Second part of the 2nd lecture ,, Now lets start with the development of calvarium which contains: 1-cranial

vault 2-cranial base

Cranial vault : flat bones separated by sutures.

Composed of frontal , parietal , temporal and occipital bones. These bones develop from the membranous covering of the brain .

-At birth : bones are separated by connective tissue called fontanelles - growth at sutures closes fontanelles around one year after birth but bones remain separated by thin periosteal-lined sutures for years . -osteogenesis spreads from ossifications centers which start at the 8th week intra-uterine , also ossification influenced by underlying neural epithelium .

Growth and remodeling of cranial vault :

-growth at sutures and deposition of bone in the inner and outer surfaces . -enlargement results from displacement by expansible growth of brain accompanied by osteogenesis at sutural margins ; when there is a growth at the sutures area, they start to go away from each other and move up so the cranial vault can go up and grow . -brain growth play a role in patterning the shape of the skull and in directing its growth because the brain give stimulation to the growth sites. -resorptive, remodling and deposition flattens bones as head enlarges , deposition from outside and resorption from inside. -cranial vault achieves > 90% of adult size by age 5 . -So ,, Cranial vault undergoes intramembranous ossification and surface apposition, and at sutures there will be sutural expansion stimulated by brain growth . resorption occurs at the inner surface and deposition occurs at the outer surface.

Craniosynostosis: is a condition in which one or more of the fibrous sutures in an

infant skull prematurely fuses by turning into bone (ossification).

A child with Craniosynostosis

Cranial base : defined in terms of midsagittal structures

(anterioposteriorly) as extending from basion to nasion including basi-occiput , body of sphenoid , frontal bone , cribriform plate of ethmoid . it can be divided into anterior (nasion-sella) , posterior (sella basion) and middle departments .

- the cranial base is performed in cartilage (the remnant of the primary cartilaginous skeleton) , so the cranial base was cartilage then it was replaced into bone by endochondral ossification . - as we said , the cranial base is divided into three parts ; anterior , posterior and between them there will be a cartilage (its look like a suture , but it isnt a suture) we call it synchondroses ; it is a growth centers means that they grow by themselves (with or without stimulus) .

- ossification centers appear from 3 months foetal life to 1 year, as ossification proceeds , band of cartilage called synchondrosis remain between the centers of ossification . -during the 1st 5 years , growth occurs mainly at the spheno-occipital and spheno-ethmoidal synchondrosis . -growth at fronto-ethmoidal sutures is restricted . cribiform plate attains mature length at 2-3 years . - spheno-ethmoidal synchondrosis closes at 6-7 years . -spheno-occipital synchondrosis closes at 13-16 in males & 11-14 in females. - 50% of cranial base post-natal growth is completed by the age of 3 years . - synchondrosis are the growth centers of cranial base , also their growth results in anterio-posterior increase of the cranial base length because the bone will go away from each other . - growth is by endochondral replacement at the synchondrosis since it is a cartilage ; The sutures of the cranial base are called synchondrosis as they are of endochondral origin. The direction of growth in these sutures is forwards and upwards carrying the anterior cranial base and the upper face upwards and forwards.

clinical relevance :
* Since the naso-maxillary complex is attached to the anterior cranial base and the mandible attached indirectly to the posterior cranial base , alterations in the angulations between the two parts will affect the maxilla-mandibular relations so we have class I , II , III

development of maxilla :
- starts towards the end of 7th week intra-uterine by the appearance of two centers of ossification within the ectomesenchyme of each maxillary process . there are 2 centers : 1)posterior centers give rise to maxillary proper. 2)anterior centers give rise to pre-maxilla . -these ossification centers appear later than those of mandible . -the main growth center of ossification appears above that part of dental lamina which will form the primary canine tooth germ . it is close to the point at which the infra-orbital nerve gives off the anterior superior dental branch. Ossification then proceeds in several directions : 1- vertically towards the cartilaginous nasal capsule as frontal process . 2- medially into the horizontal palatal folds as palatal process . 3- laterally as zygomatic process .

Palatine bone and pre-maxilla :

-palatine bone arise from a single center of intra-membranous ossification during the 7-8th week lateral to cartilaginous nasal capsule . -pre-maxilla :controversy as to whether this bone exists

Postnatal growth of maxilla :

-entirely by intra-membranous ossification . maxilla articulate via suture with : nasal , lacrimal , frontal , ethmoid , zygomatic , vomer (in the nose) palatine bone and premaxilla . there will be stimulation to the growth of the maxilla by intra-mambranous.

-postnatal growth occurs by sutural deposition and surface remodeling and growth is in a downward and forward direction , this result in new bone deposition on the superior and posterior sutural attachments . ** in order to move maxilla forward there should be bone deposition posteriorly .

-Enlow differentiated between growth and displacement which is a consequence of growth , the predominant direction of growth is posteriorly with displacement occurring in the anterior opposite direction . - the anterior-posterior dimension of growing maxilla increase to accommodate molar teeth.

growth of maxilla in :

1- Width : sutural deposition (mid palatal suture) 2- AP (anterio-posterior) : sutural and surface remodeling . deposition of bone at posterior surface of maxillary tuberosity accompanied by resorption at the anterior surface of maxillary complex . to maintain the shape of maxilla there will be bone resorption anteriorly and deposition posteriorly 3- height : - eruption of teeth results in growth of alveolar bone . - palate : resorption at nasal side and deposition at mouth roof (drifting) . So : anterior surface of maxilla >>bone resorption . posterior surface of maxilla>>bone deposition. palate(mouth roof) >> bone deposition. nasal floor >> bone resorption . posterior superior >> bone deposition . (this to maintain shape and form of developing maxilla.)

* Bone deposition occurs at : tuberosity region , roof of the mouth , median wall of maxillary sinus, palatal side of dental arch and alveolar processes as teeth erupt.

* Resorption occurs at : -anterior surface of the maxilla except the anterior nasal spine , nasal side of the roof of the mouth , all walls of maxillary sinus except the inner part of the medial wall , nasal side of the medial wall of maxillary sinus .

Mandible development :

-Development of mandible begins as a condensation of mesenchymal cells just lateral to meckels cartilage and proceeds as intra-membranous bone formation . -the primary centers of ossification lies at the bifurcation of the mandibular nerve into its mental and incisive branches . -meckels cartilage disintegrates and largely disappears as the bony mandible develops , although mandible develops in a close proximity to meckels cartilage , it is classified as membranous bone.

-fate of meckels cartilage : disappears except 1 or 2 remnant seen in the region of symphysis and persists until birth. The fibrous perichondrium forms spheniomandibular ligament (attach to lingual) and anterior ligament of the malleus(which is in the middle ear) and the dorsal end of the perichondrium forms the malleus and the lncus .

Secondary growth cartilages called secondary because they are not remnant of primary
cartilaginous skeleton like :

-condylar cartilage : :develops as an independent secondary cartilage 10-14 weeks IU>> early in fetal life it fuses with the developing mandibular ramus and contributes to postnatal mandibular growth. - symphseal cartilage : unites the 2 halves at the symphsis and disappears at the 1st year after birth . - coronoid cartilage : a strip along the anterior border of the coronoid process , disappears before birth .

postnatal growth of the mandible ;

-Both endochondral and intra-membranous growth ; *endochodral growth occurs at the condylar cartilage *intra-membranous growth occurs at the rest of the mandible .

**There will bone deposition posterior surface of the ramus and resorption in the anterior surface of the ramus in order to move the mandible downward and forward.

**so the growth of the condyle occurs upward and backward to move the mandible downward and backward.

-Bone deposition occurs at : outer surface of the mandible , posterior surface of the ramus and chin . -Bone resorption occurs at : inner surface of the mandible ,anterior surface of the ramus and above the chin ( thats why this area is concave) .

Done by : Rasha Al-Shboul