Prenatal and Postnatal Growth of The Cranial Vault, Base and Mid-Face

Good
Morning
...
Prenatal And
Postnatal
Growth of the
cranial vault,
base and Midface
By Dr Nizam Muhamad B. Muhamad Subr
understand growth of the body , it is necessary to understan
i. Site and location of growth

ii. Type of growth occurring.
iii. Determinant or controlling factors.
Contents
Cranium and developmental divisions

Mechanisms of ossification
Prenatal Growth and development
ovum period
somite period
late somite period
Prenatal & post natal growth of cranial vault

Prenatal growth of cranial base
Cartiliginous base
Ossification centres
Cranial flexure
Cranium
At Birth
- 45 bony elements
In Adult
- 22 bones
Face
- 14 bones
Cranium - 8 bones
Skull entities
1. Neurocranium
Cranial vault / calvaria.

Cranial Base
2. The face
3. .The masticatory
apparatus
Orognathofacial complex ;
Splanchocranium, viserocranium
Dentition
Development divisions of
skull
Phylogeny
Mechanism of bone Growth

Bone always forms (ossifies) in a precursor tissue
1. Endochondral ossification
Precursor tissue is cartilage found in both prenatal and
postnatal skeleton
2. Intramembranous ossification
Precursor tissue is membrane mesenchyme (dense
connective tissue) process forms
(1) dermal/ membrane bone
(2) sesamoid bone
(3) periosteal bone
Intramembranous ossification
Undifferentiated mesenchymal cell
Osteobla
sts secrete
Osteoid
-fibrous bone matrix
CA2+
salts
Bone laid down around blood

vessels formin a
Network of trabaculae
Endochondral Ossification
Mesenchymal cells
Condense & differentiate
Chondroblasts / chondrocytes
Hyaline cartilage model
Surrounded by perichondrium (highly vascular & contains osteogeninc ce

Intercellular substance surrounding cartilage
becomes calcified by Enzyme Alkalinephosphate
secreted by cartilage cells
Nutrition of cartilage cells cut off
Formation of empty spaces primary areolae
Blood vessels invade calcified cartilaginous matrixReduced to walls/

bars , leaving
and osteogeninc
empty spaces
cells of
Secondary
perichondrium
Secondary areolae
Osteogeninc cells of perichondrium Osteoblasts
Laydown osteoid which is calcified as lamellae of bone
Prenatal Growth and

development
The Prenatal Period

Period of the ovum
Period of the embryo
Pre-Somite period
Somite period
Post-Somite period
Period of foetus
Period of the Ovum
Conception till nidation - 7 days
Nidation ( Day 7)
Germ Disc / Bilaminar disc
Day 14 (2nd week)
Endodermal thickening
Demarcation of anterior pole of the oval
disk
Prechordal plate
Day 21 (Week 3) :
Gastrulation
Process by which the embryo acquires three germ
layers, forming the primitive streak.
Primitive streak
Somite Period Day 21 (3rd week)

Basic organogenesis
Characterized by - foldings ,
structuring as well as differentiation
of the basic tissues developed
Neurolation
Ectoderm Differentiaton (Neural Induc

Notochord
Inductive signals
Overlying ectoderm
neural tissue (neural induction).
(neural plate)
Process of neurolation
Lateral folding of the neural
plate, elevating the sides
along a midline neural
groove.
The neural tube forms by

apposition and fusion of the
two lateral apical surfaces of
the neural folds.
The complete segment of the

neural tube separates from
the overlying ectoderm sheet
and cells of the neural crest
separate from the neural
tube.
Neural crest cells

Initiation
interactions between neural
plate and presumptive
epidermis (of ectodermal
origin)
NC undergos epithelialto
mesenchymal
Transformation
stimulated by Wnts, BMPs,
FGFs
Gives rise to
ectomesenchyme tissue
Cranial neural crest
Neural Crest cells derivatives

Trunk neural crest Cranial
and Trunk
Neural
crest
Mesodermal development
Paraxial mesoderm
Intermediate mesoderm
Lateral mesoderm
Paraxial mesoderm
Somites
Intermediate mesoderm
Gonads
Kidneys
Adrenal cortex
Lateral mesoderm
Walls of embryonic coelum
Pleural
Pericardial
Peritoneal cavities
Peripharyngeal connective tissue
Somites
Lateral part
Dermatome
Ventromedial part :
Sclerotome
Intermediate part
Myotome
Skin and appendages
muscles
Vertebral columns
and its segmented
nature
Except in occipital
region
Branchial arches
Mesoderm lateral plate of the ventral foregut
region
segments
Branchial arches
Distinct bilateral mesenchymal swellings , Pharyngeal arche

- Mesodermal core augmented with neural crest
tissue
Initiate development
Neural crest cells interact with pharyngeal endoderm
Week 4 Ectomeningeal
capsule
Paraxial Mesoderm
Neural crest cells
Condenses between developing brain and foregut
Ectomeningeal capsule (base)

Ectomeninx
Endomeninx
Prenatal and postnatal growth of

cranial vault
Ectomeningeal capsule
Ectomenix
Origin : Paraxial
mesoderm +
neural crest cells
Pericranium
Calvaria
Dura mater
Arachnoid
Subarachnoid space
Pia Mater
Endomenix
Origin: neural crest cells
Ectomeninx
Mesoderm derived
Frontal,
Parietal,
sphenoid,
petrous temporal
& occipital.
Neural crest derived
Lacrimal,
Nasal,
squamous temporal,
Zygomatic,
Maxilla & Mandible
Growth of calvarial bones

1. Sutural growth
(predominant till 4th year of life)
2. Bone remocelling
- Flattening of curved calvarial bones
endocranial - resorption
ectocranial - deposition
3. Centrifugal displacement
Frontal Bone
Primary center Superciliary arch( 8th week
post conception)
Secondary center -----Zygomatic process

Nasal spine,
Trochlear fossae
(Fusion 6-7 mts)
At birth - Metopic suture
(Fusion
2-7 yrs)
Parietal bone
Two
primary ossification centers appear at region of

Parietal eminence (8th wk post conception)
Fuse by 4th month.
Delayed osssification results in saggital fontanelle at
birth
Occipital bone
Two ossification centers just above superior
nuchal line.
Intramembranous ossification.
Rest of occipital bone ossifies endocondrally.
Temporal bone
Squamous portion of temporal
ossifies intramembranously.
Single ossification center atroot of zygoma(8 week post
conception)
Ossification is complete at 3
month after conception.
Rest of temporal undergoes
endocondral osification.
Wormian bones
Unusual ossification centers develop
between individual calvarial bones
Wormian
bones /sutural
bones
Most frequently along
lamboid suture forming
interparietal bones
Small sutures
Fontanelles
At birth, the individual calvarial bones are
separated by sutures of variable width and by
fontanelles.
Six of these fontanelles are identified -
Fontanelles
Anterior Fontanelle
Time of closure : 2nd year
Posterior fontanelle
Time of closure :
2 months after
birth
Anterolateral fontanelle
Time of closure :
Posterolateral fontanelle
3 months after birth
Time of closure :
2nd year
Growth of the cranial vault

Direct influence of Neurocranial capsule
The desmocranium are embedded within a neurocranial capsule .

This capsule expands in response to volumetric increase of the capsular neural
matrix .
The embedded bones are passively carried outward , by the process of
translative growth .
The flattening of the high curvature cranial bones is achieved by

Endocranial erosion
Ectocranial deposition
Ectocranial resorption
The flattening of the high curvature cranial bones is achieved by

Endocranial erosion
Ectocranial deposition
Ectocranial resorption
New deposition on flat surfaces
Endosteal surfaces - resorptive
Increases overall thickness - expands medullary spaces.
Post-Natal Growth
Thickening not uniform :Inner table
intracranial pressure
of brain
Outer table
extracranial
mechanical influences
and functional
stresses
Post-Natal Growth
90% of cranial vault growth complete
by 5-6 yrs
In accordance with
- Scammons curve
- Cephalocaudal Gradient.
Clinical Implications
Various conditions cretinism,
progeria, trisomy 21, cleidocranial
dysostosis, Anterior fontanelles remain open
Bossing of forehead
Brachycephalic skull
Prenatal growth and Development of

the Cranial base
GROWTH OF CRANIAL BASE
Cartilages (initially)
Endochondral
ossification
Bone
Midline structure.
Moves laterally ,sutures growth &
surface remodeling becomes
prominent.
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Prenatal growth and Development of the

Cranial base
Day 40 ( late somite period )
Occipital sclerotomal mesenchyme

concentrates around notochord
underlying the developing hindbrain
Extends Cephalically forming floor of
brain
Chondrocranium
Cartilaginous base
PRENATAL GROWTH
CARTILAGES
PRECHORDAL CARTILAGE ( Presphenoid &
trabecular cranii)
PARACHORDAL CARTILAGE
HYPOPHYSEAL CARTILAGE
OTIC CAPSULE
NASAL CAPSULE
Cartilaginous
precursors
present in our
early ancestry
Prenatal growth and Development of the

Cranial base
ay 40 (late somite period)
Occipital sclerotomal mesenchyme

concentrates around notochord underlying the
developing hindbrain
Otic capsule
Noto chord
Occipital Sclerotomes
artilaginous cranial base
Nasal cartilage
(ethmoid bone, turbinates
Nasal septum, vomer)
Trabeluar cartilage
( Pre-sphenoid )
Orbito sphenoid
(lesser wing of sphenoid)
Hypophyseal cartilage
( Post sphenoid )
Pituitary
Alisphenoid
(greater wing of sphenoid)
Otic capsule
Parachordal cartilage
Notochord
Chondrocranium
artilaginous cranial base
Nasal cartilage
(ethmoid bone, turbinates
Nasal septum, vomer)
Trabeluar cartilage
( Pre-sphenoid )
Orbito sphenoid
(lesser wing of sphenoid)
( Post sphenoid )
Pituitary
Alisphenoid
(greater wing of sphenoid)
Otic capsule
Notochord
Parachordal cartilage
Prechordal cartilage (Presphenoid)

2 Prechordal / Presphenoid cartilage - Presphenoid bone
Anterior Body of the Sphenoid bone
Most anteriorly : vertical cartiligionous plate
(Mesethmoid
cartilage) within nasal septum
2 Hypophyseal cartilages - Postsphenoid
Sella turcica
Posterior Body of the sphenoid
Orbitosphenoid and
alisphenoid
Orbito sphenoid
Lesser wing
Alisphenoid
Greater wing
Optic capsule does not chondrify.
Sensory capsules
OTIC CAPSULE (vestibulocochlear)
fuses with parachordal cartilage
Periotic / petromastoid bone

Mastoid and petrous portions of the temporal bones
Otic capsule does not chondrify.
Sensory capsules
Nasal capsule (ectethmoid)
hondrifies
- 2nd month i.u
ox of cartilage divided by a median cartilage septum (mesth
ateral walls
- Lateral masses (labyriths) of ethmoid

- Inferior nasal concha
Chondrocranial Ossification
110 ossification centers in embryonic human
skull.
Ossification starts in the 4 months
Unossified chondrocranial remnants
Alae & septum of the nose,
Spheno-occpital & spheno-petrous junctions,

The apex of the petrous bone and
Between the separate parts of the occipital
bone
OSSIFICATION
OCCIPITAL
BONE - 7 centres
tramembranous centres
Supranuchal
Squamous
8 th week
2 intramembranous centres
5 endochondral centres
Infranuchal squamous
10 th week
( Kerckring centre )
Basioccipital bone
11th week
1 endochondral centre
Exoccipital bone
12 th week
OSSIFICATION
MPORAL BONE
Intramembranous
ossification 5 :
Squamous portion
centre
-
1 intramembranous
( 8 th week )
Zygomatic process
Tympanic ring
4 intramembranous
centres
( 3 th month )
21 centres of ossification
Endochondral
ossification - 16
Petrosal part
14 endochondral
centres
- ( 16th week )
Styloid process
2 endochochondral
centres
( at birth )
Start to fuse during 1st yr of life
OSSIFICATION
Ethmoid Bone
3 Endochondral Ossification centres
1. Lateral labrynths in nasal

capsule
- 2 endochondral centres
- 4th month p.c.
2. Mesethmoid cartilage
- 1 endochondral centre
forms
Perpendicular plate & crista galli
- before birth
Secondary Ossification
centre b/n Cribiform plates
and crista galli
- at Birth
Perpendicular plates unite with
labyrinths to form Ethmoid
OSSIFICATION
SPHENOID BONE -
19 ossification centres
Intramembranous ossification centres - 4

Medial pterygoid plates - 2
Lateral pterygoid plates - 2
Endochondral ossification
Centres - 13
Presphenoid
- 3
Postsphenoid
- 4
Orbitosphenoids
- 2
Alisphenoids
- 2
Pterygoid hamuli
- 2
Sphenoidal conchae - 2
OSSIFICATION
VOMER
Alae 2 intramembranous centres
Inferior nasal concha
Lamina 1 endochondral centre
CRANIAL BASE ANGULATION

Angle at the hypophyseal fossa where prechordal & chordal
parts meet
PRE NATAL GROWTH

Highly Uneven
Anterior cranial base increases its
length
and width by 7 folds between the 10th
and
40thweek of I.U life
Thank you
Good Morning
Postnatal growth of anterior

cranial base &
Prenatal growth of the mid face
Postnatal Growth
EXPANSION of cranial base occurs by
Growth of the cartilage remnants of the
chondrocranium- basicranial bones
Forces from growing brain
Postnatal Growth
Cranial base acts as a template from which the
face develops.
Suture growth is unidirectional. So remodeling is
requried.
Postnatal Growth
Endocranial compartments separated by bony
elevations
Middle & posterior fossae petrous elevation
Olfactory fossae crista galli
Right & left middle fossae Sphenoidal elevation
Right & left anterior & posterior fossae
Longitudinal midline bony ridge
POSTNATAL GROWTH
The mid ventral segments of cranial base
grows more slowly to accommodate the
medulla, pons, hypothalamus & optic
chiasma
Foramen
Drift process
Spinal Cord
remodelling
Differential
Postnatal Growth
5
6
2
1. Anterior
ethmoid
2. Cribiform plate
3. Planum sphenoidale
4. Optic Chiasma
5. Terbuculum Sellae
6. Sella Turcica
7.Dorsum Sellae
8. Basioccipital
(Melsen B. (1974) The cranial base . Acta Odontologica Scandinavica 32:1
POSTNATAL GROWTH
SYNCHONDROSIS
They are a retention left from the primary
cartilages of the chondrocranium after the
endochondral ossification centers appear
during fetal development.
POSTNATAL GROWTH
SYNCHONDROSIS BASICRANIUM
SEEN IN MIDLINE PART OF
Postnatal Growth
SYNCHONDROSIS
A growth centre
Bipolar direction of growth
Postnatal Growth
ZONES OF SYNCHONDROSIS
1.
2.
3.
4.
Familial reserve zone

Cell division zone
Hypertrophic zone
Calcified zone
A growth centre
Bipolar direction of growth
Postnatal Growth
Speno-Occipital Synchrondosis
Major contributor in the postnatal growth
Fuses :
Girls
- 12 - 13 years
Boys
- 14 - 15 years
Ossifies : 20 years
Pressure adapted
bone growth mechanism
Postnatal Growth
Spenoidal Sinus secondarily grows as
the body of the sphenoid bone
expands keeping constant junction
with the moving naso-maxillary
complex
Postnatal Growth
Expansion of middle cranial fossa
and neural contents
Secondary displacement effect
Anterior cranial floor ,

Nasomaxillary complex
Mandible
&
As Post border of N-M complex

coincides with boundary between ant
and middle cranial fossa
Postnatal Growth
Frontal lobe growth
completes by 5
years.
Temporal lobes
continue to enlarge
for several more
years and displaces
the frontal lobe
forward.
Postnatal growth of
cranial base
CLINICAL IMPLICATIONS
Configuration of neurocranium(&
brain) determines a persons head
form type
- DOLICOCEPHALIC
- BRACHYCEPHALIC
- MESOCEPHALIC
The stable anatomical structures in the

anterior cranial base are:
1) The inner contour of the anterior wall of sella

turcica.
5-6 years
2) The mean intersection point of the lower contours
of the
anterior clinoid processes and the
contour of the anterior wall of sella, Walkers s
ne Bjork
. Guide to superimposition of profile radiographs by The Structural Meth
point.
eloped . Angle orthodontics 2010)

3) The anterior contours of the middle cranial fossae.

12-14 years
ne Bjork . Guide to superimposition of profile radiographs by The Structural Meth


4) The contour of the cribriform plate
4 years
5) Details in the trabecular system in the anterior
cranial base.
4 years
6) The contours of the bilateral fronto-ethmoidal
ne Bjork
. Guide to superimposition of profile radiographs by The Structural Meth
crests.

7) The cerebral surfaces of the orbital roofs

5-6 years
ne Bjork . Guide to superimposition of profile radiographs by The Structural Meth

ACHONDROPLASIA
Disturbance in endochondral bone
formation
Deficient growth at the synchondrosis
Maxilla is not translated forward
This results in abnormal depression of the
bridge of the nose
Relative midface deficiency
Premature ossification or
synostosis of the suture between
the presphaenoid and postsphenoid
parts of the spheno-occipital suture
- depressed nasal bridge and dished
face
Anomalous development of the
presphenoidal elements
Excessive separation of orbits and
abnormally broad nasal bridge.
HYPERTELORISM
ANENCEPHALY (Absence of calvaria )
Retain acute cranial base flexure
INADEQUATE GROWTH OF
CHONDROCRANIUM
Impacted eruption of third molars
CLIEDOCRANIAL DISOSTOSIS
Abnormalities of the skull, teeth, jaws
and shoulder girdle
Abnormalities Of Cleidocranial Disostosis

Kreiborg,bjork& Skeiller (AJOMay; 1981 )
KREIBORG,BJORK & SKIELLER conducted a qualitative
screening for abnormal morphological traits in the
cranial base. (8 males & 9 females)
RESULTS
The anterior and posterior cranial base was shorter and
the cranial angle smaller in the syndrome groups
Patients shown small pituitary fossae and bulbous
dorsum sellae
The amount of bone resorption was lesser than normal.
Comparative analysis of the anterior and posterior

length and deflection angle of the cranial base, in
individuals with facial Pattern I, II and III
Thiesen G, Pletsch G, Zastrow MD, Valle CVM, Valle- Corotti KM, Patel
MP, Conti PCR. Comparative analysis of the anterior and posterior
length and deflection angle of the cranial base, in individuals with
facial Pattern I, II and III. Dental Press J Orthod. 2013 Jan-Feb;
18(1):69-75.
Objective:
To evaluate the variations in the anterior
cranial base (S-N), posterior cranial base (SBa) and deflection of the cranial base (SNBa)
among three different facial patterns (Pattern
I, II and III).
Method:
A sample of 60 lateral
cephalometric radiographs of
Brazilian Caucasian patients, both
genders, between 8 and 17 years
of age was selected.
The sample was divided into 3
groups (Pattern I, II and III) of
20 individuals each.
The inclusion criteria for each
group were the ANB angle, Wits
appraisal and the facial profile
angle (G.Sn.Pg).
To compare the mean values
obtained from (SNBa, S-N, S-Ba)
each group measures, the ANOVA
test and Scheffes Post-Hoc test
Results and Conclusions:

There was no statistically significant difference for the
deflection angle of the cranial base among the different facial
patterns (Patterns I, II and III).
There was no significant difference for the measures of the
anterior and posterior cranial base between the facial
Patterns I and II.
The mean values for S-Ba were lower in facial Pattern III with
statistically significant difference.
The mean values of S-N in the facial Pattern III were also
reduced, but without showing statistically significant difference.
This trend of lower values in the cranial base measurements
would explain the maxillary deficiency and/or mandibular
prognathism features that characterize the facial Pattern III.
Development of Face
ORGANIZING CENTERS
Prosencephalic Organising centre
Visual apparatus
Inner ear apparatus
Upper third of face
Rhombencephalic Organising centr
Middle and lower third of the face.

Middle and external ears.
Day 14 (2nd week)
disk
Prechordal plate
Day 14 (2nd week)
disk
Prechordal plate
Development of Face
Week 4 Week 10
Frontonasal Prominence
Maxillary prominence
Mandibular prominence
Stomodeum
Development of Face
Week 6
Nasal pits
Frontonasal Prominence
Stomodeum
Nasal Placodes
Development of Face
Week 6
Nasolacrimal
Groove
Median Nasal Process

Lateral Nasal Process
Maxillary Prominence
Oblique facial cleft
Nasolacrimal
Groove
Merging is completed as a result of

proliferation of the underlying
mesenchyme into the intervening
grooves.
The above is guided by the
disintegration of the contacting
surface epithelium b/w the processes
termed as Nasal fin
Failure of normal disintegration of

nasal fin
Leads to cleft of upper lip and

anterior palate
(Due to prevention of merging
of mesenchyme of max. and
medial nasal processes)
Development of Face
Week 7
Median Cleft Lip
Week 7
Week 8
Cleft Lip
Week 10
Week 10
Palatal Development
Palatine shelves
Tongue
Week 10
Palatal Development
Incisive foramen
Primary palate
Intermaxillary prominence
Secondary palate
Cleft Palate
Bifid uvula
Week 10
Various Cranio - facial defects
Acephaly (Absence of head)

Anencephaly (Absence of brain)
Acrania (Absent skull)
Acalvaria (Roofless skull)
Cranioschisis (Fissured cranium)
Premaxillary agenesis (Median cleft
lip/palate)
Premaxillary dysgenesis (Bilateral
cleft lip/palate)
Agnathia (Absent mandible)
THANK
YOU
GOOD MORNING
Growth and Development

of Maxilla
Anatomy Overview
Anatomy Overview
Prenatal development
overview
Neural crest mesenchyme
Embryonic facial
prominences
Intramembranous
ossification
Development of maxilla
and mandible
Ossification of Maxilla
4 intramembranous ossification centres
Primary
ossificatio
n centre :
Body(2)
Secondary
ossification
centres (3)
Zygomatic
(1)
Orbitonasal
(1)
Nasopalatin
e (1)
Growth and Development of Maxilla

Method of growth studies
For the precise assessment of remodelling
processes 2 methods have been used:
1. Cross sectional study using histological
sections of dried skulls.
2. Longitudinal studies using implant markers

and Cephalometric radiographs. Bjork was the
first to use this technique in 1955. In the first
technique it was difficult to note the individual
variability in the growth amount and rate.
Post Natal Growth & Development

of Maxilla
Growth in maxilla occurs by :
1. Appositional and resorptional - surface
remodeling. ( Moss transformation )
2. Displacement of the maxilla. ( Moss
translation )
Sutural theory
which can be explained by ;
Cartilaginous theory
Functional Matrix theory
Growth & Development of Maxilla

Sutural theory
by Harry Sicher & Joseph Weinmann
Sutures innate growth potential .

- generate a tissue seperating force
hence their growth would ultimately push the
maxilla in a downward and forward
direction.

Sutural theory
by Harry Sicher & Joseph Weinmann
Shortcomings
Sutures are, pressure

sensitive unlike cartilages,
which are tension sensitive
areas. Thus pressure on the
sutures
would
cause
inhibition
Bone tissue
is not
capable
of growth
of
in growth.
a field that requires level of compression
needed to produce a pushing type of

displacement
Sutures do not have inbuilt growth potential
The Cartilagenous theory

James Scott
Cartilage is a pressure adapted
tissue
1953
Sutures are a continuation of the endosteum

and periosteum b/n craniofacial bones.
sutural growth :- periosteal, permissive
(secondary)
Bone enlarges at the sutures in response
to the tension created by displacement
Nasal septum innate growth potential
Thrust effect septopremaxillary ligament
growth in fields of compression
The Cartilagenous theory
James Scott
ical extirpation of nasal septum midface
1953 deficiency
Functional matrix theory

by Melvin moss
Functional cranial component

Functional matrix
Perisoteal matrix
Skeletal unit
Micro skeleton
Growth
Capsular matrix
Transformation
+
Translation
Macro
skeleton

by Melvin moss
Functional cranial component
Sight
Functional matrix
Perisoteal matrix
eyeball
Skeletal unit
Spenoid, Ethmoid
Micro skeleton
Lacrimal, Maxilla,
Frontal , zygomatic
Growth
Capsular matrix
Orofacial capsule
Transformation
+
Translation
Orbit
Macro
skeleton

by Melvin moss
SKELETAL UNITS
Basal body
Orbital unit
Nasal unit
Alveolar unit
FUNCTIONAL MATRIX
Infraorbital nerve
Eyeball
Septal cartilage
Teeth

Displacement of maxilla
Enlow and Bang has described this by

applying the principle of Area
Relocation :
specific local areas come to occupy
new actual positions in succession,
as the entire bone enlarges,
involving both the processes;
translation and transposition.
Growth and development of maxilla

Growth of maxilla can be viewed
in 3 aspects:
1. Growth in the Height.
2. Growth in the Transverse
direction.
3. Growth in the Antero-posterior
direction.

Growth in dimensions
Pre natal life
width
length
>
At birth
width
Post natal life
length
Height :
i. Applying the Enlow and Bangs V
principle.
Deposition on oral
side.
Resorption on nasal
side.
increases the height of
the nasal cavity.
ii. Similarly surface apposition of bone

in the alveolar process, which
increases the height of palatal vault.

The height of maxilla is also increased by Displacement
iii. Primary and secondary Displacement .

Can be explained by :
Sutural theory
Cartilaginous theory
Functional Matrix theory
Transverse
Direction
i. Growth in the median
palatal suture
ii. The alveolar
remodeling in the
lateral surface or
alveolar process

Anteroposterior direction:
begins in the 2nd year of life and ceases after the
increase in width has taken place.
Surface remodeling in the
i. Maxillary tuberosity region (i.e. appositional
changes) and
ii. Sutures between the palate and the palatine
bones.
translatory changes
- Primary displacement
- Secondary displacement

Secondary displacement occurs due
to
Growth of the anterior and middle

cranial
fossa
Changes in cranial base flexure.
Increase in length of cranial base
rimary displacement of maxilla occurs due

Apposition at the
tuberosity
Palatine sutures
pushes the maxilla
forward
thus separating the

sutures and further,
causing bone apposition in
the connective tissue.

Discussion of the study conducted by
Sheldon Baumrind (AJO Jan, 87).
In their study, they used implant
markers and computer aided methods
for analyzing the lateral skull
radiographs. They used 3 reference
points. ANS, PNS and Point A.
Discussion of the study conducted

by Sheldon Baumrind (AJO Jan,
87).
1. In their findings, they found out that there was a
uniform displacement of all the 3 points (ANS , PNS,
pt . A) in the vertical direction
On an average, the mean downward displacement
was about
0.3mm / year.
2. In the horizontal direction, there was a posterior
displacement of all the 3 landmarks. However, the
displacement of PNS was greater than point A and
ANS. Thus this finding proves that the increase in
length is primarily by growth at the posterior border.
3. The backward and downward remodeling of all the
3 landmarks is reduced after about 13.5 years. This
finding was consistent with the cross-sectional
studies on dry skull.
Discussion of the study conducted by

Sheldon Baumrind (AJO Jan, 87).
Effects on dentition and occlusion
1. Bimolar width in the 1st molar area correlates
with vertical growth of maxilla, growth in
midpalatal suture and growth in height.
2. Dental arch drifts forward on an average of
5mm by late adolescence in the molar region
and by 2.5 mm in the incisor region.
3. The shortening of maxilla arch perimeter is
coincident with the eruption of 2nd molars and
not the 3rd molars.
Maxillary Tuberosity
posterior boundary of anterior cranial
fossa
the
contributes
to
horizontal lengthening of maxillary

Lateral
owsarch
posteriorly
surface
+++
+++
position on
Deposition on
sterior surface
the buccal
The
axilla displaced
teriorly
surface
Arch widens
posteriorly
posterior boundary of anterior cranial

Endosteal side
fossa
of cortex
contributes
( interior
to
surface )
The horizontal lengthening of maxillary
--Lateral
owsarch
posteriorly
surface
+++
Resorptive
+++
position on
Deposition on
sterior surface
cortex to move
the buccal
Posteriorly &
surface
axilla displaced
Laterally
the
teriorly
Arch widens
posteriorly Maxillary sinus
Increase in size
The Key ridge and reversal lines

A reversal line
showing the
crossover between
resorptive and
depository growth
fields seen in
microscope
Factors affecting
reversal
shape of bone
muscle attachments
rotations
growthfeilds
Clinical Significance :
1. Depository growth potential of the

tuberosity allows the clinician to expand
the arch by moving the teeth posteriorly
into the area of bone deposition.
2. In a Class II molar relation, such distal
molar movement aid in achieving the
treatment goal of a Class I molar
relationship.
CRIMAL SUTURE: A KEY GROWTH MEDIAT
Lacrimal bone is a
diminutive
flake of a bony island
with its entire perimeter
bounded by sutural
connective tissue

Lacrimal suture
Collagenous linkage
w/in sutural linkage
Slippage of bones along
perilacrimal sutural
interface
Maxilla displaced
inferior

Remodeling rotation of lacrimal bone
Medial superior part
Remains with lesser
expanding nasal bridge
rowth of Zygomatic region

The Malar region
Posterior
Anterior
Apposition
Resorption
This posterior remodeling to keep pace and

close contact relation with the maxillary
bone.
Posterior relocation ceases ; after increase in
dental arch length is achieved during childhood.

Deposition
The inferior edge of the
zygoma
fronto-zygomatic suture
Increase in Vertical height

of
Ant zygomatic arch & Malar
region
Lateral orbital rim

Lateral growth
Resorption
Deposition
+ Inner aspect of Zygoma
Zygomaticotemporal [anterior]
Frontozygomatic [inferior]
Displacement
Enlarges temporal
Foosa and keeps
cheek bone in
proper proportion
with enlarging face

Orbital growth
Growth of the orbit takes place by:
1. Remodeling growth.
2. Displacement among bony
elements.
As the frontal lobe of the cerebrum
expands forward and downward
the orbit roof and floor remodels
anteriorly and inferiorly by
resorption on endocranial

Orbital growth
Growth of the orbit takes place by:
1. Remodeling growth.
2. Displacement among bony
elements.
Orbit grows by the V
principle
The cone shaped orbital
cavity moves
in a direction of its wider
opening.
Deposition on the outside , thus
enlarging the volume

Palatine process
Apposition +++ Oral
surface
Resorption - - - Nasal
surface
Palatal arch
increases
in size
Undergoes downward
movement.
Growth in this region
corresponds to the Vprinciple.

The Premaxilla
Deposition +++
lingual side of
Resorption --labial surface of
the cortex
the cortex
Relocates
downward, and
slightly posterior
direction.

Nasal airway
Lining surface
of bony wall
and floor
resorptive
Downward
relocation of
palate
Lateral and
anterior
expansion

Nasal airway
Ethmoidal conchae
lateral + inferior
deposition
medial + superior
resorption
Inter nasal septum
Lengthens vertically at
sutural junctions

Maxillary rotations
Implant studies of jaw rotations by
Bjork & Skeiller in 1960s
Tantalum metallic pins used
tantalum pins (1.5 mm long and
0.5 mm in diameter)
Maxillary rotation
Internal
rotation
External
produced within
the
Produced by surface
changesof jaw
core of the jaw.
rotation

Maxillary rotations
Lateral implants :
- 4 years of age
- Inserted laterally in the
zygomatic process of
maxilla
Anterior implants
- 10 years of age
- inserted below
anterior nasal spine at
the level of apices of central incisors

Maxillary rotations
Maxillary rotations
Transverse rotations
rotations
Vertical

Maxillary rotations
Transverse rotation
Increase in width of the midpalatal
suture is not the same between
anterior and posterior regions
Hence, two maxillae rotate in relation
to each other in a transverse plane

Maxillary rotations
Vertical rotation of maxillary complex

Downward and forward displacement of
maxilla during growth are associated with
the vertical rotation
Seen with :
- Downward and forward movement
by the
palate and maxillary arch
- Movement of teeth - Vertical drift
Forward rotation of face :
Facial growth posteriorly > Anterior facial
growth

Maxillary rotations
Vertical rotation of maxillary complex
clockwise or counter clockwise rotation of
the nasomaxillary complex depend on
- the growth achieves of the overlying
basicranum
- extent of growth by the sutural system
attaching the midface to the cranial floor.
Results in a canting and misfit of the palate and
maxillary arch into open or deepbite positions.

Jaw growth and tooth eruption
Forward rotation of jaw --tips the incisor forward increasing
their prominence ; vice versa
Vertical drift : tooth and socket
drift together as a unit
translocation : as the tooth moved along
with the jaws in which it was embedded
True eruption: movement of the tooth
within its jaw
The Trajectorial Theory

1867 Meyer proposed the trajectorial
theory ;
lines of orientation of the bony
trabaculae follow the pathways of
maximal pressure and tension
Trabaculae Lines of maximum stress
w/in bone
The Trajectorial Theory

Trajectories cross at right angles ; an
excellent arrangement to resist
manifold stress on bone
Load
Wolffs law : 1870

Trabecular alignment in the bone was
primarily due to functional forces.
Direction
Change in functional forces bone
Magnitude
Produce
change
Therefore ,
of bone
o External form of bone

o Internal architecture Of
bone
function
-
; Density
Trabecular pattern
Benninghoffs lines
Functional influence
Epigenetic influence
ajectories responding collective as a unit not as a single b

Compact
cancellous bone
Benninghoffs lines
Maxilla trajectories
Vertical pillars
Frontonasal /
Canine pillar
Horizontal reinforcing
members
Pterygoid pillar
Malar zygomatic pillar
Trajectories from hard

palate ,
orbital walls ,
zygomatic arches ,
Palatal bones and
lesser wing of sphenoid
Benninghoffs lines
Maxilla trajectories
Vertical pillars
Frontonasal /
Canine pillar
Malar zygomatic
illar
Pterygoid pillar
Benninghoffs lines
Vertical pillars
Pterygoid pillar
Malar zygomatic pillar Frontonasal /
Canine pillar
From conchae of Zygomatic archLower border
Nasal cavity
of orbitFrom
incisor, canine &

premolar region
Posterior teeth
Middle portion of
Base of skull
Lateral border
Of orbit
Base of skull
piriform
aperture
Along
Crest of
nasal bone
Frontal bone
GOOOOOOOOD MORNING !!!
Growth and Development of Maxilla

Clinincal Implications
Age changes
Transverse growth
Antero posterior (sagital) growth
Vertical growth
Growth & Development of

Maxilla
Age Changes
At Birth
Hard palate : length = width
maxillary sinus : not visible
radiographically
1 2 years
Extensive remodeling
/enlargement of nasal cavity
descent of palate

Effects of dental and occlusion
THE MIXED DENTITION YEARS
Growth in width of the
dental arch anterior to the
first molar
Inter canine width
completed
Mid palatine suture
starts closing at 910 years
Ceases by 5-6 yrs
12 yrs - females
18 yrs - males
RME Best done
between 10
-14 yrs

THE MIXED DENTITION YEARS
The depository growth potential of the

tuberosity allows for arch expansion by
moving the teeth posteriorly into the area
of bone deposition
Extensive scope for growth modification
before adolescent growth spurt

THE EARLY PERMANENT DENTITION YEARS
Growth modification still

possible in boys
RME can still be tried till 12
-15 yrs

Age Changes
All para nasal sinuses increase in size
Vertical height decreases
Alveolar process
resorbed
Tooth loss
Vertical changes > AP > width

Soft tissue changes > skeletal
Nose growth continues till 25 years
Inclination of palatal plane increases [post
downwards]

Age Changes
Bimolar width in the

1st molar region
correlates
- Vertical growth of
maxilla
- Growth in the
midpalatal suture
- growth in height

Effects on dental and occlusion
Age Changes
Maxilla drifts 5mm forward in molar region
(by adolescence)
- 2.5mm in incisor region
Shortening of the arch perimeter associated with
eruption of 2nd molar
Initiation of eruption of 3rd molar occurs after the
greatest shortening of length in the maxillary dental
arch
Shortening of anterior segment mesial drift of teeth
crowding of ant segment convergence and
narrowing of the bone base
Clinical implications
Growth and development of Maxilla
Cessation of maxillary growth occurs
in 3 planes in the following order
Transverse
(width)
Early
Adolescence
Antero posterior (length)
Mid
adolescence
Vertical
decade
(height)
3rd
Tranverse (width) growth of maxilla
STOPS when the FIRST bridging of the midpalatal suture,
NOT AT FINAL COMPLETION (ossification)
infancy
Childhood
(early mixed dentition)
Early adolescence
e , transverse growth of maxilla ceases at early adolescen

ales
: 11 14 years
s
: 12 16 years
Transverse growth of maxilla

Transverse maxillary constriction
Narrow palatal vault
Unilateral
Posterior cross bites
Present in Centric occlusion

And Centric relation
Bilateral
present in
centric occlusion But
not in Centric relation
Dental cross bites

o
Quad helix
W arch
Cross elastics
Archwire to some extent

Palatal expansion
Split Removable Plate
with jack screw
or midline spring
Lingual
W- Arch
Fixed Palatal expander

With jackscrew
Rapid
( > 0.5 mm
per day )
Arch Semi Rapid ( 0.25 mm
per day )
Quad Slow
Helix
(
1 mm /
week
)

Rapid Maxillary Expansion
When to prescribe ??
Acc. to Profitt early orthodontic treatment for all

skeletal problems now is restricted to the mixed
dentition years ,
with a second phase of treatment during
adolescence
Transverse growth
of maxilla
When
to prescribe ??
Should NOT be used on

preschool children ( < 6
years )
Heavy forces and rapid expansion
Nasal humps
Paranasal swellings

When
to prescribe ??
Amount of activation, Acc. to Timms :
Up to 15 years of 15-20
age
years of ageOver
180 20 yrs of age
(2 x 90o turns daily)(4 x 45 turns daily).
( initial 90
and then
2 x 45 daily )
25 years of age : SARPE

Slow or Rapid expansion ??
Anteroposterior Growth of Maxilla
Ceases at late mid adolescence
Class II and Class III skeletal

mallocclusions can be due to
o Deficient maxilla
o Excess maxilla

Maxillary
excess
Functional Appliances
Fixed
Herbst
Jasper jumper

Maxillary
excess
Head gear
Functional Appliances
Cervical Head gear

Combination Head gear
Occipital head gear
Removable
Activator
bionator
Fixed
Herbst
Jasper jumper
Twin block
Ceases at late mid adolescence
Lee in AJO 1997
Miki 1979 and Hirato

1984
Combination Head Gear
Cervical head Gear
Occipital head Gear
Maxillary
Defficiency
cemask / Reverse Pull headgear
Petit
Delaire
Functional Applianc
Class III Frankel
Twin blocks
Vertical Growth of Maxilla
Growth is seen up to third decade
Long face Class II

Treatment
High
pull headgear to
Functional appliance
High pull head
gear To molar
High pull head gear

to maxillary splint
Bite blocks on
functional appliance
Head Gear
Cervical Head gear
Occipital head gear
Vertical Growth of Maxilla

Vertical Maxillary excess
J hooks &j pull headgear
Before
After 36 months
REFERENCES
Enlow DH, Bang S. Growth and
remodelling of the human maxilla. Am J
Orthod. 1965, 51: 446-464
Enlow DH. Handbook of facial growth.
2nd Ed.,1982, W. B. Saunders Company.
Profitt W. R. Contemporary orthodontics .
5th Ed., 2012, elsvier Publishers.
Sperber G. Craniofacial Development,

2001, BC Decker Inc.
Melsen B. Growth of the cranial vault:
Influence of intracranial and extracranial
pressures. Acta Odontol Scand. 1995, 53:
192-195.
Persson M. The role of sutures in normal
and abnormal craniofacial growth. Acta
Odontol Scand. 1995, 53: 152-161.
Timms Donald J. Rapid maxillary
expansion. Quintessence publishing co.
1981 pg 49 -55
THANK
YOU

Prenatal and Postnatal Growth of The Cranial Vault, Base and Mid-Face

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Good

By Dr Nizam Muhamad B. Muhamad Subr

understand growth of the body , it is necessary to understan

i. Site and location of growth

Cranium and developmental divisions

Prenatal & post natal growth of cranial vault

Cranial vault / calvaria.

Mechanism of bone Growth

Undifferentiated mesenchymal cell

Bone laid down around blood

Hyaline cartilage model

Surrounded by perichondrium (highly vascular & contains osteogeninc ce

Blood vessels invade calcified cartilaginous matrixReduced to walls/

Prenatal Growth and

The Prenatal Period

Period of the Ovum

Conception till nidation - 7 days

Germ Disc / Bilaminar disc

Day 14 (2nd week)

Somite Period Day 21 (3rd week)

Ectoderm Differentiaton (Neural Induc

The neural tube forms by

The complete segment of the

Neural crest cells

Cranial neural crest

Neural Crest cells derivatives

Walls of embryonic coelum

Skin and appendages

Distinct bilateral mesenchymal swellings , Pharyngeal arche

Neural crest cells interact with pharyngeal endoderm

Neural crest cells

Condenses between developing brain and foregut

Ectomeningeal capsule (base)

Prenatal and postnatal growth of

Neural crest derived

Growth of calvarial bones

(predominant till 4th year of life)

Secondary center -----Zygomatic process

primary ossification centers appear at region of

Growth of the cranial vault

The desmocranium are embedded within a neurocranial capsule .

The flattening of the high curvature cranial bones is achieved by

The flattening of the high curvature cranial bones is achieved by

Prenatal growth and Development of

GROWTH OF CRANIAL BASE

Prenatal growth and Development of the

Day 40 ( late somite period )

Occipital sclerotomal mesenchyme

Prenatal growth and Development of the

ay 40 (late somite period)

Occipital sclerotomal mesenchyme

artilaginous cranial base

artilaginous cranial base

Prechordal cartilage (Presphenoid)

Periotic / petromastoid bone

Nasal capsule (ectethmoid)

- Lateral masses (labyriths) of ethmoid

Unossified chondrocranial remnants

Alae & septum of the nose,

Spheno-occpital & spheno-petrous junctions,

3 Endochondral Ossification centres

1. Lateral labrynths in nasal

Intramembranous ossification centres - 4