The primary role of functional

matrices in facial growth

Melvin 1. Moss, D.D.S., Ph.D., and Letty Salentijn, D.D.S.
New York, N. P.

During the past decade the method of functional cranial analysis

has been developed in our laboratory. The basic postulates and the experimental
and clinical supporting data have been published extensively elsewhere.4-“Y The
orthodontic specialty recently became aware of this analytical technique, with
particular interest being expressed in the derivat,i\-e concept of the Jurrctionul
matrix. In view of the current reappraisal of the theories of cranial bone growth
by many workers (Scott3” and EnlowZA), it is appropriate to indicate the
contribution which the analytical method makes toward the resolution of
this problem. The present review first defines the two basic types of functional
matrices (periosteal and capsular) and then demonstrat.es their differing and
yet complementary roles as the primary morphogenetic agencies in skeletal
tissue growth.
Functional cranial analysis

A brief review of basic postulates is necessary. Operationally, the head is a

region within which certain functions occur. Every function is completely
carried out by a functional cranial conaponed. Each such component, in turn,
is composed of two parts: (1) a functional matrix which actually carries out the
function and (2) a skeletal unit whose biomechanical role it is to protect, and/or
support its specific functional matrix. Abundant data demonstrate that all
growth changes in the size, shape, and spatial position and, indeed, the very
maintenance in being, of all skeletal units are always secondary to temporally
primary changes in their specific functional matrices. To clarify this seemingly
sweeping statement, it is necessary to define t,he terms skeletal unit and func-
tional matrix in greater detail.
From the Division of Oral Biology, School of Dental and Oral Surgery, and the
Department of Anatomy, College of Physicians and Surgeons, Columbia University.
This study was aided, in part, by a research grant (NB-00965) from the National
Institute of Neurological Diseases, National Institutes of Health.

566
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Punctiomd matrices in facial growth 567

Skeletal units may be composed variably of bone, cartilage, or tendinous

tissues. They are not the equivalents of the “bones” of formal, classic osteology.
When such a “bone” consists of a number of skeletal units, we call them micro-
skeletal units; that is, both the maxilla and the mandible arc formed of a number
of such contiguous microskeletal units. When adjoining portions of a number
of neighboring “bones” are united to function as a single cranial component,
we term this a macroskeletal unit; the cndocranial surface of the calvaria is an
example.
In the mandible we distinguish easily a coronoid microskclctal unit related
to the functional demands of the temporalis muscle; an angular microskelet,al
unit related to the activity of both the masseter and medial pterygoid muscles;
an alveolar unit related to the presence and position of teeth; and a basal micro-
skeletal unit related to the inferior alveolar neurovascular triad matrix Thcrc
are other mandibular microskeletal units which have been detailed elsewhcre?~ I4
To a variable extent, contiguous microskeletal units are independent of each
other. This implies that changes in the size, shape, or position of the coronoid
process as a result of primary changes in temporalis muscle are relatively
independent of such changes in other mandibular microskeletal units.
The term functionaZ ma,t,rix is by no means equivalent to what is commonly
understood as “soft tissues,” this is, muscles, glands, nerves, vessels, fat, etc.,
although all of these are obviously included within the concept. Teeth are also
a functional matrix, as the experience of every dentist can attest empirically.
Indeed, most orthodontic therapy is based firmly on the fact that when this
functional matrix grows or is moved, the related skeletal unit (the alveolar
bone) responds appropriately to this morphogenetically primary demand. IIow-
cvcr, the term functional matrix is more inclusive still. There exists a further
group of matrices among which the functioning spaces of the oronasopharyngcal
cavities figure importantly.
Work in our laboratory increasingly indicates a fundamental diffcrcncc
between two basic types of functional matrix. Their designation as periosteul
and capsular most clearly indicates the sites of their activity. The differentiation
between these two t,ypes of functional matrix must be made before we intcgratc
their activities into a comprehensive picture of facial bone growth.

Periosteal matrices

The functional cranial component, consisting of the temporalis muscle and

the coronoid process, is an excellent case in point. This process first arises
within the earlier formed anlage of the temporalis muscle whose contractile
abilities are well developed in prenatal stages. Its subsequent growth also occurs
within this muscular matrix. The fibrous noncontractile portion of the temporalis
muscle is attached to the coronoid process in a variable manner-indirectly to
the outer fibrous layer of the periosteum for the most part and, to a slight
degree, by insertion into skeletal tissue itself, chiefly at a relatively late post-
natal age. There exist considerable mutually confirmatory data showing that
experimental removal of the mammalian temporalis muscle, or its denervation,
experimentally, postinfectively, or posttraumatically, invariably results in an
568 Moss and Salentijn Am. J. Orthodontics
Juae 1969

actual diminution omf coronoid process size and shape or, indeed, in its total
disappearance (Fig. 1). Similarly, it is well established that functional hyper-
trophy or hyperactivity of the temporalis muscle is productive of increased
coronoid process size and also alteration of its shape. F’inally, it is cst,ablished
also that experimental or clinical alteration of the muscles attaching to the
other mandibular ramal skeletal units can produce compensatory changes in
temporalis muscle function. This will equally well change the size and shape of
the coronoid process in proportion to the degree of muscular imbalance produced.
The fundamental point is clear. The coronoid process does not grow first and
thus provide a “platform” upon which the temporalis muscle can then alter
its functions. Quite the opposite. The total gro’wth changes in all aspects of
coronoid process form (size and shape) are at all times a direct and compensatory
response to the morphogenetically and temporally prior demands of the
temporalis muscle function. All responses of the osseous portions of skeletal units
to periosteal matrices are brought about by the complementary and interrelated
process of osseous deposition and resorption. The resultant effect of all such
skeletal unit responses to pe,riosteal matrices is to alter their size a?ld/or thei?
shape.
It is understood that there is no rigid correlation between the force of
tension or shear placed upon the periosteum by muscular contraction and either
osseous deposition or resorption. 3 While muscles are excellent examples of

Fig. 1. The dependence of the coronoid process (skeletal unit) upon the demands of its
functional matrix (temporalis muscle) is shown in these alterations in size and shape
following unilateral muscle resection. (After Schumacher and Dokladal: Acta anat.
69:378-392, 1968.)
 Functional matrices in facial growth 569

periosteal functional matrices, they do not comprise this entire category. Blood
vessels, nerves, and glands product morphologic changes in their related skeletal
units in a completely homologous manner; the changes of related osseous tissue
size and shape are brought about by the deposition and resorption of bone tissue.
Further, all of these changes are direct responses to temporally and morpho-
genetically prior changes in their specific functional matrices.
These same effects can also serve to alter the relative proportions between
the contiguous skeletal units found within one of the “bones” of formal
osteology. In this manner, the changes of the size and shape of the human
mandible, in the formal osteologic sense, can be comprehended in a general way.
The net backward displacement (or repositioning) of the several contiguous
microskeletal units forming the ramus during growth is a good example of such
an alteration. The correct interpretation of this net morphologic effect is a very
critical matter. If it is believed that the changes in size and/or shape brought
about by deposition and resorption of bone tissue constitute the entire
phenomenon of growth, then one is forced to the logical (but erroneous)
conclusion that the change in horizontal position of the mandibular ramus dur-
ing growth is produced entirely as a result of such direct microskeletal unit
tissue responses to periosteal matrices, be these tissues osseous or cartilaginous.
Such is not the case, however. Clarification of this point requires us to employ
a more comprehensive definition of growth-one that includes spatial h-a&a&n

Fig. 2. The neurocranial and orofacial capsular matrices are shown. The neural capsular
matrix consists of the entire neural mass, including the dura mater, while the orofacial
capsular matrix consists of these functioning spaces. In both cases the skeletal units exist
completely within their respective capsules.
570 Moss and Xalentijn Am. J. Orthodontics
June 1969

of bones in addition to the undoubtedchanges in their size and shape which

can often occur simultaneously.

Capsular matrices

All skeletal units, and thus all bones in the formal sense, arise, exist, grow,
are maintained, and respond morphologically while totally embedded within
their functional periosteal matrices. At the same time, all these functional
cranial components (functional matrices plus skeletal units) are organized in
the form of cranial capsules.
We prefer at this time to consider only two cranial capsules : the neurocranial
and the orofacial. Each of these capsules is an envelope which contains a series
of functional cranial components (skeletal units plus their related functional
matrices) which, as a whole, are sandwiched in between two covering layers. In
the neurocranial capsule these covers consist of the skin and the aura mater,
whereas in the orofacial capsule the skin and mucosa form these limiting layers.
All spaces intervening between functional components themselves, and between
them and the limits of the capsule, are filled with indifferent loose connective
tissue.
Each capsule surrounds and protects a capsular functional matrix-in one
case, the neural mass which consists of the brain plus leptomeninges and, most
important, cerebrospinal fluid; in the second case, the oronasopharyngeal func-
tioning spaces. The common factor in both cases is that the capsular matrices
exist as vdumes (Fig. 2).

Neurocranial capsule

In the case of the neural skull, it is quite easy to visualize t,he calrarial
bones as lying within a neurocranial capsule. The composition of this capsule
in the adult is easily stated; these are the so-called l‘five layers” of the scalp,
then the bone itself, and, finally, the two-layer aura mater. Parenthetically, the
ealvarial bones consist of a number of contiguous skeletal units: outer table,
inner table, diploic space (and variably sinuses). Each of these microskeletal
units obviously has its specific periosteal matrix, muscles and vessels being good
examples.
In the ncurocranium we are dealing with a volume of neural mass. It has
been demonstrated repeatedly that it makes little difference whether or not this
neural mass contains a “normal” amount of brain tissue. It is the total neural
mass volume which is morphogenetically significant,. Second, the expansion of
this enclosed and protected capsular matrix volume is the primary event in the
expansion of the neurocranial capsule. The response of the capsule, as a whole,
is to expand in a compensatory manner. All of the included and enclosed func-
tional cranial components, that is, the periosteal matrices and their microskeletal
units, are then obligatorily carried outward within the capsule in a tot.ally
passive manner. The calvarial functional cranial components, as a whole, are
passively and secondarily translated in space. It is extremely important to note
here that such translations occur without the necessity of involving the processes
of selective periosteal apposition and resorption. Admittedly, in “normal”
 Functional matrices in facial growth 571

growth it is difficult to determine this point by superficial analysis, since the

activity of periosteal matrices on their respective microskeletal units goes 011
simultaneously (Fig. 3). It is only when we examine these pathologic, or
experimentally produced, situations in which pcriosteal matrices have been
prevented from exerting their morphogenetic activity that we can observe
clearly the passive, nonperiosteal, translative growth produced by the capsular
matrices. In the neurocranium, hydrocephaly is such a condition. The expansion
of the neurocranial capsule is always proportional to the increase in neural
mass. But this same increase in intracranial pressure effectively obliterates
vascular flow within the capsule and so prevents periosteal accretion of bone
at sutural areas, thus producin, 0’ the characteristic excessively large fontanelles
and other sutural dehiscences. Similarly inhibited is the growth of periosteal
matrices which normally produce the increasing differentiation of the inner
and outer tables and of the diploic space.

TM..

Diploe
Fig. 3. The expansion of the neurocranial capsule in response to the morphogenetically
primary expansion of the enclosed neural mass. As this capsule expands, the enclosed
and embedded calvarial skeletal tissues are passively translated in space in response to
the growth of this capsular matrix. At the same time, these same skeletal units respond
to the altered demands of their functional periosteal matrices. They do so by expanding
in area and in thickness, by altering from a simple system of open, radiating trabeculae
to one with inner and outer tables of compact bone with an intervening diploic area.
If simple translation occurred alone, the figure on the right would result. It is explicitly
stated that the amount and regions of periosteal growth are diagrammatic only. The
simultaneous delamination of the neurocranial capsule is also seen. From a simple dura
mater/epidermis in the early fetus, we see the full expansion of such changes in the
adult. S, Skin; C, dense connective tissue layer; A, aponeurotic layer; 1, loose connective
tissue layer; P, periosteum. [All five of these layers form the scalp.) T.M., Temporalis
muscle; P.L.D.M., periosteal layer of dura mater; F.L.D.M., fibrous layer of dura mater;
S.S., sagittal suture.
572 ilIoss and Xalentijn Am. J. O~thodomtics
June 1969

The point is simple. The neural skull does not grow first and thus provide
swcc for the secondary expansion of the neural mass. Rather, the expansion
of the neural mass is the primary event which causes the secondary and
compensatory growth of the neural skull.

Orofacial matrices

All functional cranial components of the facial skull arise, grow, and are
maintained within an orofacial (splanchnocranial) capsule, This capsule SUP-
rounds and protects the oronasopharyngeal functioning spaces. It is the volu-
metric growth of these spaces which is the primary morphogenetic event in
facial skull growth.
These three functioning spaces, or rather the unitary space they form, are
not volumes haphazardly “left over, ” as it were, when facial “bones, ” muscles,
glands, vessels, and nerves finish their growth. The functional reality of the
respiratory and digestive systems is their patency, and the volume of that
patency is related to the genera1 metabolic demands of the body as a whole.
The oronasopharyngeal functioning space is particularly related to the relatively
dominant cranial respiratory functional space volume. This conception of
the morphologic and functional primacy of functioning spaces receives strong
support from the independently developed work of Bosma.
The oral and pharyngeal “regions” arc said to have a primary function
in maintaining a patent airway. This is accomplished by a dynamic musculo-
skeletal postural balance which is termed the “airway-maintenance mechanism. ”
Ontogenetically, Bosmal believes that “a recent concept is the development
of head and neck posture about this pharyngeal airway” and that the related
functional cranial components are so dynamically balanced that this airway
is maintained throughout the range of motion of the head and neck. The
morphogenetic primacy of this capsular matrix is indicated as follows: “Post-
natal development of the tongue is also intcgra.lly related to the acquisition of
an open masticatory cavity. Teleologically speaking, it is this expansion of
nvailable performance area which makes the anteriorward elongation and
greater motility of the tongue feasible and possible.“2
It is significant to note that both the neural and orofacial functioning
spaces originate by the process of enclosure. The orofacial capsular matrix
comes into being in those embryonic stages during which the several facial
processes (medial and laterial nasal, mandibular, and maxillary) arise. The
probably genetically controlled interstitia,l growth of their underlying mesoderm
(ectomesenchyme) causes the several enlargements, swellings, and movements
so well described in recent textbooks on embryology. In a very real sense, this
growth of the primordial capsule actually forms the oronasal functioning space.
Originally, the presumptive oronasal space had no more than a stomodeal
membrane to mark its future point of junction with the pharyngeal space
developing caudally to this membrane. Rupture of the stomodeal membrane
joins the endodermally enclosed pharyngcal space to the common oronasal
volume. The formation of first the primitive and then the secondary palate
serves only to subdivide the nasal and oral portions of this same facial
Volume
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Punctiod matrices in facial growth 573

functioning space. Once formed, all subsequent fetal and postnatal orofacial
capsular growth now is a response to the volumetric increase of this same space.

Mandibular growth

Let us return to mandibular growth for a demonstration of the integrated

activity of periosteal and capsular matrices in facial growth. It is now
established beyond doubt that the mandibular condylar cartilages are not
primary sites of mandibular growth. They are the loci at which secondary,
compensatory periosteal growth occurs. (See Moss and Rankow2’ for a recent
review.) The bilateral removal of mandibular condylar cartilages in growing
experimental animals, as in man, does not inhibit either the spatial translation
of the now acondylar complex of contiguous mandibular functional cranial
components; nor does it inhibit the changes in the form of their microskelctal
units as their individual matrices alter their functional demands. Admittedly,
the condylar skeletal unit ceases to exist, and we may expect certain skeletally
reflected compensatory changes in other contiguous mandibular cranial com-
ponents due to the loss of lateral pterygoid activity, but that is all. An
interesting example of this is shown in Fig. 4. The critical point is easy to
state. If there are no condylar processes, how does the “mandible” (as a whole)

-.- 3/61
---m-v z/66
- 4168
Fig. 4. Mandibular growth of a patient subsequent to complete bilateral condylectomy.
The motion of the mandible, in three planes of space, has been achieved by the growth
processes: translation in response to capsular matrix growth and transformation of size
and shape in response to intact, noncondylar, periosteal matrices. (An earlier figure is
illustrated in Moss and Rankow.27)
Fig. 5. A, Interosseous growth of the mandible is shown by registration of two tracings
taken from a longitudinal growth study. The mental and mandibular foramina, as well
as the course of the interior alveolar canal, are shown. The totality of the growth changes
shown here is the sum of the skeletal unit responses to both periosteal and capsular
matrices. B, lntraosseous growth of the same mandible is shown when the two tracings are
registered at the mental foramina when the anterior cranial base tracings are kept
parallel. C, When the tracings of A and B are superimposed, this figure is produced.
The two mandibular outlines with solid lines are the two positions of the earlier
tracing; the outline with a broken line is the oldest tracing. It is now seen that the greatest
portion of the growth changes in a downward and forward direction are due to passive
translation in response to the expansion of the orofacial functioning spaces. Periosteal
appositions [plus signs) and resorption [in black) account for relatively minor changes
in the anterior and lower borders, while being totally responsible for the backward and
upward motion of the condylar and angular processes. It is seen that B, the in-
traosseous drawing, in fact showed all of the periosteal growth changes. It is stressed
that the upward periosteal growth at the condylar process is a compensation for the
downward and forward translation of the mandible, and not its course.
 Functional matrices in facial growth 575

alter its spatial position? No combination of periosteal growth changes of

microskeletal unit form (size and shape) is capable of explaining this. It is
only by considering that the orofacial capsule expands in response to the
morphogenctically prior volumetric expansion of the orofacial functioning
spaces that we can comprehend the observed translation in space. On the other
hand, we must be equally aware that this passive translation did not, of
itself, cause the coronoid, a.ngular, or alveolar microskeletal units to alter their
form.
Mandibular growth (as well as neurocrunial growth) is seen now to be a
combination of the morphologic cfects of both capsular and periosteal matrices.
The capsular matrix growth causes an expansion of the capsule as a whole. The
enclosed and embedded macroskeletal unit (the “mandible” as a whole),
accordingly, is passively and secondarily tradtrted in space to successively
new positions. In normal conditions the periosteal matrices related to the
constituent mandibular microskeletal units also respond to this volumetric
expansion. Such an alteration in their spatial position inevitably causes them
to grow; that is, causes changes in their functional demands. These now call
forth direct alterations in the size alzd shape of their microskcletal units. The
sum of translatio~z plus changes in form comprises the totality of mandibular
growth.
Two points are implicit: (1) If the periosteal matrices are not capable
of functioning normally, their specifically related skeletal units will alter their
spatial position (that is, be translated) without undergoing consequent changes
in their size and shape and (2) such changes in size and shape, of themselves,
are insufficient biologic causes of translation. It is only when we conceptually
combine the effects of both capsular and periosteal matrices, of growth changes
in both position and form of the skeletal units, that we begin to comprehend
the phenomenon of facial growth totally.
Recent work in our laboratory indicates that it is possible to begin t(J
depict separately the effects of the two types of growt,h processes in the human
mandible. Although this work will bc published in detail elsewhere, Fig. 5
gives a good indication of the direction of our thought at present. In the upper
figure WC register two longitudinal growth study mandibular tracings on the
out.linc of the anterior cranial base. The difference in both mandibular position
and form is t,he sum of the effects of both periosteal and capsular matrices. Wc
term this a demonstration of interosseous growth. For reasons to be described
elsewhere, registration of the two mandibular tracings on the mental foramen
(the middle figure) shows what we now term intraosseous growth.25 In the
lower figure we register the tracings of both inter- and intraosseous growth
on the outline of the chronologically oldest outline. When this is done, we
observe two positions of the earliest outline. The vertical and anteroposterior
difference between these two earlier tracings is the result of capsular growth,
that is, of spatial translation. The difference between the lowermost of these
younger tracings and the oldest tracing is the result of t,he changes in form
brought about by the activity of periosteal mat,rices, that is, by deposition
and resorption of bone tissue.
576 Moss and Xalentijn Am. J. Orthodontics
June 1969

Summary

A brief review of the fundamental postulates of the method of functional

cranial analysis is given, with particular emphasis on the definition of the
functional matrix. Two basic types of such matrices-periosteal and capsular-
are tlescribrti. Pcriosteal matrices include muscles and teeth, while the capsular
mat,rices arc conceived of as volumes clnclosed and protected by both the neuro-
cranial and the orofacial capsules. In the neural skull the capsular matrix is the
neural mass. In the facial skull this matrix is the functioning space of the
oronasopharyngral cavity.
We note the following differences between the activity of periosteal and
capsular functional matrices. Periosteal matrices act upon skeletal units in a
direct fashion by the processes of osseous deposition and resorption (or of
cartilaginous or fibrous tissue multiplication. Their net effect is to alter the
form (size and shape) of their respective skeletal units. Capsular matrices
act upon functional cranial components as a whole in a secondary and indirect
manner. They do so by alterin g the volume of the capsules mit.hin which the
functional cranial components are embedded. The effect of such growth changes
is to cause a passive translation of these cranial components in space.
Cranial growth is a combination of the morphogenetically primary activity
of both types of matrix. Growth is accomplished by both spatial translation
and charges in form.

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