. A treatise on nervous and mental diseases, for students and practitioners of medicine. is low, the orbits are greatly thickened, theborders of the orbit are also increased in size from dilatation of thefrontal sinuses surrounding the orbital cavity. The conjunctiva, fat,and muscles of the eye may be also hypertrophied, and exophthalmusmay be present. The lids are long, thick, and brown, and in casesof exophthalmus they may not cover the eyes. The nose is gener-ally greatly enlarged in all its dimensions, the alse being thickened,and the septum may be double its usual thickness. The lips aree
. A treatise on nervous and mental diseases, for students and practitioners of medicine. is low, the orbits are greatly thickened, theborders of the orbit are also increased in size from dilatation of thefrontal sinuses surrounding the orbital cavity. The conjunctiva, fat,and muscles of the eye may be also hypertrophied, and exophthalmusmay be present. The lids are long, thick, and brown, and in casesof exophthalmus they may not cover the eyes. The nose is gener-ally greatly enlarged in all its dimensions, the alse being thickened,and the septum may be double its usual thickness. The lips areespecially swollen, the lower one most so, so that the latter may even ACROMEGALY. 545 turn downward. The hypertrophy also affects the tongue, but thisusually preserves its normal shape, although it may be so large as toproject from the mouth and interfere with the pronunciation ofwords. The palatine arch, the soft palate, the tonsils, and thefauces are also increased in size, so that the voice becomes gut-tural and metallic. The uvula is occasionally elongated and enlarged, Fig. Photograph of a case of acromegaly. Patient aged fifty years. exciting cough. The chin is an especially prominent feature, beingmassive, projecting downward and forward, and all the soft struc-tures of the face are thickened. The upper jaw is not nearly somuch affected as the lower, which often becomes prognathous, asthe result of which the teeth are separated more or less from oneanother, and the upper dental arch tends to fit inside the lower. Theears are sometimes increased in size. The cranium itself is somewhatincreased in its antero-posterior diameter, chiefly owing to dilatationof the frontal sinuses. Usually there is a curvature of the spine inthe cervico-dorsal region, the back being slightly humped, the patientnot being able to hold the head up, but bending it forward. Aslight lordosis may also be present, usually in the lower part of and lumbar regions. The vertebral spines h
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