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| IMC Wiki | Skull growth

Skull growth

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Symptom: Open bite

There are two different types of the disorder:

Vertical growth pattern in case of dysgnathia
#pic# #pic#

Vertical growth pattern in case of Binder's syndrome = cranio-facial deformity
#pic# #pic#
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Similar clinical pictures

that nevertheless require different treatment schemes because they are of different origins:
  • In border areas, there are transitional types between 'normal development' and deformity
  • An exact diagnosis is required!
#pic#

Origin of deformities

  • Ionizing radiation
  • Chemical or physical pollutants
  • Endocrinopathies
  • Stress (possible psychiatric origin)
  • Gene modification
  • Infection
  • Teratogenic origin
  • Other reasons

Period of genetic determination

  • Characterizes the time of organ development
  • The period during which a deformity developed can be determined from the deformity itself and its severity concluded from this period.
#pic#

Prenatal development

Problems may affect the whole skull.

Postnatal development

Problems usually affect individual regions, such as the maxilla and/or the mandible.

Development of the base of the skull

Base of the skull = border structure between neurocranium and viscerocranium

The development of the base of the skull influences that of the neurocranium and viscerocranium.
#pic#

Weeks 5 and 6 of embryonal development.

#pic#
  • Mesenchymal densification in the area of the axial head mesoderm.
  • Transformation of this mesenchymal cover in the area of the base of the skull into a blastema.
  • Development of the cartilaginous chondrocranium.
  • The skullcap remains membranous.
The chondral base that is open to the top consists of 4 regions (Stark 1975).

#pic#
  • Trabeculae cranii
  • Ala orbitalis (lesser wing of sphenoid bone)
  • Ala temporalis (greater wing of sphenoid bone)
  • Occipital region
Chondral base of the skull = primary growth centre

Development is influenced by:

#pic#
  • genetic,
  • functional,
  • and hormonal factors.
The chondral base is successively transformed into bone by enchondral ossification.
#pic#

Problems of chondroblast activity during development may lead to severe deformities, such as Apert syndrome.
#pic#

Ala minor ossis sphenoidalis develops from the ala orbitalis.

Sphenoid bone and acoustic labyrinth develop from the ala temporalis (pars squamosa by desmal ossification).
#pic# #pic#

Together, 1 and 2 form the temporal fossa = glenoid fossa of temporal bone.

The position of the temporo-mandibular joint (TMJ) is pre-determined by the chondral base of the skull in a vertical, sagittal and transverse direction, as well as the angle between the two petrous bones.
#pic#

Developmental disorders may lead, for instance, to Goldenhar's syndrome (oculo-auricular dysplasia).
#pic# #pic#

The trabeculae cranii develop into:
#pic#
  • Ethmoid sinus
  • Ethmoid bone
  • Crista galli
  • Nasal septum
  • Cartilaginous nasal capsule
This area is decisive for the sagittal and vertical development. Developmental problems in this area may lead to disorders, such as Binder's syndrome.
#pic#

Development of the skullcap

Desmal ossification of the skullcap occurs parallel to the enchondral ossification of the base of the skull.
#pic#

In week 7 and 8 of embryonal growth, centers of ossification develop in both the neurocranium and the viscerocranium, together with musculature.
#pic#

The membranous character remains in the area of the sutures.
#pic#

A suture consists of an osteogenetic cellular inner layer, covered by a fibrous vascular layer.
#pic#

Growth in the area of the sutures by functional forces = musculature.
They lead to distraction of the centers of ossification and reactive appositional bone growth on the margin of the centers of ossification = secondary growth center
#pic# #pic#

The extent of movement can be concluded from the suture's design.
#pic#

Craniofacial sutures = secondary growth center
#pic#

Problems lead to craniostenosis with typical skull modifications, also in the viscerocranium.
#pic#

Development of the face

Weeks 5 and 6 of embryonal development:
Development of the chondral nasal capsule from the trabeculae cranii = primary growth center, and successive bone formation by enchondral ossification.
#pic#

Problems arising during the development in the area of the chondral nasal capsule can result in deformities, such as Binder's syndrome.
#pic#

Weeks 7 and 8 of embryonal development:
Initial occurrence of centers of ossification and simultaneous development of mimic muscles that are connected to the centers of ossification.
#pic# #pic#

Development of facial sutures = secondary growth center
#pic# #pic#

Lebowerg recognized the significance of facial sutures for the development of the face.

Muscles connect primary and secondary growths centers.
#pic#

Greatest vertical development of the face in the zygomaticomaxillary suture (Sarnat 1968)
#pic# #pic#

Developmental problems in the muscular matrix may result in cleft lips, among other things.
#pic#

Developmental problems in the osteogenic matrix may result in the closure of individual sutures or an open bite.

In animal trials, developmental anomalies were observed in the premaxilla when the sutures were closed artificially.
#pic# #pic# #pic#

Unilateral closure of sutures results in the sagittal shortening of the skull and deviation of the nose.

Prenatal development disorders result in severe deformities of the whole skull.