Craniofacial Develeopement of Mandible and Its Applied Aspect

CRANIOFACIAL
DEVELEOPEMENT OF
MANDIBLE
AND ITS APPLIED
ASPECT
Dr. Swayam Mohapatra,1st year PGT
Dept. Of Pediatric and Preventive Dentistry,
Institute of Dental Sciences
1
TABLE OF CONTENTS
 Introduction
 Pre Natal Growth and Development
 Theories of Growth and Development Related to Mandible
 Post Natal Growth and Development
 Age Changes
 Developmental Anomalies Related to Mandible
 Conclusion
2
01.
INTRODUCTION
3
MANDIBLE
 Greek word ‘mandere’-to masticate/chew
 Latin word ‘mandibula’-lower jaw
 Mandible – Largest and Strongest bone of the face
 Only movable bone of all the bones of the face.
 Derived from the First Branchial Arch
 Start developing at about 4th week Intra Uterine Life.
 Major part of the viscero cranium, is the second skeletal

element to ossify, the clavicle being the first.
4
BRANCHIAL ARCH DERIVETIVES
5
02.
PRENATAL
GROWTH & DEVELOPMENT
6
PRENATAL GROWTH AND DEVELOPEMENT
Period of OVUM Period of EMBRYO Period of FETUS

1st - 14th Day 14th - 56th Day 56th - 270th Day
(Day of fertilization – 2nd week) ( 2nd week – 8th week ) (9th week – till birth)
7
PRENATAL GROWTH AND DEVELOPEMENT
Mandibular development involves cells that, originating from the neural crest
and populating the First Pharyngeal Arch.
Signals from ectoderm,paraxial mesoderm, Meckel’s cartilage

and pharyngeal pouch endoderm
Neural
crest cells
Osteoblasts
8
 The trunk of the Mandibular Nerve  By 6th Week I.U.L
medial to and above the dorsal end of the
cartilage
 At the junction of its dorsal and middle

one-thirds  lingual nerve leaves the main
trunk and passes to the medial side of the
cartilage
 The remaining nerve fiber bundle

continues forward toward the midline along
the supero-lateral aspect of the cartilage.
 At junction of the middle and ventral one-

thirds  the inferior alveolar nerve divides
into: mental nerve and incisive nerve
9
Meckel’s cartilage Condensation of the
Intramembranous
extends as a solid mesenchyme occurs in
ossification begins at
cartilagenous rod the angle of incisive and
this condensation  first
surrounded by mental branches of
bone of the mandible.
fibrocellular capsule. Inferior alveolar N.
10
Dixon AD, Hoyte DAN, Ronning O. Fundamentals of craniofacial growth. London, England: Routledge; 2017
Backward to a point
Spreads
FROM where mandibular nerve
anteriorly divides into lingual and
to the midline CENTER OF OSSIFICATION
inferior alveolar branches
11
Mental Nerve comes to lie in a shallow groove  definite notch on the superior margin of the
bone
By 19 mm Crown-rump Length (CRL) the bone in the region of the mental notch has grown
medially below the incisive nerve and then upward between the nerve and Meckel‘s cartilage
deepening trough of bone is created, composed of lateral and medial plates that are
united beneath the Incisive Nerve
Notch containing the mental nerve is converted into a foramen by a spur of bone that
extends posteriorly over the nerve from the anterior lip of the notch
Further growth of bone over the incisive nerve from the lateral and medial plates begin to
convert the trough into an incisive canal, forming the first segment of the mandibular canal
12
At 40-50 mm CRL, in the 3rd month of fetal life  the developing tooth germs lie some
distance superficial to the body of the mandible
Dental organs and papillae of the deciduous tooth germs commence to differentiate bone
of the mandible comes into a closer relationship with them starting development of an
"alveolar element" that eventually will provide sockets for attachment of the teeth
Upward extensions of the medial & lateral plates, above the incisive and inferior alveolar
nerves, one on each side of the tooth germs Lateral And Medial Alveolar Plates
Developing teeth then lie in an open trough or gutter of bone that later is subdivided by inter
dental bony septa into a series of small basins or alveoli
13
During the first few weeks of its development, the mandible shows deposition of new bone
on all surfaces
As the tooth buds increase in size  resorption of the inner surface of the alveoli is by
osteoclastic activity. This begins at about 10th week and continues as long as the developing
teeth enlarge
By 10th Week (40 mm CRL stage)  The ramal element is first mapped out as a Pre osteoblast
Condensation forming the ramal extension. Coronoid and angular processes are added for
attachment of the muscles of mastication, as the "muscular element"
13th week  Resorption begins on the lingual side of the neural element and ramus and on
the buccal surface of the coronoid process.
14
SECONDARY CARTILAGE
 Appears between the 10th and 14th weeks post
conception.
Derivatives of secondary cartilage
Part Of
Head Of Mental Region
Coronoid
Condyle
Process
15
Dixon AD, Hoyte DAN, Ronning O. Fundamentals of craniofacial growth. London, England: Routledge; 2017
FORMATION OF THE CONDYLE
• Mesenchymal condensation
5th week – ventral part of mandible
• Cone shaped cartilage at

10 week
th
Ramal region
14th week • First evidence ossification
• Migrate inferiorly and fuses

4 month
th
with mandibular ramus
17
Sperber. G.H et al, craniofacial embryogenetics and development. 2 nd edition. Peoples’s medical publishing housing- USA shelton, connecticut;2010. p. 121--186
FORMATION OF CORONOID PROCESS
By 10-14 week of IUL – Appearance of Secondary

accessory cartilage within temporalis muscle – Coronoid
Process
Grow as a response to temporalis muscle
Becomes incorporated into expanding ramus and

disappear before birth
18
Permkumar. S. Textbook of orthodontics. 2nd edition. Elsevier; 2015. p. 14-66.

FORMATION OF MENTAL FORAMEN
• Ossification starts - 7th month post conception

• Ventrally to mental foramen
- Acessory endochondral ossicles formed
 mental ossicle  incorporated in chin region
• Dorsally to mental foramen
- Resorption to its lateral surface
19
Sperber. G.H, et al, craniofacial embryogenetics and development. 2 nd edition. Peoples’s medical publishing housing- USA shelton, connecticut;2010. p. 121--186
03.
POSTNATAL GROWTH
AND
THEORIES OF MANDIBULAR
GROWTH 20
01. GENETIC THEORY
• Proposed by ALLAN G BRODIE, 1941
• All growth is compelled by genetic influence i.e: genetic encoding of

mandible determines its growth.
• Role of genetics in growth is fundamental and has overriding influence

in establishing the basic facial pattern.
• The genes are - SoX9,CTGF (Connective Tissue Growth Factor)FGF,

Lim, Prx1, Prx2
21
02. CARTILAGINOUS THEORY
• Proposed by James H Scott , 1950.
• According to Scott - Mandible  diaphysis of long bone
• Bent into horse shoe shape with epiphysis removed
• Cartilage constitute half of epiphyseal plate
• Mandible  Grow upward and backward direction
22
Enlow DH. Essentials of facial growth. WB Saunders; 1996.

03. FUNCTIONAL MATRIX THEORY
• Largest amount of growth and variability in morphology – Post nataly
• It is divisible into several skeletal subunit.
Alveolar unit • Teeth act as functional matrix
Coronoid • Action of temporalis muscle

process
Angle and ramus • Masseter and medial pterygoid

of mandible
Condylar • Lateral pterygoid

process
23
04. UNLOADED NERVE CONCEPT
• Basal tubular portion serves as a protection for the
mandibular canal & it follows a logarithmic spiral in its
downward & forward movement beneath the cranium
• Most constant part of mandible - the arc from foramen

ovale to the mandibular foramen and mental foramen
24

05. ENLOW’S ‘V’ PRINCIPLE
• Most of the facial bones have a ‘V’ shaped
configuration.
• Bone deposition occurs in the inner side of ‘V’
and resorption occurs in the outer surface
• Due to this the bone moves in the direction towards
the wide end of ‘V’
• Simultaneously deposition takes place at the ends
of the two arms of the ‘V’ resulting in its widening.
25

06. ENLOW’S COUNTERPART PRINCIPLE
• Any given facial or cranial part relates specifically to other structural & geometric counterpart in the
face & cranium
PART COUNTERPART
Nasomaxillary Complex Anterior Cranial Fossa
Pharyngeal Space Middle Cranial Fossa
Breadth Of Ramus Poster Cranial Fossa
Maxillary Arch Mandibular Arch
26

04.
POSTNATAL GROWTH
OF MANDIBLE
28
AT BIRTH – THE NEONATAL MANDIBLE
• Ascending ramus low and wide
• Coronoid process  relatively large and

projects well above the condyle
• Body  an open shell containing the buds

and partial crowns of the deciduous teeth
• Mandibular canal  runs low in the body
29

BY 1ST YEAR AFTER BIRTH
 Initial separation of the right and left bodies of the
mandible at the midline symphysis menti is gradually
eliminated between the 4th and 12th months after
birth, when ossification converts the syndesmosis into
a synostosis, uniting the two halves
 Although the mandible appears as a single bone in the

adult, it is developmentally and functionally divisible
into several skeletal subunits
The Basal Bone of the Body forms one unit, to which are
attached the Alveolar, Coronoid, Angular, and Condylar
Processes and the Chin. 30
RAMUS
Ramus moves posteriorly by remodelling
Bone deposition – posterior side
Bone resorption – anterior side
Drift of the Ramus – Posterior Direction
Remodeling
Hunterian concept associated with
Basic Hunterian pattern of growth ramal uprighting
31

After up righting – undergoes rotational pattern
of growth , by selective deposition/resorption
Anterior ramal border

Inferior- Resorption
Superior- Deposition
Posterior ramal border

Inferior- Deposition
Superior- Resorption
32
CORONOID PROCESS
• Follows Enlow’s V principle.
• Medial surface  Deposition (increase in

thickness)
• Buccal surface  Resorption
Due to backward growth  the area that was

occupied once by ramus and coronoid process,
comes to be occupied by the lingual tuberosity 
increase in both length and width of mandible
33
CONDYLE
• Growth increases at puberty reaching a peak – 12½ -14
years & Ceases – 20 years
• The condyle grows like an expanding V  deposition
on the inner aspect of V and resorption on the outer
surface
• Inferiorly facing end of buccal surface  Depository
• Superiorly facing end of lingual surfaces  Depository
• The region that was once condyle is gradually
remodeled to a neck  condyle relocates to a more
posterior and superior position
34
CONDYLAR CARTILAGE
• The condylar cartilage of the mandible uniquely serves as both
1. An articular cartilage in the temporomandibular joint,
2. A growth cartilage analogous to the epiphyseal plate in a long bone,
• The growth cartilage  act as a “functional matrix”  stretch the

periosteum
 lengthening periosteum to form intra membranous bone beneath it 
causes the mandibular ramus to grow upward and backward  displacing
the entire mandible in an opposite downward and forward direction
• Bone resorption close to the condylar head accounts for the narrowed
35
condylar neck.
SIGMOID NOTCH
• Bone deposition - Post. Border of Coronoid

• Bone resorption - Ant. Surface of Condylar neck.
• Periosteal bone deposition - Lingual surface
Periosteal bone resorption - Buccal surface of
Sigmoid notch.
• Because of this remodeling, anterior region of
condylar neck shifts in lingual direction.
36
ANGLE OF MANDIBLE
LINGUAL BUCCAL
SIDE SIDE
Resorption –Posterior Inferior Aspect Resorption – Antero Superior Part

Deposition – Antero Superior Aspect Deposition – Postero Superior Part
Flaring of angle of mandible as age advance
37

ANTEGONIAL NOTCH
• "law of electrogenesis“, by Frost
• Region of active muscle pull  bone becomes concave

• Areas without muscle attachment  convex.
• Specific signals generated  Concave surface= Negative
 Convex surface = Positive.
• Surface apposition is seen in concave surface
• Surface resorption at convex surface.
• Pull of Masseter Muscle  Surface concave 

deposition at the gonial angle.
• This forms the antegonial notch
38
BODY OF MANDIBLE
• Lateral surface  Depository

• Medial Surface  Superior Aspect  Deposition
 Inferior Aspect  Resorption
• Body of mandible lengthens Antero-Posteriorly

• Resorption in anterior border of ramus – accommodate
erupting permanent molar Deposition
Resorption
39
MENTAL FORAMEN
Infant Adult
Clinical implications –
• Administration of local anesthetic to the mental nerve
• Infants- the needle –at Right Angle from behind to achieve entry.
• Adults- syringe needle – obliquely to the body of the mandible to enter the
mental foramen
40
LINGUAL TUBEROSITY & LINGULA
• Junction of corpus and ramus at the medial aspect
• Equivalent to maxillary tuberosity
• Posteriorly facing surface - Deposition of bone
• Protrudes  lingual direction
• Prominence – resorption in lateral and below to it
• Resorption – produced depression – lingual fossa
41
ALVEOLAR PROCESS
• Protective trough to the tooth buds
• Adds height and thickness of body
• A ledge extends lingually to ramus – accommodate 3rd molar
• Clinical Significance – Due to labile alveolar bone –

orthodontic movement of teeth takes place
42
CHIN
• Formed in part of mental ossicle from accessory
cartilage
• Infancy – poorly developed
• Adulthood – significantly developed
Labial Cortex - Periosteal Resorption

Endosteal Deposition
Lingual Cortex - Periosteal Deposition
Endosteal Resorption
• Clinical Significance – Microgenia – under developed

chin 43
DEVELOPMENT OF TMJ
• At birth, the growth is exuberant, but progressively diminishes.
By 1st year  Condyle : ↓ vascularization, entire growth

cartilage layer becomes significantly thinner.
This continues upto the 3rd year.
By 2 ½ years  Articular eminence increase from 2-4mm
 due to resorption of the bone in the roof of the
mandibular fossa and deposition at the anterior and posterior part
formation of ‘S’ shape curve
By 6-7 years  The articular eminence enlarges to 5
6mm in height
 Articular layer of condyle becomes thicker
 Cartilage layer becomes thinner – 0.3mm
 Underlying trabeculae becomes thicker
• Growth continues till  7 to 12 years of age.

44
2nd and 3rd decade:
 Characterized by progressive slowing of growth process
 By 13-15 years decreased thickness of cartilage layer
 Presence of proliferative layer atleast till age of 18 years
 Cortical bone cap coalescing with subchondral trabecular bone by 10-12 years of age. This
increases in thickness upto 3rd decade of life
 Bone cap is completed by 20 years of age although cartilage and sparse cartilage cells remain.
4th decade:
 Cartilage completely replaced by the bone
 Articular tissue  Relatively unchanged may undergo changes depending on biomechanical loading
•This marks the end of active growth of the condyle.
45
By 5th decade  -Mandibular fossa became more deep and
-Articular eminence becomes more prominent
• In older adult temporal fossa: less pronounced chondroid layer.
• Articular eminence : is made of chondroid bone
• As age progresses further there is flattening of the articular fossa and decrease in prominence
of the articular eminence
46
Questions:
1. 1st ossification center of mandible- Mesenchymal sheath of Meckel’s cartilage near the future
mental foramen
2. Servo System Theory- Petrovic,1970 stated that:
(I) The hormonally regulated growth of the midface and anterior cranial base, which provides a
constantly changing reference input via the occlusion
(II) The rate-limiting effect of this mid facial growth on the growth of the mandible. While growth
of the mandibular condyle and of the sutures may be affected directly and indirectly by systemic
hormones.
3. Newer Theories:
(I) Synthetic Hypothesis: Considered chondrocranium as the key factor for the development of the
cranium and face
(II) Aponeurotic Tension model: Explains the role of muscle plasticity as a vector for craniofacial
growth and the effect of cranial rotation in shaping facial form 47
4. Hunterian Concept of growth:
Linear model for mandibular growth where there is:
-Resorption in the anterior border of ramus
-Deposition in the posterior border of ramus
Thus, lengthening the mandible
48
01.
AGE CHANGES OF
MANDIBLE
49
ALVEOLAR RIDGE
Alveolar ridge height increases in presence of development of teeth
Lower ridge height  less retentive dentures , difficulty in placing implants
Shallow vestibule in infants  Deeper vestibule in adults  Shallow vestibule in old age
Only present as a open shell Alveolar and subdental Gets resorbed

region of body are equal
50
MENTAL FORAMEN
 The direction of exit of Mental Nerve  Oblique in children

 Perpendicular in adults
 Also the position determines the depth of penetration of needle
Near lower border Midway between upper and lower border Near the upper boarder
Clinical implications –
• Administration of local anesthetic to the mental nerve
• Adults- the needle – Obliquely from behind to achieve entry. 51
• Infants- needle - at Right Angle to the body of the mandible to enter the mental foramen
RAMUS
 Obliquely placed ramus  promotes rapid Antero-Postero lengthening of mandible
 Gradual uprighting happens  mandible grows downwards and forward
 Thickness is proportional to  Posterior cranial fossa & parapharyngeal space
Oblique in direction Vertical in direction Oblique in direction

52
ANGLE REGION
 Gonial region is wider & antegonial notch is shallow  in infants
 Gonial region shrinks & antegonial notch is deep  in adults
 Antegonial notch is flattened  in old age
Obtuse (near 180 ) Right angle (near 90 ) Obtuse (near 140 )
53
CORONOID & CONDYLAR PROCESS
Coronoid process is larger Condylar process is above Condylar process is above

and is above the level of the level of coronoid the level of coronoid
condylar process process process
But is bent backwards
54
MANDIBULAR CANAL
Lies a little Runs nearly parallel to the Runs closer to the upper
above the mylohyoid line alveolar ridge
mylohyoid line 55
56
ANATOMICAL
AT BIRTH ADULT OLD AGE
LANDMARK
Alveolar Ridge Only present as a open shell Alveolar and subdental region of Gets resorbed
body are equal
Mental Foramen Near lower border Midway between upper and lower Near the upper boarder
border
Ramus Oblique in direction Vertical in direction Oblique in direction
Angle Obtuse (near 180 degrees) Right angle (near 90 degrees) Obtuse (near 140 degrees)
Coronoid & Condylar Coronoid process is larger and is Condylar process is above the Condylar process is above the
Process above the level of condylar level of coronoid process level of coronoid process
process But is bent backwards
Mandibular canal Lies a little above the mylohyoid Runs nearly parallel to the Runs closer to the upper
line mylohyoid line alveolar ridge
Symphysis Menti Present, the bone remains in two Represented by a fain ridge only n Not recognizable or absent
halves united together by fibrous the upper part
tissue
57
02.
GROWTH
MODIFICATION OF
MANDIBLE
58
 Growth modification is meant to take the advantage of the body's natural growth to guide
the unfavorable position of lower jaw to a more favorable normal position.
 Growth modification is most effective, while the jaw is still developing, which is around the
time of puberty, before growth is complete
The Timing Of Growth Spurts

1. Just before birth. 4. Prepubertal growth spurts:
2. One year after birth Boys =14 - 16 years
3. Mixed dentition growth spurts: Girls = 11 -13 years
Boys = 8 – 11 years
Girls =7- 9 years
59
Growing Mandible
Skeletal
class II
Mandibular
Mandibular
deficient and
deficiency
maxillary excess
Headgear and
Myofunctional
myofunctional
therapy
appliance
60
Profitt WR: Contemporary Orthodontics, St Louis, CV Mosby,1986

Growing Mandible
Skeletal
class III
Mandibular excess
Mandibular
and maxillary
Excess
deficiency
Facemask followed by
Chin cup chin cap / myofunctional
appliance
61

MYOFUNCTIONAL THERAPY
ACTIVATOR
62

FUNCTION REGULATOR
FR1 - Class I & II div I Malocclusion

FR1a – Class I mo – mid to moderate crowding, class I
deep bite
FR1b – Class II,div I – Overjet not exceed 5mm
FR1c – Class II, div II – more than 7mm
FR2- Class I & II Div 1and 2
FR3- Class III
FR4- Open bite & Bi-maxillary protrusion
FR5- Used along with headgear
63

HEADGEAR
Used to limit and redirect excess maxillary growth
-Intrusion of maxilla -Extrusion of maxilla - vertical dimension of face

- Lower facial height - Lower facial height -Long face class 2 pts
64

FACE MASK
• Used in case of prognathic mandible and retrusive maxilla

• Bending the condylar neck – stimulating TMJ adaptations to posterior
displacement
Delaire type Tubinger type Petit type

65

CHIN CUP
Restrict the forward and downward growth of mandible
66

MILWAUKEE BRACE
• Used for the correction of scoliosis
• Exerts tremendous force on the mandible leading to retardation of Mandibular
growth
67
Iyyer. B.S, Orthodontics the art and science. 5th edition. Arya medi publishing house; 2012. p. 9-27.
03.
GROWTH
PREDICTION OF
MANDIBLE
68
NEED FOR GROWTH PREDICTION
• Growth prediction is an estimation of the amount of growth to be expected.
• Ability to predict the magnitude and direction of a patient’s facial growth early in life would
enable the clinician to identify those individual who requires interceptive growth modification
and to ensure that the appropriate treatment can be rendered while growth is expected.
• Growth prediction helps the clinician to intercept and correct the malocclusion.
• It can be used as patient education aids.
69
04.
DEVELOPMENTAL
DISTURBANCES
OF MANDIBLE
71
POTENTIAL DISTURBANCES OF NORMAL JAW DEVELOPMENT
✘ Failure of the neural crest to form the margins of the neural tube.
✘ Slowed migration of crest cells away the neural tube.
Develops predominantly
✘ Defective mitotic division of neural crest cells. during embryonic period
from 4th – 8th week.
(critical time)
✘ Increased neural crest cell adhesion.
✘ An unusually high rate of neural cell death
✘ A failed epithelial-mesenchymal interaction either the maxilla or mandibular
prominences that prevents bone cell differentiation.
✘ Defect of the influence of related nerves, muscles or blood vessels.

72
ACHONDROPLASIA
• FGFR3 mutation- change in mandibular shape, size
and position
• Primary cause of dwarfism

Dental Considerations
• Most common form of chondrodysplasia
• Macroglossia resulting in
• Mid face hypoplasia
tongue thrusting and
• Cartilages are severely disturbed open bite
• Posterior crossbite
• Affects both endochondral and membranous
• Delayed eruption of
ossification permanent teeth in some
73
• Limited joint movements cases

AGNATHIA
✘ Characterized by hypoplasia or absence of mandible
✘ Partial absence of mandible more common > absence of

Entire mandible
✘ Agnathia-Otocephaly complex- Agnathia + Malformed ears
AETIOLOGY -Failure of migration of neural crest

mesenchyme into maxillar prominence
-Atrophy in the development of the mandibular
prominences at 4th – 5th week Post conception
• PROGNOSIS: Poor and it is considered to be lethal.
Treatment-Mandibular reconstruction 74
75
MICROGNATHIA
Means Small jaw, Retrusion of jaw can also produce an
image of micrognathia
Syndromes including
• Pierre robin syndrome
• Cat-cry (cri du chat) syndromes,
• Treacher collins syndrome
• Progeria
• Patau syndrome
• Nagar syndrome -Lower crowding of teeth
-Airway obstruction
76
Neville, Damm, Alen, Bouquot. Oral and maxillofacial pathology. 3rd edition. Elsevier; 2009. p. 1-53.
MACROGNATHIA
• Refers to the condition of abnormally Large Jaws .

• Aetiology – unknown, follows hereditary patterns.
• Diseases associated with  Paget’s Disease of bone
 Acromegaly
 Leontiasis ossea
• Treatment – Surgical correction – ostectomy or
resection portion of a mandible
-Generalized spacing
-Macroglossia
77
Shafer, hine, levy. Shafers’s textbook of oral pathology. 7th edition. Elsevier; 2012. p. 3-80.
CONGENITAL HEMIFACIAL HYPERTROPHY
✘ Represents hyperplasia rather than hypertrophy.
✘ Female: Male = 2:1,often affecting on right side.
✘ Asymmetry starts at birth  Enlargement is more accentuated at the age of 6 and
continues till the overall growth ceases.
✘ Enlargement of the mandible and teeth on the affected side.
✘ The bone is wider and thicker.
-Premature shedding of deciduous teeth
-Roots of the tooth are enlarged
-Permanent teeth on the affected side
are enlarged and develops more rapidly
TREATMENT:
78
No specific treatment, other than cosmetic Surgery Surgery is done after the cessation of growth
Neville, Damm, Alen, Bouquot. Oral and maxillofacial pathology. 3 rd edition. Elsevier; 2009. p. 1-53
HEMIFACIAL MICROSOMIA (Goldenhar’s syndrome)
• Rare congenital defect - incomplete development of the ear, nose,soft palate, lip, and
mandible.
• ETIOLOGY - Anomalous development of the 1st and 2nd branchial arch
• Cleft lip and palate
• Unilateral tongue hypoplasia
• Hypoplasia of the maxillary and mandibular
arches
• Micrognathia
• Gingival hypertrophy
• Micrognathia
• Delayed tooth development
79
80
MEDIAN MANDIBULAR CYST
✘ It is an extremely rare and controversial lesion
✘ Located along the midline of the mandible

✘ Developed Due To Entrapment Of Epithelium during fusion of two
halves of the mandible.
✘ Asymptomatic (diagnosed during routine radiographic
examination).
Produce expansion of the involved cortical bone and associated
teeth
✘ It is unilocular, well circumscribed radiolucency may be seen in
midline
TREATMENT :  Surgical Enucleation

81
82
STAFNE BONE CYST
✘ This condition represents a focal concavity of the cortical bone on
the lingual surface the mandible
✘ In most of the cases, Biopsy reveals histologically normal salivary gland,
suggesting  developmental defect containing submandibular S.G.
✘ Asymptomatic radiolucency below the mandibular canal between
the molar teeth and angle of the Mandible
✘ Well circumscribed by a sclerotic border
✘ Anterior lingual salivary defects associated with the Sublingual S.G
 Here the lingual surface the mandible showing an anterior
cortical defect caused by sublingual gland can be appreciated
✘ CT image showing well defined concavity in lingual surface
TREATMENT  No treatment required > if the lesion is static

Surgery > if there is increase in size
PROGNOSIS: Good
83
84
TORUS MANDIBULARIS
✘ Develops along the lingual aspect of the mandible, just above the
mylohyoid line in the region of premolars
✘ Etiology: Genetic or Environmental.
✘ Bilateral involvement occurs in more than 90% of cases.
✘ May be single/multiple nodules
✘ Asymptomatic unless the overlying mucosa is ulcerated due to
secondary trauma.
✘ Radiograph shows the radiopacity that is superimposed over the
roots of the mandibular teeth
TREATMENT  Surgical removal is required to accommodate

complete/partial dentures.
 May recur in presence of teeth. Differential diagnosis: Abscess formation,
Bone cancer, Salivary gland tumors, Vascular
tumors, and Fibromas
85
PARAMEDIAN LIP PITS
• Rare congenital invaginations of the lower lip

• Arise from persistent lateral sulci on the embryonic
mandibular arch
• Bilateral
• Symmetric fistulas – on each side
TREATMENT - Excision
86
87
MANDIBULAR CLEFTS
• Extremely rare condition
• 1819, the first case was reported by Couronne. So far fewer than 80 cases have
been described in the world literature so far.
• Result from - lack of development of the midline of 1st branchial arch
88
Neville, Damm, Alen, Bouquot. Oral and maxillofacial pathology. 3 edition. Elsevier; 2009. p. 1-53
rd
89
MANDIBULOFACIAL DYSOSTOSIS
• Hypoplasia of mandible + macrostomia + high arched palate+ bird

or fish like face + antimongoloid slant + coloboma of lower eye lids
Treatment
• Severe cases - facial reconstruction
• Combined orthodontic therapy + orthognathic surgery
90
CORONOID HYPERPLASIA
• Rare developmental anomaly resulting in limited mandibular movements
• Male: Female = 5:1
• Often seen in puberty
TYPES
UNILATERAL BILATERAL
Enlarged Coronoid process Mandibular restrictions may

impinging on the posterior surface of progressively worsen over several
the zygoma restricting the mandibular years during child hood and reach
movements maximum severity in late teens.
 Mandible deviates to the affected side
No pain /associated abnormality in
occlusion.
TREATMENT : Coronoidectomy / Coronoidotomy  intraoral approach.

Post-operative physiotherapy > re-establishing normal function. 91
92
CONDYLAR HYPERPLASIA
✘ Enlargement of the mandible

✘ Etiology :unknown
Some possible etiological factors  Local circulatory disturbance
 Endocrine disturbance.
 Trauma
✘ Discovered in adolescence/young adults.
✘ Facial asymmetry, prognathism, open bite, cross bite
✘ Radio graphically there is irregular enlargement of the Condylar head
✘ Some cases may demonstrate hyperplasia of the entire ramus
TREATMENT  Unilateral condylectomy.

Unilateral/bilateral mandibular osteotomies.
Patient with compensatory maxillary growth > maxillary
osteotomy. 93
Frequent orthodontic therapy
BIFID CONDYLE
✘ Rare developmental anomaly characterized by double-headed
mandibular condyle
✘ Some may have medial and lateral heads divided by
anteroposterior grooves
✘ Etiology : Anteroposterior bifid condyle > traumatic origin.
✘ Mediolateral > traumatic, teratogenic,abnormal muscle
attachements,persistence of fibrous septum in fibrous cartilage
✘ Discovered in routine radiographs. Shows bilobed appearance
of the Condylar head
✘ Asymptomatic
✘ Some may have “pop” or “click” of the TMJ during mouth
opening.
TREATMENT  Asymptomatic > no treatment required. 94

Temporomandibular therapy may be required.
95
TMJ ANKYLOSIS
Clinical Features
•Facial asymmetry •Bird-face
•Microgenia •Convex facial profile
•Short posterior facial •Retrognathic mandible
height •Obtuse cervico-mental
•Minimal condylar angle
movements on palpation •Marked decreased
lower face height
• Ankylosed mass can be - Fibrous

Fibro-osseous
Osseous 96
TMJ ANKYLOSIS
INFECTION
TRAUMA •Otitis media
• Condylar fracture •Supurative arthritis
• Heamarthrosis •Parotitis
• Obstetric trauma •mastoiditis
CAUSES
SURGICAL
INFLAMATION
• Post-op complication of
• Rheumatoid arthritis
TMJ / orthognathic surgery
• Ankylosing spodylitis During birth use of forceps to pull
• Still’s disease the
• Psoriatic arthritis head out
97
TREATMENT – Surgical Rehabilitation

CONCLUSION
All the events taking place during development of mandible play an important role in
determining the final structure of mandible, any deviation of which can give rise to various
abnormalities in the oro facial region.
 A thorough knowledge is required by a Pedodontist to:
 Understand the aetiology behind such anomaly, and intervene them at the earliest.
 Gain idea about growth vectors , which enables to modify them to get a favourable
outcome
 Evaluate the age changes of various skeletal landmark
98
REFERNCES
• Dixon AD, Hoyte DAN, Ronning O. Fundamentals of craniofacial growth. London, England: Routledge;
2017
• Sperber. G.H, sperber. S.M, guttmann G.D, tobias P.V, craniofacial embryogenetics and development. 2 nd
edition. Peoples’s medical publishing housing- USA shelton, connecticut;2010. p. 121--186
• Enlow DH. Essentials of facial growth. WB Saunders; 1996.
• Permkumar. S. Textbook of orthodontics. 2nd edition. Elsevier; 2015. p. 14-66.
• Agarwal V, Tandon R, Singh K, Chandra P, Agarwal S. Growth prediction methods: A review. IP Ind J of
Ortho and Dentofa Res 2021;7(2):106–13.
• Neville, Damm, Alen, Bouquot. Oral and maxillofacial pathology. 3rd edition. Elsevier; 2009. p. 1-53
• Shafer, hine, levy. Shafers’s textbook of oral pathology. 7th edition. Elsevier; 2012. p. 3-80.
• Iyyer. B.S, Orthodontics the art and science. 5th edition. Arya medi publishing house; 2012. p. 9-27.
99
THANK YOU
100

Craniofacial Develeopement of Mandible and Its Applied Aspect

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Craniofacial Develeopement of Mandible and Its Applied Aspect

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CRANIOFACIAL

 Pre Natal Growth and Development

 Theories of Growth and Development Related to Mandible

 Post Natal Growth and Development

 Developmental Anomalies Related to Mandible

 Greek word ‘mandere’-to masticate/chew

 Latin word ‘mandibula’-lower jaw

 Mandible – Largest and Strongest bone of the face

 Only movable bone of all the bones of the face.

 Derived from the First Branchial Arch

 Start developing at about 4th week Intra Uterine Life.

 Major part of the viscero cranium, is the second skeletal

Period of OVUM Period of EMBRYO Period of FETUS

Signals from ectoderm,paraxial mesoderm, Meckel’s cartilage

 At the junction of its dorsal and middle

 The remaining nerve fiber bundle

 At junction of the middle and ventral one-

• Cone shaped cartilage at

14th week • First evidence ossification

• Migrate inferiorly and fuses

By 10-14 week of IUL – Appearance of Secondary

Grow as a response to temporalis muscle

Becomes incorporated into expanding ramus and

Permkumar. S. Textbook of orthodontics. 2nd edition. Elsevier; 2015. p. 14-66.

• Ossification starts - 7th month post conception

- Resorption to its lateral surface

• All growth is compelled by genetic influence i.e: genetic encoding of

• Role of genetics in growth is fundamental and has overriding influence

• The genes are - SoX9,CTGF (Connective Tissue Growth Factor)FGF,

Enlow DH. Essentials of facial growth. WB Saunders; 1996.

Alveolar unit • Teeth act as functional matrix

Coronoid • Action of temporalis muscle

Angle and ramus • Masseter and medial pterygoid

Condylar • Lateral pterygoid

• Most constant part of mandible - the arc from foramen

Enlow DH. Essentials of facial growth. WB Saunders; 1996.

Enlow DH. Essentials of facial growth. WB Saunders; 1996.

Nasomaxillary Complex Anterior Cranial Fossa

Pharyngeal Space Middle Cranial Fossa

Breadth Of Ramus Poster Cranial Fossa

Maxillary Arch Mandibular Arch

Enlow DH. Essentials of facial growth. WB Saunders; 1996.

• Ascending ramus low and wide

• Coronoid process  relatively large and

• Body  an open shell containing the buds

• Mandibular canal  runs low in the body

Enlow DH. Essentials of facial growth. WB Saunders; 1996.

 Although the mandible appears as a single bone in the

Drift of the Ramus – Posterior Direction

Enlow DH. Essentials of facial growth. WB Saunders; 1996.

Anterior ramal border

Posterior ramal border

• Medial surface  Deposition (increase in

Due to backward growth  the area that was

• The growth cartilage  act as a “functional matrix”  stretch the

• Bone deposition - Post. Border of Coronoid

Resorption –Posterior Inferior Aspect Resorption – Antero Superior Part

Flaring of angle of mandible as age advance

Enlow DH. Essentials of facial growth. WB Saunders; 1996.

• Region of active muscle pull  bone becomes concave

• Pull of Masseter Muscle  Surface concave 

• Lateral surface  Depository

 Inferior Aspect  Resorption

• Body of mandible lengthens Antero-Posteriorly