Mohammed Ali Murshed^[1] , MarwaSamehShamaa² ,MaherAbd El-Salam Fouda^{3 1}Department of Orthodontics, Faculty of Dentistry, Mansoura University, Mansoura city, Egypt ²Department of Orthodontics, Faculty of Dentistry, Mansoura University, Mansoura city, Egypt. ³Department of Orthodontics, Faculty of Dentistry, Mansoura University, Mansoura city, Egypt. Abstract: Objective: To evaluate the skeletal, dentoalveolar and soft tissue effects on Class ll division 1 malocclusion in growing patients following treatment by Twin-Block (TB) appliance with intermaxillary and extraoral traction force. Materials and Methods: Fifteen Class ll patients 10 girls and 5 boys; mean age 10.7 ± 1 year treated with Twin block appliance in addition to intermaxillary and extraoral traction force. Mean observation interval was 10.2 months. Cephalometric variables changes were evaluated before and after treatment. Results:The results showed significant sagittal and vertical skeletal changes (increased SNB, decreased ANB and SNA and increased facial height) and a great significant decrease in the overjet and overbite after treatment. A significant improvement in the soft tissue and attractiveness was obtained. Conclusion: The Twin block appliance with intermaxillary and extraoral traction force produced highly significant skeletal effects in terms of mandibular advancement and growth stimulation with dentoalveolar and soft tissue improvements in short duration.