Int. J. Oral Maxillofac. Surg: 1986: 15: 629-631 (Key words: macroglossia; acromegaly; glossectomy] Partial glossectomy for macroglossia in an elderly acromegalic A case report DONALD WINSTOCK AND SAMAN WARNAKULASURIYA Department of Oral Surgery, St. Batholomew's Hospital, London EC I, England ABSTRACT - A case is presented where the enlargement of the tongue due to acromegaly failed to respond to bromocriptine therapy, resulting in marked dysarthria. A partial glossectomy technique for tongue reduction is described, and the surgical and anaesthetic problems associated with acromegaly are discussed. (Acceptedfor publication 19 November i985) Macroglossia is a well-known manifestation of acromegaly. Other oral aspects include mandibular prognathism, spacing of the teeth in the lower jaw, and thickening of the soft tissues', The majority of acromegalies do not require any surgical intervention for oral signs and symptoms; however, cosmetic surgery such as mandibular osteotomy is sometimes undertaken, particularly in young acromegalies'>, and a number of them may need tongue reduction prior to jaw surgery. Troublesome macroglossia, per se, needing surgical correction is uncom- men. The purpose of this paper is to present a case of acromegaly presenting with marked macroglossia leading to dysarthria and inability to wear dentures. Attention is drawn to the difficulties in the management of an elderly acromegalic patient under gen- eral anaesthesia which (among aero- megalics) can be associated with much mor- bidity. Case report A 75-year-old caucasian male acromegalic was referred to us by the Department of Endocrin- ology complaining of rapid enlargement of the tongue noticed over 2 months, and not respon- ding to dopamine agonist therapy with bromo- criptine. The medical history revealed a 5-year history of enlarging hands and feet, and progress- ive deafness. His acromegaly was controlled by regular medication, and he was on antihyperten- sive therapy. The patient weighed 88 kg and his height was 175.7;cm he exhibited a mild kyphosis. He presented a typical acromegalic face, with a markedly prognathic mandible and an unusually protruding tongue. Oral examination revealed an enormous tongue which appeared to be edematous but of uniform consistency. In the resting position, his tongue was anterior to the vermillion border of the lower lip (Fig. I). When