INTRODUCTION TO

CRANIOFACIAL GROWTH
Dr Faizan ul Hassan
B.D.S, F.C.P.S(ortho), C.H.P.E
Assistant Professor
Orthodontics
RCD
CONTENTS:
1. Introduction
2. Craniofacial embryology
3. Mechanisms of bone growth
LEARNING OBJECTIVES:
• Explain the processes of craniofacial development, including
the role of the cranial neural crest cells

• Describe post-natal craniofacial growth from birth onwards

1. INTRODUCTION
GROWTH
• It is defined as an increase in size by natural development and is the
consequence of cellular proliferation and differentiation.

• It involves many interactions between the different bones that make up

the skull and between the hard and soft tissues.

• Growth can affect

• the severity of the malocclusion, improving it or worsening it as growth continues;
• the progress and outcome of orthodontic treatment,
• the stability of the orthodontic result.

• Orthodontic treatment may also have an effect on facial growth.

DEVELOPMENT
The normal sequential events occurring throughout individual’s
life, between fertilization and death.

Development= Growth
Differentiation
Maturation
Translocation
DIFFERENTIATIO
N

• It is the conversion of
the generalized cells or
tissues to more
specialized kinds during
development. It is a
change in quality
MATURATION
• It is the qualitative change that occurs in a tissue with aging
TRANSLOCATION
• It is the change in position.
• Example:-
• Chin is translocated in downward direction with
growth.
2. CRANIOFACIAL EMBRYOLOGY

• Craniofacial anomalies represent three-quarters of all birth

defects.

• We will discuss in detail

a) Neural crest cells
b) Pharyngeal arches
c) Development of face
d) Development of palate
a). Neural crest cells
• Neural crest (NC) is
ectomesenchymal tissue
arising from the crest of the
neural fold

• These cells are considered as

4th germ layer.

• It is capable of forming many

different cell types
(pluripotent) and is highly
migratory.
Diagrammatic representation of neural tube
and neural crest development.
A, Cross section through trilaminar disc at day
18 i.u. The appearance of the neural plate
marks the beginning of neural tube
development.
B and C Development of the neural tube from
the neural plate and migration of the neural
crest cells from the neural folds.
(Redrawn from Meikle, M. C. (2002)
Craniofacial Development, Growth and
Evolution, Bateson Publishing, Norfolk,
England).
b). Pharyngeal arches

• Six pairs of pharyngeal arches develop, decreasing in size from

cranial to caudal, among which one (number 5) is rudimentary.

• Development is initiated by migrating neural crest cells

interacting with lateral extensions of the endoderm germ
layer lining the future pharynx and augmenting the
mesodermal core of these extensions.
• The arches are separated by
• Externally - grooves/clefts
• Internally - pouches

• Each arch consists of

• cartilage
• Muscular component
• Vascular component
• Nervous element
c). Facial development
• The development of the face begins at the end of the 4th
week in utero (i.u.) with the appearance of five processes
around the stomodeum which is the primitive mouth and forms
the topographical centre of the developing face.

• These processes are:

 FACIAL
PROCESSES

2 MANDIBULAR 2 MAXILLARY FRONTO-NASAL PROCESS

PROCESSES PROCESSES (Nasal Placode)
2 LATERAL
2 MEDIAL NASAL
NASAL
• the remainder
PROCESSES
• the lower lip PROCESSES
of the upper lip • the philtrum • unites with the medial
nasal and maxillary
• lower portion prominence to form
• the secondary • primary palate
of the cheeks the ala.
palate
• the four maxillary • The nasolacrimal
• other • the upper incisor teeth groove invaginates to
form the nasolacrimal
mandibular portion of the duct with the upper
structures cheeks • their surrounding end forming the
alveolar bone lacrimal sac.
d). Formation of palate (7–9 weeks i.u.)
• The primary palate :
• Arises from medial nasal processes at the
beginning of 7th week i.u.

• It will house the four upper incisor teeth and their

surrounding bone.

• Secondary palate:
• It arises from the maxillary processes.

• The remainder of the hard palate, maxillary

dentition and soft palate arise from the secondary
palate .
CLEFT LIP AND PALATE
• Any disturbance in the timing and/or process of palatal shelve elevation
from a vertical to a horizontal orientation and their subsequent fusion is
likely to cause clefting.
Epidemiology
• The most common craniofacial malformation in humans -1 in every 700
live births.
• High – Native Americans
• Low – black Africans
• May be unilateral or bilateral. More so on left in unilateral cases.
• Males are affected more frequently.
• Isolated clefts of the palate are a separate entity, occurring in 1 per 2000
live births and affecting females more than males.
Aetiology
• Failure to merge of the maxillary and intermaxillary processes and the
palatal shelves and may occur from inadequate migration of NC or
excessive cell death.
• caused by deficiency of NC cells.
• Isolated cleft palate aetiology is of a physical nature.
3. MECHANISMS OF BONE GROWTH

• Ossification
The process by which new mineralised bone is formed is
termed ossification.

• Ossification occurs in two ways:

a. intramembranous
b. Endochondral

In the mature craniofacial skeleton, there are no qualitative differences

between bone derived from endochondral or intramembranous
mechanisms
Intramembranous Endochondral
• It is seen during • A cartilage is formed
embryonic development first and then bone is laid
by direct transformation down on it
of mesenchymal cells
into osteoblasts and
occurs in sheet-like
osteogenic membranes.

• Important in the • Important in the

formation of flat bones formation of long bones

• Long bones of limbs,

• Cranial vault, some axial skeleton and cranial
facial bones, parts of base
mandible and clavicle
Bones formed by Intramembranous
Ossification
Mostly forms bones of the calvaria and facial regions

⚫Frontal bone, Parietal bone, Parts of occipital bone (interparietal)

⚫Parts of sphenoid (greater wing, pterygoid plates)
⚫Parts of temporal bone (squamous and tympanic)
⚫Maxilla, Zygoma, Lacrimal bone
⚫Nasal bone, Vomer
⚫Mandible

Occurs mostly where mild tension forces are present

Endochondral ossification
• Ossification takes place in a hyaline cartilage framework and begins in a
region known as the primary ossification centre.

• Ossification spreads from the primary ossification centre.

• At growth centres, the chrondroblasts are aligned in columns along the

direction of growth, in which there are recognizable zones of
• cell division
• cell hypertrophy
• calcification.

• Growth at these primary centres causes expansion, despite any opposing

compressive forces such as the weight of the body on the long bones.

• This process is seen in both the epiphyseal plates of long bones and the
synchondroses of the cranial base.
Bones formed by Endochondral Ossification
Mostly forms bones of the cranial base

⚫Sphenoid bone
⚫Parts of occipital bone
⚫Ehtmoid bone
⚫Temporal bone
⚫Malleus, Incus, Stapes
⚫Hyoid bone
Synchondroses
• Structurally, it resembles two epiphyseal cartilages
placed back to back and have a common central
zone of resting cells.

• They have two directions of linear growth in

response to functional and non-functional stimuli
and the bones on either side of the synchondroses
are moved apart as it grows.

• Differential growth can occur.

• At birth, there are three synchondroses in the

cranial base
• Spheno-occipital – active until 16 yrs of age
• Spheno-ethmoidal – active until 7 years of age
• Fronto-ethmoidal – active until puberty

• The most important of these is the spheno-occipital

synchondrosis.