The document discusses the sites and types of growth in the craniofacial complex. It begins by defining the structures that make up the craniofacial complex, including the cranial vault, floor of the cranium, naso-maxillary complex, and mandible. It then examines the specific sites and types of growth for each structure. For the cranial vault, growth occurs at the sutures and through surface remodeling of the bony plates. The floor of the cranium grows at synchondroses and sutures, as well as through surface remodeling. The maxilla grows through translation downward and forward guided by growth of the cranial base, as well as through sutural growth. The

1. SITES & TYPES OF
GROWTH
IN CRANIOFACIAL COMPLEX
DR. SARANG SURESH HOTCHANDANI (BDS)

2. TO UNDERSTAND GROWTH IN ANY AREA OF BODY
IT IS NECESSARY TO UNDERSTAND
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3. TO UNDERSTAND GROWTH IN ANY AREA OF BODY
IT IS NECESSARY TO UNDERSTAND
We are Going
to Learn this
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4. CRANIOFACIAL COMPLEX CONSISTS OF;
1. Cranial Vault
1. Bones of upper & outer surface of brain
2. Floor of Cranium/Brain
1. Occipital bone
2. Sphenoid bone
3. Ethmoid bone
3. Naso – Maxillary Complex
1. Maxilla
2. Nose
4. Mandible
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5. CRANIAL VAULT

6. SITE/LOCATION OF GROWTH & REMODELING
•Primary site of growth at cranium
• Sutures
• Secondary site of growth
• Inner & outer surface of bony plates
• Resorption on inner surface
• Deposition on outer surface
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7. TYPE OF GROWTH AT CRANIAL VAULT
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8. FLOOR OF
CRANIUM

9. SITE/ LOCATION OF GROWTH & REMODELING
• In center for midline
structures
• Synchondroses (Growth Sites of
Cranial Base)
• These are bands of cartilage which
remained after ossification of cranial
base bones by endochondral
ossification.
• 3 in number
• Spheno-occipital synchondroses
• Inter sphenoid synchondroses
• Spheno-ethmoidal synchondroses
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10. SITE/ LOCATION OF GROWTH & REMODELING
•Laterally;
•Sutures
•Surface remodeling or apposition(outer &
inner)
• E.g. Growth of sphenoid sinus
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11. DIAGRAMMATIC REPRESENTATION OF GROWTH AT
THE INTERSPHENOID SYNCHONDROSES.
• Histologically looks like
two sides epiphyseal plate
• Area of cellular hyperplasia
in center and maturation
occur in both sides.
• This cartilage produce
immoveable joint while
cartilage of long bone produce
moveable joint.
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12. TYPES OF GROWTH IN CRANIAL VAULT
•Endochondral ossification at center
•Surface apposition at lateral plates
and sutures.
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13. NASO MAXILLARY
COMPLEX

14. SITE OF GROWTH IN MAXILLA
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15. TYPE OF GROWTH IN
MAXILLA
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16. MAXILLA…
• Maxilla moves forward by growth of cranial base behind it.
• GROWTH PATTERN OF MAXILLA
• It grows out from under the cranium
• Means, maxilla must move a considerable distance downward & forward relative to cranium &
cranial base.
• This occurs in two ways;
• By push from behind created by cranial base growth &
• Coz maxilla is attached to anterior part of cranial base and lengthening of cranial base pushes
maxilla forward.
• By growth at sutures.
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17. As growth of
surrounding soft tissues
translates the maxilla
downward and forward,
opening up space at its
superior and posterior
sutural attachments, new
bone is added on both
sides of the sutures.
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18. MAXILLA…
•Growth of cranial base occurs till 6th year of age & stops at
7th year.
• In achondroplasia, growth of cranial base does not occur which
result mid face deficiency because maxilla is not moving
forward.
•After 7 years, forward & downward movement of maxilla
occurs at sutures.
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19. MAXILLA…
• In maxilla, sutures are attached superiorly & posteriorly.
• The sutures remain the same width, & various processes of
maxilla becomes longer.
• Because bone apposition occurs on both sides of
sutures. So bones to which maxilla is attached
also become larger.
• Part of posterior border of maxilla is free surface in the
tuberosity region.
• Bone is added at this surface creating additional space into which
primary and then permanent molars erupt.
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20. MAXILLA…
• In maxilla, bone is removed from outer/anterior surface while
deposited on inner surface.
• So, overall growth occur by both downward and forward
translation/movement of maxilla and simultaneously surface remodeling.
• In maxilla, surface remodeling of bone occur in the opposite direction to that in which it
is being translated/moved.
• However it is not rule that in every bone remodeling occurs in opposite direction, just like in growth
of palate in which remodeling occurs in the same direction to which the palate is being translated.
• Palate also moves downward & forward along with maxilla, but here at the same time the bone is
removed on the nasal side and deposited on the oral side, and anterior part of alveolar process is
resorptive area, here resorption occur to cancel forward growth of palate caused by maxilla.
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21. MANDIBLE

22. MANDIBLE
• Both, endochondral and periosteal activity occur.
• Endochondral at mandibular condyle
• Periosteal activity by direct surface apposition and
remodeling at all other areas of mandible.
• There is negligible role of growth of cranial base and
movement of TM joint due to growth of cranial base
unlike maxilla.
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23. PATTERN OF GROWTH OF MANDIBLE
• two ways depending on frame of reference;
• if cranium is reference area and considered as stable cranial base, then
• chin moves downward & forward
• from other reference area, data from vital staining;
• minimal changes in the body and chin area, while, there is growth & remodeling of ramus, moving it
posteriorly
• Both ways are correct, so the overall concept of growth of mandible is, mandible
is translated downward and forward and grows upward and backward in
response to this translation, maintaining its contact with skull.
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24. PATTERN OF GROWTH OF MANDIBLE
• So, the principal sites of growth of mandible are;
• Posterior surfaces of ramus
• Condylar
• Coronoid process
• As a growth site, anterior part of mandible along with chin is inactive
as growth site.
• It is translated downward and forward due to growth occurring at condyle
and posterior surface of mandible.
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25. PATTERN OF GROWTH OF MANDIBLE
• Body of mandible grows by periosteal apposition only on its posterior surface.
• Ramus grows upward by endochondral replacement at condyle accompanied by
surface remodeling.
• Mandible grows longer by apposition of new bone on posterior surface, while
resorption on anterior surface.
• In infancy, ramus is located at about the spot where the primary 1st molar will erupt.
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26. GROWTH OF SOFT
TISSUES
GROWTH OF FACIAL SOFT TISSUES DOES NOT GROW IN PARALLEL TO
FACIAL HARD TISSUES.

27. GROWTH OF LIPS
• Growth of lips is slower than growth of hard tissues of face before adolescence.
• Growth spurt of lips occur after adolescence
• Lip height is short during mixed dentition
• Lip incompetence (Lip separation at rest) is maximum during childhood and decreases during adolescence.
• Lip thickness reaches at maximum during adolescence and then decrease
• For some girls, loss of thickness seems problem and want treatment.
• Lips are framed by nose above and chin below.
• Lip prominence decrease after adolescence because of growth of chin and nose at adolescence
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28. GROWTH OF NOSE
•Growth of nasal bone is completed at
about age 10.
•After this age, growth only occurs in nasal
cartilage and soft tissues which growth spurt
in adolescent and that’s why nose become
prominent at adolescent (especially in boys).
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29. THE END
SARANG SURESH HOTCHANDANI (BDS)
BIBI ASEEFA DENTAL COLLEGE, SMBBMU.
Larkana, Sindh, Pakistan.
hotchandanisarang@gmail.com
www.twitter.com/fetusdentista