An inquiry into the nature of the skeletal changes in acromegaly / by Arthur Keith.

  • Keith, Arthur, Sir, 1866-1955.
Date:
1911
Catalogue details

Licence: In copyright

Credit: An inquiry into the nature of the skeletal changes in acromegaly / by Arthur Keith. Source: Wellcome Collection.

Provider: This material has been provided by The Royal College of Surgeons of England. The original may be consulted at The Royal College of Surgeons of England.

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    as an average. In the Nicolucci specimen it is 90 mm., in the Greenwich 82, in the Deville 83, in O’Brien 83, in the Thompson-’Walker 71. In the Neanderthal race, so far as we yet know it, the length of the upper face varies from 80 to 90 mm.—the same as in the acromegalic. As already said, the chief increase affects the depth of the alveolar margin. This increase I regard as being due to the intermittent pressure of mastication, pressure acting as a stimulus to the alveolar margin of the maxilla. The facial changes in acromegaly are further seen when the face is studied from the front. In Fig. 11 these changes are represented. On the left hand of that figure I have superimposed the normal skull on the Greenwich specimen ; on the right hand side on O’Brien’s skull. One sees at once there is slight increase in the inter-orbital diameter ; it amounts to from 3 to 5 mm. The chief change in the orbit concerns its outer wall. The external angular process of the frontal and the ascending process of the malar move not only forwards, as we have already seen, but also outwards from 8 to 10 mm., thus enlarging the orbits in an outward and downward manner. (Fig. 11.) The increase is connected with the temporal changes already described. The growth of the malar and zygoma is remarkable ; they are apparently stimulated by the traction of the masseter, the depth of the body of the malar being increased from 8 to 15 mm. (Figs. 10, 11.) The interzygomatic diameter in the type skull is 129 mm. (130 is the mean measurement); in O’Brien it is 153, in the Deville specimen 150, in the Greenwich 150, in the Nicolucci 154, and in the Thompson-Walker specimen 124. As already said, the last specimen shows many aberrant features. The increase in the depth of the alveolar margin is shown, so are the remarkable changes in the mandible. The depth of the symphysis has increased ; the condyles and ascending rami have moved apart. The extent of these changes may be estimated from Fig. 11, which is reproduced one-half natural size. The total increase in face length in well-marked cases of acromegaly is about 20 mm ; the increase from one angle of the jaw to the other rather less. Changes in the Vault and Capacity of the Skull. Mr. Cecil Beadles noted a fact in connexion with pathological thickening of the vault of the skull which I have verified—viz., that this thickening affects the frontal section of the vault first and most. The process commences in the forehead and spreads backwards. It will be noted further that the thickening along the vault is bounded on each side by the temporal lines. Thus between the origins of the temporal muscles there is built up a strong sagittal arch of 22 Beadles, Cecil: loc. clt.