5 Postnatal Growth of The Craniofacial Region Reviewer
5 Postnatal Growth of The Craniofacial Region Reviewer
5 Postnatal Growth of The Craniofacial Region Reviewer
Postnatal growth of the Craniofacial (endosteal) surfaces of each bone and the relocation, or cortical drift,
will follow the direction of external bony deposition.
Region
The mandible does not
Human Skull grow by a simple
twenty-two(22) bones symmetrical
enlargement.
Neurocranium (8)
(8 cranial bones)
The relocation of a bone takes place via differential changes in both size
and shape, which are mediated by surface deposition and resorption.
4. Functional matrix theory Endochondral growth
Melvin Moss Surface remodelling
describes bone growth within the craniofacial skeleton as being
infl uenced primarily by function. How much does the anterior cranial base grow?
From the age of 5 through to 20 years, the distance from sella to nasion
Functional matrix will increase approximately 8-mm in females and 10-mm in males, with
represents all the tissues, organs and spaces that perform a given this growth being essentially complete by the age of 14 and 17 years,
function, whilst skeletal units are the bones, cartilages and respectively.
tendons that support this function.
Two types of functional matrix exist:
Periosteal matrices; and The sphenoethmoidal and sphenooccipital synchondroses make the
Capsular matrices. most significant contributions to postnatal growth of the cranial base.
The sphenoethmoidal synchondrosis is usually ossified at around 7 years
Periosteal matrix of age.
consists of the soft tissues intimately related to a skeletal unit, The sphenooccipital synchondrosis persists for longer.
such as muscles and tendons; whilst capsular matrices are the Direct histological examination of autopsy material suggests that in
organs and tissue spaces associated with specific regions within females it closes around 13 – 15 years of age, whilst in males it remains
the skull, such as the neurocranium, orbits and oropharynx. patent until 15 – 17 years.
Skeletal units are also further subdivided into:
Microskeletal units; and
Macroskeletal units. Growth of the nasomaxillary complex
Nasomaxillary complex
5. Servosystem theory forms the middle part of the facial skeleton and is dominated by
Alexandre Petrovic the orbits, nasal cavity, upper jaw and zygomatic processes.
The primary cartilaginous skeleton of the craniofacial region is not
influenced by the local and systemic environment to the extent that A number of bones make contributions to this region, including the
secondary cartilage of the mandibular condyle is. frontal, sphenoid, zygomatic, lacrimal, nasal, maxillary, palatine,
Based upon these observations, he proposed that two principle ethmoid and vomer.
factors determine growth of the craniofacial region:
Genetically regulated growth of the primary cartilages The maxilla grows downwards and forwards in relation to the anterior
within the cranial base and nasal septum determine growth cranial base, accompanied by the orbits and nasal cavity, with all three
of the midface and provide a constantly changing reference regions increasing in volume as they grow.
input, which is mediated via the dental occlusion; and
The mandible is able to respond to this changing occlusal
reference by muscular adaptation and locally induced
Growth of the mandible
condylar growth.
The mandible also grows downwards and forwards in relation to the
cranial base and this is achieved by:
Growth of the cranial vault Bony remodelling via subperiosteal resorption and deposition; and
Cartilaginous growth at the condyle.
Cranial vault
is composed of the squamous parts of the frontal, temporal and The ramus is remodelled in posterior, superior and lateral directions by
occipital bones, and the paired parietal bones. bony resorption and deposition.
Growth of the cranial vault is intimately linked with growth and The condyle is also a major site of growth within the mandible.
expansion of the brain, which passively displaces the individual bones of
the skull vault in a concentric manner. Condylar cartilage
As this displacement takes place, the intramembranous bones of the is a secondary cartilage that forms within the mandibular condyle at
cranium grow in two ways: around 10 weeks of embryonic development.
Compensatory bone growth at the sutures; and Initially, it forms a large carrot-shaped wedge within the whole of
Surface periosteal and endosteal remodelling. the condyle, but progressive ossification during early postnatal life
results in a small cap of proliferating cartilage remaining beneath
the fibrous articular surface of the condyle until around the end of
Sutures the second decade.
are specialized fibrous joints situated between adjacent
intramembranous bones and they mediate growth along the
osteogenic fronts of these bones as they are displaced away from
How does the condylar cartilage differ from an epiphyseal growth
each other.
Sutures are tension-adapted; they do not generate the forces plate?
underlying bone displacement, but respond to them, adding new bone
in equilibrium with bony separation and therefore maintaining patency.
Centres of rotation
Mandibular growth rotations are marked (X).
Growth in length of the mandibular ramus occurs essentially at the
condyles, but this growth is variable in direction and often involves a
component of rotation
Forward rotations are the most common, associated with centres of
3(Three) different types of mandibular growth rotation rotation through the condyles, incisors or premolars
Backward rotations take place through centres in the condyles or the
1. Total rotation most distal-occluding molars.
represents a change in inclination of the body or corpus of the Dentoalveolar compensation
mandible relative to the anterior cranial base. A considerable amount of individual variation exists in the amount and
The body is represented by a reference line constructed along the direction of maxillary and mandibular growth that occurs during
implants, or by natural reference structures present within this region. postnatal development.
the sum of the matrix and intramatrix rotations The dentoalveolar compensatory mechanism attempts to maintain a
normal interarch occlusal relationship in the presence of variation in the
2. Matrix rotation skeletal pattern.
represents a change in inclination of the soft tissue matrix of the
mandible in relation to the anterior cranial base. A number of different factors are responsible for dentoalveolar adaptation:
A line drawn tangent to the lower border of the mandible represents Normal mechanisms of tooth eruption;
the soft tissue matrix and the condyles lie at the centre of this rotation. Soft tissues forces; and
Occlusal forces and mesial drift.
3. Intramatrix rotation
is the difference between the total and matrix rotations if the Adult craniofacial growth
mandibular body rotates within the soft tissue matrix. Although most craniofacial growth is complete by the end of
This difference reflects bony remodelling that takes place along the adolescence, longitudinal studies have demonstrated that a small amount
lower border of the mandible and is defined by the change in inclination continues during adult life.
seen between an implant reference line and the mandibular lower This tends to initially reflect the original growth pattern, especially when
border. there is an underlying skeletal discrepancy; however, later in adult life,
changes in the vertical dimension predominate.
True rotation
was used to represent a total rotation.
is the fundamental rotation that takes place between the
mandible and cranial base
Apparent rotation
Apparent rotation of the mandible represented a matrix rotation.
is the result of true rotation and remodelling of the mandibular
lower border and is the change apparent on a cephalometric
radiograph in the absence of implants.