Post on 21-Apr-2017
SITES & TYPES OF GROWTH IN CRANIOFACIAL COMPLEXDR. SARANG SURESH HOTCHANDANI (BDS)
#ORTHODONTICS
05/02/2023SARANG SURESH HOTCHANDANI 2
TO UNDERSTAND GROWTH IN ANY AREA OF BODY IT IS NECESSARY TO UNDERSTAND
Site
/Loc
atio
n
of G
row
thType of
Growth at
that Site
Mechanism of Growth
Controlling
factors in
Growth
05/02/2023SARANG SURESH HOTCHANDANI 3
TO UNDERSTAND GROWTH IN ANY AREA OF BODY IT IS NECESSARY TO UNDERSTAND
Site
/Loc
atio
n
of G
row
thType of
Growth at
that Site
Mechanism of Growth
Controlling
factors in
GrowthWe are Going to Learn this
05/02/2023SARANG SURESH HOTCHANDANI 4
CRANIOFACIAL COMPLEX CONSISTS OF;
1. Cranial Vault1. Bones of upper & outer surface of brain
2. Floor of Cranium/Brain1. Occipital bone
2. Sphenoid bone
3. Ethmoid bone
3. Naso – Maxillary Complex1. Maxilla
2. Nose
4. Mandible
CRANIAL VAULT
05/02/2023SARANG SURESH HOTCHANDANI 6
SITE/LOCATION OF GROWTH & REMODELING
• Primary site of growth at cranium• Sutures
• Secondary site of growth • Inner & outer surface of bony plates
• Resorption on inner surface • Deposition on outer surface
05/02/2023SARANG SURESH HOTCHANDANI 7
TYPE OF GROWTH AT CRANIAL VAULT
Formation • Intramembranous Ossification
Growth & Remodeling
• Surface apposition from periosteal activity
FLOOR OF CRANIUM
05/02/2023SARANG SURESH HOTCHANDANI 9
SITE/ LOCATION OF GROWTH & REMODELING
• In center for midline structures• Synchondroses (Growth Sites of
Cranial Base)• These are bands of cartilage which
remained after ossification of cranial base bones by endochondral ossification.
• 3 in number• Spheno-occipital synchondroses
• Inter sphenoid synchondroses
• Spheno-ethmoidal synchondroses
05/02/2023SARANG SURESH HOTCHANDANI 10
SITE/ LOCATION OF GROWTH & REMODELING
•Laterally;• Sutures• Surface remodeling or apposition(outer &
inner)• E.g. Growth of sphenoid sinus
05/02/2023SARANG SURESH HOTCHANDANI 11
DIAGRAMMATIC REPRESENTATION OF GROWTH AT THE INTERSPHENOID SYNCHONDROSES.
• Histologically looks like two sides epiphyseal plate• Area of cellular hyperplasia
in center and maturation occur in both sides.• This cartilage produce
immoveable joint while cartilage of long bone produce moveable joint.
05/02/2023SARANG SURESH HOTCHANDANI 12
TYPES OF GROWTH IN CRANIAL VAULT
•Endochondral ossification at center
•Surface apposition at lateral plates and sutures.
NASO MAXILLARY COMPLEX
05/02/2023SARANG SURESH HOTCHANDANI 14
SITE OF GROWTH IN MAXILLA
Sutures Maxillary Surface
05/02/2023SARANG SURESH HOTCHANDANI 15
TYPE OF GROWTH IN MAXILLA
Intr
amem
bran
ous
Appo
sitio
n at
Su
ture
s
Surf
ace
Rem
odel
ing
05/02/2023SARANG SURESH HOTCHANDANI 16
MAXILLA…
• Maxilla moves forward by growth of cranial base behind it.
• GROWTH PATTERN OF MAXILLA• It grows out from under the cranium
• Means, maxilla must move a considerable distance downward & forward relative to cranium & cranial base.• This occurs in two ways;
• By push from behind created by cranial base growth &
• Coz maxilla is attached to anterior part of cranial base and lengthening of cranial base pushes maxilla forward.
• By growth at sutures.
05/02/2023SARANG SURESH HOTCHANDANI 17
As growth of surrounding soft tissues
translates the maxilla downward and forward, opening up space at its superior and posterior
sutural attachments, new bone is added on both
sides of the sutures.
05/02/2023SARANG SURESH HOTCHANDANI 18
MAXILLA…
• Growth of cranial base occurs till 6th year of age & stops at 7th year.• In achondroplasia, growth of cranial base does not occur which
result mid face deficiency because maxilla is not moving forward.
• After 7 years, forward & downward movement of maxilla occurs at sutures.
05/02/2023SARANG SURESH HOTCHANDANI 19
MAXILLA…
• In maxilla, sutures are attached superiorly & posteriorly.
• The sutures remain the same width, & various processes ofmaxilla becomes longer.• Because bone apposition occurs on both sides of
sutures. So bones to which maxilla is attachedalso become larger.
• Part of posterior border of maxilla is free surface in thetuberosity region.• Bone is added at this surface creating additional space into which
primary and then permanent molars erupt.
05/02/2023SARANG SURESH HOTCHANDANI 20
MAXILLA…
• In maxilla, bone is removed from outer/anterior surface while deposited on inner surface.• So, overall growth occur by both downward and forward
translation/movement of maxilla and simultaneously surface remodeling.• In maxilla, surface remodeling of bone occur in the opposite direction to that in which
it is being translated/moved.• However it is not rule that in every bone remodeling occurs in opposite direction, just like in growth
of palate in which remodeling occurs in the same direction to which the palate is being translated.• Palate also moves downward & forward along with maxilla, but here at the same time the bone is
removed on the nasal side and deposited on the oral side, and anterior part of alveolar process is resorptive area, here resorption occur to cancel forward growth of palate caused by maxilla.
MANDIBLE
05/02/2023SARANG SURESH HOTCHANDANI 22
MANDIBLE
• Both, endochondral and periosteal activity occur.• Endochondral at mandibular condyle• Periosteal activity by direct surface apposition and
remodeling at all other areas of mandible.
• There is negligible role of growth of cranial base and movement of TM joint due to growth of cranial base unlike maxilla.
05/02/2023SARANG SURESH HOTCHANDANI 23
PATTERN OF GROWTH OF MANDIBLE
• two ways depending on frame of reference;• if cranium is reference area and considered as stable cranial base, then
• chin moves downward & forward
• from other reference area, data from vital staining;• minimal changes in the body and chin area, while, there is growth & remodeling of ramus, moving it
posteriorly
• Both ways are correct, so the overall concept of growth of mandible is, mandible is translated downward and forward and grows upward and backward in response to this translation, maintaining its contact with skull.
05/02/2023SARANG SURESH HOTCHANDANI 24
PATTERN OF GROWTH OF MANDIBLE
• So, the principal sites of growth of mandible are;• Posterior surfaces of ramus
• Condylar
• Coronoid process
• As a growth site, anterior part of mandible along with chin is inactive as growth site.• It is translated downward and forward due to growth occurring at condyle
and posterior surface of mandible.
05/02/2023SARANG SURESH HOTCHANDANI 25
PATTERN OF GROWTH OF MANDIBLE
• Body of mandible grows by periosteal apposition only on its posterior surface.
• Ramus grows upward by endochondral replacement at condyle accompanied by surface remodeling.
• Mandible grows longer by apposition of new bone on posterior surface, while resorption on anterior surface.
• In infancy, ramus is located at about the spot where the primary 1st molar will erupt.
GROWTH OF SOFT TISSUESGROWTH OF FACIAL SOFT TISSUES DOES NOT GROW IN PARALLEL TO FACIAL HARD TISSUES.
05/02/2023SARANG SURESH HOTCHANDANI 27
GROWTH OF LIPS
• Growth of lips is slower than growth of hard tissues of face before adolescence.
• Growth spurt of lips occur after adolescence
• Lip height is short during mixed dentition
• Lip incompetence (Lip separation at rest) is maximum during childhood and decreases during adolescence.
• Lip thickness reaches at maximum during adolescence and then decrease• For some girls, loss of thickness seems problem and want treatment.
• Lips are framed by nose above and chin below.
• Lip prominence decrease after adolescence because of growth of chin and nose at adolescence
05/02/2023SARANG SURESH HOTCHANDANI 28
GROWTH OF NOSE
•Growth of nasal bone is completed at about age 10.• After this age, growth only occurs in nasal
cartilage and soft tissues which growth spurt in adolescent and that’s why nose become prominent at adolescent (especially in boys).
THE ENDSARANG SURESH HOTCHANDANI (BDS)
BIBI ASEEFA DENTAL COLLEGE, SMBBMU.Larkana, Sindh, Pakistan.
hotchandanisarang@gmail.com www.twitter.com/fetusdentista