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4. Achondroplasia
Megalocephaly – small
foramen magnum
Early spheno-occipital closure
Low nasal bridge Prominent
forehead
Midfacial hypoplasia, narrow
nasal passages
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5. Apert syndrome
Short a-p diameter of skull
Early Craniosynostosis of
coronal suture
Small nose, maxillary
hypoplasia
Narrow palate, with or with
out cleft lip or palate
Delayed or ectopic eruption
of the teeth
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6. Crouzon syndrome
Ocular proptosis
Frontal bossing
Hypoplasia of the maxilla
Curved parrot – like nose,
inverted V shaped palate
Short A – P diameter and
lateral diameter of the skull
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7. Treacher Collin’s syndrome
Improper migration of
neural crest cells
Malar hypoplasia
Malformation of the
auricles
Ear defects
Cleft of the palate
Incompetent soft palate
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9. CLEFT OF THE LIP and PALATE
Cleft lip and palate occur in 1 out of 800 live
births
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10. Types
Cleft of the Lip
(Unilateral / Bilateral)
Complete or Incomplete
When unilateral it is
often on the Left side
When bilateral it
usually also affects the palate.
rare.
Isolated cleft lip is
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11.
Cleft of the Lip and
Palate
(Unilateral / Bilateral)
Unilateral:
May include
the hard palate and the soft
palate.
Sometimes, only one structure
affected.
Bilateral:
Usually the most severe
type of cleft.
Has severe tissue
deficiency.
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12. Cleft of the Lip and Palate
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13.
Submucous cleft
Seen in the soft palate.
Lack of muscle in the
velum; but there is
presence of mucosal tissue.
Often discovered late in
childhood.
Often is accompanied
with bifid uvula.
Bifid Uvula
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14. Other classification
Veau Classification - 1931
Veau Class I: isolated soft palate cleft
Veau Class II: isolated hard and soft palate
Veau Class III: unilateral CLAP
Veau Class IV: bilateral CLAP
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15. Etiology
Genetic Disorders:
More than 400 syndromes known to cause cleft of lip
and palate.
Chromosomal Aberrations
Teratogenically Induced Disorders
Drugs: Dilantin, thalidomide, aspirin (when used in excess),
retinoid, etc.
Excessive alcohol, nicotine, caffeine.
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16. Etiology
X-rays, some viral infections, etc.
Mechanically Induced Abnormalities
Amniotic rupture
Intra-uterine tumors
Irregularly shaped uterus, etc.
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18. Sutural Theory
Weinman & Sicher
Sutures have innate
growth potential
Push bones apart
Oblique in nature
Sliding effect
Resultant thrust in the
anterior and inferior
direction
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19. Shortcomings
- Bone tissue in not capable of growth in a
field that requires level of compression
needed to produce a pushing type of
displacement
- Suture is essentially a ‘tension’ adapted
tissue
- Sutures do not have inbuilt growth potential
•
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20. Cartilagenous theory
James Scott
Nasal sept um has innat e
gr owt h pot ent ial
Thur st ef f ect by
sept omaxillar y ligament
Bone enlar ges at t he
sut ur es in r esponse t o t he
t ension cr eat ed by
displacement
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21.
Removal of the nasal septum lead to
decreased A – P growth
Vertical growth was unaffected
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22.
Shortcomings
Extripation of septum caused tissue
destruction
Concept of multiple assurance;
latham and scott – growth mechanisms are
multifactorial
Compensation of growth occurs in
the neighbouring tissues
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23. THE FUNCTIONAL MATRIX
HYPOTHESIS
One Function
Functional Cranial Component
Functional Matrix
Skeletal Unit
1. Periosteal Matrix ------------------------------->
2. Capsular Matrix
-------------------------------->
a. Masses
b. Functioning spaces
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1. Microskeletal
2. Macroskeletal
24.
The growth of cranifacial cartilage is
entirely secondary to the growth of
functional matrices
Translation of the bones of the face is due
to the primary expansion of the oro and
naso pharyngeal cartilages
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28. The Nasomaxillary Remodeling
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
11.
The Maxillary tuberosity
The Lacrimal Suture
Key ridge
Vertical drift of teeth
Nasal airway
Palatal remodelling
Downward maxillary displacement
Maxillary sutures
The Cheekbone and Zygomatic
Arch
Orbital Growth
A - point
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29. The Maxillary tuberosity
Depository field
Backward facing
periosteal surface
Widening of the arches
Tension produced by the
displacement of the bone
Clinical implication –
distalization of the molars
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30. The Lacrimal Suture
Surrounded by sutures
Slippage during the
growth
Co-ordinates with
growth of the
surrounding bones
Undergoes remodelling
rotations
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33. Vertical drift of teeth
Vertical and horizontal
drift of the alveolus
Remodeling of the Pdl
Partially bonded cases
ex; 2 X 4 app to control
the vertical drift
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34. Nasal airway
Lateral and anterior
expansion
Downward
relocation of the
palate
Vertical expansion
of the vomer
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37. Palatal remodelling
Follows the ‘V’ principle
Palate in child is
completely replaced
Process of RME is not
a biologic process
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39. Downward maxillary displacement
Frontal slide at sutural
junctions with the
lacrimal zygomatic,
nasal and ethmoidal
bones.
Increase in the height of
maxilla
RME and face mask
therapy
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40. The Cheekbone and Zygomatic Arch
The malar region and anterior
part of the zygoma undergo
posterior remodeling
(relocation) movement
The inferior edge of the zygoma
is heavily depository.
Zygomatic arch moves laterally
by resorption on the medial side
within the temporal fossa and
by deposition on the lateral
side.
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42. Orbital Growth
Floor of the nasal
cavity is lower than
floor of the orbital
cavity
They are part of
maxilla ; remodeling
is in opposite
directions
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45. Implant study
Tantalum implants
1.5 mm & 1.2 mm
Lateral implants – 2 on each side of
zygomatic process of the maxilla
Anterior implants – 1 on each side below
the ANS ; inserted at the age of 10 – 11 yrs
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47. Growth of the maxilla from 4 to 10 yrs
Maxillary height
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48.
No relation b/w growth in width of the
median suture and the sutural growth of
maxilla
Transverse growth is indirectly proportional
to the growth of the alveolar process
Sutural growth is directly propotional to the
growth of alveolar process and the orbital
growth
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50.
Bimolar width – increases during puberty,
followed by a small
decrease
Bicanine width – decrease in the width from
4 yrs to the adult age
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53. Growth of the maxilla from 10 yrs to the
adult age
Maxillary length
There was no change in the sagittal
relationship b/w anterior and lateral
implants
Hence the anterior surface is stable during
the growth
Change is produced by remodeling
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55.
Length of the dental arches decreases
Increase in crowding
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56. Vertical rotation
Nasal floor maintains itself constant in
relation to the S-N plane
Forward rotation causes an incerased
resorption in the anterior part of the nasal
floor
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61. Summary
Growth at the median suture is an important factor in the
growth of width of the maxilla
There is an decrease in the arch length during growth due to
the transverse rotation of the maxillae
Sutural lowering of the maxilla is about half as great as
appositional growth
Anterior portion of zygomatic arch can be used as reference
structure
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62.
Handbook of orthodontics - Moyers
Hand Book of Facial Growth- ENLOW
Grays Anatomy
Factors affecting the growth of midface –
monograph no 6 – James A McNamara
Prenatal Growth and Morphology of the
Human Bony Palate - BERTRAM S.
KRAUS - J. Dent Res 1960; 1177 - 1199
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63.
Sagittal Growth of the Nasomaxillary
Complex during the Second Trimester of
Human Prenatal Development ALPHONSE R. BURDI - J. dent. Res ;
1965 – 112 - 125
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64. Thank you
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