Craniofacial Changes Among Children and Adolescents Submitted to Growth Hormone Therapy: A Systematic Review.

The aim of this systematic review was to investigate the association between craniofacial changes and growth hormone (GH) therapy among children and adolescents with GH deficiency or idiopathic short stature (ISS). The PRISMA guideline was followed to carry out all stages of this review. An electronic search was conducted in seven databases, without year or language restrictions. The study selection was carried out in two stages by two calibrated examiners. Studies exploring craniofacial changes among children and adolescents with GH deficiency or ISS undergoing GH therapy were included. After data extraction, the risk of bias was assessed using the Joanna Briggs Institute (JBI) Critical Appraisal tool and the RoB 2.0 Checklist. The certainty of the evidence was assessed using the GRADE tool. Among the 4494 identified citations, seven studies met the eligibility criteria. These studies evaluated the impact of GHs on cephalometric measurements and dental age. No differences between immediate and delayed treatments were found in maxillary and mandibular dimensions. All selected articles showed a low risk of bias. A low certainty of evidence was observed for all outcomes assessed. GH therapy appears to result in a small increase in mandibular dimensions, although without clinical significance characteristic of adverse effects. Clinical trials and long-term follow-up studies of these patients are needed to develop accurate recommendations regarding the effects of GHs in the craniofacial region. Growth hormone may result in a slight increase in mandibular and maxillary dimensions, without significant adverse effects to general health. Controlled intervention studies with long-term follow-up are needed to establish more precise recommendations. Trial Registration: PROSPERO database (https://www.crd.york.ac.uk/prospero/): CRD42024511329.