Chapter 3

The Developmental Sequence

This is a short summary of the overall pattern of combined remodeling and displacement movements representing the essence of the "big picture". The multiple growth process in all the various parts of the face and cranium are described separately as individual "regions" or "stages." Keep in mind that these growth processes take place simultaneously. Facial and cranial enlargement, in which form and proportions remain constant, constitutes "balanced" growth. But because regional imbalances always occur during the actual developmental processes, changes in facial shape and form always take place as the face grows into adulthoood. Imbalances in growth produce imbalances in structure which we come to recognize. The face of each of us is the aggregate sum of all the many balanced and imbalanced craniofacial parts combined into a composite whole. The process of compensation provides for a certain latitude of imbalance in some areas in order to offset the effects of disproportions in other regions. Certain structures develop in relation to other counterparts in the head. Testing for part-counter part relationships is relatively easy. The regional growth changes outline below are discussed in terms of both remodeling and displacement.

Regional Change (Stage) 1

The bony maxillary arch lengthens horizontally in a posterior direction. Bone has been deposited on the posterior-facing cortical surface of the maxillary tuberosity. Resorption occurs on the opposite side of the same cortical plate, which is the inside surface of the maxillar withing the maxillary sinus.

Regional Change (Stage) 2

As the maxillary tuberosity grows and lengthens posteriorly, the whole maxilla is simultaneously carried anteriorly. The amount of forward displacement exactly equals the amount of posterior lengthening (Stage 1).

Regional Change (Stage) 3

What are the counterparts to the bony maxillary arch development? They include the nasomaxillary complex, the anterior cranial fossa, the palate, and the corpus of the mandible. The mandible will be discussed in this stage. The mandible is divided into 2 major parts, the corpus (body) and the ramus. The body of the mandible is the structural counterpart to the body of the maxilla. The mandibular corpus lengthens to match the elongation of the maxilla by remodeling conversion from the corpus.

Regional Change (Stage) 4

Like the maxilla, the whole mandible is displaced anteriorly. This is achieved through posterior remodeling of the condyle and the posterior part of the ramus.

Regional Change (Stage) 5

The whole mandible is displaced anteriorly by the same amount that the ramus has relocated posteriorly. As the bone becomes displaced, it simultaneously remodels (Stage 4) to keep pace with the amount of displacement.

Regional Change (Stage) 6

All of the growth and remodeling changes described in the preceding stages have been taking place, the dimensions of the temporal lobes of the cerebrum and the middle cranial fossae have also been increasing at the same time.

Regional Change (Stage) 7

All cranial and facial parts lying anterior to the middle cranial fossa become displaced is a forward direction. This is a secondary type of displacement because the actual enlargement of these various parts is not directly involved. The anterior cranial fossa and nasomaxillary complex are carried, not pushed forward as the frontal and temporal lobes of the cerebrum enlarge by respective growth increases.

Regional Change (Stage) 8

The expansion of the middle cranial fossa has a displacement effect on the mandible (via secondary displacement), but to a lesser extent.

Regional Change (Stage) 9

What counterbalances the changes that occur as a result of development of the middle cranial fossa? Just as the lengthening of the middle cranial fossa places the maxillary arch in a progressively more anterior position, the horizontal growth of the ramus places the

mandibular arch in a like position. The ramus is the specific structural counterpart of the middle cranial fossa. Both are counterparts of the pharyngeal space.

Regional Change (Stage) 10

The entire mandible is displaced anteriorly at the same time that it remodels posteriorly. The oblique manner of condylar growth necessarily produces and upward and backward projection of the condyle with a corresponding downward as well as forward direction of mandibular displacement.

Regional Change (Stage) 11

The floor of the anterior cranial fossa and the forehead grow by deposition of the ectocranial side with resorption from the endocranial side. The posterior-anterior length of the anterior cranial fossa is now in balance with the extent of horizontal lengthening by its structural counterpart, the maxillary arch (Stage 1). The enlarging brain displaces the bones of the calvaria (skull cap) outwards. The ethnomaxillary (nasal) region undergoes equivalent growth increments to the anterior cranial fossa above and the maxillary arch and palate below it.

Regional Change (Stage) 12

The vertical lengthening of the nasomaxillary complex, as with its horizontal elongation, is brought about by a composite of (1) growth by deposition and resorption, and (2) a primary displacement movement associated directly with its own enlargement. The anterior part of the bony maxillary arch has a periodsteal surface that is resorptive. The reason is because this area grows straight downward.

Regional Change (Stage) 13

Vertical growth by displacement is associated with bone deposition at the many and various sutures of the maxilla where it contacts the multiple, separate bones above and behind it. The increment of bone growth in the suture exactly equals the amount of inferior displacemtn of the whole maxilla. This is primary displacement. Vertical changes also occur by direct relocation by resorptive and depository remodeling. Teeth move also by the processes of vertical drift and eruption. Teeth themselves have very little capacity for remodeling. They can, essentially, only be moved by the displacement process, either in conjunction with remodeling of an individual alveolar socket or displacement of the entire arch as a unit. It is the bone that must undergo any remodeling required.

Regional Change (Stage) 14

The amount of vertical separation between the upper and lower arches caused by the vertical growth of both the middle cranial fossa and the ramus must balance an equivalent

amount of lengthening in the nasomaxillary complex and the dentoalveolar region of the mandible. The mandibular teeth and alveolar bone drift upward to attain full occlusion. This is produced by a superior drift of each tooth, together with a corresponding remodeling increase in the height of the alveolar bone.

Regional Change (Stage) 15

While the upward movements of the mandibular teeth and remodeling of the alveolar sockets are taking place, remodeling changes also occur in the incisor alveolar region, the chin, and the corpus of the mandible.

Regional Change (Stage) 16

The forward part of the zygoma and the malar region of the maxilla remodel in conjunction with the contiguous maxillary complex, and their respective modes of growth are similar. Just as the maxillar lengthens horizontally by posterior remodeling growth, the malar area also remodels posteriorly by continued deposition of new bone on its posterior side and resorption from its anterior side.

Regional Change (Stage) 17

Just as the whole maxillary complex is displaced anteriorly and inferiorly as it simultaneously enlarges in overall size, the malar area is moved anteriorly and inferiorly by primary displacement as it enlarges.