Growth and Development

Presented By, Imtiyaz Hebbal

P G Dept Of Orthodontics and Dento-fascial Orthopedics

Nizhny Novgorod State Medical Academy

THE HUMAN LIFECYCLE

Babyhood
This is the first stage

in the lifecycle of the human. Babies are born after spending 9 months developing in their mothers womb. When they are born they have to be fed and cared for by their parents. They begin to develop teeth at 5 or 6 months. At around 1 year babies begin to walk but they are still very dependent on their parents.

Childhood
As the child gets older

it can begin to do more things for itself. By the age of 5 a child can walk, run, talk and feed itself but it is still dependent on its parents. During this time children grow and lose their first set of teeth and get a new set.

Adolescence
Children become

teenagers at the age of 13. During this time boys and girls begin to develop into adults. The rate of development depends on the individual but both boys and girls will notice changes to their bodies. Adolescents like to become less dependent on their parents and will often do things by themselves.

Adulthood
At the age of 18

people become adults. They then become responsible for their own actions and no longer rely on their parents to look after them. Adults do not grow anymore but need to look after their bodies to ensure a long and healthy life.

6th - 15th centuries Medieval period

Preformationism: children seen as little

adults. Childhood is not a unique phase. Children were cared for until they could begin caring for themselves, around 7 years old. Children treated as adults (e.g. their clothing, worked at adult jobs, could be married, were made into kings, were imprisoned or hanged as adults.)

16th Century Reformation period

Puritan religion influenced how

children were viewed. Children were born evil, and must be civilized. A goal emerged to raise children effectively. Special books were designed for children.

17th Century Age of Enlightenment

John Locke believed in

tabula rasa

Children develop in response

to nurturing.

Forerunner of behaviorism

www.cooperativeindividualism.org/ locke-john.jpg

18th Century Age of Reason

Jean-Jacques Rousseau

children were noble savages, born with an innate sense of morality; the timing of growth should not be interfered with.

Rousseau used the idea of stages

of development. beliefs

Forerunner of maturationist

19th Century Industrial Revolution

Charles Darwin
theories of natural selection and

survival of the fittest

Darwin made parallels between

human prenatal growth and other animals.

Forerunner of ethology

20th Century

Theories about children's development expanded around the world.

Childhood was seen as worthy of

special attention.

Laws were passed to protect children,

Definations
Growth The self multiplication of living substances (J.S.Huxley) Increase in size, change in proportion and progressive complexity.(Krogman) An Increase in size (Todd) Entire series of sequential anatomic and physiologic change taking places from the beginning of prenatal life of senility (Meridith) Quantitivie aspect of biologic development per unit of time (Moyers) Change in any morphological parameters which is measureable (Moss)

Development According to Todd is a progress towards maturity According to Moyers`` is a naturally occurring unidirectional changes in the life of an individual from its existence as a single cell to its elaboration as a multifunctional unit terminating to death. Thus it encompasses the natural sequential events between fertilization and death.

Dentist role as physician

Dentist are considered as Oral Physician act as a case finderfor medical or

psychiatric referral. Similarly, the dentistoften is the first health professional to treat abused patients,particularly those with head and neck trauma. Such patientsalso may have related substance abuse problems, which requirethe dentist to correlate systemic manifestations with the orofacialtrauma

Dentist Role as Anthropologist

In Solving Legal cases dental

anthroplogist plays an important role Dental Profiling Bite mark examination.

Dentist as Genesist
diagnose hereditary malformation

complexes and counsel afflicted patients and their families The vast majority of these heritable syndromes have significant expression in the oral-craniofacial complex

MEASURE OF ASSESSING GROWTH

Physical

Analyzing with a standard growth chart These type of charts are commonly used for height and weight, the growth of any part of the body can be plotted in below way. The"normal variability, a s derived from large-scale studies of groups of children, is shown by the solid lines on the graphs. An individual who stood exactly at the midpoint of the normal distribution would fall along the 50% line of the graph One who was larger than 90% of the population would plot above the 90% line; one who was smaller than 90% of the population would plot below the l0% line. These charts can be used in two ways to determine whether growth is normal or abnormal, first 1. First, the location of an individual relative to the group can be established, 2. Second and perhaps more importantly, growth charts can be used to follow a child over time to evaluate whether there is an unexpected change in growth pattern.

Conginitive
Cognitive development, the

development of intellectual capabilities occurs in a series of relatively distinct stages, Given by Swiss psychologist Jean Piaget. In Piaget's view, adaptation occurs through two complementary Processes assimilation and accommodation. Perspective of cognitive development

Chronolgical assesment
It is defined as age measured by years

lived since birth. It is considered as a poor indicator of maturity as it provides little validity for identifying the stages of development progression through adolescence to adulthood. It may help to categorize the individual as early, average or late maturer. This enables an orthodontist to determine andpredict the rate and magnitude of facial growth and help decide the time, duration and method of treatment.

1.SEXUAL/PUBERTAL AGE 2. DENTAL AGE

Sexual Age

Dental Age

GROWTH SPURTS

 Human growth is not a steady and

uniform process of accretion in which all body parts enlarge at the same rate and same increment per year. Postnatally growth does not occur in a steady manner. There are periods of sudden rapid increases,which are termed as growth spurts.

3 types of spurts are seen

PHYSIOLOGICAL ASSESSMENTS IN GROWTH AND DEVELOPMENT

the brain, brain cells in the hypothalamus begin to secrete substances called releasing factors. In the anterior pituitary, the hypothalamic releasing factors stimulate pituitary cells to produce several related but different hormones called pituitary gonadotrophins. Their function is to stimulate endocrine cells in both

The first events of puberty occur in

Timing of puberty
In Females puberty occurs 2 years earlier

then males. Adolescence in girls can be divided into three stages,based on the extent of sexual development, First is the appearance of breast buds and early stages of the development of pubic hair. Secondly there is noticeable breast development. Pubic hair is darker and more widespread, and hair appears in the armpits (axillary hair). The third stage in girls occurs I to Itl2years

 In boys, four stages in development can be correlated

with the curve of general body growth at adolescence, First, fat spurt. The maturing boy gains weight and becomes almost chubby, with a somewhat feminine fat distribution. At stage II, about I year after stage I, the spurt in height is just beginning. At this stage, there is a redistribution and relative decrease in subcutaneous fat, pubic hair begins to appear, and growth of the penis begins. The third stage occurs 8 to 12 months after stage II and coincides with the peak velocity in gain in height. At this time, axillary hair appears and facial hair appears on the upper lip only. Stage IV for boys, which occurs from 15 to 24 months after stage III, facial hair on the chin as well as the upper lip, adult distribution and color of pubic and axillary hair, and a further increase in muscular strength.

Metabolic Rate

How do you know that your weight is NORMAL?

You must Know your BMI i.e Body Mass

Index BMI = Weight (Kg) / Height 2(Meter) If BMI is less that means you are undernourished If BMI is more that means you are over weight or obese

How to interpret your BMI ?

BMI should be routinely monitored 5th percentile means lower limit of normal 95th percentile means upper limit of normal 50th percentile means average Insert table of BMI age and gender

Anatomy of hand and wrist

urpose of skeletal age determination. The method is ra

. The bones of the proximal row are scaphoid, lunare, t

nger, All the metatarsals ossify from one prim

bones of the phalanges are referred to as the

ular bone most often present embedded in tend

 Cross sectional study Longitudinal Mixed longitudinal study

Method of Studying growth and Development

 A cross-sectional study compares

groups of individuals of different ages simultaneously

A longitudinal study follows a single group of individuals as they develop

Mixed Longitudinal Studies

longitudinal

Mixed

studies are a combination of the cross-sectional and longitudinal types

TWIN STUDY OF GROWTH AND DEVELOPMENT

Human twin can be of 2 types a.Monozygotic twins b.Dizygotic twins

Monozygotic twins are two individuals developed from a single fertilized ovum, which divides into two at an early stage of development. These have genetic makeup identical to each other Dizyglaotic twins are two individuals developed from two searate ova, ovulated and fertilized at same time. These are not genteically identical

Twin studies are done by analyzing monozygotic and dizygotic in specific manner. In case of monozygotic twins, they have a similar genetic make up, but post natally some have different environmental conditions. This help us to study the expression of the genetic factor and at the same time, the environmental influences o this genetic expression

 In dizygotic twin who have a similar

environental conditions the influence of genetic as well as the environmetnal factor in the expression and developmental of an individual can be studied

Limitations Identification of different types of twins as well as their developmental environment, the work of many researchers has thrown light into the understanding of genetic contribution in the growth and development of individual.

FACTORS AFFECTING PHYSICAL GROWTH The developmental ontogeny of the dento facial complex is dependent primarily upon the following three elements: 1. Genetic endowment These include: a. Inherited genotype, like heredity b. Operation of genetic mechanisms, like race 2. Environmental factors These include a. Nutrition and biochemical interactions b. Physical phenomena like temperature, pressures, hydration, etc. 3. Functional forces These include: a. Extrinsic and intrinsic forces of muscle actions,like exercise b. Space occupying organs and cavities c. Growth expansion

Genetic Factor
The basic control of growth, both in

magnitude and timing, is located in the genes. The potential for growth is genetic. The actual outcome of growth depends on the interaction between the genetic potential and environmental influences. Genetic factors most likely play a leading role in male-female growth differences. The marked advancement of girls over boys in the rate of maturation is attributed to the delaying action of the Y chromosome in males. By delaying growth, the Y chromosome allows males to grow over a longer period of time than

Factors Affecting Growth & Development

Large variation among individuals A number of factors affect growth and

development, including:

Heredity Nutrition Socioeconomic status Exercise

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Heredity
Genetic information that

is passed on from generation to generation These genes are also affected by environmental factors For example, malnutrition may prevent an individual from growing to their

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Nutrition

Adequate nutrients are

essential for growth & development Carbohydrates and fats are primarily used for energy Proteins contribute to the growth and repair of body tissues, including muscle Vitamins, minerals and water are also essential for various functions and reactions that occur in the body

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Nutrition
Undernourishment

or malnutrition can delay growth Undernourishment exists even in countries with abundant food supplies Overeating is also a problem in these countries and can lead to obesity when combined with a sedentary

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Socioeconomic Status
Body size is positively

related to socioeconomic status and may be related to nutrition That is, socioeconomic status affects
Income (money to spend on food) Education (knowledge about healthy food) Time (food selection and preparation time) Availability (access to

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Socioeconomic Status
Other factors may contribute to the

differences observed in growth & development among individuals, such as

Lower levels of stress; Better sleeping patterns; and Regular exercise

These factors are easier to ensure

when the basic necessities are met

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Table about maternal and fetal problem

GROWTH CHARTS AND GROWTH CURVES

GROWTH AS A GENERAL BIOLOGICAL PROCESS AS A LIFE CYCLE

Cell growth morphogenesis

Morphogenesis is a biologic process having an underlying control system at the cellular and tissue levels. Morphogenesis works constantly toward a state of composite, architectonic balance among all of the separate growing part s. This means that the various parts developmentally merge into a functional whole, with each part complementing the others as they all grow and function together. During development, balance is continuously transient and can never actually be achieved because growth itself constantly creates ongoing, normal regional imbalances. This requires other parts to constantly adapt(develop) as they all work toward composite equilibrium. It is such an imbalance itself that fires the signals which activate the interplay of histogenic responses. The genetic and functional determinants of a bone's development (i.e., the origin of the growth-regulating signals) reside in the composite of soft tissues that turn on or turn off, or speed up or slow down, the histogenic actions of the osteogenic connective tissues (periosteum, endosteum, sutures, periodontal membrane). Growth is not "programmed" within the bone itself 01: its enclosing membranes

Critical period of development

1a specific time during which the environment has its greatest impact on an individual's development. 2the time during gestation when critical organ systems are formed.

Growth Gradient

the change in overall body proportions that occurs during normal growth and development. at about the third month of intrauterine development, the head takes up almost 50% of the total body length, length. A t this stage th e cranium is large relative to the face and represents more than half the total head. In contrast, the limbs are still rudimentary and the trunk is underdeveloped. time of birth, the trunk and limbs have grown faster than the head and face, so that the proportion of the entire body devoted to the head has decreased to about 30%. The overall pattern of growth there after,Follows this course, with a progressive reduction of the relative size of the head to about l2% of the adult. At birth, the Legs represent about one third of the total body length, while in the adult, they represent about half. more growth of the lower limbs than the upper limbs during postnatal life is seen "cephalocaudal gradient of growth."

Head and Neck Embryology

Branchial Apparatus
4 arches are well developed by 4th

week of gestation 5th and 6th arches are still rudimentary Development takes place over weeks 4 to 7 Contribute mostly to neck development but the first arch contributes to facial development

Head & Neck Embryology

Branchial Apparatus Thyroid Gland Tongue Development of the face Nose Palate Ear

Branchial Apparatus

Branchial Apparatus
Arches mesenchymal tissue surrounded by

ectoderm and endoderm Clefts (or grooves) Separate adjacent arches along ectodermal surface Pouches Outpouching of endoderm from foregut Penetrate adjacent mesenchyme

Branchial Arches

Each arch contains: A cartilagenous component A muscular component An aortic arch (artery) A nerve

First Branchial Arch

Divides early into 2 portions Maxillary process dorsally (maxilla,

zygoma, squamous temporal bone) Mandibular process ventrally

 Cartilage (Meckels Cartilage) Dorsal end becomes the malleus

and incus Intermediate portion regresses, but the perichondrium forms: Anterior ligament of the malleus Sphenomandibular ligament Ventral portion forms the mandible

 Muscular component Muscles of mastication (temporalis,

masseter, med & lat pterygoids) Accessorymuscles of mastication (mylohyoid, ant belly of digastric) Tensor tympani Tensor veli palatini

 Aortic arch Maxillary artery

Nerve Trigeminal nerve (CN V)

Second Branchial Arch

Cartilage (Reicherts Cartilage) Dorsal end becomes stapes (except

footplate) and styloid process Intermediate portion regresses and perichondrium forms the stylohyoid ligament Ventral end forms the lesser cornu of the hyoid and the upper half of the hyoid bone

 Muscular Component Migrates over superficial face to form

the muscles of facial expression Stapedius muscle Stylohyoid muscle Posterior belly of digastric Aortic Arch Hyoid artery Stapedial artery

 Nerve

Facial Nerve (CN VII)

Third Branchial Arch

Cartilage Located ventrally and forms the lower half of the body of the hyoid and the greater cornu Muscular Component Only one muscle: stylopharyngeus Aortic Arch Common carotid, external carotid, proximal internal carotid

Nerve Glossopharyngeal (CN IX)

Fourth Brachial Arch

Cartilage Thyroid cartilage Muscular Component The 3 pharyngeal constrictors Cricothyroid muscle Aortic Arch Left: Aortic arch Right: Right subclavian Nerve Superior laryngeal branch of vagus (CN X)

Sixth Pharyngeal Arch

Cartilage Cricoid cartilage, arytenoid, corniculate and cuneiform Muscular Component Intrinsic muscles of larynx Aortic Arch Left: pulmonary artery, ductus arteriosus Right: pulmonary artery, distal end degenerates Nerve Recurrent laryngeal nerve of vagus (CN X)

Branchial Arch Summary

Branchial Clefts (or grooves)

4 clefts The 2nd to 4th clefts become buried

by theovergrowth of the 2nd arch to form the cervical sinus Cervical sinus has dissapeared by week 7 The first cleft persists and invades the mesenchyme opposite the first pouch This becomes the EAC and ectoderm

Branchial Cleft

Pharyngeal Pouches

1st pharyngeal pouch

Elongates into the tubotympanic

recess The distal part contacts the 1st pharyngeal cleft and forms the inner lining of the TM The tubotympanic recess becomes the tympanic cavity and mastoid antrum Connection of the recess with the pharynx becomes the eustachian tube

2nd Phayrngeal pouch

Forms the tonsillar fossa Endoderm forms the surface

epithelium and lining of tonsillar crypts At 20 weeks lymphoid tissue invades the endoderm and forms the palatine tonsils

3rd Pharyngeal Pouch

Forms 2 diverticula: dorsal and

ventral Endoderm of dorsal diverticula: inf parathyroid Endoderm of ventral diverticula: lobule of thymus These diverticula become detached from the wall and migrate caudally. Thymus comes to lie in the superior mediastinum

Pharyngeal Pouches

4th Pharyngeal Pouch

Also develops dorsal and ventral

diverticula The dorsal bud becomes the sup. parathyroid The ventral bud becomes the Ultimobranchial body The ultimobranchial body fuses with the thyroid gland and disseminates within it to give the parafollicular C cells which produce calcitonin

 5th pouch never develops Controversy re: originof

ultimobranchial body

TONGUE
4th week: elevation

on floor of pharynx, just rostral to foramen cecum: Median Tongue Bud(Tuberculum impar) Distal Tongue Buds develop just lateral to median tongue bud Both of the above

 Distal tongue buds overgrow the

median tongue bud and merge with each other These form the ant 2/3 of the tongue Median tongue bud forms no adult structure

to foramen cecum: 1. Copula: from 2nd arch 2. Hypobranchial emminence: from 3rd & 4th arches The hypobranchial emminence overgrows the copula which disappears The post 1/3 of the tongue is formed by the rostral part of the hypobranchial emminence (Arch 3) Caudal part of hypobranchial emminence (Arch 4) forms the epiglottis

At same time 2 elevations develop caudal

 Branchial

mesenchyme forms the soft tissue, vascular and lymphatics of the tongue. Tongue muscles originate from the occipital somites which bring with them innervation (CN XII)

 Innervation to

tongue: Ant 2/3: CN V Post 1/3: CN IX

Development Of Face

Five facial primordia contribute to development of the face: The frontonasal prominence Paired Maxillary prominences Paired Mandibular prominences

 4th week: thickening of ectoderm in the

ventrolateral parts of the FNP: Nasal Placodes Mesenchyme on the edges of the placodes proliferates to form: medial and lateral nasal prominences As a result the nasal placodes now lie in a depression called nasal pits which enlarge dorsally to form the nasal cavities. These nasal cavities are separated from the oral cavity by the oronasal membranes which rupture to form the primitive choana

 Growth of

maxillary prominences pushes medial nasal prominences medially These fuse to form the nasal bulb, the philtrum, the premaxillary segment of the

 The lateral nasal prominences, which

become the ala are separated from the maxillary prominences by the nasolacrimal grooves which become the nasolacrimal ducts. The sinuses form as outpouchings of the ectoderm of lateral nasal walls The olfactory epithelium develops from ectoderm

Palate
Primary and Secondary Palate

Primary Palate Develops from the fusion of the medial nasal prominences between the maxillary prominences Forms the adult portion of the palate which is anterior to the incisive foramen

Secondary Palate Origin of the hard and soft palate Develops from internal projections of the maxillary prominences called the lateral palatine processes As mandible develops, the tongue drops and the palatine processes grow medially and fuse in the midline. They also fuse with the nasal septum and the primary palate. Ossification occurs in an antero-posterior direction

DIFFERENTIAL GROWTH OF HEAD AND BODY

the change in overall body proportions that occurs during normal growth and development. at about the third month of intrauterine development, the head takes up almost 50% of the total body length, length. A t this stage th e cranium is large relative to the face and represents more than half the total head. In contrast, the limbs are still rudimentary and the trunk is underdeveloped. time of birth, the trunk and limbs have grown faster than the head and face, so that the proportion of the entire body devoted to the head has decreased to about 30%. The overall pattern of growth there after,Follows this course, with a progressive reduction of the relative size of the head to about l2o/o of the adult. At birth, the Legs represent about one third of the total body length, while in the adult, they represent about half. more growth of the lower limbs than the upper limbs during postnatal life is seen "cephalocaudal gradient of growth."

Development and Maturation Chondrocranium

Mechanism of Bone growth

.

in new depth understanding of facial morphogenesis is essential so that clinician can grasp.
An

a) b)

Differences between normal and range abnormal.

of

Biologic reasons for these variations and differences. in of

c) Reasons for rationales utilized diagnosis, treatment planning and selection appropriate clinical process.

d) Biologic reasons underlying the problems of retention, rebound and relapse after treatment.

Concepts to be discussed in dynamics of growth are:- Pattern of growth - Variability - Timing - Differential growth - Remodeling

Drift

- Displacement - Relocation - flexure - boundaries Basicranial Growth field

Pattern : In general sense, the pattern reflects proportionality. Pattern in growth represents not just a set of proportional relationship at a point in a time, but the change in these proportional relationships over time. Pattern of growth refers to the changes in these spatial proportions over time.

The facial growth pattern also shows the cephalocaudal gradient. Mandible being further away from the brain, tend to grow more and later than the maxilla, which is closer. An important aspect of pattern is predictability. The proportional relationship within a pattern can be specified mathematically. A change in growth pattern would indicate an alteration in the expected and predictable sequence of changes in proportions expected for that individual.

VARIABILITY : Variability is the law of nature. Because of infinite number of genetic possibilities, no to individuals are ever exactly alike. Variations in response to environment cause increasing difference among similar individuals with time. Variability may be demonstrated in many ways. In physical growth, variability is demonstrated by the use of statistics, which express quantitatively the range of differences found in a large population of individuals of similar age, sex, socioeconomic background and race

can be difficult, but clinically very important to decide weather an individual is merely at the extreme of the normal variation of changes in proportions expected for that individual.
It

Rather than categorizing people as normal or abnormal, it is more useful to think in terms of deviations from the usual pattern and to express variability quantitatively. One way to do this is to evaluate a given child relative to peers on a standard growth chart.

TIMING : A final major concept in physical growth and development is timing. Variation in growth and development because of timing are particularly evident in human adolescence. Some children grow rapidly and mature early, completing their growth quickly and thereby appearing on the high side of developmental charts until their growth ceases and their contemporaries begin to catch-up.

Differential Growth The human body does not grow at some rate throughout the life. Different organs grow at different rates to a different amount and at a different times. This a termed differential growth. The concept of differential growth can be explained on the basis of scammons curve of growth

The body tissue can be broadly classified into four types i.e. Lymphoid tissue Neural tissue General tissue Genital tissue Each of these grow at different times and different rates.

bone does not grow by generalized, uniform deposition of new bone (+) on all outside surfaces, with corresponding resorption (-) from all inside surfaces. Because of the topographically complex nature of each bone's shape, the bone must have a differential mode of enlargement, in which some of its parts and areas grow much faster and to a much greater extent than others
A

Two basic kinds of growth movement occur during the enlargement of each bone in the facial and cranial skeleton: (1) remodeling , which produces the size, shape, and fitting of a bone, and (2) displacement. Displacement is a movement of whole bones away from one another, creating the space within which growth enlargement of each of the separate bones takes place. Cortical drift is the process that carries out the remodeling functions, and it is a direct growth movement produced by deposition of new bone on one side of a cortical plate, with resorption from the opposite side.

THE BONE REMODELING PROCESS The surface that faces toward the direction of movement is depository (+). the opposite surface, facing away from the growth direction, is resorptive (-). If the rates of deposition and resorption are equal, the thickness of the cortex remains constant. If deposition exceeds resorption, overall size and cortical thickness gradually increase. Different combination of resorption and deposition (drift) in a variety of regional directions and amounts throughout the entire bone provide for the remodeling enlargement of the bone as a whole.

DIFFERENTIAL GROWTH

DIFFERENTIAL GROWTH

CORTICAL DRIFT

RELOCATION

V PRINCIPLE AND REMODELING PATTERN

DISPLACEMENT

DISPLACEMENT

SECONDARY DISPLACEMENT

POST NATAL GROWTH OF MAXILLA

POST NATAL GROWTH OF MANDIBLE

BRAIN ENLARGEMENT , BASICRANIAL FLEXURE , AND FACIAL ROTATIONS The enormous human cerebrum similarly expands around a much smaller enlarging midventral segment (the medulla, pons, hypothalamus, optic chiasma).This causes a bending of the whole underside of the brain. The flexure of the cranial base results. The foramen magnum in the typical mammalian skull is located at the posterior aspect of the cranium. In man, it is in the midventral part of the expanded cranial floor at an approximate balance point for upright head support on a vertical spine.

The expansion of the frontal lobes displaces the frontal bone upward and outward. This results in the distinctive, bulbous, upright "forehead" of the human face, although it is really part of the neurocranium and not the face proper. The frontal lobes also relate to a rotation of the human orbits into new positions. As the forehead is rotated into a vertical plane by the brain behind it, the superior orbital rim is carried with it. The eyes now point at a right angle to the spinal cord. The spine is vertical, and the orbital axis is horizontal. Vision is directed toward forward body movement.

The expansion of the frontal and, particularly, the temporal lobes of the cerebrum relates to a rotation of the orbits towards the midline and the eyes come closer together. The enlarged human cerebrum has caused a downward rotational displacement of the olfactory bulbs. the olfactory bulbs relate directly to the alignment and the direction of growth of the adjacent nasal region. The plane of the nasomaxillary region is thereby approximately perpendicular to the plane of the olfactory

As the bulbs become rotated progressively from a vertical position to horizontal one because of increase in brain size or because of its shape, the whole face is similarly rotated from a horizontal to a vertical plane. Or, stated another way, the face is rotated down by the expanded anterior cranial floor as it rotates downward as a result of the enlargement of the frontal lobes.
.

NASOMAXILLARY CONFIGURATION The maxilla of most mammals has a triangular configuration .In man, it is uniquely rectangular. This is caused by a rotation of the occlusion into a horizontal plane to adapt to the vertical rotation of the whole midface. In the human maxilla, the design change that allows for this resulted in the creation of a new arch-positioning facial region, the suborbital compartment. Most of this phylogenetically expanded area is occupied by the otherwise nonfucntional maxillary sinus (uses such as air warming, nasal drip, and voice resonance are secondary. An orbital floor was also newly created in conjunction with this added facial region.

The characteristic vertical human facial profile is a composite result of (1) a bulbous forehead, (2) rotation of the nasal region into a vertical plane, (3) reduction of snout protrusion in conjunction with medial orbital convergence, (4) rotation of the orbits into upright positions, (5) rotation of the maxillary arch downward and backward, and (6) bimaxillary reduction

Reduction of the nasal region associated with orbital convergence and olfactoryanterior cranial fossa rotation must necessarily also be accompanied by a more or less equal reduction in maxillary arch length, because the floor of the nasal chamber is also the roof of the mouth. The protrusion of the cartilaginous and soft tissue portion of the nasal complex provides for downward-directed external nares. This aims the inflow of air obliquely upward into the vertically disposed nasal chambers towards the vertically aligned sensory nerves of the olfactory bulbs located on the ceiling of the chambers.

GROWTH FIELD BOUNDARIES The growth of each of the face involves two basic considerations. The first is the amount of growth, and the second is the direction of growth. These two factors constitute the growth "vector." The floor of the cranium, in turn, is the template upon which the face is built. The junctional part of the face cannot be significantly wider, for example, than the maximal width of the cranium The length of specific parts of the cranial floor are expressed as equivalent dimensions for the face.

The forward boundary of the brain is shared by the forward border of the nasomaxillary complex. The direction of growth by the nasal part of the face is established by the olfactory bulbs and the sensory olfactory nerves. These two factors underlie the "vector" of midfacial growth, that is, the amount and the direction. The nasomaxillary complex grows as far forward as the edge of the brain in a direction approximately perpendicular to the olfactory bulbs.

The posterior boundary of this fossa establishes the corresponding posterior boundary for the midface. This is essentially a nonvariable anatomic relationship. The direction of growth in this region is established by the particular special sense located in this part of the face, which is the visual sense. the posterior plane of the midface extends from the junction between the anterior and middle cranial fossae (and the inferior junction between the frontal and temporal lobes) downward in a direction perpendicular to the neutral line of the orbit. This plane passes almost exactly along the posterior surface of the maxillary tuberosity.

The inferior boundary of the nasomaxillary complex is established by the bottom-most surface of the brain and cranial. A line from the floor of the posterior cranial fossa passes through , or very nearly so, both the inferior corner of the posterior maxillary tuberosity and the inferior corner of the front part of the bony maxillary arch (prosthion). This relationship is achieved only after facial development is complete, because neurocranial growth precedes facial growth.

Any variation in the alignment of the nerve is usually accompanied by a corresponding upward or downward rotational alignment of the palate. In its neutral position. If the palate has undergone a severe clockwise or counterclockwise rotation during development, the palatal plane will project well above or below, respectively, the occipital point.

The growth in each region of the face involves two basic factors: (1) the amount of growth by any given part and (2) the direction of growth by that part. The brain establishes (or at lest shares) the various boundaries that determine the amount of facial growth. this is because the floor of the cranium is the template upon which the face is constructed. The directions of regional growth among the different parts of the face are inseparably associated with the special sense organs housed within the face. These two factors establish a prescribed growth perimeter that defines the borders of the growth compartment occupied by the nasomaxillary complex

CONCLUSION The conventional method used to show facial growth is superimposition of serial head film tracings. Sella is usually used as a registration point for the superimposition. Superimposing on the cranial base demonstrates the downward and forward expansion of the whole face relative to cranial base.

GROWTH SITES

1.

1.The 2.The 3.The 4.The

cranial vault Cranial Base nasomaxillary complex Mandible

Cranial Vault

Cranial Base

Naso Maxillary Complex

Mandible

F u n ctio n a l M a trix H y p o th e sis ( Moss Hypothesis )

The functional matrix is primary and the presence, size, shape, spatial position, and growth of any skeletal unit is secondary, compensatory, and mechanically obligated to changes in the size, shape, spatial position of its related functional matrix (Moss, 1968)

Functional Matrix Hypothesis ( Moss Hypothesis )

The origin, development and maintenance of all skeletal units are secondary, compensatory and mechanically obligatory responses to temporally and operationally prior demands of related functional matrices.

THE FUNCTIONAL MATRIX HYPOTHESIS

One Function

Functional Cranial Component

Functional Matrix 1. PeriostealMatrix -------------------------------> 2. Capsular Matrix --------------------------------> a. Masses b. Functioning spaces

Skeletal Unit 1. Microskeletal 2. Macroskeletal

Types of Functional Matrix

1. Periosteal matrix 2. Capsular matrix (e.g., muscles) (e.g., brain, oral cavity) Active growth Passive growth Deposition and resorption No deposition Affect size and/or shape No resorption Affect location

Growth

Craniofacial Growth
Active growth process

Active growth ( Periosteal ) + Passive growth ( Capsular ) = Total growth

1 ) Sutural growth 2 ) Bone remodeling 3 ) Cephalic cartilage growth

Passive growth process

1 ) The growth of neural , orbital , CSF , and other masses and real substances 2 ) The expansion of oro - naso - pharygeal and other functioning spaces

Use of the Functional Matrix in the therapy of orthodontics , dentofacial orthopedics , and orthognathic and craniofacial surgery
------------> Skeletal Unit

1 . Orthodontics l Matrix

[Alveo

2 . Dentofacial Orthopedics and Orthognathic Surgery psular Matrix -------------> Multiple Skeletal U [Functional Appliances] [Jaw Bon

psular Matrix -------------> [Distraction osteogensis: e.g., hemifacial microsomia]

Multiple Skeletal U [Jaw Bones]

3 . Craniofacial surgery Capsular Matrix -------------> [Craniotomy: e.g. Crouzon Syndrome] [Distraction osteogensis: e.g., Treacher Collin Syndrome]

Multiple Skeletal [cranial bones [facial and jaw bones]

Craniofacial bones
Lamellar

bone Non lamellar bone Fine cancellous bone Coarse cancellous bone Woven bone Bundle bone Composite bone

Non Lamellar bone

Makes No

up fine cancellous bone tissue

distinct stratification in fibre orientation

Woven bone
Type

of non lamellar bone Weak , disorganised, poorly mineralised Not found in adult human skeleton under normal conditions First bone formed in response to orthodontic loading.

Bundle bone
Present

adjacent to periodontal ligament Presence of perpendicular striations called sharpeys fibres. Formed on depository side of socket, laid dowm in the direction toward the moving tooth root.

Composite bone
Predominant

bone type during early retention phase Most rapid means of producing strong bone Formed by deposition of lamellar bone within a woven bone lattice.

Fine cancellous bone tissue

Formed

by periosteum and endosteum Marrow spaces are fine It is located in cortex e.g. posterior border of a growing ramus in a child Fastest growing of all bone types

Cranial Base
Reasonably

stable reference structure in cephalometric analysis Basis to compare and understand abnormal growth patterns

ANATOMY

ANTERIOR CRANIAL FOSSA MIDDLE CRANIAL FOSSA POSTERIOR CRANIAL FOSSA

Synchondrosis and cranial base

Centers of ossification appear early in embryonic life

in the chondrocranium, indicating the eventual location of the basioccipital, sphenoid and ethmoid bones that form the cranial base. As ossification proceeds, bands of cartilagec alled synchondroses remain between the centers of ossification

Types
Synchondrosis between the sphenoid and occipital bones,

spheno - occipital synchondrosis, The intersphenoid synchondrosis between two parts of the sphenoid bone, and the spheno - ethmoidal synchondrosis, between the sphenoid and ethmoid bone