The effect of growth hormone therapy on mandibular and cranial base development in children treated with total body irradiation

The aim of the present investigation was to study craniomandibular development during growth hormone (GH) therapy in nine girls and one boy, aged between 7.3 and 16 years, who exhibited pronounced growth reduction after total body irradiation (TBI) and bone marrow transplantation (BMT). Age- and sex-matched healthy children with normal dentofacial development constituted the control material. The investigation data were based on measurements made on lateral skull radiographs taken at the start and, on average, 6 months after cessation of GH treatment. The control group comprised similar longitudinal cephalographic records. The results showed that GH therapy in patients who exhibited growth retardation after TBI and BMT had only a minor effect on cranial base dimensions, probably due to the fact that the development of this area is completed at a relatively early age. The effect of GH treatment on mandibular growth was very obvious. The dimensional increase of the mandibular variables in the patients was equivalent to, or in some cases even exceeded, that of the controls. In relation to basion, the mandibular condyles were displaced in a backward/upward direction in the patient group. Displacement in the opposite direction was recorded in the controls. It seems likely that the development seen in the patients is a reflection of a normalization of the condyle-fossa relationship made possible by enhanced condylar growth. This change should be advantageous for the function of the craniomandibular complex.