Clinical Findings

Clinical examination revealed an enlarging mandible with the appearance of prognathism (Figure 3) with spacing of teeth (Figure 2) that was not present in earlier clinical visits. His tongue appeared to have grown larger (Figure 4). Outside the mouth, he had coarse facial features which manifested as frontal bossing, full lips and a change in eye position. Upon further examination, his hands were spade-like (Figure 5) and the patient admitted that they were larger than before. Radiographically, his jaw could not be fit into the panoramic radiograph (Figure 6) because of the large size. The bony trabeculae of the mandible appeared normal but spaced out (Figure 6). The patient was referred to his primary care physician. An MRI scan of the brain showed a pituitary swelling which was biopsied.

Figure 1 This photograph was taken at the patientís first clinical presentation to the dentist. Note the spacing of the mandibular teeth. The brown-gray color of the teeth is not related to this condition.

Figure 2 This photograph was taken at the patientís first clinical presentation to the dentist. It demonstrates frontal bossing and full lips.

Figure 3 This photograph was taken at the patientís first clinical presentation to the dentist. It demonstrates mandibular prognathism.

Figure 4 This photograph was taken at the patientís first clinical presentation to the dentist. It demonstrates a large tongue

Figure 5 This photograph was taken at the patientís first clinical presentation to the dentist. It demonstrates large, spade-like hands.

Figure 6 This panoramic radiograph demonstrates a large mandible. The entire mandible could not be fit in the panoramic radiograph.