facial skeleton is in response to growth of the tongue, dentition and

the facial and masticatory muscles. Latham and Scott (1970) have
postulated that there is a multiple assurance principle involved in facial
growth, that is that several systems are involved in producing growth,
and if one system fails others continue to produce growth. It must be
emphasized that there is a certain independence of growth even of
intimately connected parts of the head if pathological conditions
intervene. For example, the cellular tissue at the head of the mandibular
condyle is particularly vulnerable to damage by trauma or infection. If
this tissue is damaged, this has an effect on the growth of the mandible,
but there is little or no effect on the growth of the masticatory muscles
or on their bony attachments to the jaws. The effect on growth seems to
be confined to that growth contributed in the condylar cartilage area,
that is, growth in length and height of the mandible, and even appositional
bone growth does not seem to be affected.
There have been many studies of the effects of pathological
conditions on facial growth. However, while it is desirable to understand
normal growth in order to interpret pathological changes, it is probably
much less realistic to attempt to understand normal growth from a study
of pathological conditions. In the light of present knowledge it would
seem reasonable to believe that normal growth of the head depends
on the complex interrelationship of growth of all the components,
including the function of the muscular components, with a large genetic
element involved in both rates and timing of growth and in determination
of final size and form.
Normal variation
Variation exists between normal individuals both in growth and in the
final form and size of the head, quite apart from the effect of any
pathological conditions. Indeed, the main bulk of orthodontic treatment
deals with the amendment of normal variation. Variation in growth is
largely variation in the rates and amount of growth at different ages.
Perhaps the best example of this is the variation in the timing of the
puberal growth spurt. There is a general sex difference in the age at the
puberal growth spurt, with females tending to exhibit puberal growth
some 2 years earlier than males. There are also individual differences. In
a study of mandibular growth in girls, Tofani (1972) found that the age
of maximum puberal growth in length ranged from 11 to 13 years, and
the duration of the total growth spurt ranged from 2 1/2 to 3 years. Thus
prediction of the final dimensions of the jaws in a growing child, or the