial abnormalities in patients with acromegaly. J Craniomaxillofac Surg. 2003;31:80–7.

    Article  Google Scholar 

  7. Ebner FH, Kürschner V, Dietz K, Bültmann E, Nägele T, Honegger J. Craniometric changes in patients with acromegaly from a surgical perspective. Neurosurg Focus. 2010;29:E3.

    Article  Google Scholar 

  8. Seiryu M, Ida H, Mayama A, Sasaki S, Sasaki S, Deguchi T, et al. A comparative assessment of orthodontic treatment outcomes of mild skeletal Class III malocclusion between facemask and facemask in combination with a miniscrew for anchorage in growing patients: a single-center, prospective randomized controlled trial. Angle Orthod. 2020;90:3–12.

    Article  Google Scholar 

  9. Baumrind S, Frantz RC. The reliability of head film measurements: 2. Conventional angular and linear measures. Am J Orthop. 1971;60:505–17.

    Article  Google Scholar 

  10. Freundlich T, Arueste D, Manríquez G, Díaz A. Cephalometric comparison between an acromegalic patient and his twin brother. Odontoestomatologia. 2019;21:81–8.

    Article  Google Scholar 

  11. Atreja G, Atreja SH, Jain N, Sukhija U. Oral manifestations in growth hormone disorders. Indian J Endocrinol Metab. 2012;16:381–3.

    Article  Google Scholar 

  12. Spalj S, Mestrovic S, Lapter Varga M, Slaj M. Skeletal components of class III malocclusions and compensation mechanisms. J Oral Rehabil. 2008;35:629–37.

    Article  Google Scholar 

  13. Janson G, de Souza JE, Alves Fde A, Andrade P Jr, Nakamura A, de Freitas MR, et al. Extreme dentoalveolar compensation in the treatment of Class III malocclusion. Am J Orthod Dentofac Orthop. 2005;128:787–94.

    Article  Google Scholar 

  14. Solow B. The dentoalveolar compensatory mechanism: background and clinical implications. Br J Orthod. 1980;7:145–61.

    Article  Google Scholar 

Download references


This work was supported in part by a Grant-in-Aid for Scientific Research (B) (No. 19H02194 and 20H03868).


Not applicable.

Author information

Authors and Affiliations


Corresponding author

Correspondence to Noriaki Shoji.

Ethics declarations

Conflict of interest

The authors declare that they have no conflict of interest.

Ethics approval

All procedures followed were in accordance with the ethical standards of the responsible committee on human experimentation (institutional and national) and with the Helsinki Declaration of 1964 and later versions. The study was approved by the Research Ethics Committee of the Tohoku University Graduate School of Dentistry (No. 2018-3-37).

Informed consent

Informed consent was obtained in the form of an opt-out option on the Tohoku University Graduate School of Dentistry website where information about the conduct of the study, including the research objectives, were published.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Tanaka, A., Shoji, N., Kojima, I. et al. A comparative study on cephalometric differences in maxillofacial morphology between skeletal Class III cases with and without acromegaly: a pilot study. Oral Radiol 38, 224–233 (2022).

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI:


  • Acromegaly
  • Non-acromegalic patients
  • Cephalometric analysis
  • Skeletal Class III malocclusion
  • Mandibular prognathism