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Origin of
Malformations
INDIAN DENTAL ACADEMY
Leader in continuing dental education
www.indiandentalacademy.com
www.indiandentalacademy.com
Maxillary hypoplasia with narrow or high
arched palate
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Achondroplasia
Apert syndrome
Cleidocranial Dysostosis
Crouzon syndrome
Marfan’s syndrome
Treacher Collin’s syndrome
Fetal alcohol , Valproate syndrome
Cleft lip and palate
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Malar hypoplasia
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
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Treacher Collins Syndrome
Blooms syndrome
Trisomy 13 and 18

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Achondroplasia


Megalocephaly – small
foramen magnum



Early spheno-occipital closure



Low nasal bridge Prominent
forehead



Midfacial hypoplasia, narrow
nasal passages
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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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Crouzon syndrome
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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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Treacher Collin’s syndrome
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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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Fetal Alcohol syndrome

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Microcephaly
Short palpebral
fissures
Maxillary hypoplasia
Short nose, smooth
philtrum and lip

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CLEFT OF THE LIP and PALATE


Cleft lip and palate occur in 1 out of 800 live
births

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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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

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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Cleft of the Lip and Palate

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

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.

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Bifid Uvula

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Other classification


Veau Classification - 1931
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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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Etiology


Genetic Disorders:
More than 400 syndromes known to cause cleft of lip
and palate.



Chromosomal Aberrations

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Teratogenically Induced Disorders



Drugs: Dilantin, thalidomide, aspirin (when used in excess),
retinoid, etc.



Excessive alcohol, nicotine, caffeine.
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Etiology


X-rays, some viral infections, etc.



Mechanically Induced Abnormalities

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Amniotic rupture

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Intra-uterine tumors



Irregularly shaped uterus, etc.
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Theories of growth

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Sutural Theory
Weinman & Sicher
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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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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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Cartilagenous theory
James Scott

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Nasal sept um has innat e
gr owt h pot ent ial

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Thur st ef f ect by
sept omaxillar y ligament

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Bone enlar ges at t he
sut ur es in r esponse t o t he
t ension cr eat ed by
displacement
www.indiandentalacademy.com




Removal of the nasal septum lead to
decreased A – P growth
Vertical growth was unaffected

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

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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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
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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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Postnatal growth of
the midface

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Outline

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The Nasomaxillary Remodeling
Quantitative description of the growth in
three planes of the space

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The Nasomaxillary
Remodeling

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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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The Maxillary tuberosity
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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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The Lacrimal Suture
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




Surrounded by sutures
Slippage during the
growth
Co-ordinates with
growth of the
surrounding bones
Undergoes remodelling
rotations
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The Lacrimal Suture

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Key ridge




Posterior depository
field
Anterior resoptive
field

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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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Nasal airway




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Lateral and anterior
expansion
Downward
relocation of the
palate
Vertical expansion
of the vomer

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Nasal airway

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Nasal airway

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Palatal remodelling


Follows the ‘V’ principle



Palate in child is
completely replaced



Process of RME is not
a biologic process
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Palatal remodelling

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Downward maxillary displacement




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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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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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The Cheekbone and Zygomatic Arch

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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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A - point


Reversal of the
remodeling occurs

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Quantitative description of
the growth in three planes of
the space
A. Bjork and V. Skieller

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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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Parameters
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Maxillary height
Maxillary width
Bimolar width
Bicanine width
Mutual rotation of the maxillae
Vertical rotation
Remodelling of the zygomatic process
Alveolar process and dental arch
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Growth of the maxilla from 4 to 10 yrs


Maxillary height

www.indiandentalacademy.com





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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

Maxillary width

• Coincided with the maximum
pubertal growth spurt

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

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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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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

Transverse growth

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


Length of the dental arches decreases
Increase in crowding

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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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

Zygomatic process

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

Dental arch

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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

www.indiandentalacademy.com






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
www.indiandentalacademy.com


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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Thank you
For more details please visit
www.indiandentalacademy.com

www.indiandentalacademy.com

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