GROWTH OF CRANIAL BASE

PRESENTED BY : DR. ARVIND JUNEJA

MDS 1ST YEAR
DEPARTMENT OF ORTHODONTICS AND
DENTOFACIAL ORTHOPAEDICS
BHOJIA DENTAL COLLEGE AND HOSPITAL
BADDI
 CONTENTS
• Introduction
• Functions of cranial base
• Anterior, middle and posterior cranial fossae
• Individual bones of cranial base
• Pre-natal growth
• Ossification in individual basicranial bones
• Cranial base flexure
• Post-natal growth
• Clinical implications
• References
 INTRODUCTION

The cranial base is of considerable

importance to the orthodontist as it serves
as a reasonably stable reference structure in
roentgen-cephalometric analysis.
For orthodontists, biologists and
anthropologists, the patterns of normal
development should be known to serve as a
basis for comparing and understanding
abnormal growth patterns.
FUNCTIONS OF CRANIAL BASE:

• Basicranium supports and protects the brain and spinal

cord.
• It articulates the skull with the vertebral column, mandible
and maxillary region.
• It acts as an adaptive or buffer zone between the brain, face
and pharyngeal region whose growth are paced differently.
• Internal surface of the cranial base shows a natural division
into anterior, middle and posterior cranial fossae.
 THE ANTERIOR CRANIAL FOSSA

• Limited in front and on each

side by frontal bone.
• Its floor is formed by:
• 1. Orbital plate of frontal
bone.
• 2. Cribriform plate of the
ethmoid
• 3. Anterior part of the body
and lesser wing of sphenoid.
ORBITAL PLATE OF FRONTAL BONE

• Forms the greater part of the floor of the

fossa on each side of the median plane
• Separates the orbit and its contents from the
inferior surface of the frontal lobe of the
brain.
• In its antero-medial part it is split into two
laminae to contain part of an airspace, the
frontal sinus.
CRIBRIFORM PLATE OF ETHMOID

• Separates the fossa from nasal cavity and forms the roof of the
latter.
• Anteriorly it presents a median crest like elevation CRISTA
GALLI which projects upwards in between the two cerebrals
hemispheres (which is a land mark in frontal/anteroposterior
cephalograms).
The numerous small foramina which perforate the cribriform plate of
ethmoid transmit the minute olfactory nerves from the nasal mucosa to
the olfactory bulb.
THE SPHENOID BONE
• Completes the fossa’s floor from behind. Centrally is the
anterior part of the upper surface of its body termed the
jugum sphenoidale.
• This separates the fossae from
bilateral air spaces in the body
of the sphenoid named the
sphenoidal sinuses.
• Lateral to the jugum the floor of
the anterior fossa is formed by
lesser wing of sphenoid.
• Optic canal is located at the
junction of lesser wing and
body of the sphenoid bone.
THE MIDDLE CRANIAL FOSSA
• In front it is bounded by posterior
borders of the lesser wings of
sphenoid and body of sphenoid,
• Behind by superior borders of the
petrous parts of the temporal bone
and dorsum sella of sphenoid
bone, laterally by the temporal
squamae, parietal bone and
sphenoidal greater wings.
• Centrally the floor is narrower and formed by sphenoid body.
• Optic canal is present between roots of a lesser wing and lateral
to the body of the sphenoid.
• Behind the sulcus the upper sphenoidal surface is the sella
turcica, whose ant. slope bears a median tuberculum sellae,
behind which is the hypophyseal fossa.
• Posterior to it the dorsum sellae projects up & forwards.
• Hypophyseal fossa is present
in the middle cranial fossa,
which contain the hypophysis
cerebri.
• Laterally the middle cranial
fossa is deep and supports the
temporal lobe of cerebrum.
THE POSTERIOR CRANIAL FOSSA
THE POSTERIOR CRANIAL FOSSA
• The largest and deepest of the
cranial fossa.
• Surrounded by dorsum sella,
posterior part of the body of
the sphenoid and basilar part
of the occipital bone
anteriorly;
• Behind by the lower portion
of the occipital squamae.
• On each side by the petrous and mastoid parts of temporal
bone and lateral parts of occipital
• Above & behind by the mastoid angles of the parietal
bones.
• It contains the cerebellum, pons and medulla oblongata.
THE FORAMEN MAGNUM

• It is in the floor of the fossa and surrounded by the parts of

the occipital bone.
• Somewhat ovoid in shape
• communicates with the vertebral canal where the medulla
oblongata becomes continuous with the spinal cord.
BONES FORMING THE CRANIAL BASE
 THE OCCIPITAL BONE

• It forms much of the back and base of the cranium.

• Trapezoid in shape, concave internally.
• Contains 3 parts:
• Squamous part.
• Basillar part.
• Lateral / condylar part.
THE SPHENOID BONE

• It is in the base of the

skull,wedged between the
frontal and the temporal bones
and basilar part of occipital
bone.
• Has a shape of a bird with
wings stretched out .
The sphenoid consists of:
Central portion or body
Greater wings
Lesser wings
Pterygoid processes
Lateral pterygoid plates
Medial pterygoid plates
THE TEMPORAL BONES

• This paired bone forms the sides

and base of the skull.
• Each consists of 4 parts:
• Squamous part.
• Petromastoid part.
• Tympanic.
• Styloid process
THE FRONTAL BONE

• It is an irregular cap like bone

which forms the region of the
forehead
• On each side it has a horizontal
orbital part which forms most of the
roof of the orbital cavity.
• The portion of the bone which
projects downwards between the
supraorbital margins is named as the
nasal part.
THE ETHMOID BONE

• It is cuboidal and extremely light in

build.
• It consists of 3 parts:
• Cribriform plate (perforated one)
• A perpendicular plate
• Lateral masses (labyrinths)
THE INFERIOR NASAL CONCHAE
These are curved laminae, which lie horizontally in the lateral walls
of nasal cavity.
PRENATAL DEVELOPMENT OF CRANIAL BASE
• Cranium can be divided into 2 parts:
• Neurocranium: It protects and supports the brain and
sense organs.
• Viscerocranium: Which is related to alimentary,
respiratory tracts, face, maxilla and mandible.
• Basicranium or cranial base is related to the both neural
and visceral components.
• At cellular level, bones of cranial base develop by the
following processes:
• Hyperplasia (Prominent feature of all forms of growth)
• Hypertrophy(sec. Factor)
• Secretion of extracellular material
CHONDRIFICATION

• Earliest evidence of formation of cranial base is seen in the

late somite period i.e. 4th – 8th week of intrauterine life.
Mesenchyme derived from primitive streak, neural crest and occipital
sclerotomes

condenses around the developing brain

“ectomeningeal capsule”

basal portion

future cranial base .

During this period:
The occipital sclerotomal mesenchyme Concentrates around the
notochord underlying the developing hindbrain

cephalic extension

floor of the brain.

 CHONDRIFICATION CENTRES

Chondrification centers form

in the following regions:
• Parachordal
• Hypophyseal
• Nasal
• Otic
PARACHORDAL REGION

Chondrification centers forming

around the cranial end of the
notochord are appropriately called
the parachordal cartilages.
Fuse with the sclerotomes arising
from occipital somites.
• The sclerotome cartilage is considered to be the first part
of the skull to develop and it forms the boundaries of
foramen magnum, providing the anlagen for basilar and
condylar parts of the occipital bone.
OCCIPITAL BONE

• Ossified from 7 centres,

which are 2 intramembranous
5 endochondral.
7 centres
• Supranuchal Squamous portion – 2 intramembranous centres
(8th week)
• Infranuchal squamous – 2 endochondral centres (10 th week)
• Basioccipital bone – 1 endochondral (11th week)
• Exoccipital bone – 2 endochondral centres (12 th week)
• A pair of endochondral ossification centres appears in the
12th wk forming the lateral boundary of foramen magnum
& posterior portion of occipital condyles.
• An occasional centre appears in the post. Margin of the
foramen magnum in 16th wk-KERCKRING’s CENTRE
which unites with the rest of squamae before birth.
OSSIFICATION TEMPORAL BONE

21 centres
• Squamous portion-1 intramembranous centre (8 th week)
• Tympanic ring – 4 intramembranous centres (3 th month)
• Petrosal part – 14 endochondral centres (16th week)
• Styloid process – 2 endochochondral centres(at birth)
OSSIFICATION ETHMOID BONE

3 centres
• Perpendicular plate & crista galli – 1 endochodral centre
• Lateral labrynths in the nasal cartilages- 2 endochondral
centres
OSSIFICATION SPHENOID BONE
19 centres
• Basisphenoid – 3 presphenoid & 4 postsphenoid
endochondral centres
• Greater wings – 2 centres
• Lesser wings - 2 centres
• Medial pterygoid plates – 2 intramembranous centres
• Lateral pterygoid plates – 2 intramembranous centres
Sphenoidal conchae – 2 endochondral centres
 OSSIFICATION VOMER

Alae – 2 intramembranous centres

INFERIOR NASAL CONCHA

–1 endochondral centre
 CRANIAL BASE FLEXURE

• During the embryonic and

early fetal periods,the
enormous human cerebrum
expands around a much
smaller enlarging midventral
segment (the medulla,pons,
hypothalamus,optic
chiasma).
This causes a bending of the whole underside of the brain and the
flexure of the cranial base results, in the region of the pituitary fossa,at
the spheno-occipital junction,so that the developing face becomes
tucked in under the cranium.
• The body has become vertical, but the neutral visual axis is
still horizontal ,as in other mammals.
• This cranial base flexure effectively enlarges the
neurocranial capacity and causes downward rather than
forward displacement of face during its growth from the
cranial base.
This relates to two key features:
1. The spinal cord is now aligned vertically, a change that
permits upright, bipedal body stance with free arms and
hands
2. As the forehead is rotated in a vertical plane with the
growth of the frontal lobe, the superior orbital rim is carried
with it.
 CRANIAL BASE ANGULATION

• Precartilage stage – 150°

• Cartilage stage – 130°
• Preossification stage – 115°-
120°
• Ossification stage – 125°-130°
 UNEVEN NATURE OF CRANIAL BASE
GROWTH
• Growth of the cranial base is highly uneven.
• The uneven growth of the parts of the brain is reflected in
the related parts of the cranial base adapting as
compartments or cranial fossae
• Unevenness is also seen in rate of growth
• Eg. the anterior cranial base increases in length and width
by even fold between the 10th and 40th weeks I.U.
whereas,
• The posterior cranial base grows only 5 fold.
POSTNATAL GROWTH OF
CRANIAL BASE
• Cranial base has a potent role in the development of
structure, dimensions, angles and placement of various facial
parts.
• Floor of the cranium is a template from which face develops.
• Any difference in the development of basicranium will be
reflected in the facial growth.
• Growth of the central ventral axis of the brain and of the
related body of the sphenoid and basioccipital bones is
slow, providing a comparatively stable base.
• Laterally, cranially and caudal to this base, the anterior,
middle and posterior fossae expand enormously in keeping
with the growth of related parts of the brain.
The cranial base grows postnatally by complex
interaction between the following growth processes:
1. Extensive cortical drift and remodelling
2. Growth of the cartilage remnants of the
chondrocranium that persist between the basicranial
bones.
3. Expansive forces emanating from the growing brain
displacing the bones at the suture lines
CORTICAL DRIFT AND REMODELLING

• Endocranial surface of cranial floor has a different mode of

development when compared with the calvaria because of
its complex structure and curvature.
• The endocranial or neural surface of the basicranium in
contrast to the roof is resorptive in most areas
• The reason is that the sutures do not have the capacity to
provide for the multiple directions of enlargement and the
complex magnitude of remodeling required.
• Remodeling is required to accommodate the massively
enlarged human brain.
FOSSA ENLARGEMENT

• The unidirectional sutural

growth occurs at locations
1 and 2, which is not
sufficient to accommodate
the brain expansion.
• Fossa enlargement is accomplished
by direct remodeling involving
deposition on the outside with
resorption from the inside.
Various endocranial compartments are separated from
one another by elevated bony partitions:
• The olfactory fossae are separated by Crista galli.
• Middle and posterior fossae are divided by the
petrous elevation
• Right and left middle cranial fossae are separated by
the longitudinal midline sphenoidal elevation.
• Right and left anterior and posterior cranial fossae
are divided by a longitudinal midline bony ridge
• All these elevated partitions, unlike of the remainder of
the cranial floor are depository in nature because as
fossae expand outward by resorption, the partitions
between them must enlarge inward by deposition to
maintain the proportions
• The mid ventral segments of cranial floor grow more
slowly than the floor of the laterally located fossae.
This accommodates the slower development of the
medulla, pons, hypothalamus, optic chiasma in contrast
to the massive rapid expansion of the hemispheres.
• A markedly decreasing and tapering gradient of sutural
growth occurs as the ventral midline is approached but
direct remodeling also occur to provide for the varying
extents of expansion required among the different
midline parts themselves and much faster growing
lateral regions.
• Unlike the roof, the floor of the cranium provides the
passage of cranial nerves and major cerebral vessels.
• The process of remodeling growth in the basicranium
provides for the stability of these nerves and vascular
passageways.
• The foramen moves by deposition and resorption
keeping pace with corresponding movement of
nerve/vessel.
• The foramen enclosing each cranial nerve and major
blood vessel also undergoes its own drift process to
constantly maintain the proper position (Relocation)
• Growth in the posterior cranial fossa is more when
compared with growth of the spinal cord and foramen
magnum.
• Differential remodeling process maintains the
proportionate placement of spinal cord, even though
the floor of the posterior cranial fossa, which surrounds
the spinal cord expands to a considerably greater extent
than the circumference of the foramen magnum
• The resorption occurs from the lining side of the forward
walls of the middle cranial fossa
• Deposition on the orbital face of the sphenoid and in the
sphenofrontal suture
• Forward displacement of the anterior cranial fossae occurs
as the frontal lobes are displaced anteriorly
• The petrous elevation increases by deposition on the
endocranial surface.
• Lengthening of clivus occurs by growth at SOS.
• The foramen magnum is progressively lowered by resorption
on the endocranial surface and deposition on the ectocranial
side.
• Endocranial fossa enlarge by a combination of endocranial
resorption and ectocranial deposition.
SYNCHONDROSES

The midline part of the basicranium is characterized by

the presence of synchondroses.
They are the “left over” from the primary cartilages of
the chondrocranium after the endocranial ossification
centers appear during fetal development.
• By their interstitial growth,the interposed cartilages or
“synchondroses” can separate the adjacent bones as
appositional bone growth adds to the sutural edges of
the bones
DIFFERENT SYNCHONDROSES SEEN IN
CRANIAL BASE

• Spheno-occipital
• Spheno-ethmoidal
• Intra occipital
• Inter-sphenoidal
THE SPHENO-OCCIPITAL SYNCHONDROSIS

• It is the principal growth cartilage of cranial base

during childhood
• As all growth cartilages are associated with (directly)
bone development, the SOS provides a pressure
adapted bone growth mechanism unlike the sutural
areas which show tension adapted mechanism.
• Because cranial base supports the
mass of the brain and face, SOS
in the midline is subjected to
craniofacial muscular forces.
• As endochondral bone growth
occurs at the SOS, the sphenoid
and the occipital bones become
moved apart by the 1°
displacement process.
• At the same time new endochondral bone is laid down
by the endosteum within each bone (Medullary fine
cancellous bone). Compact cortical (Intramembranous)
bone is formed around this core of endochondral bone
tissue. .
• Each bone thereby becomes lengthened. Both bones
also increase in girth by periosteal and endosteal
remodeling.
• The interior of the sphenoid bone eventually becomes
hollowed to form the sizable sphenoidal sinus.
• Sphenoidal sinus expansion does not push the maxilla.
The sinus grows secondarily as the body of the
sphenoid bone expands around it keeping constant
junction with the moving nasomaxillary complex.
THE SYNCHONDROSIS HAS A SERIES OF
ZONES LIKE PRIMARY CARTILAGE

• Familiar reserve zone.

• Cell division zone.
• Hypertrophic zone.
• Calcified zone.
• Similar to an epiphyseal plate, but unlike the condylar
cartilage, the chondroblasts in the cell division zone are
aligned in distinctive columns that point along the line
of growth
• Unlike the epiphyseal plate the synchondrosis has 2
major (Bipolar) directions of linear growth.
• Structurally the synchondrosis is essentially 2
epiphyseal plates positioned back to back and separated
by a common zone of reserve cartilage
• SOS is the last of all synchondrosis to fuse and starts fusing
at 12-13 years in girls, and 14-15 years in boys and
completing ossification of the external aspect by 20 years of
age.
• This prolonged growth period allows for continued posterior
expansion of the maxilla to accommodate last erupting molar
teeth and provides space for growing nasopharynx
SPHENO-ETHMOIDAL SYNCHONDROSIS
• A cartilaginous band between the sphenoid and ethmoid bones.
• Believed to ossify after 5yrs of age.

INTER SPHENOIDAL SYNCHONDROSIS

• Between 2 parts of sphenoid
• Ossifies at birth

INTRA OCCIPITAL SYNCHONDROSIS

• This ossifies by 3-5 yrs of age.
• The size, shape and characteristics of cranial floor have
evolved in direct phylogenetic association with the brain it
supports, but the basicranium itself has presumably
developed a genetic capacity of its own growth that is some
how independent of the brain.
• Extrinsic control factors are also involved; but to what extent
they are involved is not fully understood, since the cranial
floor can develop to a greater or lesser extent, even though
the brain is malformed
EXPANSIVE FORCES FROM BRAIN GROWTH
AT SUTURES
Some of the sutures
of cranial base:
• Spheno-frontal
• Fronto-temporal
• Spheno-ethmoid
• Fronto-ethmoid
• Fronto-zygomatic
The expansion of the middle cranial fossa and its neural
contents

Secondary displacement effect on the anterior cranial

floor , underlying nasomaxillary complex and mandible.
• Because the posterior boundary of nasomaxillary
complex is developmentally positioned to exactly
coincide with the boundary between the anterior and
middle cranial fossae some amount of forward
displacement of both the anterior cranial fossa and the
nasomaxillary complex occurs.
• The temporal and frontal lobes have fibrous
attachments to the middle and anterior cranial fossa.
• As both lobes expand these 2 fossae are thus pulled
away from each other.
• This set up tension fields in various frontal, temporal,
sphenoidal, and ethmoidal sutures and this also
presumably triggers sutural bone responses.
• At about 5 years of age, frontal lobe growth and
anterior cranial fossae expansion are largely complete.
• The temporal and middle cranial fossa, however
continue to enlarge for several more years
• The expansion of each temporal lobe continues to displace
the frontal lobe forward and this in turn causes tension in
the osteogenic suture systems between these 2 areas.
• The anterior fossae and the maxillary complex are carried
anteriorly by the frontal lobes, which is moved forward
because of temporal lobe enlarging behind it.
TIMING OF CRANIAL BASE GROWTH

1. By birth, 55-60 % of adult size is attained.

2. By 4-7 yrs, 94 % of adult size is attained.

3. By 8-13 yrs, 98 % of adult size is attained.

STUDY: CRANIAL BASE GROWTH FOR DUTCH
BOYS AND GIRLS (AJO 1994 NOVEMBER) -
MONIQUE HENNEBERKE AND BIRTE PRAHL ANDERSEN

• In this study growth and development of the cranial

base in children who were treated orthodontically were
compared with children who were not.
The hypothesis tested was that there is no difference in cranial
base growth between children with and without orthodontic
treatment.
This was a mixed longitudinal study of
• 153 boys and 167 girls samples for S-N
• 116 boys and 116 girls for N-Ba and S-Ba,
• All were of 7-14 years of age.
CEPHALOMETRIC POINTS USED IN THIS
STUDY
RESULTS

• The effect of orthodontic therapy on cranial base

growth was apparently so limited that no significant
differences could be demonstrated between children
with or without treatment.
• The cranial base displayed sexual dimorphism in
absolute size, timing and amount of growth.
• All C.B. dimensions examined in this study were
greater in boys than in girls.
• Girls did not show adolescent growth spurts, where as
all boys showed that for S-N and N-Ba.
REFERENCES

1. Craniofacial Embryology - G.H.SPERBER

2. Essentials Of Facial Growth - D.H.ENLOW
3. Gray’s Anatomy - Gray
4. Contemporary orthodontics - W.R.PROFFIT
5. Orthodontics-The art and science-- S.I.Bhalajhi
7. Cranial Base Growth For Dutch Boys & Girls –
M.Herneberke,b.P. Andersen (AJO November; 1994)