Acromegaly

To the Editor: In their review article, Giustina and Colao (November 13 issue) 1 discuss acromegaly and its craniofacial manifestations. Dentists and oral and maxillofacial surgeons are often among the first to identify early signs of acromegaly, such as macroglossia, diastemas, and mandibular prognathism (class III malocclusion). 2,3 However, unlike what is depicted in the article, occlusal plane inclination and overbite cannot be evaluated on panoramic radiographs owing to inherent projectional distortion; proper assessment involves clinical examination and cephalometric analysis. 4 Of note, although medical or surgical treatment of acromegaly may improve soft-tissue features, the skeletal alterations resulting from long-standing excess of growth . . .