Good Morning

PRE-NATAL & POST-NATAL

GROWTH & DEVELOPMENT
OF CRANIOFACIAL COMPLEX
(MAXILLA, MANDIBLE,
PALATE, TONGUE & TMJ)

Dr. Aron Arun Kumar Vasa

 Contents
Introduction
Pre-natal Growth & Development
Period of Ovum
Period of Embryo
Period of Fetus
Post-natal Growth & Development
Cranial Base
Maxilla
Mandible
Conclusion
References
 INTRODUCTION
Every Pedodontist must be an applied biologist &
should keep in mind the fact that the child is in a
dynamic changing state & presents no static picture.

The fully developed Cranio-facial skeleton represents

the sum of its separate parts in which growth is
highly differentiated and occurs in different rates & in
different directions
Growth & development of an individual can be divided in to

Post-natal
Pre-natal

Period of Ovum Period of embryo Period of Fetus

1-14th day 14th – 56th day 56th – 270th day
 Pre-Natal Growth & Development
It is a dynamic phase in the human
development.
During this phase Height increases by almost
5000 times as compared to only 3 fold
increase during post-natal period.
Weight increases by 6.5 billion fold from
Ovum to Birth & Post-natally there is only 20
fold increase from birth to adulthood.
PERIOD OF OVUM (1st 2 Weeks)
The union of the Oocyte and spermatozoon
probably occurs at receptor sites specific for
species.
Alterations taking place in the plasma
membrane of the oocyte & Zonapellucida
ensure that no other spermatozoon can enter
the oocyte.
 Fertilization results in: -
Restoring of diploid number of chromosomes
Determinination of sex
Division of the Ovum in to several cells for
e.g., 2 celled stage, 3 celled stage, 4 celled
stage, 8 celled stage, morula (16 celled stage)
 Trisomy & Monosomy

If on fertilization a gamate containing 24 chromosomes

fuses with the normal gamate containing 23 chromosomes,
the resulting zygote will possess 47 chromosomes, i.e., 1
homologous pair has a 3rd component. Thus the cells are
trisomic for the given pair of chromosomes. Eg. Down’s
syndrome

If 1 member of the homologus chromosome pair is missing

a very rare condition called monosomy prevails.
Approximately 10% of all human malformations are caused by
alterations in single gene. Such alterations are transmitted in
several ways of which 2 are of special importance.

Autosomal dominant
Autosomal recessive

Autosomal dominant: -
Gene is inherited usually from single parent
Statistically 1/2 of the new generation affected
Trait usually appears in every generation
E.g., Achondroplasia, Cleidocranial dysostosis,
Osteogenesis imperfecta & some forms of amelogenesis
imperfecta
Autosomal recessive: -
The abnormal gene can express itself only when it is received from
both the parents. E.g., Chondro ectodermal dysplasia, Some cases of
microcephaly, Cystic fibrosis.

Genotype:- Genetic makeup

Phenotype:- The expression of genotype coupled with environmental
factors in an individual
Anomalies produced by teratogens acting during 1-4 weeks of
fertilization. Results in death of the embryo, therefore seldom seen in
babies reaching full term.
Fetal alcohol syndrome
Most teratogenic agents leading to facial & dental malformations
exert their effect during the period of morphogenesis &
histodifferentiation (4-8 weeks). E.g., oblique facial clefts, median
cleft lip (Hare lip), bilateral cleft lip, microstomia, macrostomia, Cleft
lip & palate.
Formation of morula
 Morula
Embryo by process of cleavage reaches 16
celled stage
Looks like a mulberry that’s why called so
Zonapellucida still presents
Contains outer rim of cells called trophoblast
Inner cell mass called embryoblast
 Test Tube babies
In-vitro fertilization
Gonadotrophins are administered to stimulate
growth
Just before ovulation Ovum is removed, place in
sutable medium & spermatazoa are added
Once the embryo reaches 8 celled stage it is
implanted in Uterus
20% Success rate
 Function of Zonapellucida
Trophoblast has the property to stick to any
epithelium and eat up the cells
Zonapellucida helps in preventing implantation of
embryo in abnormal location
Zonapellucida disappears as soon as the morula
reaches the uterine lumen
Thus embryo gets implanted in lateral wall of uterus
 Formation of Blastocyst
Some fluid passes into morula from uterine wall seperating
the inner cell mass (embryoblast) and outer cell mass
(trophoblast)
As the fluid quantity increases it acquires the shape of cyst
Trophoblast cells become flattened and embryoblast cells
get attached to one side
Now it is called blastocyst and cavity is called blastocoele
The site of attachment of inner cell mass is called
embryonic or animal pole and opposite site abembryonic
pole
 Formation of germ layers
Some cells of inner cell mass differentiate into
flattened cells that come to line its free surface,
these constitute Endoderm
Endoderm is the first of the three germ layers to be
formed
Remaining cells of inner cell mass become columnar.
These cells form the second germ layer the
ectoderm. The embryo is now in the form of disc
having 2 layers
A space appears b/w the ectoderm (below) &
trophoblast (above) called amniotic cavity which is
filled by amniotic fluid or liquor amni
Primary yolk sac
Extra embryonic mesoderm (primary mesoderm)
Extra embryonic coelom (Chorinic cavity)
Parietal/Somatopluric extra emryonic mesoderm
(Chorionic plate)
Visceral/splanchnopleuric extra-emryonic mesoderm
Connecting stalk
Formation of chorion & Amnion
Secondary yolk sac
Prochordal plate: Divides embryo into right &
left
Primitive streak
Intraembryonic mesoderm (Gastrulation)
Cloacal membrane
Alternative view of formation of germ layers
Time table of events in period of ovum
Fertilization to formation of bilaminar disc is called
pre-organogenesis period( 1 – 14 days)
2 days after fertilization the embryo is in 2 cell stage.
3 days after fertilization the embryo has become
morula
On the 4th day, the blastocyst has formed.
By the 8th day, the bilaminar disc has been
established.
Around the 14th day, the prochordal plate and
primitive streak are seen.
On the 16th day, we see the formation of the
intra-embryonic mesoderm, i.e., the
embryonic disc is now 3 layered.
Period of Embryo
 Formation of notochord

It’s a midline structure

Develops from cranial end of primitive streak to
caudal end of prochordal plate
Primitive Knot/primitive node/Henson’s node
Blastopore
Notochordal process/head process
Does not give rise to vertebral column but lies in its
future position
Most of it disappears but parts of it persist in the
region of each intervertibral disc as the nucleus
pulposus
Process of formation of notochord
 Neural tube

Formed from ectoderm over notochord

Extends from prochordal plate to primitive
knot
Divisible into cranial enlarged part which
forms brain and caudal tubular part which
forms spinal cord
The process of formation is called neurulation
Sub-divisions of intra embryonic mesoderm

Paraxial mesoderm
Lateral plate mesoderm
Intermediate mesoderm
 Formation of the intra-embryonic coelom
Forms by appearance of cavities in lateral plate
mesoderm
With the formation of intra-embryonic coelom lateral
plate mesoderm splits in to
1. Somatopleuric/parietal, intra embryonic
mesoderm (contact with ectoderm)
2. Splanchnopleuric/visceral intra embryonic
mesoderm (contact with endoderm)
Intra embryonic coelom gives rise to pericardial,
pleural & peritoneal cavities
Heart forms from splanchanopleuric mesoderm
forming floor of this part of the coelom
Folding of embryo
 The Neural crest
Forms from neuro ectoderm
Migrate & differentiate extensively with in the developing
embryo
Spinal & cranial sensory ganglia, Sympathetic neurons,
Schwann cells, pigment cells & meninges
Most of the connective tissue of the head is formed
Migration is essential for development of teeth & face
All the tissues of teeth (except enamel) & its supporting
apparatus are derived directly from these cells
Treacher collins syndrome
Derivatives of germ layers & neural crest
Head formation
 Pharyngeal (Branchial) Arches
Separate premitive stomatodeum from the developing heart
Formed by proliferating lateral plate mesoderm sandwiched b/w
ectoderm & endoderm bilaterally
Later reinforced by neural crest cells
6 cylindrical thickenings thus form, but 5th disappears as soon as it is
formed
Separated externally by small clefts called branchial grooves
(Ectodermal clefts)
On the inner aspect of pharyngeal wall are corresponding small
depressions called pharyngeal pouches
In aquatic vertebrates both branchial grooves & pharyngeal pouches
fuse to form gill slits
Formation
 Nerves & muscles of the arches
Arch Nerve of the Muscles of the arch
arch
First Mandibular Medial & lateral pterygoids, Masseter,
(Mandibular (Trigeminal) Temporalis, Mylohyoid, ant belly of
arch) V th nerve digastric,tensor tympani, tensor palati

Second Facial Muscles of face, Occipito-frontalis,

(Hyoid VII th nerve platysma, Stylohyoid, Posterior belly of
arch) digastric, Stapedius, Auricular muscels
Third Glossopharyngeal, Stylopharyngeus
IX th nerve
Fourth Superior Larngeal Muscles of Pharynx & larynx
Sixth Recurrent laryngeal Muscles of Pharynx & larynx
 Derivatives of arch cartilages
Arch Derivatives
Cartilage
1st arch Mallus, Incus, Anterior ligament for mallus,
(Meckel’s spenomandibular ligament & lays down the
cartilage) meshwork for formation of mandible & some part of
it may be included in mandible
2nd arch Stapes, Styloid process, stylohyoid ligament, smaller
(Reichert’s (lesser) cornu of hyoid bone, superior part of body of
cartilage) hyoid bone(S5)
3rd arch Greater cornu of hyoid bone, lower part of the body
of hyoid bone

4th & 6th arch Cartilages of larynx, controversial, may have

contribution from 5th arch
 Fate of grooves & pouches
First groove & pouch form external auditory meatus, tympanic membrane,
tympanic antrum, mastoid antrum & pharyngotympanic/eustachian tube
Ectodermal grooves/clefts
2nd arch cleft grows much faster than the succeeding arches & comes to over hang
them. The space b/w the overhanging 2nd arch & 3rd, 4th & 6th is called cervical sinus
Cavity of the cervical sinus is normally obliterated but part of it may persist and
give rise to swelling in the neck along the anterior border of the
sternocleidomastoid these are called branchial cysts & most commonly they are
located below the angle of mandible
If the cyst opens on to the surface it is called branchial sinus
Rarely cervical sinus may open in to the lumen of the pharynx in the region of tonsil
Endodermal pouches
1st pouch:
Its ventral part is obliterated by the formation of tongue
Dorsal part along with the dorsal part of 2nd pouch form tubotympanic recess,
auditory (pharyngotympanic) tube, middle ear cavity including tympanic antrum
2nd pouch:
Epithelium of ventral part gives palatine tonsil
Dorsal part takes part in the formation of tubotympanic recess
3rd pouch:
Inferior parathyroid glands
Thymus
4th pouch:
Superior parathyroid glands
Contributes to thyroid gland
5th pouch:
Forms ultimobranchial body in some species
In humans believed to be incorporated in 4th pouch giving rise to caudal pharyngeal
complex, which gives rise to superior parathyroid glands and parafollicular cells of
thyroid
Nerve supply to the arch
Dual nerve supply to 1st
arch, post-trematic
mandibular & pre-
trematic Chorda
tympani (facial)
Dual innervation
reflected in ant 2/3 of
tongue derived from
ventral part of 1st arch
 Somitomeres
Recent investigations suggest the mesenchyme
giving rise to the muscles of the pharyngeal arches is
derived from paraxial mesoderm of cranial occipital
somites
Its organization is influenced by neural crest cells
Paraxial mesoderm forms 7 masses of mesenchyme
called somitomeres
Somitomere 1 & 2 Muscles supplied by occlomotor nerve

Somitomere 3 Superior oblique muscle supplied by

trochlear nerve
Somitomere 4 Muscles of 1st pharyngeal arch supplied by
mandibular nerve
Somitomere 5 Lareral rectus muscle supplied by
abducent nerve
Somitomere 6 Muscles of 2nd pharyngeal arch supplied
by facial nerve
Somitomere 7 Stylopharyngeus (3rd arch) Supplied by
glossopharyngeal nerve
Occipital somites 1 & Laryngeal muscles (4th to 6th arches)
2 supplied by vagus nerve
Occipital somites 3 to Muscles of the tongue supplied by
5 hypoglossal nerve
Fate of Somites
 Myotome
In cervical, thoracic, lumbar & sacral regions one spinal
nerve innervates the myotome
The no. of somites formed in these regions corresponds
to no. of spinal nerves
In coccygeal region the number of somites exceed the
number of spinal nerves but many of them
subsequently degenerate.
The first cervical somite is not the most cranial somite
to be formed cranial to it there are Occipital somites &
pre-occipital somites (pre-optic)
Pre- optic Somites are supplied by 3rd, 4th & 6th cranial
nerves
 Parathyroid Glands & Thymus
3rd pouch gives rise to Inferior parathyroid glands &
Thymus
4th pouch gives rise to superior parathyroid glands
Later when thymus descends downward it pulls
along with it the parathyroid III glands caudally
making them Inferior
While parathyroid IV is prevented from moving
downward b’coz 4th pouch is closely related to
developing thyroid
 Clinical significance

B’coz of their developmental history:

Superior parathyroid glands are constant in position
Inferior parathyroid glands may descend into lower
part of neck or even into mediastinum
They may remain in their site of origin near the
bifurcation of common carotid artery
 Development of thyroid gland
Develops mainly from the thyroglossal duct which develops
behind tuberculum impar as a diverticulum
Later the site of origin of diverticulum becomes an
depression which is called foramen ceacum, as tuberculum
impar descends caudally
As the diverticulum grows down its tip bifurcates &
proliferates to form lobes of thyroid gland
Parafollicular cells are derived from the caudal pharyngeal
complex (derived from 4th & 5th pharyngeal pouches),
which merge with descending thyroid gland
 Anomalies of the thyroid gland
Anomalies in shape
Pyramidal Lobe
The isthmus may be absent
One of the lobes of the gland may be very small
Anomalies in position
Lingual thyroid
Intra lingual thyroid
Supra hyoid thyroid
Infra hyoid thyroid
Intra thoracic thyroid
Ectopic thyroid tissue: -
Larynx, trachaea, Oesophagus, pons, pleura,
pericardium & Ovaries
Remanants of thyroglossal duct
Thyroglossal cysts
Thyroglossal fistula
Carcinoma of thyroglossal duct

In surgical removal of thyroglossal cysts & fistula it is

important to remove all the remnants of the
thyroglossal duct
Fusion of Process
 Formation of face

Develops in b/w 24th & 38th day

Facial Clefts
 Formation of palate
Primary palate (pre maxilla) develops from
fronto nasal & median nasal process
Common oronasal cavity is bounded by
primary palate & occupied mainly by
developing tongue
Palate proper develops from primary &
secondary components
Secondary palate:
Formation starts b/w 7 & 8 weeks & completes by 3rd month
Only after its formation there is distinction b/w oral & nasal cavites
3 outgrowths appear in oral cavity, the nasal septum grows downward in the
midline from frontonasal process & 2 palatine shelves from each side, extend from
maxillary process towards midline
The shelves are 1st directed downward on each side of the tongue
After 7 weeks of development the tongue is withdrawn from b/w the shelves,
which now elevate & fuse with each other above the tongue & with the primary
palate
The nasal septum & 2 shelves converge & fuse along the midline
The closure of the secondary palate involves an intrinsic force in palatine shelves
the nature of which has not been determined yet. The high concentration of
glycosaminoglycans which attract water & make the shelves turgid has been
suggested as has the presence of contractile fibroblasts in palatine shelves, another
factor in the closure of secondary palate is the displacement of tongue from b/w
the palatine shelves by the growth pattern of the head
Fusion:
For the fusion of the shelves to occur elimination of the
epithelial covering is necessary
DNA synthesis ceases some 24-36 hrs before the epithelial
contact
Surface epithelial cells are sloughed off leading to the exposure
of basal epithelial cells
These cells are carbohydrate rich that permits ready adhesion
& formation of junctions to achieve fusion of process leading to
formation of midline seam
To achieve ectomesenchymal continuity this seam must be
removed this is achieved by growth of palatal shelves with
which it fails to keep pace with, it is reduced to islands, later
looses basal lamina & they transform into fibroblasts
Palatal Clefts
 Development of tongue
Starts to develop at about 4 weeks IU
Tuberculum impar in center & 2 lateral lingual swellings unite
to form mucous membrane of anterior 2/3 of tongue
Mucosa on root (posterior 1/3) of the tongue is formed by
hypobranchial eminence (corpula) which is derived from 3rd
arch which overgrows second arch
Mucosa on posterior most part of the tongue is derived from
4th arch
The muscles of the tongue arise from occipital myotomes
which have nerve supply from hypoglossal nerve (XII cranial
nerve)
Occipital Somites: (4-5), Hypoglossal nerve
 Nerve Supply of tongue
Sensory:
Anterior 2/3 Chorda tympani (through lingual
branch of mandibular nerve)
Posterior 1/3 glossopharyngeal nerve
Posterior superior laryngeal (branch of vagus)
Motor:
Hypoglossal nerve
 Anomalies of Tongue
Microglossia,macroglossia, aglossia
Bifid tongue (non fusion of lingual swellings)
Ankyloglossia/tongue tie, Ankyloglossia superior
Median rhomboid glossits (persistance of
tuberculum impar in front of foramen caecum)
Lingual thyroid (sub-mucosal, intra-muscular)
Remnants of thyroglossal duct may form cysts at the
base of tongue
Fissured/scrotal tongue
 Development of mandible
Develops from the mandibular process of 1st branchial arch
The cartilage of the 1st arch (Meckle’s cartilage) forms lower jaw in the
primitive vertebrates
In human beings Meckle’s cartilage has close positional relationship to the
developing mandible but makes no contribution to it
The mandibular nerve has close relationship to the Meckel’s cartilage,
beginning 2/3 of the way along the length of cartilage At this point
mandibular nerve divides in to lingual and inferior alveolar branches
These nerves run in medial & lateral to the meckel’s cartilage
Inferior alveolar nerve further divides into incisor & mental branches
On the lateral aspect of Meckel’s cartilage, during the 6th week of the
embryonic development a condensation of mesenchyme occurs in the
angle formed by the division of inferior alveolar nerve & its incisor &
mental arches
At 7 weeks intramembranous ossification begins in its condensation
forming the 1st bone of the mandible
Bone formation spreads anteriorly towards midline & posteriorly
towards the point where mandiular nerve divides into lingual &
inferior alveolar
This spread of new bone formation occurs anteriorly along the lateral
aspect of the meckel’s cartilage forming a trough that consists of
lateral & medial plates that unite beneath the incisor nerve
The trough of bone extends anteriorly to meet adjoining one, the 2
separate ossification centers remain separated at the mandibular
symphysis until shortly after birth
The trough is soon converted into a canal as bone forms over the
nerve, joining the lateral & medial plates
Backward extension of ossification along the lateral aspect of the
Meckel’s cartilage forms a gutter later converted into a canal that
contains the inferior alveolar nerve
The ramus of the mandible develops by a
rapid spread of ossification posteriorly into
the mesenchyme of the of the 1st arch, turning
away from meckel’s cartilage. This point of
divergence is marked by the ligula in the adult
mandible, the point at which the inferior
alveolar nerve enters the body of mandible
Thus by 10 weeks rudimentary mandible is
formed almost entirely by membranous
ossification with little direct involvement of
Meckel’s cartilage
 Fate of Meckel’s cartilage

Posterior extremity forms malleus, incus &

sphenomandibular ligament
Most of the cartilage is absorbed except for
some portion in midline which may cause
endochondrial ossification
Further growth of the mandible until birth is
influenced by the appearnce of 3 secondary
cartilages (condylar, coronoid, symphyseal cartilages)
& development of muscular attachments
Condylar cartilage appears at 12th week of
development
Coronoid process appears at about 4 months IU
The symphyseal cartilages 2 in number appear in
connective tissue b/w the two ends of Meckel’s
cartilage but are entirely independent of it, they are
obliterated with in the 1st year of the birth.
Thus mandible is membrane bone developed in relation to the nerve of the
1st arch & almost independent of Meckel’s cartilage. The madible has neural,
alveolar & muscular elements & its growth is assisted by the development of
secondary cartilages
 Development of maxilla

Maxilla develops from a center of ossification in

mesenchyme of maxillary process of 1st arch which is
associated closely with cartilage of nasal capsule.
As in the mandible the center of ossification appears in the
angle b/w the divisions of the nerve (i.e., where the
anterior superior dental nerve is given off from the inferior
orbital nerve)
From this center bone formation spreads posteriorly below
the orbit toward the developing zygoma & anteriorly
toward the future incisor region ossification also spreads
toward the frontal process
As a result of this pattern of bone deposition a bony trough
forms for the infra orbital nerve
From this trough a bony downward extension of bone
forms the lateral alveolar plate for the maxillary tooth
germs
Ossification also spreads in to the palatine process to form
the hard palate
The medial alveolar plate develops from the junction of the
palatal process & main body of the forming maxilla
This plate together with its lateral counterpart forms a
trough of bone around the maxillary tooth germs, which
eventually become enclosed in bony crypts in the same
way as described for mandible
A secondary cartilage also contributes to the
development of maxilla, zygomatic/malar cartilage
At birth the frontal process of maxilla is well marked
but body consists little mare than alveolar process
containing tooth germs & small zygomatic & palatal
process
Maxillary sinus develops around 16th week of IUL. At
birth the sinus is still rudimentary in the size of
small pea
 Common Features of Jaw Development

Both begin from a single center of ossification

related to the nerve & to a primary cartilage
Both form a neural element related to the nerve
Both develop an alveolar element related to the
developing teeth
Both develop secondary cartilages to assist in their
growth
 Development of TMJ
Before the condylar cartilage forms, a broad band of
undifferentiated mesenchyme exists b/w the
developing ramus of the mandible and developing
squamous tymapnic bone
With formation of condylar cartilage, this band is
reduced rapidly in width & converted into a dense
strip of mesenchyme
The mesenchyme adjacent to this strip breaks down
to form the joint cavity & the strip becomes the
articular disc of the joint
 Salivary gland development
Parotid & submandublar appear in connective tissue around
6th week
Sublingual in 8th week
Development of major & minor salivary glands is same as any
other gland in the body
Organization is completed by 3rd month & differentiation of
terminally located acinar cells & canalization of ducts by 6th
prenatal month
The acini of the mucous glands become functional during the
6th month, where as serous glands become functional by birth
The Fetal Period (3rd – 9th month)
Post-natal growth & development
 Post-natal growth of cranial base

The maxilla is attached to cranial base by means of

number of sutures. The mandible too is attached to the
cranial base at TMJ, thus growth process occurring at the
cranial base can affect the placement of maxilla & the
mandible
The cranial base grows post-natally by complex
interaction b/w the following 3 growth processes
1. Extensive cortical drift & remodeling
2. Elongation at synchondroses
3. Sutural growth
 Cortical Drift & Remodeling
Remodeling refers to process of bone deposition &
resorption so as to bring about change in size, shape &
relationship of the bone
The cranium is divided into bony elevations & ridges which
show bone deposition in cranial base, while predominant
part of the floor shows bone resorption
Intra cranial bone resorption helps in increasing the intra
cranial space to accommodate the growing brain
The foramina undergo deposition & resorption so as to
constantly maintain their proper relationship with the
growing brain
 Elongation at the synchondroses
Most of the cranial base is formed by cartilaginous process
Certain bands of cartilages remain at the junction of various
bones
They are important growth sites & primary cartilages
The important Synchondroses in cranial base are
1. Spheno-occipital synchondroses
2. Spheno-ethmoid synchondroses
3. Inter-Sphenoid synchondrodses
4. Inter-occipital synchondroses
Spheno-occipital synchondroses
Believed to be principal & most important growth
cartilage of cranial base during childhood
Active up to 12-15 years, will be fused by 20 years
Pressure or compression adapted bone growth
Sphenoid & occipital bone enlarge in length b’coz of
this synchondroses
It carries anterior part of the cranium bodily forwards
Spheno-ethmoid synchondroses ossifies by 5-
25 years
Inter-sphenoidal synchondroses ossifies by
birth
Intra-occipital synchondroses ossifies by 3-5
years of age
 Sutural Growth
1. Spheno-frontal
2. Fronto-temporal
3. Spheno-ethmoid
4. Fronto-ethmoid
5. Fronto-zygomatic
Timing of cranial base growth
By birth, 55-60%
4-7 years, 94%
8-13 years, 98%
 Post-natal growth of maxilla/naso
maxillary complex
1. Displacement
2. Growth at sutures
3. Surface remodeling
Displacement
 Growth at sutures
Tension adapted growth is seen in sutures
They position maxilla downward and forward
Maxilla is connected to cranium & cranial base by
number of sutures
1. Fronto-nasal suture
2. Fronto-maxillary suture
3. Zygomatico-temporal suture
4. Zygomatico-maxillary suture
5. Pterygo-palatine suture
 Surface remodeling
Increase in size
Change in shape
Change in functional relationship
 To summarize maxillary growth

Length increases by sutural growth & the surface apposition

at maxillary tuberosity
Width increases by the growth at median palatine suture &
apposition at zygomatic bone
Height increases by sutural growth, surface apposition &
alveolar growth
Growth sites in maxilla
1. Maxillary tuberosity
2. Sutures
3. Alveolar border
4. Nasal septum
5. Lateral walls-surface apposition
 Post-natal growth of mandible

Of the facial bone mandible undergoes the largest

amount of growth post-natally & also exhibits the
largest variability in morphology
While mandible appears as single bone in adult, it is
developmentally & functionally divisible in to several
skeletal sub-units
Body is one unit to which is attached alveolar
process, coronoid process, ramus, lingual tuberosity
& chin
 Ramus

Moves progressively posterior by combination of

resorption & deposition
Resorption at anterior border & deposition at
posterior border results in drift posteriorly
Function of remodeling of ramus:
To accommodate increasing mass of masticatory
muscles
To accommodate increasing breadth of pharyngeal
space
To allow lengthening of body so as to accommodate
molars
 Corpus/Body
As the ramus displaces the former ramal bone
is converted into posterior part of body of
mandible
Helps to accommodate for erupting molars
 Angle
Lingually:
Resorption on posterio-inferior aspect
Deposition on anterio-superior aspect
Buccally:
Resorption on anterio-superior aspect
Deposition on posterio-inferior aspect
This results in the flaring of the mandible as age
advances
 Lingual Tuberosity
Direct equivalent of maxillary tuberosity
Major site of growth for lower bony arch
Forms boundary b/w the ramus & body
Moves posteriorly by deposition on its posteriorly
facing surface
Prominence of tuberosity increased by presence of
large resorption field just below it (lingual fossa) &
deposition on its medial surface
 Alveolar process
Develops in response to tooth buds
Develop & increase in height along with teeth
eruption
Adds to the height & thickness of body
Manifested as a ledge extending in to ramus to
accommodate the 3rd molars
Fails to develop in case of absence of teeth
Resorbed after extraction
 Chin
Specific human characteristic
Influenced by sexual & specific genetic factors
Males more prominent than females
Mental protuberance forms by bone deposition
during childhood
Bone resorption in alveolar process above it leads to
concavity
Point ’B’
 Condyle

The role of condyle in growth of mandible has

remained controversy (2 schools of thought)

1. Growth occurs at condyle surface which leads the

cranial base to push it downwards & forwards
2. Growth of soft tissues including the muscels &
connective tissue carry the mandible forwards
away from cranial base
 Coronoid Process
Follows ‘V’ principle, Deposition occurs on
lingual surface
Increase in height follows ‘V’ principle
Brings about posterior growth movement in ‘V’
pattern
Briefly, the coronoid process has a propeller
like twist, so that its lingual side paces 3
general directions all at once. i.e., posteriorly,
superiorly & medially
 To summarize mandibular growth

Length increases by:

Surface apposition at the posterior border of ramus & resorption at
anterior border
Deposition at bony chin
Growth at condylar cartilage
Height Increases by:
Surface apposition at alveolar border
Apposition at lower border of mandible
Growth at condylar cartilage
Width increases by:
Sutural growth up to 1st year post-natally
Lateral surface apposition at outer surface
 Growth sites in mandible
Mandibular condyle
Posterior border of ramus
Alveolar surface
Lower border of mandible
Sutures
 Mandibular foramen
3 years below the level of occlusion
6 years at the level of occlusion
12 years below the level of occlusion
Conclusion
Describe the growth of mandible from birth to 16 years?

Describe the development and congenital anomalies of hard and soft palate?

Define growth and development. Describe in detail the pre-natal and post-natal
development of mandible?

Discuss various changes in dental arches from birth to adolescence?

Discuss the relationship between cranial and facial growth which parameter is
easy to control?

Ossification of Mandible.

Role of condyle in growth of Mandible.

Age Changes of Mandible.

Pharyngeal pouches

Meckels cartilage.
 References
1. Human embryology – 7th ed – Inderbir Singh
2. Ten cate’s Oral Histology – 6th ed – Antonio Nance
3. Orthodontics-Art & Science – 1st ed – Bhalajhi SI
4. Textbook of Pedodontics – 1st ed – Shobha Tandon
5. Essentials of Facial Growth – Enlow
6. Handbook of Orthodontics – 4th ed – Robert E. Moyers
7. Textbook of Orthodontics – 3rd ed – M.S. Rani
8. Google Internet Search
Thank You