THE GROWTH OF THE CRANIO-FACIAL SKELETON *

B y JAMES H. SCOTT

Anatomy Department, Queen's University, Belfast.

Introduction
G R O W T t t of the facial ,skeleton cannot usefully be studied in
isolation from the growth of the skull as a whole, therefore, in
this paper various aspects of both cranial and facial growth
will be discussed with the main emphasis, however, on the latter.
The chief methods used in the study of skull growth can be classified
as follows :
(1) Measurement. This gives information on the increase in size of
the whole skull and of individual bones. Certain standard measure-
ments have been used in anVhropology for a considerable time and more
recently m a n y more measurements have been introduced with the use
~f x-ray studies in cephalometrics (Krogman and Sassouni, 1957).
This latter means of study has also made possible the use of serial
measurements in the same individual at chosen intervals of time f r o m
birth onwards (Broadbent, 1931; Brodie, 1941, 1953).
(2) The use of dyes such as madder and alizarin (Brash, 1934;
Moore, 1949; Craven, 1956). This method was introduced in the 18th
(,entury by Duhamel and J o h n Hunter. It has the advantage of giving
information on the actual sites of bone growth, but must be used with
care as new bone is ]aid down in the internal reconstruction of bones
as well as at the regions where the addition o,f new bone to the surface
of (~ld bone is taking t~la'ce.
(3) Radioactive isotopes. Injections of radioactive substances such
as calcium or phosphorus render the bones formed after injection radio-
active. These radioactive regions can produce contact prints on photo-
graphic film (autoradiography) after the bones or suitable sections are
ground down to the necessary thickness (Dixon, 1961).
(4) Recently BjSrk (1955) has used metallic implants in the s t u d y
of facial growth b~ man. Providing t'he implants are not dis,placed,
this is probably the most accurate method of determining both the
amount of growth and the rate of growth in various parts of the skull.
Growth of a complex organ such as the skull cannot be understood
without a sound knowledge of its development and of the differential
growth of organs and tissues such as the brain, eyeballs, tongue, car-
tilage and muscle, which influence different parts of the skull in various
proportions at different periods o~ development. As well as the s t u d y
of individual bones, it is necessary to have some knowledge of the sites
of growth and the rates of gr(~wth which occur in different parts of the
skull at different times. The pioneer work in this anMytical approach
is thut of Keith and Campion (1921) and Brash (1924), which has been
~,xtended by Moss et al. (1956, 1960), Meredith (1954, 1959, 1960) and
others.
*This p a p e r is a s u m m a r y of w o r k carried o u t b e t w e e n 1953 a n d 1961 on t h e g r o w t h
o f t h e Cr&nio-facial Skeleton. I t follows c o n t r i b u t i o n s p u b l i s h e d in the Proceedings o f
t h e R o y a l Society of Medicine in 1954 a n d 1958.
276
 THE GROWTH OF THE CRANIO-FACIAL SKELETON 277

In this paper it is proposed to give a correlated account of skull

growth, with special reference to growth of the face, based on some
recent investigations.

The Chondrocranium and Skull Form

Before the appearance of ossification centres for the bony elements,
which begin to appear during the 7th week of foetal life, the cranio-
facial skeleton is laid down in cartilage. The chief elements of the
ehondrocranium are :
(:l) The mid'line cranial base extending fr(~m the foramen magnum
to the foramen caecu~n. In this mass of cartilage there develops at a
later date the basioccipital and exoccipita] regions of the occipital bone;
the body and lesser wings and the roots of the greater wings of the
sphenoid bone; and the perpendicular plate (mesethmoid) of the ethmoid
bone.
(2) The bilateral auditory capsules which later ossify around the
inner ear mechanism to form the petrous part of the temporal bones.
(3) The nasal capsule. This is closely related to the front (prepitui-
tary) part of the midline cranial base. It consists of the midline septal
cartilage where the perpendicular plate of the ethmoid (mesethmoid)
develops after birth, and two lateral parts in which the facial part of
the ethmoid and the inferior turbinate commence to ossify in the side
wall of each nasal cavity during foetal life.
(4) Meckel's cartilage. This is the cartilaginous skeleton of the
first pharyngeal (mandibular) arch and exten,ds from the middle ear
region to the chin.
When the bony e]elnents of the craniofacia] skeleton commence to
develop they can be divided into three groups according to their
relationship to the ehondrocranium :
(1) Bones developing within the chondroeranial cartilage (car-
tilaginous bones). These include
(a) The exoccipital and basioccipital parts of the occipital bone;
the body, lesser wings and a small part of the greater wings o3
the sphenoid bone; the crista ga]li and perpendicular plate of
the ethmoid (mesethmoid); the petrous portion and the styloid
process o~ the temporal bone.
(b) The facial cthmoid; the inferior turbinate and part of the
mandible.
(2) Bones developing in fibrous condensations closely related to the
chondrocranial skeleton. These i~clude : the maxillary, palatine, lacrimal,
nasal and zygomatic bones; the v(~mer, the greater part of the mandible,
and the tympanic plate of the temporal.
(3) Bones developing independently of the chondrocranium (mem-
brane bones). These include : the frontal, parietal, squamosal temporal
and squamosal occipital bones, most of the greater wings of the sphenoid.
All these membrane bones help to make up the cranial vault and are
closely related to the growing brain.
The cranial base consists chiefly of cartilage-replacing bones; the
cranial vault consists of membrane bones, and the facial skeleton of
cartilage-replacing bones or of bones developing in close relationship
278 IRISH JOURNAL OF :MEDICAL SCIENCE

to the chondrocranium. It will be understood, therefore, how the form

of the face is largely determined, in the first place, by its cartilaginous
skeleton around which, and in which, the facial bones develop.

Methods of Bone Growth

There are three methods of bone growth in the skull.
1. Bone growth by the conversion of cartilage into bone. Ossifica-
tion eentres appear within the chondrocranial cartilage and grow by
replacement of cartilage as in a typical long bone. Between individual
bony centres there are areas of growing cartilage which form syn-
chondroses. These are similar in structure and function to the
epiphyseal plates of long bones and are important sites of craniofacial
growth. They differ from the epiphyseal plates of limb bones in that
growth occurs on both sides, that is, they are functionally double-
action epiphyseal plates. The most important are :
(a) The spheno-oecipital synchondrosis in the midline cranial base
between the occipital and sphenoid bones. It persists to 15-18
years of age.
(b) The sphenoidM synchondrosis in the midline cranial base
~between the anterior and posterior parts of the body of the
sphenoid (,pres~henoid and post-sphenoid elements). In man
it closes just before birth but in most other animals, including
monkeys, it persists until the beginning of adult life. In the
anthropoid apes it probably closes at or about the time of
birth.
(c) The bilateral synchondrosis between the body and great wing
of the sphenoid (between the membranous and cartilaginous
elements). This also closes in man at about the time of birth.
(Scott, 1958 a.)
In the mandible there are two regions where growing cartilage is
converted into bone: at the condyles, and at the midline symphysis.
The former is an important growth centre until the beginning
of adult life; the latter until the first year after birth. These
mandibular cartilages are not, however, part of the primordial
chondrocranium but are " secondary " cartilages developing later and
independently of the chondrocranium (Charles, 1925; Symons, 1951).
2. Growth by surface deposition. In this method of growth new
bone is laid down beneath a surface periosteum and quite independently
of cartilage formation. It is the method whereby long bones increase
in girth. All the skull bones depend on this method for part of their
growt.h even though they may commence to grc~w in cartilage. Surface
deposition becomes of greater significance during the later periods of
skull growth. It is often associated with surface resorption which is
responsible for the growth of cavities, such as the nasal cavity and
sinuses, the cranial cavity and the medullary cavities of individual
bones; and the balance between bone deposition and resorption is an
important factor in changing the form of individual bony elements of
the skull.
3. Suture growth. This is essentially the same as surface deposi-
tion, taking place at the edges of adjacent bones bounding a suture. At
 TIlE GROWTH OF THE CRANIO-FACIAh SKELETON ~79

a growing suture there are five layers of tissue (Pritchard et al., 1956).
These are the cellular osteogenetic layer of the periosteum associated
with each of the bones bounding the suture; a fibrous layer of the
periosteum associated with each bony unit and bounding the cellular
osteogenetic layer; and an intermediate layer between the adjacent
fibrous layer containing connecting fibres arrd blood vessels. At e~ch
suture there are two growth centres, one for eaeh bony unit, and these
are independent of one another in their growth. That is, at a suture
one bone may grow faster than the other.
There are two views regarding the mechanism responsible for the
separation of the bones bounding a suture. Ac'cording to the classical
view (Weinmann and Sicher, 1955) the proliferation of the soft tissues
in the suture separates the bones bounding it. According to the other
view (Scott, 1953, 1954), separation o~f the bones at sutures is pro-
duced by the growth of an organ such as the brain or eyeball or by
the growth of cartilage either at a synchondrosis between two bony
elements or in close relationship to the suture. According to this view
the bones grow into the space produced by separating mechanisms
which may be situated some distance from the actual sutures. If
growth within the .sutures was responsi,ble for their separation it is
difficult to understand the failure of the vault of the skull to grow in
microcephaly.
,~'uture Systems
There are a great number of sutures in the skull but they all fall into
one of the following groups or suture systems :
(1) The circum,maxillary suture system separating the maxilla from
the adjacent facial bones; ~he nasal, lacrimal, facial ethmoid, palatine,
zygomatic and vomer.
(2) The craniofaeial suture system separating the maxillary (at
fronto-maxillary suture), nasal, lacrimal, facial ethmoid, palatine, vomer
and zygomatic bones from the bones of the anterior cranial segment;
the frontal, mesethmoid and s.phenoi~d.
Growth at these two suture systems allows the upper facial skeleton
to bc thrust downwards and forwards. The separating mechanism is
the cartilage of the nasal capsule during foetal life, and the cartilage
of the nasal septum after birth.
(3) The coronal suture system. This separates the anterior cranial
segment (frontal, mesethmoid and sphenoid) from the mid,dle cranial
segment (~tem.poral and parietal). Art pterion the main limb runs behind
the sphenoid but there is also an anterior limb running in front of the
sphenoid separating it from the frontal and mesethmoid bones. This
limb of tile coronal suture is closely related to the circummax~llary and
craniofacial suture systems in the pterygo-palatine fossa.
(4) The lambdoidal suture system separates the middle cranial seg-
ment (temporal and parietal) from the occipital bone.
Both the coronal suture system (posterior limb) and the lambdoidal
suture system reach the midline cranial base in close relationship to the
spheno-oecipital synchondrosis and the growth of this cartilage, as well
as ~hat of the brain, is resp~onsible for the separation of the bones bound-
lag these sutures.
280 IRISH JOURNAL OF MEDICAL SCIENCE

(5) The sagittal suture systen~. At birth this suture system is com-
plete, separating ~he skull into left and right halves. As seen from
the front the sutures making up this system are the interparietal, inter-
frontal (metopic), internasal, intermaxillary and the mandibular sym-
physis. I t also includes the mid-palatal suture. At the base o£ the
skull it runs on each side of the midline cranial base to foramen
magnum. At the back of the skull it divides to pass on either side of
the midline occipital bone. Growth at this suture system regulates
growth of the skull in width; the separating mechanisms are the grow-
ing brain, the cartilages at ,the roots of the great wings of the sphenoid
and the cartilage uniting the lateral and septal walls of the nasal cwp-
sule beneath the frontal and nasal bones.

Pe,riods of ~¢kull Growth

1. From foetal life to about the 3rd year after birth.
This is the period in which the growth at the various suture systems
is most active. The growing brain, the growing eyeballs, the growing
tongue and the cartilage of ~the skull base and nasal capsule are separa-
ting the cranial and facial bones which maintain contact with one
another only by active g r o ~ h at the sutures. In some regions, as at
the fontanelles of t'he cranial vault, the process of separation is so
rapid that the growing bones are unable to keep contact with one
another.
During this period, however, the union between certain bony elements
stabilises the growing sku~ll and limits the amount of growth at the
various suture systems.
(a) Just before birth in man the two parts of th,~ sphenoid body
unite. This probably limits the process of flexure in the
midline cranial base which takes place during foetal life
(Scott, 1958 b). Between the 10th and 40th week of foetal
life (birth) the cranial base angle increases from about 130 °
to 150 ° (Ford, 1956). This helps to carry the face forwards
relatiw~ to the cranium. In animals in whic~h this synchon-
drosis persists, as well as allowing of further opening out of
the cranial base angle, it probably plays a more direct role
in facial growth as it lies in the sam~, ~orona] plane as the
pterygo-palatine (retromaxillary) sutures and would produce
a separation of the bones permitting the maxilla to grow
backwards for as long as the synchondrosis was an active
growth centre.
(b) Shortly after birth (in the first year) the two halves of the
mandible unite, and the greater wings of the sphenoid ~oin the
body of the sphenoid so that the sphenoid becomes a single
bone reaching from one temporal fossa to the other. The
frontal bones in the great majority of skulls also commence to
unite. In a small percentage of skulls, however, the metopie
suture persists into adult life. These changes probably reduce
the growth potentiality of the sagittal suture system. By the
end of the first year, the interparietal, internasal, and
intermaxillary sutures are the chief parts of the system which
 TIlE GROWTH OF THE CRANIO-FACIAL SKELETON 2~1

remain, and after this time it is probable that growth at these

isolated sutures is greatly reduced as the width between the
orbital cavities across the bridge of the nose is early stabilised.
There is now established a fronto-sphenoidal bony ring forming
a rigid supporting framework for the facial skeleton (Scott,
1958a) which projects downwards and forwards from this
cranial basis.
(c) Between the 1st and 3rd years the mesethmoid (cranial) part
of the ethmoid unites with the facial ethmoid on either side as
a result of ossification of the cribriform plate. This results in
the ethmoid becoming continuous between one orbital cavity
and the other and stabilises the upper part of the nasal cavity,
limiting the amount of growVh in the craniofaeial suture system.
By the third year the only suture systems which are still complete are
the lambdoidal, the coronal and the circummaxillary.
2. From about the 3rd year to about the 10th year.
During this intermediate period growth continues in certain isolated
sutures but surface deposition comes to play a greater part in cranio-
facial development. There is still probably some growth of the cartilage
of the nasal septum thrusting the maxilla downwards and forwards
alto,wing of growth at the sutures between the maxilla and adjacent
facial bones. The distance from pituitary, fossa to the spheno-
ethmoidal suture reaches adult dimensions (Brodie, 1941), as does the
distance between the pituitary fossa and the foramen caecum (Ford,
1958). This indicates cessation of growth at the anterior (presphenoid)
limb of the coronal suture system. Growth is still active at the spheno-
occipital synchondrosis and in the cartilage of the mandibular condyles.
Growth is also active in the alveolar processes in preparation for the
eruption of the permanent dentition and this growth is the result of
surface deposition of new bone beneath the mucoperiosteum of the gums
and is responsible for the three-dimensional growth of upper and lower
alveolar processes which includes the process of " mesial migration " of
the dentition. Apart from the cartilaginous growth centre in the
condyles, growth of the mandible is entirely by surface deposition
especially in the alveolar region and at the posterior border of the
ramus. Growth of the cranial vault is partly the result of suture
growth especially at the coronal and lambdoidal suture systems and
partly by surface deposition and resorption. The latter process is of
special importance in adjusting the frontal, parietal and occipital
concavities to the expanding brain, a process involving changes in the
form of these bones which could not be carried out by suture growth
alone.
3. The third and final period of growth is from about the 10th year
to adult life.
By the 10th year the following parts of the skull have reached, or
almost reached, adult dimensions :
(a) the size of the cranial and orbital cavities;
(b) the distance from pituitary fossa to foramen caecum (de Coster,
1951; Scott, 1954; Ford, 1958);
282 IRI,q.rl JOURNAl, OF MEDICAL S(HENf,~N

(c) the distance between the inner margins of the orbital cavity
(the width of the upper part of the nasal cavity);
(d) the petrous region of the temporal bones.
At about this time the cartilage of the nasal septum ceases to grow,
or if it does continue to grow it no longer has the ability to separate
the facial bones at the suture systems because of the stabilisation of the
sutures by dense connective tissue fibres binding the bones together in
order to withstand the increasing forces of mastication as the permanent
dentition replaces the deciduous dentition. If the septal cartilage con-
tinues to grow beyond this period it tends to buckle up, producing a
deviation of the septum to one or other side. ~epta] deviation may,
however, commence as early as foetal life.
During this period the spheno-oceipita] synchondrosis and the
¢.ondylar cartilages of the mandible are still active, but apart from
these cartilaginous growth centres, growth is by surface deposition
and resorption. This is especially marked in the alveolar processes,
around the orbital margins, at muscular processes such as the zygomatic
arches, pterygoid plates, mandibular angle and coronoid processes and
in the skull vault. Even though brain growth is almost complete there
is still some growth at the coronal and lambdoidal suture systems where
the bones of the cranial segments are still being separated by growth at
the spheno-occipital synehondrosis. This permits of surface deposition
on the inner surface as well as the outer surface of the bones of the skull
vault. The diploic tissue develops between the thickening inner and
outer cortical layers, and the frontal sinus invades the base of the
frontal bone.
Surface deposition also plays an important part in the growth of the
articular (glenoid) fossa, extending it outwards and forwards (articular
eminence) and of the external auditory canal (Scott, 1955), while
growth of condylar cartilages tends to become limited to a thin strip of
its upper and anterior surfaces.
The thesis propounded here and in other papers (Scott, 1948, 1954)
differs from the ordinary teaching chiefly in regard to growth of the
maxilla. According to the classical theory put forward by John Hunter,
and more recently by Keith and Campion (1921), Brodie (1942),
Weinmann and Sicher (1955) among others, space is provided for the
,lpper permanent molars entirely by growth at the back of the maxilla
as a result of continuing growth at the eircummaxillary suture system
associated with a forward and downward displacement of the maxillary
bones. The key to the problem depends on whether the teeth migrate
through the jaws. Hunter and many workers following him postulated
that the first permanent molars did not move in the jaws once they had
erupted. Brash (1926) in pigs, Baume (1953) in macaca rhesus monkeys,
Krogman (1931) in anthropoi.d apes and Friel (1945) in man, have
either state, or provided evidence, that the whole dentition migrates
through the jaw bones. More recently studies involving the use of
metallic implants have shown the actual amount of migration occurring
]n the lower jaw of monkeys (Latham and Scott, 1960). I f the teeth
migrate forwards or forwards and outwards, space must be provided
for them by surface deposition at the front and sides of the alveolar
 THE GROWTH OF THE CRANIO-FACIA[, SKELETON 2~.~

processes. Evidence for this can be readily seen in comparing the skulls
of young and adult anthropoid apes which show a great development of
alveolar prognathism between birth and adult life. F o r w a r d migration
of the teeth will provide space at the back of the dentition for the
erupting permanent molars without any necessity for excessive growth
,Lt the retro-maxillary sutures or resorption at the anterior border of th, ~
mandibular ramus. Resorption at the front of the ramus, however, is
probably present to some extent in relation to the backward migration
of the temporal muscle attachment in order to maintain the vertical
direction of the anterior fibres as the mandible is thrust downwards and
forwards. It is not necessary to remove bone here to make room for the
teeth, as in many jaws, especially in those with a wide ramus; the third
molar is entirely or in p a r t situated on the inner side of the ramus. It
is sometimes stated that growth of the maxillary tuberosity (upper
alveolar bulb) " thrusts the maxilla forwards " from the pterygoid
plates. The alveolar bulb, however, does not come into contact with any
other bone but is free to grow backwards on the outer side of the pala-
tine and lateral pterygoid plate (Diamond, 1946). This is especially
well illustrated in the skull of the pig.

The Growth of Different Craniofacial Regions

1. The midline cranial base can be divided into three segments from
behind forwards (Scott, 1958b).
(a) F r o m anterior edge of foramen magnum to pituitary fossa
(posterior segment).
In man growth of this region depends ahnost entirely on the
spheno-occipital synchondrosis as the foramen magnum
remains constant in position at the base of the skull and does
not, as in the anthropoid apes, migrate backwards. The
posterior segment of the cranial base grows at a fairly steady
rate until adult life is reached.
(b) F r o m the pituitary fossa to the foramen caecum.
Growth in this middle segment of the cranial base takes
place at the spheno-ethmoidal and fronto-ethmoidal sutures
which are related to the fronto-sphenoidal sutures in the
anterior cranial fossa and to the retro-maxillary sutures in the
pterygo-palatine fossa.
This segment reaches adult dimension.~ during the first
decade.
(c) F r o m foramen caecum to nasion (meeting point of the nasal
and frontal bones in the sagittal plane).
This anterior segment of the cranial base grows by surface
deposition and continues to grow until adult life.
2. The cranial vault. This region is associated with growth of the
brain but depends in p a r t on the growth of the cranial base. Most
of its growth is complete by the end of the first decade, but a limited
amount of growth continues probably until adult life.
3. The orbital cavities. These in'crease in capacity until about the
end of the first d ~ a d e by which time they have almost reached .adu~lt
284 IRISH JOURNAL OF :MEDICAL SCIENCE

dimensions. After this time there may be some surface deposition

around the rim in relation to a thickening of the fseia] buttress system.
This process is very marked in t~he anthropoid apes (Schultz, 1940).
The horizontal limbs of both the circum-maxillary and craniofacia]
~uture systems are found in the orbital cavities on both the medial
and lateral waiIs and growth of the eyeball possibly plays a ,part in
separating the bones at these sutures although the most important
factor in this process is probably the cartilage of the nasal septum.
4. The nasal cavities. Up until about the 3rd year, and to a lesser
degree to about the 10th year, the height of the nasal cavities is deter-
mined mainly by the growth of the scptal cartilage thrusting the
maxillary and palatine bones downward and forward. After about the
10th year the upper intraorbital part of the nasal cavity (above the
level of the F r a n k f o r t plane), shows very little f u r t h e r growth. The
lower p a r t of the cavity, however, continues to increase in height by a
descent of the hard palate as a result of bone deposition on the oral
surface and bone resorption on the nasal surface. This process pro-
duces a considerable increase in the height of the inferior meatus
which is the main airway through the nasal cavity to the nasopharynx.
Growth in width of the upper part of the nasal cavity is almost com-
plete by the 3rd year with the ossification of the cribriform plate of
the ethmoid. A f t e r this time the ethmoid thickens by surface deposi-
tion on the orbital surface associated with the development of the
ethmoidal air sinuses.
5. The alveolo-palatal region. This is the part of the facial skeleton
bounding the oral cavity. During foetal life the rapidly growing
tongue separates the mandible from the upper jaw and keeps the gum
pads apart. At about the time of birth the growth of alveolar bone
has increased sufficiently to contain the tongue within the oral cavity
proper. From this time until adult life growth of the cartilage of the
mandibular condyles separates the mandible from the upper facial
skeleton and vertical growth of the alveolar bone is necessary to main-
tain the teeth in normal occlusion. Failure of alveolar bone growth is
responsible for many forms of open and ~closed bite, and for certain
types of Class I I malocclusion. Bilateral failure of condylar cartilage
growth results ~n a retracted, underdeveloped mandible, while excessive
growth of the cartilage will produce a Class I I I relationship. The
basic form ef the dental arches is probably deternfined early in foetal
life by the form of the nasal capsule, Meckel's cartilage and the dental
lamina (Scott, 1957), but the final size of the arches will depend on
functional as well as on genetic factors. It is uncertain to what extent
arch form and size depend on the balance of pressures exerted by the
muscles of the tongue, lips and cheeks although habits such as tongue-
thrusting undoubtedly produce malocclusion of the teeth.
{i. The facial buttress system. This is superimposed upon the other
parts of the facial skeleton (Weinmann and Sicher, 1955), and depends
for its develepment on the functional activity of the mastieatory
apparatus. It has been analysed by Tappen (1953) using the split-line
technique. The areas of the facial skeleton concerned become more
robust by surface deposition of bone and strengthened by an increase
 THE GROWTH OF THE (JRANIO-FAC[AL SKELETON 2~5

in the density of the cancellous bony tissue. It undergoes its period of

most active development d u r i n g and ~fter p u b e r t y with the completion
of the dentition and the full development of the muscles of mastication.
In anthropoid apes the facial buttress system is especially well developed,
more especially in male animals and is associated with the develop-
ment of sagittal and nucha] crests in the cranial region of the skull.
i n these animals the skull is f u r t h e r consolidated by the fusion ()f many
of the eraniofaciaI sutures.

Summary
A knowledge of eranio~acial growth is o~ vital importance in ortho-
dontics, in m a n y branches o~ ore-facial surgery and in anthropology.
I t has been the purpose of this papcr to give a general outline of the
process without excessive attention to details. There is still need for
f u r t h e r research and there is still too much speculation in regard to
m a n y of the statements made in this paper. It is hoped that others
will be encouraged to continue with this work and correct what needs
correcting and substantiate what is true.

R e f e r e n f~e,b'.
B a u m e , L. J. (1953). The t o p o g e n e s i s of the m a n d i b u l a r p e r m a n e n t molars. Oral Surg.
6 ; 850.
Bj6rk, A. (1955). Facial g r o w t h in m a n s t u d i e d w i t h the aid of metallic i m p l a n t s . Acta
odont. Scand., 13 : 9.
Brash, J . C. (1924). " The G r o w t h of the J a w s • o r m a l a n d A b n o r m a l in H e e l t h a n d
Disease ". D e n t a l B o a r d of the U n i t e d K i n g d o m .
-- (1926). The g r o w t h of alveolar b o n e a n d its r e l a t i o n to m o v e m e n t s of the teeth.
Trans. Brit. Soc. Study Orthodont. for 1926. p. 43.
- - - - (1934). Some p r o b l e m s in the g r o w t h a n d d e v e l o p m e n t a l m e c h a n i s m s of bone.
Edinburgh Med. J. 41 : 305.
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BOOKS RECEIVED
BROWNE a n d WILLIAM. Recent Advances in Obstetrics and Gynaeeology. 10th Ed.
:DENN~-BRow~. The Basal Ganglia and their relation to Disorders of Movement.
GRETCHE~ L. HUMASON. A n i m a l Tissue Techniques.
BRODAL, POMPEIANO a n d WALBORG. The Vestibular Nuclei and their Connections,
KENNET~r MACLEAN. Medical Treatment.
1%evised b y SIR :DAVID HENDERSON a n d I v o R BATCHELOR. Textbook of Psychiatry.
9th Ed.
CLIFFORD F. STOREY. Acquired Surgical Lesions of the Esophagus.
GEORGE TIEVST~'. Iodizing Radiation.
L. POLLER. Theory and Practice of Anticoagulant Treatment.
WALTER ADDISON JAYNE, The Healing Gods of Ancient Civilizations.
:D~CAN E. REID. A Textbook of Obstetrics.
JoHN M. LOR~. A n Atlas of Head and Neck Surgery.
BRECHNER. WALTER a n d DILLON. Practical Electroencephalography for the Anae~thesi-
ologist.
BENJAMIN B. WELLS. Clinical Pathology. 3rd Ed.
C. LEE BUXTON. A Study of Psychophysical Methock~ for Relief of Childbirth Pai~.