A longitudinal study of the effects of surgery, radiation, growth hormone, and orthodontic therapy on the craniofacial skeleton of a patient evidencing hypopituitarism and a Class II malocclusion: report of a case.

Facial growth is an important factor for the orthodontists in the timing of treatment of the patient with a Class II malocclusion who has a potential for retarded growth. This patient had an isolated idiopathic growth hormone deficiency and hypothyroidism and was treated during a circumpubertal growth spurt in two phases. The first phase involved a functional appliance and the second was accomplished with fixed appliances. The case report affords one of the rare opportunities to document and analyze the multifactorial effects of surgery, radiation, growth and thyroid hormones, and orthodontic treatment on the craniofacial growth of a patient evidencing a Class II, Division 1 malocclusion (retrognathic mandible). Hand-wrist, panoramic, cephalometric radiographs, dental, and skeletal height and weight measurements are employed. Six-year posttreatment dental and craniofacial skeletal changes and management problems are presented as well.