Naso maxillary complex 5

Pre natal and post natal
growth and development
of nasomaxillary complex
www.indiandentalacademy.com

Growth and development of
Nasomaxillary complex
 Anatomy
 Pre natal growth
 Post natal growth
 Clinical implications

ANATOMY OF MAXILLA
 Two maxillae articulate to form
– 1. Whole upper jaw.
– 2. Roof of oral cavity.
– 3. Greater part of floor and
lateral wall of nasal cavity and part of
nasal bridge.
– 4. Greater part of floor of each
orbit.

ANATOMY OF MAXILLA.
 PARTS OF MAXILLA.
– 1. BODY –LARGE AND PYRAMIDAL IN
SHAPE.
– 2. FOUR PROCESSES. FRONTAL
ZYGOMATIC
ALVEOLAR
PALATINE
MAXILLA HOUSES THE LARGEST SINUS OF THE
FACE THE MAXILLARY SINUS

Palatine process[maxilla]
Maxillary sinus
Frontal process
Maxillary process [palatine]
Alveolar process
ANATOMY – MEDIAL VIEW
Horizontal plate of palatine

Nasal notch
Zygomatic process
ANS
Alveolar process
ANATOMY-LATERAL VIEW
Frontal process

Pre natal growth and
development

Pre-natal growth
 At fourth week of of IUL-
1.migration of neural crest cells
2.formation of brachial arches
STOMODEUM
FRONTONASAL
MAXILLARYMAXILLARY
MANDIBULAR MANDIBULARwww.indiandentalacademy.com

Medial nasal
process
Lateral nasal process
Maxillary process
Mandibular process

 Maxillary and Mandibular processes-
{ first brachial arch}
 Frontonasal processes- { downward
proliferation of mesenchyme of developing brain}
Medial nasal Lateral nasal
Mesenchyme of first arch
maxilla
palatine
mandible
zygomatic
Part of temporalwww.indiandentalacademy.com

 AT SEVENTH WEEK IUL-
1.Formation of upper lip
2.Intramembranous Bone
ossification Takes Place
3.Formation of Nasal Septum
4.Nasolacrimal Duct
5.Formation of Primary Palate

AT SEVENTH WEEK IUL
 Primary ossification center -for each
maxilla at termination of infraorbital
nerve above canine tooth dental lamina.
 Secondary center
zygomatic
orbitonasal
intermaxillary
nasopalatine

AT EIGHT WEEK IUL
 Intramembranous ossification centers
appear for;
-Nasal and lacrimal bones.
-Medial pterygoid plate of sphenoid.
-Vomer.
-Zygomatic bone

 Anteroposterior maxillo- mandibular
relationship approaches that of
newborn infant
 Maxilla increases in height
BY TWELFTH WEEK

 FRIEBAND-{the growth of palate in
human fetus}
 1st
trimester-narrow
 2st
trimester-moderate width
 3st
trimester- wide
 Breadth>length
 Height changes less dramatic

Pre-natal Growth and
development of palate
 Formation of primary and secondary
palate
 Elevation of palatal shelves
 Fusion of palatal shelves

Early palate formation
 28th
day of IUL
 -disintegration of buccopharangeal
membrane
 -stomadeal chamber
 Horizontal extensions
Oral cavity
Nasal cavity
2 palatal
shelves
Single primary palate

 Structure of palate
 PALATOGENESIS
Secondary palatePrimary palate
5TH
week IUL 12 TH
week IUL6 9
CRITICAL PERIODwww.indiandentalacademy.com

Primary palate
Frontonasal
process
Medial nasal
mesenchyme
W
e
g
d
Wedge shaped mass
between internal
surface of maxillary
prominence
Primary palatePre-maxilla

Primary
palate
Primary palate

Secondary palate
2 horizontal mesenchymal projections
Maxillary prominence
Lateral palatine process
Fuse-
With each other
Primary palate
Nasal septum
Secondary palate

Secondary palate
PALATAL SHELVES

Elevation of palatal shelves
 At 6 weeks
1. Tongue {undifferentiated tissue}
pushes dorsally
2. palatal shelves become vertical
3. Elevation occurs from vertical to
horizontal position

Elevation of palate
Nasal
septum
Palatal
shelves
tongue
Histological section

At 8 weeks
Elevation of palatal shelves
Muscular
movement
Pressure
differences
Biomechanical
transformation
Intrinsic
shelf force Differential
mitotic growth
Withdrawal of
embryo’s face

Fusion of palatal shelves

Fusion of the palatal
shelves
In the closest union there is still some
separate existence of component parts ;
in the most complete separation there is
some reminiscence of union
Samuel Butler

Fusion of palate
Incisive foramen
Mid palatine
raphe

Formation of palate[summary]
Primordium
of
Formed
by
Derived
from
Primary
palate
Secondary
palate
Pre
maxilla
Hard and
soft
palate
Median
palatine
process
Lateral
palatine
process
Frontonasal
process
Maxillary
process

Musculature of palate
 Tensor veli palatini 40 days 1st
arch
 Palatopharangeous 45 days
 Levator veli palatini 8th
week 2nd
arch
 Palatoglossus 9th
week
 Uvular muscle 11th
week 2nd
arch

Growth in dimensions
 Length - 7-8 weeks IUL
 Width - 4th
month onwards
height
width
length
Arched palate

Growth in dimensions
 Pre natal life
length > width
 At birth
length = width
 Post natal life
width > length

 Growth at mid palatal suture ceases at
1-2 years
 Apposition
inferior surface
alveolar process
 Resorption –superior{nasal} surface

V principle of Bang and Enlow
 Entire ‘v’ shaped
structure moves
in a direction
towards the wide
end of the ‘v’
Remodeling of palate

Factors affecting growth of
palate
 elevation of head and lower jaw
 Oxygen and nutritional deficiency
 Excess endocrine substances
 Drugs
 Irradiation
 vascularity
teratogens

Elevation of head and lower jaw

ANOMALIES OF PALATE
 Epithelial pearls

ANOMALIES OF PALATE
 Torus palatinus

ANOMALIES OF THE PALATE
High arched palate
MARFANS
SYNDROME
CROUZON
SYNDROME
CLEIDOCRANIAL
DYSOSTOSIS

ANOMALIES OF PALATE
 Cleft palate
Failure of fusion of the lateral palatine
process with each other or with the
median palatine process

Genesis of cleft palate
 Delay in shelf elevation
 Disturbance in mechanism of shelf
elevation
 Failure of shelves to contact due to lack
of growth
 Failure to displace the tongue during
closure [Pierre Robin syndrome]

Genesis of cleft palate
 Failure to fuse after contact as
epithelium does not break down
 Rupture after fusion
 defective merging

Types of cleft palate
Bifid uvula
Unilateral
cleft palate
Bilateral
cleft palate

Bilateral
cleft palate
Bifid uvula
Unilateral cleft palate

Etiology of cleft palate
Infectious
agents
irradiation drugs
Nutritional
deficiency
Excess
hormones
Smoking
and
alcohol

Clinical features of cleft palate
 Feeding problems particularly in infants
in whom suckling process demands
intact palate
 Nasal regurgitation/nasal twang in voice
 Collapsed arch
 Difficulty in speech and swallowing

Post natal growth of
maxilla

Post natal growth of maxilla
 Surface remodeling
 displacement
 CRANIAL BASE MAXILLA
apposition resorption
MOSS
TRANSPOSITION
TRANSLATION
SUTURES

 Surface apposition
 Sutural growth
 nasal septum growth
 Spheno occipital synchondrosis
 In contrast to cranial base maxilla is
dominated by intra membranous
ossification

Surface apposition

Sutural growth

Spheno occipital synchondroses

 Growth in height vertical
 Growth in width transverse
 Growth in length A - P

HEIGHT
 DEPOSITION ON
THE ORAL SIDE
 RESORPTION ON
THE NASAL SIDE
ENLOW AND BANG ‘V’
PRINCIPLE

Sagittal view Coronal view
HEIGHT - ‘V’ PRINCIPLE

HEIGHT
APPOSITION IN THE
ALVEOLAR
PROCESS
ERUPTION OF
TEETHwww.indiandentalacademy.com

Primary displacement
HEIGHT

PRIMARY DISPLACEMENT
 SUTURAL THEORY
 CARTILAGENOUS THEORY
 FUNCTIONAL MATRIX HYPOTHESIS

SUTURAL THEORY
 SUTURES HAVE
INNATE
GROWTH
POTENTIAL
 OBLIQUE
NATURE
 SLIDING EFFECT
SICHER

CARTILAGENOUS THEORY
 NASAL SEPTUM –INNATE GROWTH
POTENTIAL
 THRUST EFFECT–
SEPTOPREMAXILLARY LIGAMENT
 MORE ROLE IN A-P THAN VERTICAL
 SURGICAL REMOVAL OF NASAL
SEPTUM
SCOTT

Removal of nasal septum –mid face
deficiency

FUNCTIONAL MATRIX
HYPOTHESIS

 BASAL BODY INFRAORBITAL
NERVE
 ORBITAL UNIT EYEBALL
 NASAL UNIT SEPTAL CARTILAGE
 ALVEOLAR UNIT TEETH
MOSS
SKELETAL UNITS FUNCTIONAL MATRIX

FUNCTIONAL MATRIX
HYPOTHESIS

HEIGHT
ENLARGING
ORO
FACIAL
CAPSULE
REMODELING
CHANGES IN
THE ORBIT

WIDTH
 Finished earlier in postnatal life
 WIDTH
GROWTH IN MID
PALATINE SUTURE
REMODELING IN THE
LATERAL SURFACE OF
ALVEOLAR PROCESS
Mutual transverse rotations of
maxillary halves give palate ‘u’ shape

LENGTH
 Begins rapidly in the 2nd
year of life
Maxillary
tuberosity
Palato -
maxillary
suture
primary secondary
displacementwww.indiandentalacademy.com

QUANTITATION OF MAXILLARY
REMODELING
 Uniform displacement of all 3 pts in vertical
direction [downward displacement –0.3mm/year]
 Horizontal direction posterior displacement of all
3 pts [however the displacement of PNS was
greater than ANS and pt A ]
 THE INCREASE IN LENGTH IS PRIMARILY
BECAUSE OF GROWTH IN POSTERIOR BORDER
Sheldon Baumrind,Edward Korn
AJO JAN 1987

Maxillary tuberosity
 Established by the posterior boundary
of anterior cranial fossa
 Helps in posterior and horizontal
lengthening of arch
Anterior displacement
= posterior lengthening

Key ridge
Reversal occurs at
the key ridge
Posterior - apposition
Anterior - resorption

Maxillary sinus
 PRE NATAL
 lateral evagination of mucous
membrane in middle meatus –3rd
month
IUL
 AT BIRTH
 2mm -long, 1mm in width + height
 PNEUMATISATION
PRIMARY SECONDARY

Maxillary sinus
AGE CHANGES
Expands - 2mm
vertically
3mm A-P - every
year
> in size -
resorption in walls +
alveolus

Maxillary sinus
 POST NATAL
 All internal
surfaces
resorption
[expect medial]
 Rapid continues
downward growth
close proximity to
buccal maxillary
teeth

Zygomatic region
Posterior relocation
anterior posterior
Increase in height
frontozygomatic Inferior
border
Lateral growth
displacement
Zygomaticotemporal [anterior]
Frontozygomatic [inferior]www.indiandentalacademy.com

Nasal airway
Lining surface of
bony wall and floor resorptive
Downward relocation
of palate
Lateral and anterior
expansion

Nasal airway
 Ethmoidal
conchae
lateral + inferior
deposition
medial + superior
resorption
 Inter nasal
septum
Lengthens
vertically at
sutural
junctions www.indiandentalacademy.com

Clinical Implications
and Summary

Pre natal growth
Formation of
germ layers
Day 17
Fetal alcohol
syndrome
[mid face
deficiency]
Migration
and
proliferation
of cell
population
Day 19-28
Treacher Collin
syndrome

Pre natal growth
Primary palate
formation
28-38
days
Cleft lip /cleft palate
other facial clefts
Secondary
palate
formation
42-55
days
Cleft palate/synostosis
CROUZON syndrome
Epithelial pearls
Torus palatinus
high arched palatewww.indiandentalacademy.com

Post natal growth

Post natal growth
AT BIRTH
Hard palate : length = width
maxillary sinus : not visible
radiographically
1 – 2 years
Extensive remodeling descent of
palate /enlargement of nasal cavity
Mid palatine suture growth
ceases
No synostosis

Post natal growth
THE MIXED DENTITION
YEARS

Post natal growth
mid palatine suture
starts closing at 9- 10
years
RME BEST DONE
BETWEEN 9-14 yrs
THE MIXED DENTITION YEARS
Growth in width of the
dental arch anterior to the
first molar
Ceases by 5-6 yrs
Inter canine width
completed
12 yrs - females
18 yrs - males

Post natal growth
 THE DEPOSITORY GROWTH POTENTIAL OF
TUBEROSITY ALLOWS FOR ARCH
EXPANSION BY MOVING THE TEETH
POSTERIORLY INTO THE AREA OF BONE
DEPOSITION

 EXTENSIVE SCOPE FOR GROWTH
MODIFICATION BEFORE ADOLESCENT
GROWTH SPURT
THE MIXED DENTITION YEARS

Post Natal Growth
THE EARLY PERMANENT
DENTITION YEARS
•Growth modification still possible in
boys
•RME can still be tried till 12 -15 yrs
•>15 years complete closure[synostosis]
Orthognatic surgery

Age changes
 All para nasal sinuses increase in size
 Vertical height decreases
 Vertical changes > AP > width
 Soft tissue changes > skeletal
 Nose growth continues till 25 years
 Inclination of palatal plane
increases[post downwards]
Alveolar process
resorbed
Tooth loss

References
 Contemporary orthodontics- PROFFIT
 Principles and practice of orthodontics –
GRABER
 Essentials of facial growth- ENLOW
 Craniofacial embryology- SPERBER
 The developing human-KEITH MOORE
 oral histology and embryology-
TENCATE
 Handbook of orthodontics-MOYERS

References
 quantitation of maxillary remodeling-S
BAUMRIND ,E KORN –AJO JAN 97
 Dentistry for child and adolescent-MAC
DONALD
 Clinical pedodontics-FINN
 Color atlas of Embryology
MOORE,PERSUAD
 Clinical oral pathology-NEWILLE
,WHITE
 Diseases of oral mucosa-
BORK,HOEDE

Naso maxillary complex 5

Recommandé

Recommandé

Contenu connexe

Tendances

Tendances (20)

En vedette

En vedette (17)

Similaire à Naso maxillary complex 5

Similaire à Naso maxillary complex 5 (20)

Plus de Indian dental academy

Plus de Indian dental academy (20)

Dernier

Dernier (20)

Naso maxillary complex 5