Development of cranial vault & base /certified fixed orthodontic courses by Indian dental academy

GROW TH AND
DEVELOPMENT OF CRANIAL
VAULT

www.indiandentalacademy.com

INDIAN DENTAL ACADEMY
Leader in continuing dental education


In the closest of union there is still
some separate existence of
component parts; in the most
complete separation there is still a
reminiscence of union.
The notebook of Samuel Butler


SKULL
At Birth- 45 bony elements
 In Adult- 22 bones
Face- 14 bones
Cranium- 8 bones



Four regions of the Craniofacial complex:o

The Cranial Vault

o

The Cranial Base

o

The Naso-maxillary complex

o

The Mandible


Further –
Pre - natal and Post - natal growth
Attention to:i.
Site and location of growth
ii. Type of growth occurring.
iii. Determinant or controlling factors.


ANATOMY


Norma Verticalis – Above



Norma Basalis – Below



Norma Lateralis – Side



Norma Occipitalis – Back



Norma Frontalis - Front


anatomy


Span –
 Superciliary ridges & glabella of frontal bone
upto & including Squamous occipital bone.
Also includes part of Squamous temporal bone
laterally.


anatomy
When viewed from above:a. Ellipsoidal (roughly)
b. Bones –
 Frontal
 Parietal
 Occipital
 Temporal
 Greater wing of sphenoid

anatomy
c.

Sutures
 Frontal (metopic)
 Coronal
 Sagittal
 Lambdoid
 Parietal with Sphenoid
 Parietal with Temporal
 Bregma
 Lambda

scalp


Pre-Natal Growth
Mesenchyme first arranged as capsular membrane
Endomeninx – Neural crest origin
Ectomeninx – Neural crest and
paraxial mesoderm.


Pre-Natal Growth
Ectomeninx

Duramater

Superficial membrane

Vault

Base

Pre-Natal Growth
Endomeninx

Piamater


Arachanoid

Pre-Natal Growth


Close relation between ectomeninx and
endomeninx except in areas of venous sinuses.



Dura mater- Fiber bundles- Falx cerebri, Falx
cerebelli and Tentorium cerebelli- closely
related &strongly attached to the sutural
system- later develops in the vault .



Shape of brain

Pre-Natal Growth
Site

site of future bones

Ossification

Intra membranous

Controlling factor

Brain growth


Pre-Natal Growth
Mesoderm –
Frontal, Parietal, sphenoid, petrous temporal &
occipital.
Neural crest –
Lacrimal, nasal, squamous temporal, zygomatic,
maxilla & mandible


Pre-Natal Growth


Frontal Bone


Primary centre ------ Superciliary arch(8th wk)



Secondary centers ------ zygomatic process,
(fusion 6-7 mts)

nasal spine,
trochlear fossae

At birth- Metopic suture, fusion 2-7yrs

Pre-Natal Growth


Parietal bone




Occipital bone (Squamous part)




Region of Parietal eminence 8th wk, fuse by 4th
month.
Just above superior nuchal line

Temporal bone (Squamous part)


Root of zygoma

Pre-Natal Growth


Tympanic ring of temporal bone


4 centers in lateral wall of tympanum appear in
the 3rd month of i.u birth, fuse at birth.



Formation of Sutural/ wormian bones


Unusual centers of ossification


Pre-Natal Growth


Osification centers appear around 8th week IU.



Fontanelles
 Close at various times- 2 months to 2 years


Fontanelles


Pre-Natal Growth
-Control of Morphogenesis

3 questions posed by Van Limborgh:

Relationship between skull and primordia of other
organs?



Co-ordination of endochondral and
intramembranous ossification?



Co-ordination of growth of skull and other organs?


Pre-Natal Growth
-Control


Intrinsic genetic factors



Epigenetic factors



Environmental factors


Intrinsic Genetic control
Local epigenetic factors

Cranial
Cranial
differentiation
differentiation

General epigenetic factors
Local Environmental factors
General Environmental factors


Pre-Natal Growth
-Control

Shift of belief:Genetic influence

Epigenetics

Examples- Primordia of eye.
- Brain.


Post-Natal Growth
Related to Growth of the Brain
 Maximum growth upto the 5th year of life – (91% as
shown by Davenport)



Post-Natal Growth
Various Theories of Growth, and how they relate to
the cranial vault.
Sicher’s Sutural dominance theory
Scott’s Cartilaginous theory
Moss’ FMH


Sicher’s Theory

Desmocranial
Desmocranial
Growth
Growth



Post-Natal Growth


Scott’s theory

Inherent growth controlling factors present in
Cartilages & Periosteum.



Sutures respond secondarily


Post-Natal Growth

Chondrocranial
Chondrocranial
Growth
Growth


Desmo- Sutures
cranial
Periosteal
Growth growth


Post-Natal Growth
Moss’ FMH


Desmocranial
Desmocranial
Growth
Growth


Post-Natal Growth
Sicher – Intrinsic control
Hydrocephalus, anencephaly, microcephaly




Scott – Cartilage not responsive to pressure or
tension, but intra membranous bone is.


Post-Natal Growth


Post-Natal Growth


Synchondrosis

Sutures

Sarnat, Burdi, Baume, Petrovic etc.
Also explains why growth of cranial base is less
influenced by brain growth than growth of Cranial
vault - Van Limborgh


Post-Natal Growth
Moss’ explanation for brain growth controlling growth
of the cranium…
Hydrocephalus, synostosis


Post-Natal Growth
V A U L T

Brain
B A S E

Post-Natal Growth
Van Limborgh's Summarization:1.

Intrinsic control of growth is exhibited at synchondroses

2.

Intrinsic control of sutural growth is less

3.

Synchondroses should be considered as Growth centre

4.

Sutural growth controlled by both cartilaginous growth and
growth of other structures.

5.

Periosteal bone growth (vault) controlled epigenetically by
adjacent structures

6.

Growth of cranial vault also controlled by local
environmental factors (muscle forces inclusive)

Chondrocranial
Chondrocranial
Growth
Growth


Desmocranial
Desmocranial
Growth
Growth



Post-Natal Growth
Growth of the cranial vault –
direct influence of Neurocranial capsule


New deposition on flat surfaces
 Endosteal surfaces- resorptive
 Increases overall thickness- expands medullary
spaces.



Post-Natal Growth
Thickening not uniform:Inner table
Brain
Outer table

mechanical influences
and functional stresses

Growth of the frontal sinus (Benninghoff)


Post-Natal Growth
Arc of curvature of the whole bone decreases


Post-Natal Growth
90% of cranial vault growth complete by 5-6 yrs
In accordance with
-Scammon’s curve
- Cephalocaudal Gradient.


Clinical Implications


Distortion of head during birth – Fontanelles




Synostosis syndromes
 Courzon’s syndrome
 Apert’s syndrome




Other conditions – Hydrocephalus, Anencephaly,
Microcephaly




Various conditions – cretinism, progeria, trisomy
21, cleidocranial dysostosis,  Anterior fontanelles remain open
 Bossing of forehead
 Brachycephalic skull




Herniation of dura mater into the nose

Dura remains in contact with the ectoderm in the
region of the anterior neuropore.
Ventral bending of the fronto-nasal process brings
this junction close to the future nose.
Nasal capsule forms around this, and the junction
sinks forming the foramen caecum


The dura then separates from the ectoderm, and
foramen caecum closes.
If this foramen fails to close, dura can herniate in to
the nose.
Also formation of dermoid cysts, sinus or
encephalocele.



Abnormal external forces applied to the cranial
vault, as by headboards, by primitive tribes.


GROW TH AND
DEVELOPMENT OF CRANIAL
BASE
Dr. Safeena


Cranial Base
Reasonably stable reference structure in
cephalometric analysis
 Basis to compare and understand abnormal
growth patterns



Functions


Supports & protects the brain & spinal cord



Articulation of skull with vertebral column ,
mandible & maxilla



Buffer zone between the brain, face &
pharyngeal region


ANATOMY


ANTERIOR CRANIAL FOSSA



MIDDLE CRANIAL FOSSA



POSTERIOR CRANIAL FOSSA


1.
2.
3.

Orbital part of frontal bone
Cribriform plate of ethmoid
Anterior part of the body of sphenoid & lesser
wing


CRIBRIFORM PLATE OF ETHMOID

THE SPHENOID BONE
 Anterior part of the upper surface of its body is
termed the JUGUM SPHENOIDALE


ORBITAL PLATE OF FRONTAL BONE
It separates the orbit and its contents from the
inferior surface of the frontal lobe of the brain
Its antero medial part split into 2 laminae

FRONTAL SINUS


It is deeper than the anterior fossa
 It shaped like a butterfly. In front it is bounded by
posterior borders of the lesser wing of sphenoid
and the body of the sphenoid,
 Behind by superior borders of the temporal bones
& Dorsum sellae of sphenoid bone


Centrally



Optic Canal
Hypophyseal Fossa

Laterally







Superior Orbital
Fissure
Foramen Rotundum
Foramen Ovale
Foramen Spinosum
Foramen Lacerum

Largest and deepest of the cranial fossa


VARIOUS FORAMINA
 FORAMEN MAGNUM
 JUGULAR FORAMIN
 INTERNAL ACOUSTIC
MEATUS
 FACIAL CANAL
 HYPOGLOSSAL CANAL

PRENATAL GROWTH
Cranial base develops by endochondral bone
formation


PRENATAL GROWTH
CHONDRIFICATION


Mesenchyme derived from paraxial mesoderm and neural
crest .



Form ECTOMENINGEAL CAPSULE .



Earliest evidence of skull formation.



Mesenchyme starts converting into Cartilage
Starting on day 40 i.u. Cartilage


PRENATAL DEVELOPEMENT
CRANIUM

NEUROCRANIUM

VISCEROCRANIUM

BASICRANIUM


At the cellular level




Hyperplasia
Hypertrophy
Accretion


CARTILAGES


PARACHORDAL CARTILAGE



HYPOPHYSEAL CARTILAGE



OTIC CAPSULE



NASAL CAPSULE


PRIMORDIAL CARTILAGES


PRENATAL GROWTH
PARACHORDAL CARTILAGES
Chondrification centers forming around the cranial
end of the notocord

Parachodal cartilages fuse with the sclerotomes
arising from occipital somites surrounding the
neural tube

PRENATAL GROWTH


PRENATAL GROWTH
2 Hypophyseal cartilages - Postsphenoid
Sella turcica
Body of the sphenoid (post. Part)


PRENATAL GROWTH
2 Presphenoid cartilage- Presphenoid bone
Body of the sphenoid bone
(ant. Part)


PRENATAL GROWTH
Most anteriorly- presphenoid cartilages- Mesethmoid
Ossifies into perpendicular plate of ethmoid
Upper edge forms crista galli


PRENATAL GROWTH
Orbito sphenoid - Lesser wing
 Alisphenoid
- Greater wing



PRENATAL GROWTH
OTIC CAPSULE
Mastoid and petrous portions of the temporal
bones
Otic capsule does not chondrify.


PRENATAL GROWTH
NASAL CAPSULE- 2nd month i.u
Cartilages of nostrils and the nasal septal cartilage
 Functional matrix- downward & forward growth
 It helps in transferring compressive forces from
incisor region to the sphenoid region


CHODROCRANIAL OSSIFICATION



110 ossification centers in embryonic human skull.
Ossification starts in the 4 months

UNOSSIFIED CHONDROCRANIAL REMNANTS –
 Alae & septum of the nose,


Spheno-occpital & spheno-petrous junctions,



The apex of the petrous bone and



Between the separate parts of the occipital
bone

CHODROCRANIAL OSSIFICATION


OSSIFICATION
OCCIPITAL BONE - 7 centres
 Supranuchal Squamous portion –
2 intramembranous centres ( 8 th week)
 Infranuchal squamous –
2 endochondral centres (10 th week)
(Kerckring centre)


OCCIPITAL BONE
Basioccipital bone – 1 endochondral
(11th week)
Exoccipital bone – 2 endochondral centres
(12 th week)


OSSIFICATION
TEMPORAL BONE - 21 centres
Squamous portion-1 intramembranous centre
(8 th week)- Zygomatic process
 Tympanic ring – 4 intramembranous centres
(3 th month)
 Petrosal part – 14 endochondral centres
(16th week)
 Styloid process – 2 endochochondral
centres(at birth)
Start to fuse during 1st yr of life



OSSIFICATION
ETHMOID BONE – 3 centres
 Perpendicular plate & crista galli –
1 endochodral centre
 Lateral labrynths in the nasal
cartilages- 2 endochondral centres


OSSIFICATION- SPHENOID BONE
Intramembranous ossification centres
 Medial pterygoid plates – 2
 Lateral pterygoid plates -2
Endochondral ossification centres
 Presphenoid
– 3
 Postsphenoid – 4
 Orbitosphenoids - 2
 Alisphenoids
- 2
 Pterygoid hamuli - 2

OSSIFICATION
VOMER
Alae – 2 intramembranous centres

Inferior nasal concha
Lamina – 1 endochondral centre


OSSIFICATION
BONE
OCCIPITAL
(2)

SITE & NUMBER OF OSSIFICATION
INTRAMEMBRANOUS
ENDOCHONDRAL
_ Supranuchal
squamous (2)

Infranuchal squamous
Basilar (1)
Exoccipital (2)

TEMPORAL

_ Squamous (1)
Tympanic (4)

Petrosal (14)
Styloid (2)

ETHMOID

_

Lateral labrynths (2)
Perpendicular plate;
Crista (1)


OSSIFICATION
BONE

-

SITE & NUMBER OF OSSIFICATION
INTRAMEMBRANOUS
ENDOCHONDRAL
VOMER
_ AlAE (2)
SPHENOID _ Medial pterygoid
Presphenoid (3)
plates (2)
Postsphenoid (4)
Lateral pterygoid
Orbitosphenoid (2)
plates (2)
Alisphenoids (2)
Pterygoid hamulus (2
Sphenoidal conchae (2)
INFERIOR NASAL
CONCHA _
Lamina (1)

CRANIAL BASE ANGULATION
Angle at the hypophyseal fossa where prechordal &
chordal parts meet each other


CRANIAL BASE ANGULATION


PRE NATAL GROWTH
Highly Uneven
Anterior cranial base increases its length
and width by 7 folds between the 10th and
40thweek of I.U life
Posterior cranial base grows only 5 fold


POSTNATAL GROWTH
EXPANTION of cranial base occurs by
 Growth of the cartilage remnants of the
chondrocranium- basicranial bones
 Forces from growing brain


POSTNATAL GROWTH
Cranial base acts as a template from which the face
develops
The endocranial surface of the basicranium is
resorptive in most areas
Remodeling is required to accommodate the
massively enlarged human brain

POSTNATAL GROWTH
FOSSA ENLARGEMENT


POSTNATAL GROWTH
Endocranial compartments- separated by bony elevations
• Middle & posterior fossae – petrous elevation
•

Olfactory fossae – crista galli

•

Right & left middle fossae – Sphenoidal elevation

•

Right & left anterior & posterior fossae – Longitudinal
midline bony ridge


POSTNATAL GROWTH
Fossa expands outward by resorption,
 Partitions between them enlarge inward by
deposition



POSTNATAL GROWTH
The mid ventral segments of cranial base grows more
slowly to accommodate the medulla, pons,
hypothalamus & optic chiasma
Foramen

Drift process

Spinal Cord

Defferential remodelling


POSTNATAL GROWTH
SYNCHONDROSIS- SEEN IN MIDLINE PART OF
BASICRANIUM


POSTNATAL GROWTH
SYNCHONDROSIS

A growth centre
Bipolar direction of growth


POSTNATAL GROWTH
SPHENO-OCCIPITAL SYNCHONDROSIS
Major contributor in the postnatal growth
Fuses at 12-13 years in girls
and 14-15 years in boys and
ossifies at 20 years of age
Pressure adapted
bone growth mechanism

POSTNATAL GROWTH


Sinus secondarily grows as the body of the
sphenoid bone expands keeping constant junction
with the moving naso-maxillary complex


POSTNATAL GROWTH
Post border of N-Mcomplex coincides with boundary
between ant and middle cranial fossa
Secondary displacement effect
(Anterior cranial floor , nasomaxillry complex &
mandible)


POSTNATAL GROWTH


Frontal lobe growth
completes by 5years.



Temporal lobes
continue to enlarge for
several more years and
displaces the frontal
lobe forward.


POSTNATAL GROWTH


CLINICAL IMPLICATIONS
Configuration of neurocranium(& brain) determines a
person’s head form type
- DOLICOCEPHALIC
- BRACHYCEPHALIC
- MESOCEPHALIC


Cranial base growth for Dutch boys
and girls –Monique Henneberke &
Birte Prahl Andersen (AJO 1994)

Hypothesis that there is no difference in the cranial
base growth between children with or without ortho
treatment- was tested
 S-N 153(boys)and 167 (girls)
 N-Ba and S-Ba 116 (boys) and 116 (girls), 7-14 yrs
Mixed longitudinal study


RESULTS
1.

The effect of orthodontic therapy on cranial base
was not significant

2.

The cranial base displayed sexual dimorphism in
absolute size, timing and amount of growth.

3.

Girls did not show growth spurts where as boys
showed growth spurts for S-N and N-Ba.

ACHONDROPLASIA
Disturbance in endochondral bone formation
Deficient growth at the synchondrosis
Maxilla is not translated forward
This results in abnormal depression of the bridge of
the nose
Relative midface deficiency



Premature ossification or synostosis of
the suture between the presphaenoid and
postsphenoid parts of the spheno-occipital suture
- depressed nasal bridge and dished face




Anomalous development of the presphenoidal
elements
Excessive separation of orbits and abnormally
broad nasal bridge. -HYPERTELORISM



ANENCEPHALY (Absence of calvaria )

Retain acute cranial base flexure




INADEQUATE GROWTH OF CHONDROCRANIUM
Impacted eruption of third molars

CLIEDOCRANIAL DISOSTOSIS
Abnormalities of the skull, teeth, jaws and shoulder
girdle




Abnormalities Of Cleidocranial Disostosis –
Kreiborg,bjork& Skeiller (AJOMay; 1981 )

KREIBORG,BJORK & SKIELLER conducted a qualitative
screening for abnormal morphological traits in the cranial
base. (8 males & 9 females)
RESULTS






The anterior and posterior cranial base was shorter and the
cranial angle smaller in the syndrome groups
Patients shown small pituitary fossae and bulbous dorsum
sellae
The amount of bone resorption was lesser than normal.

I will praise thee: for I am fearfully and
wonderfully made.
Psalm CXXXIX 14


REFERENCES
1. Craniofacial Embryology
-G.H.SPERBER
2. Essencials Of Facial Growth
-D.H.ENLOW
3. Contemporary orthodontics
W.R.PROFFIT
4. Anatomy –Gray
5. Grants Atlas
6. Abnormalities Of Cleidocranial Disostosis – Kreiborg,bjork&
Skeiller (Ajo May; 1981 )
7. Cranial Base Growth For Dutch Boys & Girls –
M.Herneberke,b.P. Andersen (Ajo November; 1994 )

Leader in continuing dental education


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