GROWTH AND DEVELOPMENT

OF MAXILLA AND MANDIBLE

Dr.k.Spandana

1st year postgraduate

Contents
 Introduction

 Importance of maxilla and mandible

 Prenatal craniofacial growth

 Brachial arches

 Meckel’s cartilage

 Embryology of face (maxilla, palate and mandible)

 Growth and development definitions

 Growth movement

Post-natal development of maxilla and palate

 Postnatal development of mandible

 Applied anatomy
MAXILLA
 The maxilla forms the upper jaw by fusing together two irregularly-
shaped bones along the median palatine suture, located at the midline
of the roof of the mouth.

 The maxillary bones on each side join in the middle at the intermaxillary
suture, a fused line that is created by the union of the right and left
‘halves’ of the maxilla bone, thus running down the middle of the upper
jaw.
 The bones help to form the upper jaw, sub-segments of the eye sockets,
and the lower sections and sides of the nasal cavity. Additionally, they
reduce the heaviness of the skull, help support the back teeth, and help
to allow the voice to resonate.
 Each half of the fused bones contains four processes. These include the
zygomatic, frontal, palatine, and alveolar processes of the maxilla.


  They also contain the infraorbital foramen, an opening in the bone just
below the eye sockets, and the maxillary sinus, which helps to protect
important facial structures during an accidental trauma, like the crumple
zone of a car

INCISIVE FORAMEN MAXILLARY SINUS

INFRAORBITAL FORAMEN

Importance of maxilla
 Houses the teeth
 Forms the roof of the oral cavity
 Forms the floor of and contributes to the lateral wall and roof of the
nasal cavity
  Houses the maxillary sinus
 Contributes to the inferior rim and floor of the orbit.

MANDIBLE
 Mandible is a unique bone both by its structure and function. lt is a
horse shoe shaped bone with vertical ramus at the end of the
horseshoe. It houses the only movable joint of the skull at both its ends.
Mandible has a corpus, two ramii, two coronoid and two condylar
processes. lt holds the lower set of teeth in its alveolar process by means
of gomphosis.

Importance of mandible
Mandible plays an important role in vital functions:
 Aesthetics,
 Speech
 Respiration
 Mastication
 Deglutition
 Facial expressions
PRENATAL CRANIOFACIAL GROWTH
Human life starts with the fertilization of ovum by spermatozoa in the fallopian
tube of the female reproductive system. It is a cascade of events with a highly
complex phenomenon with three distinct stages :-
1. Period of ovum : Conception to 7-8 days of intrauterine life
2. Period of embryo: 2nd to 8th week IUL
3. period of foetus : 3rd -10th lunar month.

1. Period of ovum:
 It is from the fertilization of oocyte by sperm which results in formation
of zygote which further divides in to blastomere by process of mitosis
after that morula will be formed. Finally with a blastocystic cavity it
implants in uterine endometrium.
 Primarily cleavage of ovum and attachment to uterine wall with length of
1.5 mm will takes place.

2. Period of embryo:
2nd to 8th week IUL This period can be further divided into the following three
stages: -
a. Presomite 8-20 days
b. Somite 21-31 days;
c. Post somite 4th-8th week

a. Presomite period
It is the period of formation of the fetal membranes, amnion and
chorion, that provides nutritional supply to the developing embryo and
the formation of primary germ layers.
b. Somite period is the period of organogenesis from 21st to 31st dav of
IUL. Anomalies in development would occur in this period.
 i. The visceral organs differentiate from mesoderm and
endoderm. Embryo little more than 3 mm. head begins to
take shape
ii. About the 4th week of I.U.L. developing brain and
pericardium form two prominent bulges on ventral aspect,
separated by primitive oral cavity or stomodeum
iii. Pharyngeal arches laid down on ventral and lateral aspect of
foregut initially 6 in number. Separated by a pouch with in
pharynx and a cleft on outside. Later 5th arch will disappear.
iv. Each arch consists of nerve, artery and cartilage
 c. In the post somite period, the organs and systems formed during the
somite period increase in size and the external body form is
established.

MECKELS CARTILAGE
• The 1st pharyngeal arch is the mandibular arch which contains the
Meckel’s Cartilage. It appears at about 6th week of I.U. life. Provides a
Template for subsequent development of the mandible.
• The Meckel’s cartilage is a lower jaw in primitive vertebrates. In
humans no contribution to the development it only has a positional
relationship

• At 6th week, a solid cartilaginous rod surrounded by a fibro cellular

capsule extends from the developing ear region to the midline. The
two cartilages from each side don’t meet in the midline but are
separated by a thin band of mesenchyme
• These cartilages form the cartilaginous bar of the mandibular arch
and are two in number, a right and a left.
• Meckel’s cartilage has a close, relationship to the mandibular nerve,
at the junction between posterior and middle thirds, where the
mandibular nerve divides into the lingual and inferior dental nerve.
• On the lateral aspect of the Meckel's cartilage, condensation of the
mesenchyme takes place at the angle formed by the inferior alveolar
nerve and the incisal and the mental branches.

• At 7 weeks intra membranous ossification begins at the site of

condensation forming the first bone of the mandible.
• From this point the bone formation spreads anteriorly to the midline
and posteriorly to the point where the mandibular nerve divides in to
the inferior alveolar and the lingual branches.
• These new bone forms a trough that consists of lateral and medial
plates that unite below the incisor nerve. This trough extends to the
midline and comes in close approximation with the similar trough of
the opposite side
• These two ossification centers remain separated at the symphysis
region until shortly after birth. Backward extension of ossification
along lateral aspects of the Meckel’ s cartilage forms a gutter later
covered into a canal that contains the inferior alveolar nerve.
 • The ramus of mandible develops by a rapid spread of ossification
posteriorly into the mesenchyme of the first arch, turning away from
Meckel’s cartilage. This point of divergence is marked by the lingula
in the adult mandible.

Remnants of Meckel’s cartilage:-

 Posterior most part becomes - Malleus of the inner ear and
sphenomalleolar ligament
 From the sphenoid to the lingula the Meckel's cartilage is lost
completely but the fibro cellular capsule persists as the
sphenomandibular ligament
 From the lingula till the division of the alveolar nerve into incisor and
mental branches the Meckel's cartilage resorbs completely

SECONDARY CARTILAGE
• Appears between 10th & week of I.U. life.
• Forms the 14thhead of condyle, part of coronoid process & mental
protuberances.

DEVELOPMENT OF FACE
• About 4th week of IUL that is in Somite period formation of head fold
with the developing brain and pericardium which forms 2 prominent
buldging on the ventral aspect of the embryo. These buldging are
separated by stomatodeum. The floor of stomatodaeum is formed by
the buccopharyngeal membrane, which separates it from the foregut.
• Mesoderm covering the developing forebrain proliferates and forms a
downward projection that overlaps the upper part of the
stomatodaeum. This downward projection is called frontonasal
process

• Pharyngeal arches are laid down in the lateral and ventral walls of the
most cranial part of the foregut.
• Mandibular arch that is the first pharyngeal arch forms the lateral wall
of the stomatodaeum. This arch gives off a bud from its dorsal end.
This is called as maxillary process. It grows ventrally-medially cranial
to the main part of the arch which is called as mandibular process.

• Ectoderm overlying the frontonasal process sows bilateral localized

thickening, above the stomatodaeum these are called as nasal
placodes. this sinks below the surface to form nasal pits. This pits will
be continuous with the stomatodaeum below and edges will raise
above the surface. Medial raised edge is called as medial nasal
process, lateral raised edge is called as lateral nasal process.
• THE mandibular process of the 2 sides grow towards each other and
fuse in the midline, they form the lower margin of the stomatodaeum.
So, this mandibular process gives raise to lower lip and lower jaw.
DEVELOPMENT OF PALATE

 From each maxillary process a plate like shelf grows medially this is
called palatal process. Palate will be formed from 2 palatal processes
and primitive palate formed from frontonasal process.
 Each palatal process fuses with the posterior margin of the primitive
palate
 The two palatal processes fuse with each other in the midline. Their
fusion begins anteriorly and proceeds backwards.
 The medial edges of the palatal processes fuse with the free lower edge
of the nasal septum, thus separating two nasal cavities from each other
and from mouth.
 Mesoderm in the palate undergoes intramembranous ossification to
form hardpalate to some extent remaining remains as softpalate
 The part of the palate derived from frontonasal process forms premaxilla

Reasons for the transformation from vertical to horizontal position of palate:

o Alteration in blood supply to palatal shelves
o Alteration in biochemical and physical consistency of connective tissue
of palatal shelves
o Rapid differential mitotic activity
o Appearance of an intrinsic shelf force
 o Withdrawal of embryonic face from against the heart prominence results
in slight jaw opening
o Muscular movements

DEFINITIONS OF GROWTH
As is the nature of growth, wherein the concepts keep changing with new
research findings, there has been no single definition associated with it.
Different researchers have defined growth in various ways
• TODD - 'growth is an increase in size;
• MOYER - Quantitative aspect of biologic development per unit of
time
• JX HUXLEY- The self multiplication of living substance
• KROGMAN- Increase in size, change in proportion and progressive
complexity
• MOSS- Change in any morphological parameter which is measurable

DEFINITIONS OF DEVELOPMENT
 TODD - Development means progress towards maturity.
 MOYERS- All the 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 in death.
Where as growth can be divided in to
 Interstitial :- multiplication of cells through out substance of tissue ,
increase in the intercellular material , tissue expands equally in all
directions and its shape is maintained
 Appositional growth :- Deposition of more bone on its surface at its ends
GROWTH MOVEMENT

1. Drift and displacement

2. V Principle
3. Surface principle
4. Posterior growth and anterior displacement
 DRIFT

 Drift is growth movement of an enlarging portion of a bone by the

remodelling action of its osteogenic tissues. It is a process of cortical
drift.

(A) Cortical plate of bone

(B) increase in thickness due to apposition on one of the surfaces
(C) When the resorption process on one side of the bone exceeds the
apposition process on the opposing side, the thickness of the bone will be
reduced
(D) When resorption on one side of the bone corresponds in magnitude to
apposition of the opposing side the bone will drift without changing its size.
(E) The cortical plate has drifted completely to the right when compared
to its original position in 'a’ by the process of remodelling.

DISPLACEMENT
Displacement is a physical movement of a whole bone. It is caused by
surrounding physical forces. This is of 2 types
 Primary displacement: As a bone enlarges, it is simultaneously
carried away from the other bones in direct contact with it. This
creates space within which bony enlargement take's place This is
termed as primary displacement. The bone grows and remodels by
resorption and apposition
 Secondary displacement: It is the movement of a whole bone
caused by the separate enlargement other bones, near to it. For
example, qrowth in the middle cranial fossa results in the
movement of the maxillary complex anteriorly and inferiorly.
V PRICIPLE
• The V principle is an important facial skeleton growth mechanism. since
many facial and cranial bones have 'V configuration or’ V' shaped regions
T bone deposition on the inner side, Resorption takes place on the
external surface of the 'V'.
• The V' moves away from its tip and enlarges simultaneously Thus an
increase in size and growth movement takes place in a unified process.
Hence it is also called expanding 'V' principle The movement of the bone
is towards the broad end of the V.

SURFACE PRICIPLE
• The surface principle states that bone sides which face the direction of the
growth are subject to deposition and those opposed to it undergo
resorption. These processes always take place on contralateral bone
surface so that the cortical plate follows the course of growth.
POSTERIOR GROWTH AND ANTERIOR DISPLACEMENT
• The overall growth pattern of maxilla and mandible can explain in 2
different ways. If cranium is considered as the reference area the maxilla
and mandible moves downward and forward
• On the contrary, findings from vital studies have shown particularly in the
mandible the posterior surface of the ramus, the condylar and coronoid
processes are the principal sites of growth with little changes along the
anterior pad of the mandible.
• This proves the concept that the jaw bones are translated downward and
farward while it grows upward and backward in response to the
translation. This helps to maintain spatial contact with the skull.
• When bone grows posteriorly anterior trust develops which displaces
bone anteriorly this is explained with an example that when swimming
due to posterior force reflex man is pushed anteriorly.
POSTNATAL GROWTH
• Study of the postnatal growth of the craniofacial skeleton is very
interesting because the remodeling pattern of the face is highly
programmed selective and specific.
• Cephalocaudal gradient of growth is also seen in the face. cranial vault
completes growth earlier than the base.
• Similarly maxilla completes early, but mandible though completing
growth late, has better potential for growth modification.
• Human facial skeleton is unique: craniofacium is formed of 22 bones 8
cranial and 14 facial bones inclusive of the mandible. An infants face is
almost round, the length and width of the face are equal and cranium :
face ratio is about 1:8.
• Research of postnatal growth of face has been made systematic by
studying the face regionally. Craniofacial skeleton can be divided into
cranial and facial skeleton. cranium in turn can be divided into cranial
vault and cranial base while the facial skeleton can be studied under the
nasomaxillary complex, mandible, and the temporomandibular joint.
POSTNATAL GROWTH OF MAXILLA
1. Displacement
2. Surface remodelling
3. Growth at sutures

Displacement
 During bone growth by primary displacement the entire bone is
relocated to a new position but resorbed at the surface in the direction
of growth (i.e. seen esp. in anterior surface for maxilla). There is bone
apposition at the posterior end to maintain contact with adjacent bone.
 This is explained by Enlow in which a man is pulling a cart with a brick
wall on it. As the cart is moved forward, the surface of the brick wall is
destroyed in the direction of movement and constructed in the opposite
direction.
Growth at sutures
• Maxilla cannot be considered as a separate bone instead its growth is best
studied taken into account the whole nasomaxillary complex or midface.
lt is a complex system of sutures through which all the bones are in
contact. The sutures are zygomatico maxillary, zygomatico temporal.
zygomatico frontal frontomaxillary, nasomaxillary. frontonasal,
intermaxillary, etc.
• The nasomaxillary complex consists of zygomatic bone, maxilla (with
palate), nasal bone; part of frontal (orbital).
• These sutures are all oblique and more or less parallel allowing
downward and forward repositioning of maxilla

Surface remodelling:
a. Change in functional relationship
b. Change shape of bone
c. Increase in size
POST NATAL DEVELOPMENT OF MAXILLA

• Bone deposition is seen at the entire inner aspect of the maxillary arch
and at the tuberosity. At the anterior concave surface of maxilla, the
periosteal concavity from ANS to point A is depository and the on the
periosteal surface from point A to alveolar margin is resorptive The
reverse occurs in the endosteal side of cortex, upper hall resorptive and
lower half depository.
• As the maxillary dental arch is lengthened by deposition posteriorly at
the tuberosity, the lateral surface also undergoes deposition. The
lengthening of dental arch allows space for the eruption of all the
molars.

• The frontal process of maxilla and nasal bone that form the bridge of the
nose are depository in the anterior aspect. This facilitates farward
placement of the medial part of the face compared to the lateral aspect.
The medial rim of orbit is depository and the lateral rim is resorptive
that accentuates the condition. Pyriform rim is resorptive.
• Thus the remodelling pattern of maxilla is so complex that there is an
extensive variation in the anterior surface alone. Though the bridge of
the nose receives deposits in the anterior surface. The width of bridge
does not vary much with age. This aspect of the bridge is determined
early in life and there is no great change in the distance between the
inner canthus with growth
 • The maxillary sinus is depository on the medial surface and resorptive in
all the other surfaces .This is selective remodelling as a compensation for
The laterally expanding NASAL FOSSA.
• In Zygomatic bone, as already said maxilla displaces anteriorly due to
resorption in anterior surface ,due to this zygomatic bone shifts
posteriorly by resorption at anterior and medial surface, Deposition at
posterior and lateral surface. This expand the bone bilaterally so that
bizygomatic width increases with age. So that prominence of cheek
occurs as child grows and cheek bone becomes broad.

POSTNATAL DEVELOPMENT OF PALATE

 During postnatal growth the palate will show enormous change in both
size and shape. In newborn’s the palate is shallow and horseshoe shaped
dental arch with equal length and width.
 During growth the palate receives deposition at the roof. This occurs
with remodelling of face that is Nasal floor undergoes resorptive and
nasal roof will undergo depository. This can be explained with the
expanding v principle
 The depth of palate is increased by eruption of teeth which increases the
vertical height of alveolar bone.
 Increase in width can also be seen by apposition at intermaxillary suture
and midpalatine suture but it is very minimal. So, that because of
resorption of nasal floor the palatal roof receives deposition of bone.
POSTERIOR MAXILLARY PLANE
• The location of tuberosity is marked by the posterior limit of anterior
cranial base. This is called Posterior Maxillary PM plane.
• according to Enlows counterpart principle/principle of growth equivalents
• The position of posterior limit of anterior cranial base, maxillary
tuberosity and junction of corpus and ramus of mandible (lingual
tuberosity) are all on the PM plane at the end of growth.

POSTNATAL GROWTH AND DEVELOPMENT OF MANDIBLE

• Mandible, at birth is small, with short ramus. large gonial angle. and flat
mandibular fossa with no articular eminence. The condyles are at the
level of the occlusal plane.
• Growth of mandible occurs principally by growth at condyle. Superior
and posterior growth of condyle presses against glenoid fossa or cranial
base which provides an anterior trust to displace the lower jaw farward
with the concept of anterior displacement and posterior growth.
• Growth of mandible also can be due to growth at synchondrosis which
pushes face anteriorly and inferiorly leads to separation of maxilla and
mandible to provide enough interocclusal space.
Ramus growth
• According to Hunter, Corpus lengthening occurs by remodelling of ramus
by resorption at the anterior border of ramus and deposition at
posterior border of ramus. SO, that posterior border of ramus is shifted
to most posterior position and body of mandible is lengthened.
• But mandible growth cannot occures simply by ramus remodelling it
undergoes a rotational pattern of growth with arcial pattern. The acute
ramal angle of childhood uprights in adolescence and late adulthood.

Ramal uprighthning

• Till uprighting , there is deposition on posterior border and resorption on

anterior border but after uprighting there is selective resorption and
deposition is observed In anterior border superior portion is depository
and inferior portion is resorptive. In posterior border superior portion is
resorptive and inferior portion is depository.
  Ramus finally changes its angulation slightly by deposition in anterior
margin of coronoid process. By this vertical height of ramus also
increases. During this process breadth of ramus remains same.

Mandibular foramen
With remodelling of ramus, the mandibular foramen maintains its
position by deposition in anterior rim and resorption in posterior rim.
But maintains its position centrally in medial surface of ramus.

Coronoid growth
 Coronoid process as twisted form, the medial surface of process faces
posteriorly , superiorly, and lingually all at one time.
 Deposition on medial surface of coronoid occurs which leads to
lengthening of mandible and resorption on buccal surface of coronoid
 process. This is picture showing various stages of development of
coronoid process which are superimposed as in this growth in length and
increases in thickness due to deposition on medial surface.

Orientation:
There will be distinct difference in orientation between medial surface of
coronoid process and ramus because area below depository surface of
coronoid process is resorptive i.e. medial surface of ramus. Buccal surface
of ramus is depository.
Body of mandible
• Here outer surface is depository and medial surface inferior aspect is
resorptive and superior aspect is depository.
• where as when vewing medially deposition is in form of “ L ‘’ SHAPE ie
deposition on superior half of medial surface of corpus to anterior half of
medial surface of ramus below coronoid.

Chin
The remodelling pattern near chin accentuates the prominence of the
chin. Deposition on chin itself occurs .Area of anterior surface of alveolus
above chin is resorptive and lingual periosteum of symphysis is
depository.
Condylar growth
• As in condylar growth , cap of the condyle grows endochondral
ossification and the rest of the condyle grows by intramembranous
ossification.
• Condyle grows like a expanding v, deposition on inner aspect of v
resorption on outer surface of v.
• Neck of condyle is resorptive on both buccal and lingual surfaces ; with
deposition on condylar head.
• Inferior facing end of buccal surface and superior facing end of lingual
surface are depository due to this type of remodelling condyle neck
 looks like a tear drop in cross section. And finally the region which was
once condyle is replace with neck in remodelling process.
Lingual tuberosity
• It is an important site in mandible at junction of corpus and ramus
at the medial aspect. This appears to be in line with dental arch
when viewed from occlusal aspect where as ramus is slightly away
along the arms of expanding ‘ v’.
• The region below tuberosity is resorptive thereby accentuating the
prominence of tuberosity.

Alveolar process
• Alveolar process develops as a protective trough in response to
toothbuds , it growth increases height and thickness of the body of the
mandible.
• Alveolar bone fails to develop if teeth are absent and resorbs after tooth
extraction.
 APPLIED ANATOMY

AGE CHANGES IN MAXILLA

at birth:
• transverse and AP diameter are more than vertical diameter.
• frontal process is well marked.
• maxillary sinus is with small furrow on lateral wall of nose.
In adult:
• vertical diameter is greatest due to development of alveolar process and
increase in size of sinus.

In old age
• bone reverts to infantile condition.
• Its height is reduced with resorption of alveolar process.

AGE CHANGES IN MANDIBLE

Mandibular canal:
• INFANTS : Mandibular canal runs near lower border of mandible
• ADULTS : Runs parallel with mylohyoid line
 • OLD AGE : Mandibular canal runs close to alveolar border

Angle of ramus:
 The change in direction of mental foramen has clinical implication in
administration of L.A to a mental nerve
 In infants and children – the needle is placed at right angle to the body
of mandible to entre the mental foramen
 In adult – obliquely from behind
Mental foramen :
 LOCATION OF MENTAL FORAMEN changes its vertical relation with in
the body of the mandible from infancy to adult and then to old age.
 In adult it lies between two premolars, midway between upper and
lower borders of mandible where as in old age it appears in upper
border of thinned mandible.
Resorption pattern :
 Maxilla resorbs upward and inward to become progressively smaller
because of direction and inclination of roots of tooth and alveolar
process. Centripetal in maxilla
 Opposite is true for mandible which inclines outward and becomes
progressively wider. Centrifugal in mandible

ANAMOLIES IN MAXILLA:
 Primary palate Clefts : anterior to incisive Foramen - Results from
Failure of lataral palatine Processes to meet and fuse With primary
palate.
  secondary palate Clefts : posterior to incisive foramen, As fusion of
secondary palate begins at incisive papilla and proceeds posteriorly, The
degree of cleft may vary From simplest form of bifid uvula to a complete
cleft involving both hard and soft palate.
 Complete palatal clefts results from failure of growth or lack of fusion of
three palatine processes with each other and with the nasal septum.

BIFID UVULA

ANAMOLIES IN MANDIBLE:
1. In the condition of agnathia, the mandible may is absent, due to
deficiency of neural crest tissue in the lower part of the face.
2. , It is a condition in which lower half of one side of face is
underdeveloped Hemifacia microsomia and does not grow.
3. micrognathia it is a condition with jaw undersized, is characteristic of
several syndromes, including Pierre Robin and cat’s cry (cri du chat)
syndromes, Also due to defective neural crest production, migration, or
destruction may be responsible for the hypoplastic mandible .
4. Macrognathia, producing large prognathic jaw , an inherited condition,
it is associated with pituitary gigantism
5. Mandibular cleft is a rare congenital anomaly which is formed due
failure of fusion of 2 mandibular processes.

Agnathia Hemifacia microsomia

Micrognathia Maindibular cleft

 Macrognathia

REVIEW OF LITERATURE

 If implant placed early before complete growth Vertical growth of

anterior maxilla results in infraocclusion of an implant or leads to palatal
displacement
 When placed up to age of 9years transverse growth of maxilla results in
formation of diastema
 In mandible , comparatively less impact on implant position
 In Anterior mandibular area between mandibular foramen it has least
chances in change and most favarouble in cases of oligodontia and
anodontia. sagittal growth can results in change in implant inclination.
 In posterior mandible as a result of remodelling displacement of implant
in lingual direction can occurs

Gold standard
Two superimposed cephalometric films taken in 1 year a part showing
no changes
Considerations in Dental Implant Placement in the Young Patient Seminars in
Orthodontics, Vol19, No1(March), 2013: pp24-36
 knowledge of various pattern of facial growth and changes occures in
different areas with in maxilla and mandible arches.
  This allows the surgeon to know little in timing of implant placement and
for small adjustments in implant positioning to compensate for growth
future.
SKELETAL MATURITY INDICATORS
a. Hand and wrist radiographs,
b. Cervical vertebrae
c. Mid palatal suture
d. Corpus index
e. Tooth mineralization
REFERENCES
 Craniofacial development – Sperber.
 Contemporary orthodontics - Willliam R. proffit.
 Human embryology – 7thedition – Inderbir Singh.
 Text book of human anatomy-B.D Chaurasia.
 Textbook of craniofacial growth- Sridhar Premkumar.
 Orthodontics principles and practices –T.M Graber
 Considerations in Dental Implant Placement in the Young Patient
Seminars in Orthodontics, Vol19 ,No1(March), 2013:pp24-36