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It is strongly believed and understood that growth is strongly influenced by genetic factors. Although genetic factor is one of the main factors affecting growth a variety of other factors like environmental factors. In the form of nutritional status, degree of physical activity, health or illness etc. may also contribute normal growth. Great studies have been made in recent years in improving the understanding of growth control. What exactly determines the growth of the jaws however remains unclear and continues to be a subject of intensive research. A number of theories have been explained in connection with growth of craniofacial structures. hese include!

"evel of growth control! sites #s centers of growth. $artilage as a determinant of craniofacial growth. he functional matrix concept.

Genetic theory. %utural theory.


#an $imborgh's theory.

he major difference in the first three theories mentioned in the location at which control is expressed. In the first theory, it implies that genetic control is expressed directly on bone and therefore its focus should be periosteum. he second theory states a genetic influence on his indirect

cartilage, thus bone playing a passive role. growth pattern is called as epigenetic.

he third theory states a

genetic influence to a larger extent on tissues outside the skeletal system, thus bone and cartilage growth occurring mainly epigenetically in response to a variety of other factors. GENETIC THEORY he first factors of consideration always when growth control is considered is the role of genetic factors. Although role of genetics in growth and development control has long been performed by many to have fundamental and overriding influence its exact application is not understood fully.

$ontemporary researchers have failed to accept the idea that simply gives are the exclusive determinants of all growth parameters including regional growth amounts, velocities and minute details of regional configuration. )ully understood of course is that genes are basically the participants in

maintaining the operation of any given cells organells loading to the expression of that cells particular function. )or example, functions of fibroblasts chondroblasts etc. which does their function when needed and once saturation is reached the function classes. hus the genes donot play any role as a

*starter or terminator+, it is the re,uirement of a particular situation which makes the cells to performed all these functions. LEVEL OF GROWTH CONTROL SITE VERSUS CENTERS OF GROWTH A clear distinction between site and centers of growth is necessary. he site of growth refers merely to a location at

which growth occurs and center of growth is a location at -

which independent .genetically controlled/ growth occurs. All the centers of growth are also the sites but not the reverse is true. he major support for the theory that the tissues form bone carry their own stimulus with them came from the observation that, the all pattern of craniofacial growth is relatively constant. his constancy of growth was interpreted

to mean that major sites of growth were also the centers. 0articularly the sutures between the membranes bone of cranium and jaws were considered growth centers along with sites of endochondral oscification in the cranial base and at mandibular condyle. Growth in this view, was thus the result of expression at all these sites determined genetically. hus growth at maxilla

was explained to be the result of pushing apart due to growth in the midline along the sutures.

If this theory was correct, growth at the sutures should occur largely independently of the environmental factors and it would not be possible to change the expression of growth at sutures very much. his theory was a dominant theory of growth till &234's and a variety of drawbacks were explained. It is known, at present that sutures and periosteum to a larger extent are not the primary determinants of growth, in craniofacial region. his was concluded by the fact that! a/ When an area of sutures between two facial bones is transplanted to another location .ex! to a pouch in the abdomen/ the tissues does not continue to grow. indicating lack of innate growth potential in sutures. b/ %econdly, growth at sutures is influenced by a number of outside factors. 5x! if cranial or facial bones are pulled apart, the new bone fills in and thus enlargement of bone his

is seen. If the sutures are compressed, the growth at sutures is impeded thus reducing the bone si7e than normal. his implies that the sutures are the areas that react to and not the primary determinants of growth. c/ Growth takes place in untreated cases of cleft palate even in the absence of sutures. d/ 8icrocephaly and hydrocephaly raised doubts about intrinsic, genetic stimulus of sutures. CARTILAGENOUS THEORY CARTILAGE AS A

DETERMINANT OF CRANIOFACIAL GROWTH his theory was put forward by 9ames %cott in &232. according to this theory the primary determinant of growth of craniofacial structures is the growth of cartilage. he fact

which made this theory attractive was that for many bones, cartilage makes the growing part whereas bone merely replaces the grown cartilage.

If the cartilage growth is of primary influence the growth of condyle in mandible acts as a pacemaker for growth of that bone and remodeling of ramus and other surface changes could be viewed as secondary to cartilage formation. Growth of mandible in this regard can be explained by imaging it like a diaphysis of long bones bent into horse shoe shape with cut epiphysis at the ends exposing the cartilage that represents condyles. 5piphysis

:iaphysis bent into horse shoe shape If this is a true situation then condyles should act as growth centers behaving basically as a epiphyseal growth cartilage. Growth of maxilla although is difficult to explain is not impossible. Although maxilla does not contain any cartilage.

he nasal septum contains cartilage and nasomaxillary complex grows as a single unit. 0roponents of this theory according to the study of <.:. "atham .&232/ hypothesi7e that cartilaginous nasal septum acts as a pacemaker for the growth of other aspects of maxilla. he location of nasal septal cartilage is such that its growth brings about a forward and downward pushing of maxilla thus opening the sutures. =ow the secondary .passive/ growth of bone at sutures occurs thus resulting in net increase in the si7e of maxilla. wo types of tests have been carried out to test the effectiveness of this theory. >ne by transplanting the cartilage to some other part of the body and secondly by removing the cartilage and then assessing the growth occurring in bones. $oprey and :uterloo .&2?3/ stated that not all the cartilages act similarly when transplanted. If a piece of epiphyseal plate is transplanted to a new state or culture, it

continues to grow normally indicating presence of an innate potential in the cartilage to grow. It seems that it is very difficult to get cartilage from synchondrosis at cranial base during their developmental stage. hus the results of growth of

cartilage from synchondrosis is not as good as the growth of cartilage in case of epiphysis transplantation. <onning .&233/ observed a very little or no growth of mandibular condyle cartilage when transplanted to other areas of the body or culture media. he second group of experiment were to test the removal of cartilages from their developing sites and testing for growth disturbance. 8any studies have shown that the removal of cartilage from their sites of function drastically affects the growth of related bones. %arnet .&2;3/ in his experiment on rats has shown a significant reduction in the growth of maxilla. Another support to this experiment is a reduced midface development as a whole due to surgical removal of nasal

septum in humans at an earlier stage .due to a variety of reasons like severe trauma/. A depressed growth of mandible in case of children suffered from trauma during childhood is next supporting factor due to impaction condylar cartilage. hus is appears of that epiphyseal cartilage and the cranial base synchondrosis can act as independently growing centers as can nasal septum. hus proving cartilage to be one

of the primary determinant of growth. FUNCTIONAL MATRIX THEORY OF GROWTH his theory of growth was put forward by 8elvin 8oss in early &234's. he concept of this theory is that if neither bone

not cartilage were the determinants for growth of craniofacial complex then it would appear that the control would have to be lying in adjacent soft tissues. According to this theory neither mandibular condylar cartilage, nor nasal septal cartilage are the determinants of jaw growth. Instead he theori7es that growth of


facial skeleton occurs in response to functional needs and is mediated by soft tissues in which the jaws are embedded. In this conceptual view soft tissues grow and both bone and cartilage react. he theory can also be explained by the growth of cranium in response to growth of brain. he pressure exerted

by growing brain causes saparation of sutures of the cranium thus inducing growth at the sutures thereby enhancing the increase in the si7e of cranial bones. being si7e of cranium in case of he classical examples microcephaley and

hydrocephaly. In microcephaley the growth of brain being less than normal resulting in its smaller si7e. his inturn results in a disturbed growth of cranium resulting in smaller cranium than normal. he opposite can be

explained in case of hydrocephaly where the reabsorption of $.%.). is disturbed resulting in accumulation of $%) in an abnormal amount in cranium. his in turn causes on increased

intracranial pressure leading to suppuration of cranial bones. &&

his also induces thus the bone deposition at the sutures.


although brain si7e is small, the fluid collected along with brain acts as functional matrix for the development of a larger cranium. he next example is the si7e of orbit relating to the si7e of the eyes. In case of large eyes the corresponding orbital si7e is increased and opposite for smaller eyes. hus eyes act as

functional matrix for the growth of orbits of particular si7e. In general the functional components according to this theory are divided into! &. )unctional matrix component. (. %keletal unit. All the tissues organs and spaces taken as a whole, comprise the functional matrices whereas the skeletal tissues associated with a particular matrix forms skeletal unit. he changes in their si7e, shape including operational activity is due to the activity of their functional matrix.


SKELETAL UNIT All the skeletal tissues associated with a single function are called as * he skeletal unit+. his may be comprised of

bone, cartilage and tendenous tissue, when a bone is comprised as a number of continuous units, these units are called as *microskeletal units+. 5xample, mandible has several microskeletal units like coronoid, angular, alveolar, condylar process ramus and body. 8axilla is composed of orbital pneumatic alveolar palatal, basal microskeletal units. When adjoining portions of a number of bones unit to perform a single function they are called as macroskeletal units. 5x! entire enoberanial surface of cranium. FUNCTIONAL MATRIX he functional matrix is composed of muscles, glands, vessels, nerves and functioning spaces. into! his matrix is divided


a. $apsular matrix. b. 0eriosteal matrix. a. Periosteal Matrix ! 0eriosteal matrices act directly and actively on their related skeletal components. Alterations in their functional demands produces a secondary

transformation of si7e and shape of their skeletal units. his is brought about by selective resorbtion and


he periosteal matrices include muscles,

vessels, glands nerves etc. b. Capsular Matrix ! According to capsular matrix theory the capsular matrices act indirectly and passively on their related skeletal structures thereby bringing about the necessary changes in these skeletal components which are embedded, grow and maintained in them. he facial bones move and expand in response to the growth of their capsule. his kind of growth is not brought

about by deposition and resorbtion.


he two capsules of important are neurocranial capsule and orofacial capsule. 5ch of these capsules is an envelop which contains a series of functional cranial components .skeletal units and related skeletal matrix/ which as a whole are sandwiched between two covering layers. In case of neurocranial capsule the layers include skin and dermates and in case of orofacial capsule, it includes skin and mucosal membranes. he neurocranial capsular surround and protects brain, leptmininger and $.%.). which are the functional matrices of cranium whereas the orofacial capsule surrounds and protects esopharyngeal structures. hus the function matrices have an major role in predicting the growth of craniofacial skeleton. VAN LIMBORGHS THEORY A multifactorial theory was performed in &2;4 by #an "imborgh. According to him the factors explained by all


previous theories were insufficient yet contain elements that cannot be denied. #an "imborgh explained the growth process in a view that combines all three existing theories. @e suggested five factors that he believed to control the growth. a. Intrinsic genetic factors! hey are the genetic control of skeletal units themselves. b. "ocal epigenetic factors! Aone growth is determined by genetic control originating from adjacent structures like brain eyes etc. c. General epigenetic factors! hey are the genetic factors determining growth from distant structures e.g. growth hormone, sore hormone. d. "ocal environmental factors! hey are non genetic factors from local area caries B habits, muscle forces etc.


e. General environmental factors! hey are general non genetic factors influencing growth which include B nutrition, oxygen etc. he views expressed by #an "imborghs can be

summari7ed as! a. $hondrocranial growth is mainly controlled by intrinsic genetic factors. b. :imensional growth is controlled by any few intrinsic genetic factors. c. $artilagenous part should be considered as a growth center. d. %utural growth is controlled mainly by influences arising from skull cartilages and other adjacent skull structures. e. 0eriosteal growth largely depends upon growth of

adjacent structures.


f. %utural and periosteal growth are additionally governed by local nonCgenetic environmental influence. hus a variety of factors other than genetic factor as a major determinant play important role in basic growth is development.