Which of the craniofacial components are
sites / centers, with sufficient evidence (with
& against) & why?
Neven mortaga mohamed mostafa 4/4/24 Growth (CFG)
Neven Mortaga-Assignment 3
Introduction
The craniofacial region consists of bones, muscles, nerves, blood vessels, and
other tissues that form the structure of the skull and face such as the cranium (skull),
mandible, maxilla, facial bones (the nasal bones, zygomatic bones, and lacrimal
bones), as well as various muscles responsible for facial expression, mastication, and
speech. Additionally, it includes sensory organs like the eyes, nose, and ears, along
with their associated nerves and sensory processing centers.
Craniofacial Components as Sites or Centers
The terms "growth site" and "growth center" refer to specific regions within the
skull where growth and development occur, contributing to the overall shape and
size of the head and face.
Growth site Growth center
- Localized area where growth - Region that acts as a focal point
and remodeling take place. for growth regulation and
- Dependent on growth center. coordination.
- BAUME defined growth sites - growth centers exert broader
as regions of periosteal or influences controlling the
sutural bone formation and overall skeletal growth and
modelling resorption adaptive development.
to environmental Influences - Independent growth occurs
(genetically controlled).
- Baume- proposed growth center
used to describe places of
endochondral ossification with
tissue separating force.
Include regions of bone deposition, include areas where growth hormone
resorption, or cartilage growth depending receptors are highly concentrated, as well as
on the stage of development and the regions where signaling molecules such as
specific bone involved. growth factors and cytokines play key roles
in regulating growth and differentiation.
Grows by interstitial and appositional Grows by interstitial growth.
growth
1|Page
Neven Mortaga-Assignment 3
Less sensitive to hormone and vitamin More sensitive to hormone and vitamin
deficiency. deficiency.
More responsive to mechanical stimuli. Less responsive to mechanical stimuli.
a. Mandibular Condylar cartilage. a. the pituitary gland, serves as a central
b. Mandibular coronoid cartilage. growth center.
c. Mandibular angle cartilage. b. Epiphysial plates in long bones.
d. Mandibular symphysis. c. Synchondrosis of bones.
e. Maxillary tuberosity. d. Nasal cavity.
f. Palatal suture cartilage.
All growth centers can be growth sites, but reverse is not true. The growth
of craniofacial units involves the interplay of growth sites and growth
centers.
Any dysfunction or abnormalities in either growth center or site result in craniofacial
abnormalities or conditions such as craniosynostosis restricting skull growth.
Understanding the dynamics of growth sites and growth centers is essential for
comprehending craniofacial development, the pathogenesis of craniofacial
abnormalities, and identifying key sites or centers within this complex system
enhances clinical practice, surgical outcomes, and scientific knowledge, ultimately
benefiting patients and advancing healthcare.
growth sites, growth centers, and associated theories, both for and
against their roles in craniofacial growth:
I. Growth Sites:
1. Cranial base lateral sutures plus Major and minor Cranial vault sutures
plus sutures of maxilla are growth site
- Theory: The Functional Matrix Theory, proposed by Moss and later
expanded by Enlow, supports the idea that cranial base lateral sutures are
growth sites.
According to this theory, craniofacial growth is influenced by functional
demands and mechanical forces exerted on the skull generated by muscles
and soft tissues attached to it, and masticatory function. Cranial sutures are
regarded as primary sites of growth and remodeling where bones can respond
to these forces and adapt their shapes to accommodate functional needs.
2|Page
Neven Mortaga-Assignment 3
Cranial base lateral sutures, such as the sphenoethmoidal and
sphenozygomatic sutures are sites where growth and remodeling occur in
response to these functional stimuli. As muscles exert forces during activities
like chewing, swallowing, and facial expression, they transmit mechanical
signals to the cranial base, influencing its growth and morphology.
- Evidence Supporting Cranial Base Lateral Sutures plus Major and minor
Cranial vault sutures are growth site
a. Histological Studies cranial base sutures have revealed the presence of
active osteoblasts and osteoclasts, indicating ongoing bone deposition
and resorption.
b. Experimental Studies (Animal studies) involving mechanical loading of
cranial base sutures have demonstrated changes in suture morphology
and bone growth in response to altered functional demands. For
example, increased mechanical loading can lead to accelerated bone
deposition and sutural expansion.
c. Clinical Observations of patients with craniofacial anomalies or
conditions affecting muscle function support the role of cranial base
sutures as growth sites. Patients with muscle dysfunction or altered
functional patterns may exhibit abnormalities in cranial base
morphology and sutural development.
Clinical observations of patients with craniofacial anomalies or
conditions affecting cranial sutures provide evidence for the role of
sutures as growth sites. Premature fusion of sutures (craniosynostosis)
can result in abnormal skull shape and craniofacial growth patterns,
highlighting the importance of sutural growth in normal craniofacial
development.
- Evidence Against Cranial Base Lateral Sutures plus Major and minor
Cranial vault sutures are growth site
a. Mechanical Constraints: Critics of the Functional Matrix Theory argue
that mechanical constraints imposed by adjacent bones and soft tissues
may limit the extent of growth and remodeling at cranial base sutures.
3|Page
Neven Mortaga-Assignment 3
They suggest that sutural growth may be influenced more by intrinsic
factors, such as genetic programming and skeletogenic mechanisms,
rather than external functional stimuli.
b. Genetic Factors: Some researchers propose that genetic factors play a
more dominant role in determining cranial base morphology and sutural
development than functional influences. They argue that While sutures
may respond to mechanical stimuli, genetic instructions ultimately
dictate the overall pattern of craniofacial development.
c. Finite Element Modeling: Computational studies using finite element
modeling have suggested that cranial base sutures experience relatively
low levels of strain compared to other cranial sutures during masticatory
function. This result in questioning the significance of functional
influences on cranial base sutural growth.
2. cranial base synchondroses has been considered growth site
- Theory: The Skeletogenic Theory, proposed by Moss, supports the idea that
cranial base synchondroses are growth sites.
According to this theory, cranial base synchondroses serve as growth sites
where cellular activities such as chondrocyte proliferation and matrix
synthesis contribute to craniofacial growth and development. These
synchondroses are characterized by cartilaginous tissue that gradually
ossifies over time, contributing to the expansion and elongation of the cranial
base. Cranial base synchondroses such as the sphenooccipital synchondrosis
(SOS) and the sphenoethmoidal synchondrosis (SES) are regions of
cartilaginous tissue where growth occurs through endochondral ossification.
- Evidence Supporting Cranial Base Synchondroses as Growth Sites
a. Histological Studies of cranial base synchondroses have revealed active
zones of chondrocyte proliferation, hypertrophy, and ossification,
indicating ongoing endochondral bone formation. This evidence
suggests that synchondroses are sites of active growth and remodeling
within the craniofacial skeleton.
b. Experimental Studies (Animal studies) using histological and molecular
techniques have demonstrated cellular activities associated with growth
and remodeling at cranial base synchondroses. For example, studies
4|Page
Neven Mortaga-Assignment 3
utilizing animal models have shown increased expression of growth
factors and extracellular matrix proteins within synchondroses during
periods of active growth.
c. Clinical Observations of patients with craniofacial anomalies or
conditions affecting cranial base development support the role of
synchondroses as growth sites. Patients with abnormalities in
synchondrosis formation or premature fusion may exhibit craniofacial
deformities such as craniosynostosis, highlighting the importance of
synchondroses in craniofacial growth.
- Evidence Against Cranial Base Synchondroses as Growth Sites
a. Genetic Factors: Critics of the Skeletogenic Theory argue that genetic
factors play a more dominant role in determining craniofacial growth
and development than intrinsic mechanisms associated with
synchondroses. They suggest that while synchondroses may contribute
to craniofacial growth, genetic instructions ultimately dictate the overall
pattern of craniofacial development.
b. Functional Constraints: Some researchers propose that functional
influences, such as mechanical loading from masticatory forces or
cranial expansion, may limit the extent of growth and remodeling at
cranial base synchondroses. They argue that synchondrosis growth may
be influenced more by external factors such as functional demands than
intrinsic mechanisms alone.
3. Condyle, ramus, and other surfaces of mandible are growth site
- Theory: The Skeletogenic Theory.
According to this theory, growth centers within the craniofacial skeleton
regulate growth and remodeling through intrinsic mechanisms such as
cellular proliferation, differentiation, and matrix synthesis. These growth sites
contribute to the expansion, elongation, and shaping of the craniofacial
skeleton.
The Skeletogenic Theory suggests that craniofacial growth is influenced by
interactions between genetic factors and intrinsic growth mechanisms within the
craniofacial skeleton. Growth centers located at sites such as the condyles, ramus,
5|Page
Neven Mortaga-Assignment 3
and other bony surfaces regulate growth and remodeling through cellular activities
such as osteoblast and osteoclast activity, matrix synthesis, and mineralization.
These growth sites contribute to the overall growth and morphogenesis of the
craniofacial skeleton.
- Evidence Supporting Cranial Base Condyles, Ramus, and Other
Surfaces of mandible as Growth Sites
a. Histological Studies of cranial base condyles, ramus, and other bony
surfaces of mandible have revealed active zones of bone deposition and
remodeling, indicative of ongoing growth. These findings suggest that
these surfaces serve as sites of active growth and remodeling within the
craniofacial skeleton.
b. Morphometric Analyses have demonstrated changes in cranial base
morphology and dimensions during growth and development which are
indicative of growth occurring at specific sites such as the condyles and
ramus, contributing to overall craniofacial growth.
c. Clinical Observations of patients undergoing craniofacial growth and
development provide evidence for the role of condyles, ramus, and
other bony surfaces of mandible as growth sites.
- Evidence Against Cranial Base Condyles, Ramus, and Other Surfaces as
Growth Sites
a. Functional Constraints: Critics of the Skeletogenic Theory argue that
functional influences, such as mechanical loading from masticatory
forces or cranial expansion, may limit the extent of growth and
remodeling at cranial base condyles, ramus, and other surfaces. They
suggest that growth at these sites may be influenced more by external
factors such as functional demands than intrinsic growth mechanisms
alone.
b.Genetic Factors: Some researchers propose that genetic factors play a
more dominant role in determining craniofacial growth and
development than intrinsic growth mechanisms associated with specific
bony surfaces. They argue that while these surfaces may contribute to
6|Page
Neven Mortaga-Assignment 3
overall craniofacial growth, genetic instructions ultimately dictate the
overall pattern of craniofacial development.
II. Growth centers:
1. cranial base synchondroses has been considered as growth center
especially spheno-occipital suture
- Theory: The Functional Matrix Theory supports the idea that cranial base
synchondroses are growth centers.
According to this theory, craniofacial growth is influenced by functional
stimuli, such as muscle forces and masticatory function, and the cranial base
serves as a primary functional matrix that responds to these stimuli. Cranial
base synchondroses, including the sphenooccipital synchondrosis (SOS) and
sphenoethmoidal synchondrosis (SES), are regions of cartilage where growth
occurs in response to functional demands.
- Evidence Supporting Cranial Base Synchondroses as Growth Centers
a. Functional Adaptation: Studies have shown that cranial base
synchondroses respond to functional demands by undergoing growth
and remodeling.
b.Histological Studies of cranial base synchondroses have revealed active
zones of chondrocyte proliferation and matrix synthesis, indicative of
active growth. These findings support the idea that synchondroses serve
as sites of active growth and remodeling within the craniofacial
skeleton.
c. Clinical Observations patients with craniofacial anomalies or conditions
affecting cranial base development provide evidence for the role of
synchondroses as growth centers. Patients with abnormalities in
synchondrosis formation or premature fusion may exhibit craniofacial
deformities, highlighting the importance of synchondroses in
craniofacial growth and development.
- Evidence Against Cranial Base Synchondroses as Growth Centers
7|Page
Neven Mortaga-Assignment 3
a. Genetic Factors: while synchondroses may respond to functional stimuli,
genetic instructions ultimately dictate the overall pattern of craniofacial
growth.
b. Mechanical Constraints: Some researchers propose that mechanical
constraints imposed by adjacent bones and soft tissues may limit the
extent of growth and remodeling at cranial base synchondroses. They
argue that synchondrosis growth may be influenced more by intrinsic
factors, such as genetic programming, than external functional stimuli.
2. Nasal septal cartilage is considered as growth center in the postnatal life
- Theory: nasal septal cartilage provides thrusting force to carry maxilla
forward and downward growth.
- Evidence supporting Nasal septal cartilage as Growth Centers
a. Histological Studies of Nasal septal cartilage have revealed
endochondral ossification has been seen, vomeral-edge -is an area of
proliferation and on palatal -surfaces resorption on nasal and deposition
on oral side.
b. Clinical observation of Arrhincephalic patient:
-normal vertical.
-retarded sagittal mid face.
- Evidence Against Nasal septal cartilage as Growth Centers
a. excision-retards growth (may be due to trauma, early excision does not
affect).
8|Page
