Growth & development of cranial base & vault cranial

GROWTH & DEVELOPMENT OF
CRANIAL VAULT
AND
CRANIAL BASE
www.indiandentalacademy.com

Contents
(1) Introduction
(2) Pre-Natal Growth & Development
(3) Post-Natal Growth & Development
(4) Anomalies

Introduction
Four regions of the Craniofacial complex:-
The Cranial Vault
The Cranial Base
The Naso-maxillary complex
The Mandible

Introduction
Attention to:-
(1) Site and location of growth
(2) Type of growth occurring.
(3) Determinant or controlling factors.

Introduction
The neurocranium is the fastest growing area of the
craniofacial skeleton at birth.
The face and jaws are relatively underdeveloped. Therefore
there is much more facial growth than cranial growth
postnatal
The Neurocranium comprises of the following :
Vault of the Skull or Calvaria Cranial Base
or Desmocranium. or Chondrocranium
Formed by Intra- Formed by
membranous Endochondralwww.indiandentalacademy.com

Intramembranous Bone Formation: -
Process of bone formation from undifferentiated
mesenchymal cells
OR
Bone can either form directly from osteoblast
Mesenchymal cells become condensed
at the site of bone formation
some lay down bundles of collagen fiber
Some enlarge & acquire a basophilic cyto & form osteoblast
Osteoblasts secrete a gelatinous matrix called osteoidwww.indiandentalacademy.com

They deposit calcium salts in to the osteoid
leads to conversion of osteoid to lamella
Osteoblast move away from lemellae
Some osteoblast get entrapped between two
lamellae is called Osteocytes

Introduction
Growth is a “differential” process
i.e. different parts of the cranio-skeleton undergo the
process of growth at different times, in different
directions and involve different but interdependent
functions.

Pre-Natal Growth
NORMAL DEVELOPMENTNORMAL DEVELOPMENT
The cranial vault is a derivative of the
mesenchyme, which is initially arranged
in the form of a capsular membrane
around the developing brain.

Pre-Natal Growth
The membrane composed of 2 parts
Endomeninx Ectomeninx
(Inner) (Outer)
Neural crest origin Neural crest and paraxial
mesodermDifferentiates in to Differentiates in to
Piamater
Arachnoid.
Inner dura mater
Outer superficial membrane
with osteogenic properties
Vault Base

Pre-Natal Growth

Pre-Natal Growth
During their development, the 2 layers (ectomeninx and
endomeninx) remain in close apposition, except in areas
where the venous sinuses will develop.
Fibres of Falx cerebri, Falx cerebelli and Tentorium cerebelli.
Shape of brain
The duramater and its septa show distinctly organized fibre
bundles closely related and strongly attached to the sutural
systems.

Pre-Natal Growth
In somite period embryo,
the neural tube’s covering
duramater and its surface
ectoderm are in contact.
Transient maintainance of
this contact during development
causes a dural projection,
that extends into the future
frontonasal area.

Pre-Natal Growth
Ossification of the intramembranous
calvarial bones depend upon the
presence of brain.
In its absence, no bony calvaria forms.
The condition is known as Anencephaly.

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

Pre-Natal Growth
CRANIAL VAULT CONSISTS OF: -
(1) Pair of Frontal bones: -
A pair of frontal bones appears
from single primary ossification
centers at the 8th week post
conception.
Primary centre Super ciliary arch
Secondary centers zygomatic process,
nasal spine,
trochlear fossa

Pre-Natal Growth
Fusion between these centers is completed at 6 to 7 months
post conception.
The frontal suture
persists into
adulthood in
10-15% of skulls.
At birth, frontal bones are separated by frontal or metopic
suture; synostotic fusion of this suture usually starts
about the 2nd year & unites into a single bone by 7 years.

Pre-Natal Growth
(2) Pair of Parietal bones: -
Form roof of the vault
On each side of the skull
Two parietal bones arise from two
primary ossification centers for
each bone that appear in the
parietal eminence in 8th week
post conception.
Delayed ossification may result in sagittal fontanelle at birth.

Pre-Natal Growth
(3) Occipital Bone: -
The supranuchal squamous portion of the occipital bone
ossifies intramembranously from two centers, one on each
side, appearing the 8th week post conception.
Rest of the occipital bone ossifies endochondrally.www.indiandentalacademy.com

Pre-Natal Growth
(4) Temporal Bone: -
The squamous portion ossifies
intramembranously from a
single center appearing
at the root of zygoma at the
8th week post conception.
The tympanic ring ossifies
intramembranously from
four centers appearing in the
3rd month after conception.
Forms parts of sides & Base
Rest of bone is formed by endochondrally

Pre-Natal Growth
If any unusual ossification center develop between the
individual calvarial bones, their independent existence is
recognizable as small sutural or wormian bones.
ossification first appear during 7th & 8th weeks post
conception.

Pre-Natal Growth
SKULL AT BIRTH
SUTURES: -
(1) Coronal Suture: -
Between Frontal & 2 parietal
(2) Sagittal Suture: -
Between 2 parietal
(3) Lamdoidal Suture: -
Between parietal & Occipital
(4) Squamosal Suture: -
Between parietal & Temporalwww.indiandentalacademy.com

Pre-Natal Growth
SKULL AT BIRTH
FONTANELS: - Memb filled spaces
(1) Ant Fontanel: -
Between 2 Parietal & 2 Frontal
Diamind in shape & largest
(2) Post fontanel: -
Between 2 Parietal & occipital
Closes 2 months after the birth
(3) Anterolateral (Sphenoidal): -
At junction of frontal, parietal, temporal,
sphenoid.
Paired & small irregular
Closes 3 months after the birth
(4) Posterolateral (Mastoid): -
At junction of Occipital, Parietal, temporal.
Paired & Irregular in shape

Pre-Natal Growth
Fontanels are flexible membrane junction between bone.
Which allow the narrowing of sutures.

Views of Cranial Vault
(1) Norma Verticalis: -
Top of skull rounded/ ovoid.
Frontal bone forms forehead & seperate from patietal bone
by CORONAL SUTURE.
Two parietal bones are joined
by SAGITTAL SUTURE.
BREGMA
Parietal to Occipital by
LABDOID SUTURE.
Sagital + Labdoid junction is
LAMBDA.

(2) Norma Occipitalis: -
Back of the skull markedly convex & widest.
Posterior part of parietal & Temporal bones.
Mastoid process

(3) Norma Lateralis: -
Shows large ovoid brain case.

(4) Norma Frontalis: -
Varies with shape, proportion, age, sex, race.

Pre Natal Growth control
Intrinsic genetic factors
Epigenetic factors
Environmental factors

Pre Natal Growth control
Cranial
differentiation
Intrinsic Genetic control
Local epigenetic factors
General epigenetic factors
Local Environmental factors
General Environmental factors

Post-Natal Growth
Related to Growth of the Brain
cephalocaudal gradient of growth.

Post-Natal Growth
Basically it is the combination of
(A) SUTURAL GROWTH: -
Sutures are articulation within craniofacial complex.
Location are genetically determined but
environmentally influenced.
significant role
Firm bond with adjacent bone they allow slight
movement & absorb stresses.

Post-Natal Growth
According to Pritchard 1956
Suture is composed of 5 layers: -
(1) Pair of cambian (osteogenic)
(2) Pair of Capsular Layer
(3) Middle loose layer
In course of maturation cambian layer is reduced to single
layer of osteoblast & capsular layer become thicker
Vascularity of middle loose layer is increased.

Post-Natal Growth
TYPES
(1) Serrate Sutures: -
Saw like/ notched
e.g. Sagittal, coronal
Can withstand force, blow.
(2) Denticulate Sutures: -
Small tooth like
e.g. Lambdoid
(3) Squamous/ Beveled: -
Bone overlaps the other bone.
e.g. temporal & parietal
(4) Plane/ battened: -
Flat end rough & irregular
e.g. midpalatalwww.indiandentalacademy.com

Post-Natal Growth
Growth @ Suture Site
Sutures are sites of cellular proliferation & fiber formation
where appositional Osteogenesis contributes to growth
of adjacent bones.
Sutural Fusion
Closure/ Fusion of sutures by IM ossification
Closure on outer table is slower, variable & less complete.
Metopic suture usually starts closing after 1yr
Sagittal, coronal, lambdoidal fuse between 20-40 yr

Post-Natal Growth
SYNCHONDROSES
Endochondral bone junction sites where cartilage is
interposed between contigeous bones are called as
synchondroses.
Exist prenatally

Post-Natal Growth
(2) Apposition & Resorption: -
Accretion to the calvarial bones is predominantly sutural
until 4th
yr.
Remodeling of curved bony plates allow for their flattening
out to accommodate the increase surface area.
Achieved by combination of endocranial erosion &
ectocranial deposition.
Angulation between bones changes.
In addition to rotation, the separate bones also rotate
within themselves.www.indiandentalacademy.com

Post-Natal Growth
(3) Centrifugal Force: -
Precocious development of brain determines early
predominance of neurocranium.
Brain & vault develop very rapidly, very early but also
growth ceases early than face.
NEUROCRANIUM: FACE
8:1 @ Birth
6:1 @ 2nd
year
4:1 @ 5th
year
2.5:1 @ Adult
Ultimately shape & size of vault primarily depends on
internal pressure
Acts as a Functional Matrix theory.

Post-Natal Growth
(A) Gen Factors influencing Cranial vault Morphology
(1) Race: -
Vault form is most typical racial expresion.
Dolicocephalic = Northern & Southern European
Brachycephalic = Middle Europeans, Asian people.
(2) Sex: -
Head circumference of boys is 0.9 cm larger than girls.

Post-Natal Growth
Gen Factors influencing Cranial vault Morphology
(3) Heredity: -
Vault shows interfamilial correlation than breadth & length.
(4) Climate: -
Long heads with greater surface area are with
hot climates.
Round head with Cold climate.
(5) Nutrition: -
Malnutrition leads to shortened neurocranial length, width,
height (in Rats)
“ROBUSTICITY INDEX” (wt per unit length) of cranial vault
decrease upon protein- calorie malnutrition.

Post-Natal Growth
(B) Mechanical Factors influencing Cranial vault
Morphology
(1) Intrauterine position & Labor: -
Passage From vaginal channel
Head is elongated Occipito-frontally, narrowed
bipartitely
Caesarean section
Doesn’t show much difference
(2) Positional moulding: -
Supine Position long time- Brachycephalic
Lateral position causes – Parieto occipital regionwww.indiandentalacademy.com

Post-Natal Growth
(B) Mechanical Factors influencing Cranial vault
Morphology
(3) Artificial Deformation: -
Artificial induced reshaping of vault still done in african
people.
Babies skull is moulded by wrapping it in bandage/ by
using cradle board.

Post-Natal Growth

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

Post-Natal Growth
(1) Genetic Theory: -
growth was genetically deremined
Earliest Theory to put forward

Post-Natal Growth
(2) Sicher’s Sutural theory: -
Believes craniofacial growth occurs at the sutures.
Local factors, like muscle activity had only a mild effect.

Post-Natal Growth
(3) Scott’s Cartilaginous theory:-
Inherent growth potential of Cartilages
Sutures respond secondarily

Post-Natal Growth
(4) Moss’ Functional matrix Theory: -
postulated the role of functional matrices which are formed
by non osseous tissue.
Expanding
Brain
VAULT
BASE

Post-Natal Growth
Van Limborgh's Summarization:-
Chondrocranial growth is controlled mainly by Intrinsic
genetic factors
Desmocranial growth is controlled by few Intrinsic
genetic factors
Cartilaginous parts of the skull must be considered as
growth centres
Sutural growth is controlled mainly by influences
originating from the skull cartilage & adjacent skull
structure.

Post-Natal Growth
Van Limborgh's Summarization:-
Periosteal growth largly depends upon growth of adjacent
structures.
Sutural & periosteal growth are additionally governed by
local non genetic environmental influence.

Post-Natal Growth
The lining bony surface of the whole cranial floor is
resorptive in contrast to the endocranial surface of vault
which is depository.
Circumcranial reversal line

Clinical Implications
(1) Defects in closure of Foramen Caecum: -
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.www.indiandentalacademy.com

(2) Synostosis syndromes: -
syndromes result from early closure of the sutures
between the cranial and facial bones.
limited cranial growth, maxillary growth is also limited
orbits are bulging
e.g.
Courzon’s syndrome
Apert’s syndrome
oxycephaly (tower skull)
plagiocephaly
caphocephaly
trigoncephalywww.indiandentalacademy.com

(3) Hydrocephaly, Microcephaly and Anencephaly: -

(4) Various conditions – cretinism, progeria, trisomy 21,
cleidocranial dysostosis, -
Anterior fontanelles remain open
Bossing of forehead
Brachycephalic skull

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

CRANIAL
BASE

function
Supports & protects the brain & spinal cord
Articulation of skull with vertebral column ,
mandible & maxilla
Buffer zone between the brain, face & pharyngeal region

ANATOMY OF CRANIAL BASE
(1) ANTERIOR CRANIAL FOSSA
(2) MIDDLE CRANIAL FOSSA
(3) POSTERIOR
CRANIAL FOSSA

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

(1) 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

(2) CRIBRIFORM PLATE OF
ETHMOID
It separates the fossa from nasal cavity & forms the roof of
the nasal cavity.
A median crest like elevation -CRISTA GALLI
(3) THE SPHENOID BONE
Anterior part of the upper surface of its body is
termed the JUGUM SPHENOIDALE

MIDDLE CRANIAL FOSSA
It is deeper than the anterior fossa
In front it is bounded by posterior borders of the lesser wing of
the sphenoid and the body of the sphenoid,
Behind by superior borders of the temporal bones & Dorsum
sellae of sphenoid bone

POSTERIOR CRANIAL FOSSA
Largest and deepest of the cranial fossa
Anteriorly – Dorsum sellae & body of the sphenoid
Posteriorly –Squamous part of the occipital bone
Laterally – Petrous & mastoid parts of temporal bone

PRENATAL GROWTH
At the cellular level
Hyperplasia
Hypertrophy
Accretion
Cranial base develops by endochondral bone formation

PRENATAL GROWTH
Endochondral Bone Formation: -
Mesenchymal cells become condensed
at the site of bone formation
Some mesenchymal cells differentiated in to chondroblast
lay down hyaline carti
Carti is surrounded by a memb called perichondrium
Inter-cellular sub surrounding carti cells become calcified
Nutrition to the carti cell is cut off leading to death
Primary Areolawww.indiandentalacademy.com

PRENATAL GROWTH
BV & osteogenic cells from the perichondrium invade the
calci carti matrix which now reduced to bars/ walls
Secondary areolae
Osteogenic cells from perichondrium become osteoblasts
Osteoblast lay down osteoid which later calcified to form
lamella of bone

PRENATAL GROWTH
Earliest evidence is seen in the late somite period
During the 4th
week of post conception
Mesenchyme derived from paraxial mesoderm
and neural crest condenses to from
ECTOMENINGEAL CAPSULE
Basal portion of this capsule gives rise to future cranial Base.
Development of skull & formation of cranial base is dependant on
other cranial structure like brain, cranial nerve & eye.

PRENATAL GROWTH
From 40th
day onwards this ectomeningeal capsule slowly
converted to cartilage
CARTILAGES
PARACHORDAL CARTILAGE
HYPOPHYSEAL CARTILAGE
OTIC CAPSULE
NASAL CAPSULE

PRENATAL GROWTH

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
Sclerotome cartilage is the first part of the skull to develop,
forms boundaries of foramen magnum.

PRENATAL GROWTH
HYPOPHYSEAL CARTILAGES
Cranial to termination of notochord hypophyseal pouch developes
which gives rise to Ant lobe of pituitory gland.
2 Hyphyseal cartilages – Basisphenoid
2 Presphenoid cartilages – Presphenoid bone
Orbitosphenoid – Lesser wing
Alisphenoid – Greater wing
MESETHMOID CARTILAGE

PRENATAL GROWTH
OTIC CAPSULE
Chondrify & fuse with the parachondral cartilage to ossify later
Mastoid and petrous portions of the temporal bones

PRENATAL GROWTH
NASAL CAPSULE (Ectethmoid)
Cartilages of nostrils and the nasal septal cartilage
Chondrifies in 2nd
month post conception
Functional matrix
It helps in transferring compressive forces from incisor region
to the sphenoid region

PRENATAL GROWTH
110 ossification centers appears in the
embryonic human skull
UNOSSIFIED CHONDROCRANIAL REMNANTS –
Alae & septum of the nose,
Spheno-occipital & spheno-petrous junctions,
The apex of the petrous bone and
Between the separate parts of the occipital bone
Foramen Lacerum

PRENATAL GROWTH
OSSIFICATION
OCCIPITAL BONE - 7 centres
5 ENDO 2 INTRA
Supranuchal Squamous portion –
2 intramembranous centres ( 8th
week)
Infranuchal squamous –
2 endochondral centres (10th
week)
Basioccipital bone –
1 endochondral (11th
week)
Give rise to ant portion of occipital & ant part of
foramen magnum
Exoccipital bone –
week)
Lateral border of foramen magnum & post portion of occipital

PRENATAL GROWTH
TEMPORAL BONE - 21 centres
16 Endo 5 Intra
Squamous portion-
1 intramembranous centre (8th
week)
Tympanic ring –
4 intramembranous centres (3rd
month)
Petrosal part –
week)
Styloid process –
2 endochochondral centers (at birth)

PRENATAL GROWTH
ETHMOID BONE – 3 centres Endo
Perpendicular plate & crista galli –
1 endochodral centre
Median floor of ant cranial fossa
Lateral labrynths in the nasal cartilages-
2 endochondral centres

PRENATAL GROWTH
SPHENOID BONE – 19 centres
Basisphenoid –
3 presphenoid & 4 postsphenoid endochondral centres
Greater wings –
2 centres
Lesser wings -
2 centres
Medial pterygoid plates –
2 intramembranous centres
Lateral pterygoid plates –
2 intramembranous centres
Sphenoidal conchae –
2 endochondral centres

PRENATAL GROWTH
VOMER
Alae – 2 intramembranous centres
Inferior nasal concha
Lamina – 1 endochondral centre

PRENATAL GROWTH
BONE - SITE & NUMBER OF OSSIFICATION
INTRAMEMBRANOUS ENDOCHONDRAL
OCCIPITAL _ Supranuchal Infranuchal squamous (2)
squamous (2) Basilar (1)
Exoccipital (2)
TEMPORAL _ Squamous (1) Petrosal (14)
Tympanic (4) Styloid (2)
ETHMOID _ Lateral labrynths (2)
Perpendicular plate;
Crista (1)
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)

PRENATAL GROWTH
. Cranial Base is important junction between
cranial vault & facial skeleton.
Base is relatively stable as compare to vault
& face during growth

CRANIAL BASE ANGULATION
Chondrocranium is important as a shared junction between
the neurocranial & facial skeleton.
Chondrocranial base of the newborn skull is smaller than
calvarial part.
Central region of the cranial base is composed of
prechordal & chordal parts that meet at an angle at
the hypophyseal fossa.
Cranial base become flexed between pituitary fossa &
spheno- occipital junction.

CRANIAL BASE ANGULATION
Precartilage stage – 150°
Cartilage stage – 130°
Preossification stage – 115°-120°
Ossification stage – 125°-130°
maintain this angulation post-natallywww.indiandentalacademy.com

PRE NATAL GROWTH
Highly Uneven
Diencephalon, telencephalon, rhombencephalon
Sella turcica
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

POST NATAL GROWTH
EXPANSION of cranial base occurs by
Growth of the cartilage remnents of the chondrocranium
Forces from growing brain
MULTI
DIRECTIONAL
EXPANSION OF
CRANIAL BASE

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

POST NATAL GROWTH
FOSSA ENLARGEMENT

POST NATAL GROWTH
Fossa expands outward by resorption,
Partitions between them enlarge inward by deposition

POST NATAL GROWTH
The mid ventral segments of cranial base grows more slowly
to accomodate the medulla, pons, hypothalamus & optic
chiasma.
Foramen Drift process
Spinal Cord Defferential
remodelling

POST NATAL GROWTH
SYNCHONDROSIS
Spheno-frontal synchondrosis
Fronto-ethmoidal synchondrosis
Spheno-ethmoidal synchondrosis
Inter-spenoidal synchondrosis
Spheno-occipital synchondrosis

POST NATAL GROWTH
ZONES OF SYNCHONDROSIS
Familial reserve zone
Cell division zone
Hypertrophic zone
Calcified zone
A growth centre
Bipolar direction of growth

POST NATAL 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
Spenoid & occipital bones
moves apart by PD

POST NATAL GROWTH
The interior of the sphenoid bone eventually becomes hollowed
to form the SPHENOIDAL SINUS
Sinus secondarily grows as the body of the sphenoid bone
expands with the moving naso-maxillary complex

POST NATAL GROWTH
The size, shape and characteristics of cranial base have
evolved in direct association with brain
Expansion of the middle cranial fossa
Secondary displacement effect
(Anterior cranial floor & naso- maxillry complex)

POST NATAL GROWTH
Frontal lobe growth completes by 5years
Temporal lobes continue to enlarge for several more years
and displaces the frontal lobe forward
Foramen magnum progressively lowered by resorption

POST NATAL GROWTH

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

ACHONDROPLASIA
Deficient growth at the synchondrosis
Maxilla is not translated forward
This results in abnormal
depression of the bridge
of the nose

Premature ossification or synostosis of the suture
between the presphaenoid and postsphenoid parts and
of the spheno-occipital suture
More fragile and is commonly involved in fractures ,
particularly along the foramina

Anomalous development of the presphenoidal elements
Excessive separation of orbits and abnormally broad nasal
bridge. -HYPERTELORISM
Pre mature fusion of spheno-occipital synchondrosis
Depressed nasal bridge and dished face.www.indiandentalacademy.com

ANENCEPHALY (Absence of calvaria )
Cranioschisis
INADEQUATE GROWTH OF
CHONDROCRANIUM
Impacted eruption of third molarswww.indiandentalacademy.com

REFERENCES
Craniofacial Embryology
-G.H.SPERBER
Essencials Of Facial Growth
-D.H.ENLOW
Anatomy –Gray
Contemporary orthodontics
W.R.PROFFIT
Fundamentals of craniofacial growth
Dixon
Textbook of Anatomy
Tortora

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Growth & development of cranial base & vault cranial

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