prenatal and post natal development of maxilla

PRENATAL AND POST NATAL GROWTH
AND DEVELOPMENT OF MAXILLA
NOUFAL T
2

CONTENTS
• INTRODUCTION
• GROWTH AND DEVELOPMENT DEFFNITIONS
• TERMINOLOGY RELATED TO GROWTH AND DEVELOPMENT
• MAXILLA
• ANATOMY OF MAXILLA
• PRE NATAL DEVELOPMENT OF MAXILLA
• POST NATAL DEVELOPMENT OF MAXILLA
• THEORIES OF GROWTH IN MAXILLARY GROWTH
• AGING CHANGES
• SYNDROME ASSOCIATD
• ORTHODONTIC IMPLICATION
• CONCLUSION
• REFERENCE
3

GROWTH AND DEVELOPMENT
• GROWTH
Increase in size or number
DEVELOPMENT
Increase in complexity
Growth- anatomical phenomenon
Development-physiological phenomenon
Source : CONTEMPORARY ORTHODONTICS – WILLIAM R PROFFIT-FIFTH EDITION
4

Growth and development in an individual can be divided
into prenatal and post natal with former being more
dynamic as the growth in prenatal period being 5000 times
more than what happens in postnatal era.
5

IMPORTANCE OF GROWTH
• Indicator of general health
• Identify unusual growth pattern at an early stage
• Etiology and development of malocclusion
• Identify abnormal occlusion at an early stage
• Use of growth spurts
6

SCAMMONS GROWTH CURVE
7

TWO TYPES OF BONE GROWTH
1.ENDOCHONDREAL OSSIFICATION
Convertion Of Hyaline Cartilage In To Bone
2.MEMBRANEOUS OSSIFICATION
Transformation Of Mesenchymal Connective Tissue In To
Membranous Sheets And Then In To Bone
8

GROWTH SITE AND CENTRE
GROWTH SITE
Location at which growth occurs
Eg: condylar cartilage
maxillary tuberosity
GROWTH CENTRE
Location at which independent growth occurs
Eg: Sutures between membraneous bone and jaw
9

MAXILLA
• Second largest bone of the face
• Paired bone
• Forms upper jaw, roof of the nose,part of nasal floor and much of the face
• Houses the teeth of upper jaw
• Contain maxillary sinus
10

ARTICULATIONS
• SUPERIORLY WITH NASAL LACRIMAL AND FRONTAL
MEDIALLY WITH ETHMOID,
INFERIOR NASAL CONCHA,
VOMER AND PALATINE
LATERALLY WITH ZYGOMATIC BONE
12

PRE-NATAL EMBRYOLOGY OF MAXILLA
• Around the fourth week of intra-uterine life,
a prominent bulge appears on the ventral
aspect of the embryo corresponding to the
developing brain.
• Below the bulge a shallow depression which
corresponds to the primitive mouth appears
called Stomodeum.
Source : DIAGNOSIS AND MANAGEMENT OF MALOCCLUSION BY OP KHARBANDA
14

The floor of the stomodeum is formed by the
Buccopharyngeal membrane which separates
the Stomodeum from the foregut.
By around the 4th week of intra-uterine
life ,five branchial arches form in the region
of the future head and neck.
15

The first pharyngeal arch is called the Mandibular arch and plays an
important role in the development of the naso-maxillary region.
The mesoderm covering the developing forebrain proliferates and
forms a downward projection called Fronto-nasal process.
16

The Maxillary Process grows ventro-medio-
cranial to the main part of the Mandibular arch
which is now called the Mandibular Process.
The mandibular arches of both the sides form the lateral walls of
the stomodeum.
The mandibular arch gives of a bud from its
dorsal end called the Maxillary Process.
17

Thus at this stage the primitive mouth is overlapped
from above by the Fronto-nasal Process, below by the
Mandibular process and on either side by the maxillary
process.
18

The ectoderm overlying the Fronto-nasal Process shows bilateral
localized thickenings above the stomodeum. These are called
the Nasal Placodes.
These placodes soon sink and form the Nasal Pits.
19

The formation of these Nasal Pits divides the Fronto-nasal
process into two parts :
a.The Medial nasal process
b.The lateral nasal process
20

The two mandibular processes grow medially and fuse to form the lower lip and lower jaw.
As the Maxillary Process undergoes growth, the Fronto-nasal process becomes narrow so
that the two Nasal Pits come closer.
The line of fusion of Maxillary Process and the Medial nasal Process corresponds to the
Naso-lacrimal duct.
21

POST-NATAL GROWTH OF MAXILLA
Maxilla develops primarily by Intra membranous ossification.
A Primary Intra membranous ossification center appears for each maxilla in the 8th week
of intrauterine life at the termination of infraorbital nerve just above the canine tooth
dental lamina.
Source : ESSENTIALS OF FACIAL GROWTH BY ENLOW AND HANS
22

Secondary cartilages appear at the end of 8th
week IU in the regions of the zygomatic and
alveolar processes that rapidly ossify and fuse
with the primary intramembranous center.
Two further intrmembranous pre-maxillary centers appear anteriorly one each side in the 8th
week IU and rapidly fuse with the primary maxillary center.
23

The growth of the naso-maxillary complex is produced by the following mechanisms :
• Displacement
• Growth at Sutures
• Surface Remodeling
24

DISPLACEMENT
• Maxilla is attached to the cranial base by means of number of sutures.
• growth of the cranial base has a strong influence on the naso-maxillary growth.
25

SECONDARY DISPLACEMENT OF MAXILLA
The naso-maxillary complex is simply moved anteriorly as the
middle cranial fossa grows in that direction.
26

SECONDARY DISPLACEMENT OF NMC
• Expansion of Middle Cranial fossa has secondary displacement effect on anterior
Cranial floor and thus on underlying NMC.
• Growth occurs in all the 3 dimensions….
• A-P dimension(in length)
• Transverse dimension (in width)
• Vertical Dimension (in height)
27

SECONDARY DISPLACEMENT
(A-P DIMENSION)
Ant. & Middle cranial fossa move away from each
other
NMC carried in forward direction
Bone deposited in tuberosity area
Increase in A-P dimension
28

(TRANSVERSE DIMENSION)
Left and right temporal lobes move
away from each other
Increase in transverse width of middle
cranial fossa
Increase in width of maxilla by-
•growth in mid palatine suture
•Remodeling at lateral aspect of alveolar process Source : ESSENTIALS OF FACIAL GROWTH BY ENLOW AND HANS
29

(VERTICAL DIMENSION)
Middle cranial base is in inclined
plane
Increase in dimension of Middle
cranial base
Causes displacement of NMC in downward
direction
30

Primary Displacement
• By growth of the maxillary tuberosity in a posterior direction
• Whole maxilla being carried anteriorly.
• Bone is displaced by its own enlargement
31

GROWTH AT SUTURE.
a. Fronto - nasal suture.
b. Fronto – maxillary suture.
c. Zygomatico – maxillary suture.
d. Pterygo – palatine suture.
e. Zygomatico – temporal suture.
33

• Sutures are all oblique and more or less
parallel to each other.
• Downward and forward positioning of the
maxilla as growth occurs at this sutures.
34

SURFACE REMODELING
By bone deposition and resorption
• Increase in size.
• Change in shape of bone.
• Change in functional relationship.
35

Bone remodeling changes seen in the
Naso - maxillary complex
Resorption occurs
Lateral surface of the orbital rim - lateral movement of the
of the eye ball.
Bone deposition
medial rim of the orbit and on the external surface of the
lateral rim.
36

NASAL AIRWAY
Resorption in lining surface of bony wall and floor
Downward relocation
of palate
Lateral and anterior expansion of nasal chamber
37

MAXILLARY TUBEROSITY
Bone deposition posterior margin of the maxillary tuberosity - antero-
posterior dimension of the entire maxillary body.
Helps to accommodate the erupting molars.
38

NASAL CAVITY
Bone resorption - lateral wall of the nose - an increase
in the size of the nasal cavity.
Bone resorption - floor of the nasal cavity.
Bone deposition - palatal side.
Net downward shift - increase in maxillary height.
39

The zygomatic bone
• Posterior direction
Resorption - anterior surface
Deposition - posterior surface.
• Transverse direction- Zygomatic arch
Deposition - lateral surface of the zygomatic arch Resorption -
medial surface.
40

MAXILLLARY SINUS
Expands - 2mm vertically
3mm A-P -every year
> in size - resorption in walls + alveolus
41

MAXILLARY SINUS
• POST NATAL
• All internal surfaces - resorption
[expect medial]
• Rapid continuous downward growth
close proximity to buccal maxillary teeth
42

LACRIMAL SUTURE
(KEY GROWTH MEDIATOR)
 A bone with its entire perimeter bounded by
sutural connective tissue
 Without it a developmental ‘gridlock’ will occur
among differentially developing multiple bones
 It slides maxilla downward along its orbital
contacts
 This allows whole maxilla to get displaced
inferiorly
43

Transversely, additive growth on the free ends
increases the distance and thus the buccal segments
move downward and outward.
The expanding ‘V’ in the
downward and forward
growth of the maxilla
44

KEY RIDGE
• Reversal occurs at the key
ridge
• Anterior to it – resorption
• Posterior to it - deposition
45

DRIFT OF TEETH
Dentition drift both vertically and
horizontally to keep pace with
enlarging maxilla.
It moves tooth & also socket by
remodeling
By harnessing vertical drift
orthodontist can guide teeth in
calculated position
46

KEY FACTORS IN NMC GROWTH
• Lacrimal suture
• Maxillary tuberosity
• Vertical drift of teeth
• Nasal airway
• Palatal remodeling
• Cheek bone and zygomatic arch
• Orbital growth
47

SUTURAL THEORY
• Sutures have innate growth potential
• Push bones apart
• Oblique in nature
• Sliding effect
• Resultant thrust in the anterior and
inferior direction
Weinman & Sicher
48

SUTURAL THEORY
• 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
49

EXPANSION OF CARTILAGE?
• Pressure accommodating expansion of
the cartilage in the nasal septum is the
source for the physical force that
displaces the maxilla
• Secondary to this displacement bone
formation takes place in the sutures
• Theory remained unresolved for a long
while
1. Source of maxillary displacement is
multifactorial
2. Experimental studies involving surgical
removal of septum involves
destruction of tissues, blood vessels
and nerves
50

FUNCTIONAL MATRIX CONCEPT
• Now popular explanation.
• As soft tissues grow they carry the bone along with them.
• Secondary to this bone deposition occurs at the sutures
.
51

DEVELOPMENT OF PALATE
The palate is formed by contribution of the :
a. Maxillary process
b. Palatal shelves given off by the maxillary process
c. Fronto-nasal process
52

TIMING OF GROWTH OF
MAXILLA IN WIDTH, LENGTH
AND HEIGHT
53

• Growth in width is completed first, then growth in length, and
finally growth in height.
• Growth in width of maxilla including dental arches tend to be
completed before the adolescent growth spurts .
• Intercanine width is more likely to decrease after the age of 12
years
inter canine width completed by 12 yrs of age in girls but
continue to grow until 18 yrs of age in boys
54
Source : text book of orthodontics by Sridhar premkumar

• First 5 years , growth in width at the palatal sutures mostly at the intermaxillary suture and
midpalatine sutures.
• After that increase in width of the maxilla occurs as a result of bone deposition on the outer
surface of the maxilla and by buccal eruption of the permanent teeth
55

• Growth in length and height of the jaw continues through the period of puberty.
• Girls : maxilla grows slowly downward and forward to age 14 to 15.
• In both sexes growth in vertical height of the face continues longer than growth in length.
56

ORTHODONTIC IMPLICATION
• ORTHOPEDIC APPLIANCES
HEADGEAR
FORCE OPPOSITE TO NATURAL FORCE – PREVENTING THE AMOUNT OF
SEPERATION OF SUTURES – PREVENT MAXILLARY GROWTH
57

FACE MASK
TENSION ON THE SUTURES – AUGMENTATION OF MAXILLARY GROWTH
58

VARIATION IN NMC GROWTH
• class II ( excessive mid face growth)
• class III (decreased midface growth)
• Crossbite (decreased midface growth)
• Edge to edge bite (decreased midface growth)
• Cleft Palate
59

CLASS II ( EXCESSIVE MID FACE
GROWTH)
60

CLASS III( DECREASED MID FACE
GROWTH)
61

CROSSBITE (DECREASED MIDFACE GROWTH)
62

SYNDROMES ASSOSCIATED
•PIERRE ROBIN’S SYNDROME
It results in arrested development.
Cleft palate
Micrognathia
Glossoptosis
63
Source : text book of oral pathology by shafers

CROUZON SYNDROME(
CRANIOFACIAL DYSTOSIS)
• It affects the first branchial arch.
• Maxillary hypoplasia
• High arch palate
• Strabismus(outward deviation of one of the eyes)
• Bulging or protrusion of eyeball
• Premature closing of suture :
branchycephaly)short head
scaphocephally- boat shaped skull
clover leaf shaped skull
trigonocephaly - triangle shaped skull
64

CLEIDOCRANIAL DYSOTOSIS
• Hypoplasia of maxilla
• Failure of eruption of permanent teeth
• Frontal bossing(bulging) of the forehead
• Open skull sutures , large fontanalle
• Shoulder meet in the midline-due to complete
absence of clavicle.
• lacrimal and zygomatic bones - under developed
65

APERT SYNDROME
• a congenital disorder
• malformation of the skull, face , hands and feet.
branchial arch syndrome - first branchial arch
66

HEMIFACIAL DYSPLASIA
(GOLDENHAR SYNDROME)
• Incomplete development of the ear, nose ,
soft palate, lip and mandible
• Unilateral microstomia
• Downward slanting of palpebral fissures
• High arched plate
• Palatal and uvular cleft
• malocclusion
• Maxillary premolars will be missing
67

CONCLUSION
• Maxilla develops from first branchial arch
• Growth and development of maxilla occurs - multifcatorialy
• Dfference in males and females
• Identify unusual growth pattern at an early stage
• Etiology and development of malocclusion
• Identify abnormal occlusion at an early stage
• Use of growth spurts – for orthopedic manipulation of skeletal problems
68

REFERENCES
Contemporary orthodontics- PROFFIT
Essentials of facial growth- ENLOW
69

prenatal and post natal development of maxilla

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