1

Prenatal and postnatal

development of mandible

A.MAHESH KUMAR
MDS 1ST year
Drs SIDS
2 Dept of PEDODONTICS
 Contents

1)References
2)Introduction
3)Prenatal growth of mandible
4) Meckel’s cartilage
5) Anatomy
6)Muscle attachment
7)Ossification

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 7)Remodelling
8)Neonatal mandible
9)Postnatal
development
10)Theories of growth
11)Mechanism of
bone growth
12)Age changes in
mandible
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 References

 Craniofacial embryology -- SPERBER

 Principles and practice of orthodontics --GRABER
 Contemporary orthodontics -- PROFFIT
 Oral Anatomy, Histology and Embryology –B . K. B
Berkovitz, Graham Rex Holland , B.J. Moxham.
 Clinical Pedodontics – Sidney B. Finn
 Enlow , D.H., and harris , D B; A study of postnatal
growth of the human mandible . Am. J. Orthodont.,
50;25-50,1964
 Moss , M.L.; Functional cranial analysis of the
coronoid process in rat . Acta anat .,77;11-24
 Sicher , H : The growth of the mandible. Am. J.
Orthodont.,33:30-35, 1947.
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 Growth definitions
 According to “TODD” “Growth is an increase in size.”
&“Development is progress towards maturity .”

 The self multiplication of living substance – JX Huxely

 Quantitative aspect of biologic development per unit of

time-Mayers.

 Change in any morphological parameter, which is

measurable-Moss.

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 Embryonic phase
 Growth and development of an individual can be
divided into:-

1) PRENATAL & POSTNATAL periods.

-The pre-natal period of development is a dynamic
phase in the development of a human being.
-During this period, the height increases by
almost5000 times as compared to only a threefold
increase during the post-natal period.
-The pre-natal life can be arbitrarily divided into three
periods.

7 1. Period of the Ovum( from fertilization to 14th day )

th th
 Prenatal growth of mandible
 There is a marked acceleration of mandibular
growth between the eighth and twelfth weeks of
fetal life .
 As a result of mandibular length increases , the
external auditory meatus appears to move
posteriorly.
 The mandible initially develops
intramembranously , but its subsequent growth is
related to the appearance of secondary cartilages
 The developing mandible is preceded by the
appearance of a rod of cartilage ( meckel’s
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cartilage )
 History
• JOHN HUNTER (1771) compared a series of
dried mandibles and concluded that in order to
attain space for permanent molar teeth the
mandible must grow by posterior apposition of
ramus accompanied by anterior ramus resorption.

• HUMPHRY (1866) studied growth of mandible

by inserting metal wires in the mandible of young
pigs.

• BJORK (1955): conducted implant studies on

jaws to determine the growth pattern & rotation
,when subjected to serial cephalometric methods.

9 • DONALD ENLOW : proposed the V principle of

growth and counterpart principle.
 The Pharyngeal Arches

The pharyngeal arches

appear between 4th &
5th weeks of
development

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 Each arch contain
 A central cartilage that
forms the skeleton of
the arch
 A muscular component
 A vascular component
 A neural component

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  The 1st pharyngeal
arch is the mandibular
arch which contains
the Meckel’s
Cartilage.
 It appears at about 6th
week of I.U. life.

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 MECKEL’S CARTILAGE
 Makes little contribution towards the development of
the mandible
 Provides a Template for subsequent development of
the mandible.
 During the 7th week of I.U. life, a centre of ossification
appears
 Mandibular ectomesenchyme must interact initially
with the epithelium of the mandibular arch before
forming the primary ossification can occur ; the
resulting intramembranous bone lies lateral to the
meckel’s cartilage.
 From this centre, bone formation spreads rapidly
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backwards, forwards & upwards around inferior
 MECKEL’S CARTILAGE
 Meckel’s cartilage
becomes surrounded and
invaded by bone.
 Ossification stops dorsally
at the site that will become
the mandibular lingula,
where meckel’s cartilage
continues into the middle
ear
 The dorsal end of Meckel’s
cartilage ossifies to form
the basis of two of the
auditory ossicles ( incus
and malleus).
 A small part of its ventral
14 end forms accessory
endochondral ossicles that
 The ossifying
membrane is located
lateral to the meckel’s
cartilage and its
accompanying
neurovascular bundle.
 From this primary
centre, ossification
spread below and
around the inferior
alveolar nerve and its
incisive brand and
upward to form a
trough for a
15 accommodating the
developing tooth bud.
 MECKEL’S CARTILAGE
Spread of the
intramembranous
ossification dorsally and
ventrally forms the body
and ramus of the
mandible.

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 MECKEL’S CARTILAGE
 A major portion of the meckel’s cartilage
disappears during growth and the remaining part
develops into:
1. The mental ossicles.
2. Incus and malleus.
3. Spine of the spenoid bone.
4. Anterior ligament of the malleus.
5. Spheno-mandibular ligament.

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 SECONDARY CARTILAGES
 Appears between 10th
& 14th week of I.U.
life.
 Forms the head of
condyle, part of
coronoid process &
mental protuberances.
 The secondary
cartilage of the
coronoid process
develops within the
temporalis muscle, as
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its predecessor.
 SECONDARY CARTILAGES
 In the mental region, on either side of the
symphysis , one or two small cartilages appear
and ossify in the 7th month of IUL to form
variable number of mental ossicles in the
fibrous tissue of the symphysis.
 The condylar cartilage appears in the 10th week
of IUL,which forms the future condyle .
 The condylar cartilage serves as an important
center of growth as primary or secondary .
 By the middle of the fetal life cone shaped
cartilage is replaced by the bone, but its upper
persists into adulthood, acting as both growth
and articular cartilage
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 SECONDARY CARTILAGES
 Changes in the mandibular position and form are
related to the direction and amount of the
condylar growth
 The condylar growth rate increase at puberty,
peaks between 12 1/2 and 14 years of age, and
normally ceases at about 20 years of age .

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 ANATOMY

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 MUSCLE ATTACHMENTS

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 Neonatal mandible
 Ascending
Ramus low and
wide.
 Large Coronoid
process and
projects well
above the
condyle.
 Body – open
shell containing
tooth buds and
partially formed
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deciduous
 Neonatal mandible

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 Neonatal mandible
 Mandibular canal that
runs low in the body.
 The initial separation
of the right and left
bodies of the
mandible at the
midline symphysis
menti is gradually
eliminated between
the 4th and 12th month
after birth.
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 Postnatal growth of mandible
 The shape and size of the diminutive fetal
mandible undergoes considerable transformation
during its growth and development.
 Some indications of the directions of growth of
the mandible can be obtained by superimposing
traces of neonatal and adult mandibles
 There is some evidence the region around the
mental foramen is a fixed point for such an
endeavor
 Growth of the mandible occurs by the remodeling
of bone
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 Postnatal growth of mandible
 At birth the two rami of the mandible are quite
short . Condylar development is minimal and
there is practically no articular eminence in the
glenoid fossa.
 A thin line of fibrocartilage and connective tissue
exists at the midline of the symphysis to separate
right and left mandibular bodies. Between 4
months of age and the end of first year, the
symphysial cartilage is replaced by bone.
 During the 1st year of life, appositional growth is
especially active at the alveolar border, at the
distal and superior surfaces of the ramus, at the
condyle, along the lower border of the mandible
30 and on its lateral surfaces.
 Postnatal growth of mandible
 Although the mandible appears as a single bone
in the adult , it is developmentally and functionally
divisible into several skeletal subunits

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 Postnatal growth of mandible
 The growth pattern of each of these skeletal
subunits is influenced by a functional matrix that
acts upon the bone
 1) the teeth act as a functional matrix for the
alveolar unit
 2) the action of temporalis muscle influences the
coronoid process
 3) the masseter and medial pterygoid has some
influence on the condylar process
 Of all the facial bones , the mandible undergoes
the most growth postnatally and evidences the
greatest variation in morphology
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 Postnatal growth of mandible
Growth sites in mandible
1) Limited growth takes place at the symphysis
menti until fusion occurs.
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2) At the condylar cartilages
3) The posterior border of ramus
4) Alveolar ridges

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3

1
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 Postnatal growth of mandible
 These areas of bone deposition largely account
for increase in the height , length and the width of
the mandible.
 Superimposed upon this basic incremental
growth are numerous regional remodeling
changes that are subjected to the local functional
influences involving selective resorption and
displacement of individual mandibular elements.

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 Postnatal growth of mandible
 The condylar cartilage of the mandible uniquely
serves as both
1) An articular cartilage in the TMJ, characterized
by a fibrocartilage surface layer
2) A growth cartilage analogous to the epiphysial
plate in a long bone, characterized by a deeper
hypertrophying cartilage layer.
The growth cartilage may act as a functional matrix
to stretch the periosteum, inducing the
lengthened periosteum to form
intramembranous bone beneath it
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 Postnatal growth of mandible
 The formation of bone within the condylar heads
causes the mandibular rami to grow upward and
backward , displacing the entire mandible in an
opposite downward and forward direction.
 Bone resorption subjacent to the condylar head
accounts for the narrowed condylar neck.
 Any damage to the condylar cartilage restricts the
growth potential and normal downward and
forward displacement of the mandible ,
unilaterally or bilaterally according to the sides
damaged .
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 Postnatal growth of mandible

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 Postnatal growth of mandible
 In infants condyles of the mandible are inclined
almost horizontally, so that condylar growth leads
to an increase in height.
 After first year of life , mandibular growth
becomes more selective. The condyle does show
considerable activity as the mandible moves and
grows downward and forward .
 Heavy appositional growth occurs at the posterior
border of the ramus and on the alveolar border.
Significant growth still observed in at the tip of the
coronoid process
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 Postnatal growth of mandible
 Resorption occurs
along the anterior
border of the ramus
lengthening the
alveolar border and
maintaining the
anteroposterior
dimension of the
ramus.
 Major width
contribution of the
mandible is growth
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at the posterior
 Postnatal growth of mandible
 Literally the mandible
is an “expanding V”.
Additive growth at the
ends of this “V”
naturally increase the
distance between the
terminal points.
 Continued growth of
alveolar bone with the
developing dentition
increases the height
40 of the mandibular
 Postnatal growth of mandible
 Scott divides the mandible into three basic types
of bone – basal, muscular, alveolar (or) tooth
supporting .
 Basal portion is a tube like central foundation
running from the condyle to the symphysis
 Muscular portion is under the influence of
masseter, internal pterygoid and temporal
muscles
 The third portion alveolar bone exists to hold the
teeth.

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 Postnatal growth of mandible
 Moss speaks of the mandible as a group of
microskeletal units .
 Thus the coronoid process is one skeletal unit
under the influence of the temporalis muscle.
 The gonial angle is another skeletal unit under
the influence of masseter and internal pterygoid
muscles.
 The alveolar bone under the influence of teeth.

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 Postnatal growth of mandible
 Moss delineates two basic types of functional
matrices.
 1) Periosteal matrices
 2)Capsular matrices
 Mandibular growth demonstrates the integrated
activity of periosteal and capsular matrices in
facial growth.
 Since the condyles are not primary sites of
mandibular growth but loci with secondary,
compensatory growth potential , condylar removal
does not inhibit the spatial translation of
43 contiguous mandibular functional components
 Postnatal growth of mandible
 Mandibular growth is seen now to be a
combination of the morphologic effects of both
capsular and periosteal matrices.
 The capsular matrix growth causes an expansion
of the capsule as a whole.
 Under normal conditions then the periosteal
matrices related to constituent mandibular
microskeletal unit also respond to this volumetric
expansion. Such alteration in spatial position
inevitably causes them to grow.

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 CHIN
 In infancy chin is under developed.
 As age advances the growth of chin becomes
significant
 Males are seen to have prominent chin
compared to females.
 The prominence is accentuated by bone
resorption in the alveolar region below it, creating
a concavity

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 Chin

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 Mental Protuberance

 Forms by osseous
deposition during childhood

 Prominence is accentuated
by bone resorption above it

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 Theories Of Mandibular
Growth
Genetic Theory:-
This theory states that all growth is compelled by
genetic influence
i.e.: genetic encoding of mandible determines its
growth.

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 Sutural Theory

 This theory states that genetic control is

expressed directly at the level of the bone & its
locus is the periosteum.

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 Cartilaginous Theory
 This theory states that the cartilage is the primary
determinant of skeletal growth while bone
responds secondarily & passively.
 According to this theory, the condyle by means of
endochondral ossification deposits bone, which
tends to the growth of the mandible.

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 Functional Matrix Theory
 According to this theory, the soft tissue matrix in
which the skeletal elements are embedded is the
primary determinant of growth & both bone &
cartilage are secondary followers.
 Which means the muscles, connective tissues
etc. carries the entire mandible away from the
cranial base . The bone follows secondarily at the
condyle to maintain constant contact with the
glenoid fossa.

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 Enlow’s Expanding ‘V’ Principle
 This theory states that many facial bones or a
part of the bone follows a ‘v’ pattern of
enlargement.
Due to differential deposition & selective
resorption Deposition is in the inner surface of
wide ends of ‘v’ & along the ends of ‘v’.
Resorption is seen along the outer surface of ‘v’.
CORONOID: Deposition –lingual surface,
Resorption-buccal
CONDYLE: Deposition-ant. & post. Margins,
Resorption-buccal & lingual surfaces.

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 Counterpart Principle

 This principle states that growth of any given

facial or cranial part relates specifically to other
structural & geometric counterpart in the face &
cranium
Eg;- The maxillary arch is the counter part of the
mandibular arch.

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 Mechanisms Of Bone Growth
Growth Of The Mandible Primarily Involve
1. Bone remodeling
Process of bone deposition and resorption
2. Cortical drift
Combination of bone deposition and resorption
resulting in growth movement towards deposition
surface
3. Displacement
Movement of whole bone as a unit
I) Primary displacement
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 Mechanism Of Bone Growth
Bone growth is based on certain basic principles .Bones
do not grow symmetrically but grow by complex
differentiation mechanism . All bone growth is a
complicated mixture of the two basic principles deposition
and resorption .

Deposition and resorption which are carried out by the

growth fields comprised of the soft tissue investing the
bone. As the fields grows and function differently on
different parts of the bone ,the bone undergoes
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remodeling. When the amount of bone deposition is
 Deposition and resorption
•Bone grows by addition of new bone tissue on one side
of the bony cortex.

•Bone formative changes occurs on the surface facing

towards the direction of progressive growth resulting in
new bone deposition.

•Deposition is observed on the tension side.

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 Bone remodeling

 Bone remodeling involves independent sites of

resorption and formation that change the size and
shape of a bone.

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  E.g. The ramus moves
posteriorly by the
combination of
deposition and
resorption.

 So the anterior part of

the ramus gets
remodeled

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 Functions of Remodeling
1. Progressively change the size of whole bone
2. Sequentially relocate each component of the
whole bone
3. Progressively change the shape of the bone
to accommodate its various functions

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 4. Progressive fine tune fitting of all the separate
bones to each other and to their contiguous,
growing, functioning soft tissues.

5. Carry out continuous structural adjustments to

adapt to the intrinsic and extrinsic changes in
conditions .

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 Displacement

•It is the movement of the whole bone as a unit.

•It is a translatory movement of the whole bone caused

by surrounding physical forces, and is the second
characteristics mechanism of skull growth.

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 •The entire bone is carried away from its articular
interfaces( sutures , synchondroses, condyle) with
adjacent bones.

•Displacement is of two types namely:

•Primary displacement- As a bone enlarges , it is

simultaneously carried away from the other bones in
direct contact with it.This creates space within which
bony enlargement takes place.

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 It is the physical movement of the whole bone ,as the
bone grows & remodels by resorption and apposition.

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 •Secondary displacement :It is the movement of a
whole bone caused by the separate enlargement of
other bones which may be nearby or quite distant.

•It is related to enlargement of other bone.

•For example: growth in the middle cranial fossa

results in the movement of the maxillary complex
anteriorly& inferiorly .

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 Age Changes Of The Mandible

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 Age Changes Of The Mandible

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 AGE CHANGES
AT BIRTH CHILDHOOD

ADULHOOD OLD AGE

 Age Changes Of The Mandible

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Anomalies of mandible
 Some of the syndromes associated with mandibular
abnormality
i) Down’s syndrome
i) Marfan’s syndrome
ii) Turners syndrome
iii) Kleinfelter’s syndrome
iv) Pierre-robin syndrome
v) Treacher- collin syndrome

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1. Congenital 2. Developmental
• Agnathia
• Infantile cortical
• Micrognathia hyperostosis
• Macrognathia
• Achondroplasia
• Facial
hemihypertrophy • Torus mandibularis
• Facial hemiatropy
• Stafne’s cyst

• Odontogenic cyst

• Odontogenic tumor
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 Anomalies of development
AGNATHIA
 In this condition the mandible may be absent or
grossly deficient , reflecting a deficiency of neural
crest tissue in the lower part of the face .

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 Anomalies of development
Aplasia
 Aplasia of the mandible and hyoid bone is a
rare lethal condition with multiple defects of
the orbit and maxilla.
 Well developed ears and auditory ossicles in
this syndrome suggest ischemic necrosis of
the mandible and hyoid bone occurring after
the formation of ear.

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 Anomalies of development
Micrognathia
 The diminutive mandible of micrognathia is
characteristic of several syndromes including
1) Pierre robin syndrome
2) Mandibulofacial dysostosis
3) Down syndrome
4) Oculomandibulodyscephaly
5) Turners syndrome

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 Anomalies of development
 Hypoplastic mandible
 A central dysmorphogenic mechanism of
defective neural crest production, migration, or
destruction may be responsible for the
hypoplastic mandible.
 Derivatives of the deficient ectomesenchyme are
hypoplastic accounting for the typical faces
common to these syndrome.

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 Anomalies of development
 Macrognathia
 Producing prognathism is usually an inherited
condition, but abnormal growth phenomena such
as hyperpituitarism may produce mandibular
overgrowth of increasing severity with age .

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 Anomalies of development
Hemifacial hypertrophy
 Congenital hemifacial hypertrophy , evident at
birth , tends to intensify at puberty

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 Anomalies of development
Unilateral condylar hyperplasia
Unilateral enlargement of the mandible, the
mandibular fossa, and the teeth is of obscure
etiology .

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 Silver-Russell syndrome :
The mandible as well as the maxilla are small
and retrognathic. differences in mandibular
growth causing facial asymmetries
Treatment Of Abnormal
Mandibular Growth During Its
Growth
 Appropriate functional appliances in a forward
postural position increase the condyle cartilage
growth rate and amount
 Orthopedic appliances
 It is possible to use a chin cup to deliberately
rotate the mandible down and back, redirecting
rather than directly restraining mandibular
growth.
Surgical procedures
 CORRECTION OF
ANTEROPOSTERIOR RELATIONSHIP
Mandibular advancement :-Bilateral sagittal
split osteotomy of mandibular ramus
performed from an intra oral approach, is
the preferred procedure.
Mandibular setback :- Bilateral sagittal split
osteotomy and transoral vertical oblique
ramus osteotomy can be done.
 Surgical procedures
CORRECTION OF VERTICAL
RELATIONSHIP
Long face patients have excessive eruption of
mandibular anterior teeth . This tooth chin problem
can
be treated by orthodontic intrusion or by anterior
segmental surgery to depress elongated incisor
segment. However the preferred treatment is
inferior
border osteotomy of mandible to reduce vertical
height
of chin at the same time it is augmented
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horizontally. Many patients are treated by
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