Learning Objectives 1 The Study of Physical Growth 1.

. Understand the definitions for growth, development, differentiation, translocation, maturation, physical growth, anthropometric measurement. Growth- normal dimensional changes in the amount of living substance that is measured in units of change per units of time Development- all the naturally occurring unidirectional changes in the life of a species from its existence as a single cell to its elaboration as a multifunctional unit Differentiation- the change from generalized cells or tissues to more specialized units during development ranslocation- change in position eg. he chin point moves downward and forward with growth !aturation- "ualitative changes that occur in tissues, organs, and structures in an orderly and predictable fashion during growth. #hysical Growth- he study of everything that happens in an organism from conception to full body growth and maturation $nthropometric !easurement- measurements of the body in terms of dimensions of bone, muscle, and adipose tissue. %. Understand the methods used to study physical growth, and an example of how each is used. &pinion- o loo' at something and extrapolate information from what you are able to see. (ee that two things are different or the same. &bservation- o loo' at a set of information that is provided and produce a finding from the information eg. )-1*+ of U( children will have at least 1 primary molar become an'ylosed before it finally resorbs and exfoliates ,atings and ,an'ings- -lassify things. eg classify faces, teeth, teeth development .uantitative !easurements- either direct or indirect measurement /!ost important0 !ethods for measurement1 $nthropometry- he measurements of s'eletal structures on a living individual. hese measurements are made using common landmar's over certain landmar' structures and compared to dry s'ulls to determine degree of development. hese measurements can be compared to a ban' of statistical data or to an individuals previous measurements. eg. 2ody !ass 3ndex -ephalometric ,adiography- #recisely orient the patients s'ull and ta'e a radiograph. his allows you to ta'e direct measurements of the dimensions of the bone tissue without having to ta'e into account the variations of soft tissue thic'nesses. $lso due to the precise cephalic orientation, you can overlay the radiographs and show the location and amount of growth. 4D imaging- #erformed using -$ scans and !,3 images, enable you to observe the three dimensional growth of the s'ull. (ignificantly more difficult to overlap and compare to a previous image but new technology is ma'ing this possible. his is primarily used in planning surgical treatments for patients with facial deformities. 4. Understand the differences between direct and indirect "uantitative measurements. Direct !easurements- 3nformation that is derived from measurements ta'en on a living person, cadaver, or s'eleton by means of calipers, scales, measuring tapes, and any other measurement instruments. -$nthropometry 3ndirect !easurements- 3nformation derived from images or reproductions of the actual person eg. #hotos or radiographs --$ scans, 5and-wrist scans determining s'eletal age, measurement of teeth from a stone model

6. 7hat is the general approach to determine s'eletal tissue maturation used in hand-wrist radiographs. 7hat sex differences are observed in the timing of s'eletal maturation8 $ radiograph is compared with standard radiographic images in an atlas of hand-wrist development. he main points that are trying to be observed is the se"uence of ossification of the bones in the hand and wrist /4* bones0, which often occurs in a regular se"uence. $lso observe the size of the epiphyseal growth plates in the long bones of the fingers /phalanges, metacarpals, and radius.0 $lso the adductor sesamoid bone originally is a piece of cartilage that ossifies during adolescence and is a 'ey mar'er for the growth spurt. here are several sex differences in timing of s'eletal maturation. Girls often precede boys in regards to growth spurt, dental calcification, ossification of carpel bones /hand-wrist radiograph0 - he maturity indicator -##% stage -Growth disc has same width as proximal phalanx of %nd /index0 finger -( stage - he sesamoid bone of the thumb begins to calcify -1*.) years for girls, 11.) years for boys -(!#4cap --apping of the middle phalanx of the 4rd /middle0 finger -1 year after ( stage -,U stage -9piphysis of the radius fuses -3ndirect measurements of an x-ray of a patient:s hand- -an measure epiphyseal growth plates -Generally, girls are 1 year ahead of boys in development -7hich means that you can start orthodontic treatments earlier in girls

). Understand the differences between height and velocity growth plots for stature, weight and sex. 5eight- !ales have a tendency of having a later growth spurt then female. !ales also usually go on to grow to be taller and grow for a longer period of time. 7eight- !ales are usually heavier and have a period of increased weight gain that occurs on average two years later than females.

;. 2e able to discern the differences between growth pattern, age e"uivalence and growth timing as aspects which affect physical growth variability. Growth pattern- the change in proportional relationships with time. -ertain patterns emerge in development that are seen almost universally. <or example the development of the head and face after birth is primarily the development of the structures and not the cranium, the body develops with a cephalocaudal gradient. he caudal end of the body grows more rapidly than the cephalic portion. 9ven occurs in the head, for instance the mandible develops more after birth then the maxilla as a result of it being farther caudal. he cephalocaudal gradient also means that caudally, the body is less developed at birth and primarily matures after birth. 9ach individual grows at a different rate and this produces variability in the rate and amount of variable growth. $ge 9"uivalence- 3ndividuals of the same age are neither necessarily of the same size nor the same stage of maturation and development. o attempt and detect stronger patterns of development and also to better observe abnormal growth, several ways of determining age were developed1 ('eletal age- age based on the development of the bones, primarily observed through hand-wrist radiographs. Dental age- age system where the numbers of calcified and erupted teeth are compared to the normal se"uence and an age is determined -hronologic age- $ge in years and months from birth date.

!ental age- age based on the mental maturity of an individual. #erformed using an intelligence test and extrapolated to an external information set. Growth timing- &ne ma=or growth landmar' in a person>s development is the growth spurt. his occurs when the body produces a significant enough supply of growth hormone and is an important point because it is used as a mar'er for the timing of other growth events. his is based somewhat in genetics but several patterns have been observed such as the fact that taller children tend to reach the adolescent spurt later than short-legged stoc'y children. $lso females begin their growth spurt earlier than males. he next "uestion identifies many of the variables that affect growth timing.

?. 2e able to list and understand the variables which affect the timing of growth. 5eredity- genetic control of the size of body parts, the rate of growth, and the onset of growth events. @utrition- malnutrition delays growth and may affect the size of body parts, proportions and "uality and texture of some tissues li'e teeth and bones 3llness- systemic diseases ,ace- gene pool differences affect s'eletal maturity at birth <amily size A 2irth order- <irst born children are lighter at birth, shorter and have higher 3. (ecular rends- size and maturational changes in large societies over time

Learning Objectives 2 1. 2e able to compare and contrast differences between cross section and longitudinal data sets in the study of craniofacial growth. Longitudinal B same individual measured at multiple time points. - advantages o efficient o large data sets from small population numbers o highlights individual variation - disadvantages o complete data sets ta'e years to collect o expensive o sub=ect retention over years is never 1**+ Cross sectional B different individuals at differing ages measured once to produce data set. - advantages o data collected "uic'ly o inexpensive - disadvantages o less efficient B many more sub=ects re"uired for same precision o you ma'e an assumption that groups measured and compared are similar o group averages obscure individual variations

because they happen at different times for different individuals, individual variations are important for1 onset of pubescence onset of the adolescent growth spurt

%. 2e able to define, compare and contrast craniometry, anthropometry and cephalometric radiology. Cranio!etry B techni"ue of measuring bones of the s'ull to determine physical characteristics as related to sex, race, age, individual history or body type. - used in the 1C4*>s o used a tool called a craniostat o based on measurements from human s'eletal material - today, used for the study of1 o evolution of a species o contemporary human craniofacial growth - advantages o precise measurements of s'ulls o can study different populations and species /extinct or living0 o can study the "attern of growth - disadvantage o measurements are cross sectional since sub=ect is dead #nthro"o!etry B the study of measurements of the body in terms of dimensions of bone, muscle, and adipose tissue. - refers to the measurement of living individuals - 2!3 is the most common measurement - Goal is to find soft tissue land!ar$s which represent the underlying s'eletal structure - #dvantage o -an now follow individual growth directly, by measuring soft tissue points repeatedly at different times /longitudinal0 Dongitudinal studies provide more precision Ce"halo!etric %adiology B indirect measurement of bony s'eleton and soft tissue. - most common techni"ue used today - images allow you to see s'eleton and soft tissue at the same time - advantages o combines advantages of craniometry and anthropometry o can be used for both longitudinal and cross-sectional studies - disadvantages o re"uires radiation o %D image of a 4D head o patient must be reliably positioned to obtain comparable images - 4D imaging is an emerging area 4. 2e able to describe, and give an example for vital staining, molecular biological techni"ues, autoradiography and implant radiography as experimental methods used in studying craniofacial growth. &ital Staining

$lizarin red is in=ected into the sub=ect at e"ual time intervals. he red is incorporated into the soft tissue before it is mineralized. 3n the rat mandible, it can represent growth in thic'ness of the periosteum if located around the length of the bone 3n the rat mandible, growth up near the condyle represents changes in the dimensions /length0 of the cartilage of the mandibular condyle

'olecular (iological Techni)ues - &steoblast ranscription <actor 9xperiment o 'noc' out a transcription factor that regulates osteoblast activity /-bfa-10 o 'noc'out mice will show a lac' of endochondrial and intramembranous bone formation o (tain with alizarin red and alcian blue o 2ones will stain red and cartilage will stain blue - GD<E Gene 9xperiment o GD<E gene produces myostatin o !yostatin is a growth factor which limits s'eletal fiber mass o 'noc'ing out !5- gene produces a %x increase in muscle mass o important because it can be used to show that !uscle !ass influences bone for!ation GD<E Fnoc'out mice show increased masseter muscle weight and mandibular length over the wild type GD<E 'noc'out mice show decreased cranial volume, maxillary length, and mandibular shape index from the wild type #utoradiogra"hy - radioactive isotopes incorporate into a chemical component in tissues o used in vivo o can incorporate into *+# of dividing cells /when using thymidine 540 or "roteins of the 9-! /when using 16--proline0. - good for mar'ing differences from normal development at the histological level, ex. 3ntroducing a toxin that disrupts normal growth plate development Ce"halo!etric Growth Studies - use implanted material and cephalograms to record longitudinal changes in growth - maxillary implants1 o palatal vault o zygoma o premaxilla - mandibular implants1 o anterior, middle, and posterior root canals - implants remain stable, so it gives a really good estimate of =aw growth 6. 7hat were #rofessor 2=or'>s findings for mandibular growth using the cephalometric implant techni"ue8 some mandibular areas are stable, and D& @& re"uire implants to measure them when superimposing images o internal as"ect of sy!"hysis o inferior alveolar nerve canal o inferior border of the ,rd !olar cry"t

- the mandible grows up and bac'wards888 towards the cranial cavity rather than down and forward ). -ompare and contrast intramembranous and endochondrial bone growth, including the terms, apposition and remodeling. -ntra!e!branous B bone formed by direct ossification of embryonic connective tissue - process1 o formation of ossification center o calcification o trabeculae formation o final maturation - periosteum is formed from the surface mesenchyme - superficial layers of spongy bone are replaced by compact bone - spongy bone remains in the centerG this is where the roots of teeth are found along with the periodontal ligament - found1 o s'ull calvarial bones and cranial sutures o all bones of maxilla o all of mandible except for the condyles o alveolar bone .ndochondrial B re"lace!ent of hyaline cartilageG cartilage is resorbed and the bone replaces it. - #rocess1 o mesenchymal cells differentiate into cartilage o cells undergo hyperplasia and hypertrophy o cartilage matrix calcifies and cells degenerate o disintegrating cartilage is replaced by osteogenic tissues - <ound in regions of high levels of co!"ression - <ound in bones associated with o !ovable =oints o $ll long bones of hands, limbs, and feet o (ome parts of the cranial base o !andibular condyles o @asal septum /ethmoid bone0 - &steoblasts produce bone through a""ositional growth /laying bone over scaffoldingH 9ndo880 - 4 parts of the bone o diaphysis B calcified shaftG provides support o epiphysis B boney capG forms =oint o epiphyisal growth plate B space between diaphysis and epiphysisG uncalcified cartilage that is responsible for length growth - primary ossification center o located in the diaphysis o formed when spongy bone is replaced by compact bone o forms a medullary cavity - secondary ossification centers o located at the ends of the bone o spongy bone remains in the center and no medullary cavity forms - most cartilage is replaced by the end of fetal life

remaining cartilage is used for growth Growth zones1 o ,esting B cartilage attaches to epiphysis o #roliferation B chondrocytes divide on the e"i"hysial side of the plate to form cartilage o 5ypertrophy B chondrocytes mature and enlarge o -alcifiation B chondrocytes die, matrix is calcified o &ssified bone B bone has replaced cartilage

;. Describe differences between accretionary, multiplicative and dimensional cell growth. ?. 7hen does interstitial growth and appositional growth occur in bone formation8 -nterstitial Growth B growth types that ta'e place throughout the entire tissue - happens during fetal growth - #ccretionary Growth B increase in intercellular substance. here is no increase in size or number of the cells. - 'ulti"licative Growth increase in number of cells. - *i!ensional 3ncrease in size of cells. - ,esults in a separation of internal structures #""ositional Growth B growth only on the surface of the tissue - happens at neonatal period - is really =ust !ulti"licative growth at the epiphysis and periosteum - internal structures remain in the same relative locations ?. Define the anatomical units which constitute the craniofacial s'eleton. *es!ocraniu! boney portion of neurocranium formed by intramembranous ossification - frontal bone <or #arry &nly his (uc's - parietal bone - s"uamous portion of occipital bone - s"uamous portion of temporal bone - greater wing and pterygoid plates of sphenoid bone Chondrocraniu! boney portion of neurocranium and midface formed solely by endochondrial ossification - ethmoid and inferior turbinate bones /lateral walls of nasal capsule0 - basiocciput portion of occipital bone - petrous portion of temporal bone - body of sphenoid bone S"lanchnocraniu! B visceral components of the oral cavity and masticatory system - face - =aws - oral cavity *entition B oral apparatus

<unctional units1 @eurocranium B desmocranium and chondrocranium <ace B chondrocranium and splanchnocranium &ral cavity B splanchnocranium and dentition

Learning Objectives , 1. 2e able to list the sites of new bone growth in the craniofacial s'eleton. - -ondylar cartilages of the mandible - (ynchondroses of the cranial base --- (pecifically the spheno-occipital and occipito-mastoid synchondroses - $lveolar !argins /#DD and tooth root0 - !embranous anatomic surfaces of bones /periosteum and endosteum0 - (utures in the s'ull %. 2e able to describe the different types of positional movements of bone in the craniofacial s'eleton during growth and give an example of each different type of movement. - @ote1 9nlow defines positional movement of bones as egional responses to remodeling processes.,emodeling is the basis of bone growth, whereby there is continuous deposition of bone on one surface balanced by resorption on the contralateral surface. 6 types, can have multiple going on at once. a/ Cortical *rift1 he movement of an entire cortical surface of a bone. --- 9xamples are the lateral movement of the zygomatic arch, and the posterior movement of the coronoid process of the mandible. he surface facing the direction of movement gets built up by deposition of new cortical bone, while the contralateral surface is resorbed. b/ *is"lace!ent / n totomovement01 ,e"uires two attached anatomic units /bones or soft tissues.0 7hen one tissue grows it pushes the other tissue, thus displacing it in the direction of the growth. he displaced tissue doesn't grow and change its own position, it gets pushed. --- 9xample is the downwardIforward displacement of the maxilla and midface due to the growth of the middle cranial base. here isn:t any growth going on in the maxilla or midface, they:re =ust getting pushed along by growth going on behind them. ------ @ote1 he bric' wall cartoon shows how this can be balanced by cortical drift. he bric' wall represents the maxilla experiencing cortical drift in one direction, while the movement of the cart represents the middle cranial base growing and displacing the maxilla in the opposite direction. c/ %elocation1 $ change in the position of a region within a bone due to remodeling of the surrounding regions /of the same bone.0 hin' about cutting a dec' of cards. $ card in the middle of the dec' becomes the top card after the cards above it are moved to the bottom. @obody moved the middle card, but its position in the dec' changed. JJJJJ @& 91 here are three ares in the mandible that remain stable over time. 3nternal aspect of symphysis, 3nferior alveolar nerve canal, 3nferior border of 4rd molar crypt. d/ .0"anding Princi"le1 3n U or V shaped bones /eg. mandible, and maxillaryImandibular dental arches0 show a specific pattern of length growth. hey get deposition on the internal aspect of the K, and resorption on the outer aspect. hin' of duc'sIgeese flying bac'wards. his causes an increase in length and width of the arches. --- 9xample1 !andibular 4rd molars might be impacted in a child:s mouth, but the impaction is relieved after this K growth because the increase in length and width results in more room for them to erupt. $lso happens in epiphyseal growth plates of long bones. here is deposition at the endosteal surfaces and resorption at the periosteal surface. 4. 2e familiar with each of the ; craniofacial growth patterns. - @ote1 (ize, form, and =aw relationships are trac'ed by lateral and frontal cephalometric growth studies using either cross sectional or longitudinal data. Kertical facial growth is mostly due to mandibular condylar growth resulting in a downward and forward shift of the mandibular ramus. &cclusal plane angle and mandibular plane angle decrease with age due to this shift.

11 Growth of the neurocranium closely parallels the growth of the brain. 3t:s C*-C)+ done by age ; /don:t buy your 'id a baseball hat until he:s ;.0 21 <acial growth more closely resembles the timing of long bone and body growth. 3t continues through adolescence and into young adulthood. ,1 he maxilla and mandible show a coordinated downward and forward pro=ection from the cranial base. 21 !andible moves more forward /becomes more prognathic0 than the maxilla. his is because it has cartilage in the condyles and thus grows for longer. Fids will always appear to have a more -lass % occlusion, settles into -lass 1 with continued growth. 31 here is more vertical growth occurring at the anterior of the =aws and face than in the posterior regions /mandibular ramus, etc.0 @ote that growth in the posterior region has a greater effect on the mandibular angle than an e"ual amount of growth in the anterior region. 41 here is sexual dimorphism in facial growth. Girls grow faster and stop growing at a younger age than boys, but boys show greater overall growth. --- @ote1 hese are general trends, sub=ect to lots of variation between individuals. Kariations are seen in the increments of change and the direction of mandibular growth /some people still end up in -lass % or -lass 4 occlusion.0 Kertical growth variations can also produce open bite and deep bite malocclusions. 6. -ompare and contrast mesocephalic, brachycephalic and dolichocephalic facial types. - @ote1 <acial types are classified based on bone morphologyIgrowth, cephalic index /s'ull shape, length vs width as viewed from top0, dental arch growth /and tooth eruption0, and neuromuscular changes. here are 4 <acial types. a/ 'esoce"halic5 !ost common /;*+ of faces0, ovoid shaped face, normal maxillaImandible relationship, harmonious musculature, parabolic dental arch, favorable orthodontic prognosis. b/ (rachyce"halic5 (hort wide faces, s"uare =aw /C* degree gonial angle0, mandibular growth pro=ection is more forward /less vertical growth, results in counterclockwise mandibular rotation0, overdeveloped musculature /they bite 5$,D0, and broadIs"uare dental arches. Likely to develop Class 2 division 2 deep anterior overbite malocclusion. c/ *olichoce"halic5 Dong narrow =aws, obtuse gonial angle, mandibular growth is more vertical /resulting in clockwise rotation0, musculature less developed, long narrow dental arches /'ind of pointy0, high palatal vaults, fre"uently experience dental crowding, most difficult to treat orthodontically, likely to develop Class 2 division and Class ! open bite malocclusions and sometimes even get airway problems. --- @ote1 7hen comparing their angles formed between the sella-nasion line and mandibular plane, the smallest angle is seen in brachycephalics, followed my mesocephalics, and finally dolichocephalics have the largest angle. ). Describe bone growth in the desmocranium and the types of craniofacial anomalies produced by synostosis. - Desmocranium H bony part of the cranial vault. 2ones here develop by intramembranous ossification. <ontanelles /soft spots0 eventually ossify to form cranial sutures. - (uture / ynarthrosis H a fibrous =oint articulating bones of the s'ull and face. hey are sites of active bone growth, and permit slight movement in response to mechanical stress. he 4 'inds of sutures are1 #lane /ex. midpalatal0, Denticulated /ex. coronal and midsaggital0, and 2eveled /ex. lateral s'ull bones.0 here are 4 modes of growth seen in sutures1 a0 #eriosteal deposition and endosteal resorption, results in cortical drift and outward expansion of bones. b0 Displacement at sutures due to -@( growth. Growing -@( pushes bones outwards and separates the sutures. c0 (urface appositional growth within the sutures to offset the displacement from -@( growth /otherwise sutures would be left open.0 - <usion of sutures is called ynostosis controlled by transcription factors such as /most importantly0 <ibroblast Growth <actor ,eceptors /<G<,:s0. #remature fusion results in craniofacial anomalies.

--- Crouzan "yndrome# $utosomal dominant cranial synostosis, mutation in <G<,% gene, results in widespread premature s'ull and midface synostoses, and corresponding hypoplasias /eg. midface hypoplasia due to premature synostosis on bones in middle third of the face.0 --- $rigonocephaly# #remature fusion of metopic /interfrontal0 suture. @o abnormalities in facial sutures, =ust the one cranial suture. !ost common synostosis in france. ;. Describe the type of growth which occurs in synchondrosis =oints. $t what ages do the three synchondrosis ossify and stop growing8 - -hondrocranium H cranial base, =oints here are synchondroses /cartilagenous =oints found only between bones in the cranial base.0 @ot the same as epiphyseal growth plates in long bones /epiphyseal plates ma'e one bone grow longer, whereas synchondroses grow in two directions and basically push the two articulating bones apart.0 here are 4 of them. a/ S"heno eth!oidal5 ossifies at age ?, pushes maxilla downward and forward, responsible for growth of front of face. ,adiographs superimposed at sella-nasion line to observe facial growth pro=ections. b/ -nters"henoid5 ossifies at birth, has no effect on craniofacial growth c/ S"heno occi"ital5 ossifies during adolescence /1% yrs for girls, 1) yrs for boys.0 Displaces mandible. Downward forward growth displaces mandible into a -lass 4 position. Upward and bac'ward growth displaces mandible into a -lass % position. - @ote1 $ separate slide shows the ; growth sites in the cranial base as the foramen magnum, spheno-occipital synchondrosis, spheno-ethmoidal synchondrosis, fronto-ethmoidal suture, frontal bone/surface apposition0, and occipito-mastoid suture. he next slide specifies the spheno-occipital and occipito-mastoid sutures to be growth areas. ?. 5ow is the cephalic index in an individual patient measured8 - !easured by the s'ull widthIlength. 7idth of the s'ull is expressed as a percentage of the length. Dolichocephalics have smallest index, followed by mesocephalics, and finally brachycephalics have the largest index /their s'ulls are almost as wide as they are long.0 E. Describe growth abnormities that occur in cartilaginous tissue. - Dwarfism caused by abnormalities in 5uman Growth <actor ,eceptor 4 /5G<,40 gene. - $chondroplasia H most common form of dwarfism, autosomal dominant with 1**+ penetrance, manifests as generalized defect in endochondral growth /due to deficient fibroblast proliferation, get short limbs0 and deficient growth in chondrocranium /middle third of face is underdeveloped.0 --- !andibular growth is unaffectedLL he abnormal development of the chondrocranium causes the mandible to be in -lass 4 occlusion though.

Learning Objectives 2 1. 7hat are the relative proportions of midfacial structures at birth8 $t birth the midface is relatively wide due to the precocious development of the eyes. he growth of the midface primarily occurs in a downward and forward movement. %. 7hich midfacial bones develop from intramembranous bone formation and which develop from endochondral bone formation8 endochondral bone formation1 Long bones associated with !ovable joints5 <emur, ibia and #halanges Condyles of the !andible +asal se"tu! (ones of the cranial base5 9thmoidal bone. 3nferior concha. vomer (phenoid bone /much of it0. emporal bone /part of it0. &ccipital 2one /part of it0. 3mage of the chondrocranium

3ntramembranous bone formation1

!ost of !andible $ll bones of upper face !axilla palatine -alvarial bones 2one deposited by the periosteum #eriodontal !embrane -ranial (utures 4. Understand the contribution of different bones to the development of the maxilla, including which teeth form in the different areas of bone. his "uestion was not covered thoroughly at all in either the handout or the lecture slides. 3 will attempt to answer it the best 3 can given the information available. !axillary tuberosity1 his is the postierior portion of the maxilla and is the site of molar eruption. #remaxilla1 he derivation of the human maxilla form premaxilla and maxilla is indicated by the incisive fissure, visible in young s'ulls on the palate, extending from the incisive foramen to the alveolus of the canine. his indicates that the insicors all derive from the permaxilla. 21 6ow does growth of the anterior cranial base cartilage and nasal se"tu! contribute to growth of the !idface7 $nterior cranial base cartilage1 (pheno-ethmoidal synchondroses interstitial cartilage growth moves the maxilla forward. Growth until age ?. @asal septum cartilage1 !axilla moves downward and forward. Growth until age ?. 31 6ow do tensile or co!"ressive forces affect suture growth7 ensile forces1 cause bone apposition at the suture. -ompressive forces1 -ause bone absorption at the suture. ;. Fnow which boney surfaces of the midface are areas of bone apposition or bone resorption. 'a0illa5 8acial9 "alatine9 and nasal growth "atterns5 @ow note in more detail what 'ind of remodeling is occurring. he whole maxillary complex is being translated forward as the maxilla moves away from the cranium. $t the same time1 he floor of the nose is a resorptive area, he roof of the mouth is an appositional area, and this also moves the bone of that area down and forward. (o the pattern of apposition and resorption serves to augment the translation of the roof of the mouth. 2ut the contour of the anterior part of the alveolar process is a resorptive area, so here removal of bone from the surface tends to cancel some of the forward growth due to translation of the entire maxilla. ,emodeling of the palatal vault /which is also the floor of the nose0 moves it in the same direction as it is being translatedG bone is removed from the floor of the nose and added to the roof of the mouth. &n the anterior surface, however, bone is removed, partially canceling the forward translation. $s the vault moves downward, the same process of bone remodeling also widens it.

$nterior facial periosteal surface1 resorption $nterior facial endosteal surface1 apposition -audial palatine bone /roof of the mouth01 apposition (uperior palatine bone /floor of the nasal cavity01 resorption 'a0illary tuberosity and $ey ridge growth "atterns5 !axillary tuberosity posterior periosteal surface1 apposition

<ig. 4-11)-$rea $ is moving in three directions by bone deposition on the external surface1 it lengthens posteriorly by deposition on the posterior-facing maxillary tuberosityG it grows laterally by deposits on the buccal surface /this widens the posterior part of the arch0G and it grows downward by deposition of bone along the alveolar ridges and also on the lateral side. #eriosteal surface of the Fey ridge of the maxilla1 resorptive $ ma=or change in surface contour occurs along the vertical crest =ust below the malar protuberance /small arrow in fig. 4-11;0. his cress is the M'ey ridge.N $ reversal occurs here. $nterior to it most of the external surface of the maxillary arch is resorptive. his is because that part of the bony arch in area b is concave, and labial /outside0 surface faces upward, rather than downward. his is in contrast to area a, which grows downward by periosteal disposition.

Orbial floor of the !a0illa5 he periosteal surface is depository in character, and the opposite endosteal surface overlaying the maxillary sinus is resorptive. he lateral growth of the floor in each orbit moves them away from each other, thereby increasing the breadth of the nasal cavity.

:ygo!atic "rocess and the !alar area5 he forward facing anterior side of the zygomatic process forms part of the chee' bone. he periosteal surface on this anterior facing part is resorptive while its contra lateral endosteal surface is depository. he bac'ward facing posterior side is depository and the opposite endosteal surface of its cortex is resorptive. his produces a posterior growth movement of this laterally pro=ecting zygomatic process.

he posterior side of the malar protuberance is depository while the anterior surface is resorptive. his posterior enlargement maintains the relationship with posterior growing maxillary arch. he patterns of zygomatic and malar growth maintain the chee'bone in proportionate relationships to the face, =aws, and masticatory musculature.

?. 7hat movements in midfacial bones help produce crowding or impaction of maxillary canines8 he lecture slides only give a brief explanation1 - here is a mean transverse rotation of the two maxillary bones during growth. his results in the shortening of the dental arch in the midsagittal plane. E. Understand the general concepts presented in the research information that finds associations between muscle size and craniofacial development. he lecture sides are incredibly vague on this topic and the handout is completely mute. 2ased on the slides, 3 con=ecture that the evolutionary loss of large muscles of mastication allowed the homo species to develop a larger cranium. hus the larger the muscles the smaller the craniofacial development. &#9@ 23 9H 79$F

Learning Objectives 3 1. Understand general aspects of the human genome, including definitions of the gene, D@$, transcription and translation, chromosomes and genetic variation. 5uman genome1
-3 billion base pairs -23,000 genes -23 chromosomes (with 2 copies of each per cell) -1 human cell has 2 meters of DNA -50 is repetiti!e DNA ("un#$) -%nl& 30 of the genome co'es for genes -%nl& 1(5 co'es for proteins -)his is because 1 gene can co'e for 100*s of proteins +ene, --)he functional unit of here'it&. -/an inclu'e promoters, enhancers, introns, an' e0ons DNA, -Nucleoti'e 1 sugar 2 phosphate 2 base )ranscription, -DNA is rea' b& 3NA pol&merase to ma#e a complementar& stran' -)he )*s in DNA are replace' with 4*s in 3NA 3NA splicing, -5N)3%N6 (not e0ons) are remo!e' -3esult is a functional m3NA )ranslation, -m3NA is turne' into proteins /hromosomes, -7oose DNA is wrappe' aroun' histones to ma#e nucleosome units -7i#e bea's on a string -Nucleosomes con'ense to form a fiber -)he fiber ben's bac# an' forth on itself to form loops -)he loops con'ense an' form the chromosome

+enetic !ariation between in'i!i'uals, -/an be cause' b& se!eral things, -6wapping out a single base pair (6N8 1 single nucleoti'e pol&morphism) -6mall insertions or 'eletions of DNA -3earrangement of DNA se9uences -5nsertions or 'eletions of entire genes

-:0tra copies of genes (cop& number !ariation) 2( 4n'erstan' the 'ifferences between autosomal 'ominant an' autosomal recessi!e men'elian inheritance patterns( ;e able to estimate the number of normal, carrier, an' affecte' people in ne0t generation for inheritance of a men'elian trait( -Autosomal 'ominant (not carrie' on the < or = chromosomes), -5f the trait is 'ominant an' inherite' from a parent, it will be seen in the offspring e!en if the recessi!e cop& is inherite' too --3uns in the famil&. -Affecte' parent has 50 chance of ha!ing an affecte' chil' -Autosomal recessi!e ->i' must get recessi!e copies from both parents to manifest -2 carrier parents ha!e a 25 chance of ha!ing an affecte' chil' -Normal siblings have a 67% chance of being a carrier -?e sai' this might be a test 9uestion -3easoning is, -2 carrier parents ha!e @ chil'ren -1 chil' is AA, 2 chil'ren are Aa, an' 1 chil' is aa (affecte') -3 normal #i's but 2 are carriers -2A3 1 BC 3( 4n'erstan' the genetic terms penetrance an' e0pressi!it&( -8enetrance -5f the gene is present, will it be seen$ -5f it*s 'ominant with D5 penetrance, &ou*ll see the trait in D5 -A 'isor'er can be both rare an' highl& penetrant -:0pressi!it& -?ow is the gene e0presse'$ ->in' of li#e if there*s a gene to ma#e people turn blue -:0pressi!it& is the sha'e of blue that is seen

of people

@( 4n'erstan' how traits for cleft lip an' palate are inherite', inclu'ing 'ifferences in the empiric recurrence ris#s to relati!es( -!an 'er Eou'e 6&n'rome (FDE6) -/auses cleft lip an'Aor palate -)his is an e0ample of !ariable e0pressi!it& -Autosomal 'ominant with high penetrance -/ause' b& a mutation in 53GB gene -A single nucleoti'e pol&morphism in this gene triples the ris# -Host cleft lipApalate problems ha!e non-men'elian inheritance -non-s&n'romic. -/omple0 inheritanceI -As &ou go through a pe'igree, &ouJll either see /7A8 or /8 but &ou wonJt see them mi0e' up through the famil& -/8 is less common than /7A8 -Gor bilateral /7A8, males are affecte' more fre9uentl& than females -3ecurrence ris# for relati!es -3is# goes up for future #i's if more members in the famil& are affecte' -5ncrease' ris# for others if the first person (-proban'.) affecte' is se!erel& ill -3is# 'rops as the proban' becomes more 'istant in the pe'igree -Gor actual ris# percentages for /7A8, see sli'e K@2 on lecture 5 -%ther ris# factors -H6<1 gene mutations -Gibroblast growth factors (G+G) gene mutations

-Haternal cigarette smo#ing -53GB mutation is the most important factor 5( 4n'erstan' the 'ifferences in inheritance patterns between monoL&gotic an' 'iL&gotic twins for men'elian 'iseases an' comple0 trait 'iseases( -/oncor'ance -)he presence of a trait in both twins -)raits can either be influence' b& genes or the en!ironment -5f there is a higher concor'ance in HM twins than in DM twins, &ou can assume the cause is probabl& genetic -HonoL&gotic (HM) twins -5'entical twins -6hare 100 of the same genes (100 concor'ance) -DiL&gotic (DM) twins -Graternal twins -6hare 50 of same genes -50 concor'ance if trait is autosomal 'ominant -25 concor'ance if autosomal recessi!e B( 4n'erstan' the properties of the multifactoral threshol' mo'el of inheritance for cleft lip an' palate as a comple0 unit( -+oo' for un'erstan'ing quantitative inheritance -i(e(, height, bloo' pressure, 5N -/an help to e0plain cleft lipApalate inheritance -An e0ample of a -'iscontinuous trait. -Hultifactorial )hreshol' mo'el implies that things a'' up until a threshol' is reache' an' then &ou ha!e the 'isor'er (or cleft lipApalate) -)his can account for genetic an' en!ironmental !ariables -)he ris# for cleft lip ma& be below threshol' but if the mother smo#es 'uring pregnanc&, the threshol' is crosse' an' the bab& will ha!e the 'eformit&

- here is some variability but for the most part, you either have it or you don:t Lecture 4 and P(L 11 ;nderstand the basic !echanis!s involved in !olecular biology including re"lication9 transcri"tion9 and translation a. ,eplication ma'ing new copies b. transcription D@$ ,@$ c. ranslation ,@$ protein %. ;nderstand the different for!s of genetic variation a. (ingle nucleotide polymorphisms /(@#0 base pair substitution on a chromosome b. small insertions or deletions of D@$ few base pairs c. D@$ se"uence rearrangements d. Gene insertion or deletion few base pairs e. -opy number variations f. chromosomal mutations JJmutations cause a clinical problem, variants do notJJ ,1 <now the inheritance "atterns for 'endelian traits

a. $utosomal dominant affected parent has )*+ chance of having affected child i. one affected allele results in clinical phenotype b. autosomal recessive % carrier parents have a %)+ chance of having affected child i. normal sibs have %I4 chance of being a carrier ii. two affected alleles result in clinical phenotype 21 ;nderstand twin outco!e studies and how genes = environ!ent interact to "roduce variability in craniofacial "henoty"es a. !onozygotic twins i. 3dentical ii. zygote splits iii. share 1**+ of genes iv. differences due &@DO to environment v. 1**+ concordance in mendelian diseases vi. complex disease less than 1**+ concordance due to environment b. Dizygotic twins i. fraternal ii. % sperm fertilize % eggs iii. share )*+ genes /li'e sibs0 iv. differences due to genes $@D environment v. )*+ concordance in mendelian diseases a. concordance occurance of trait in both twins b. discordance occurance of trait in one twin c. !P Q DP concordance genes 31 (e able to define the genetic ter!s >"enetrance? and >e0"ressivity? a. penetrance inherit allele disease phenotype b. expressivity great variability in what phenotype loo's li'e 41 @hat are the recurrent ris$s for cleft li" = "alate and cleft "alate for both syndro!ic and non syndro!ic for!s 8888 A1 @hat dental ano!alies are associated with facial clefting a. enamel hypoplasia due to surgical treatment of the cleft. (een in upper incisor of both dentitions b. hypodontia highest incidence in syndromic clefting c. delayed erutption of permanent dentition d. smaller size of permanent teeth B1 6ow are facial clefts classified and when do they develo" a. unilateral vs bilateral b. complete vs incomplete c. syndromic vs nonsyndromic i. cleft lip )thA;th wee' the frontonasal and maxillary process fuse to form the upper lip. <ailure of fusion results in a cleft lip ii. cleft palate 1%th wee'

a. Dateral palatine processes form and tongue distends as mandible forms lac' of this causes a problem