Prenatal growth of the human mandibular condylar cartilage

Variability in the number of mental foramina in the African green monkey (Grivet) (Chlorocebus aethiops)

This study aimed to determine the number of mental foramina (MFs) in vervet monkeys of the Cercopithecini tribe and perform a µCT analysis of mental foramina and mandibular canal morphology. A total of 19 simian skulls belonging to Chlorocebus aethiops species were used in the analyses. An average of three mental foramina was present in most individuals from the analyzed group. The Mann–Whitney test revealed no statistically significant difference between the number of foramina on the right- and left-hand side. Likewise, no statistically significant differences between the number of MFs across sexes were observed. Correlation coefficient values between mandibular length and the ipsilateral number of MF indicate a weak and statistically non-significant (p > 0.05) linear relationship. Volumetric reconstructions revealed the presence of a single periosteal sheathed mandibular canal terminated with four small mental foramina.

Longitudinal evaluation of the association between Insulin-like growth factor-1, Bone specific alkaline phosphatase and changes in mandibular length

The aim of the current longitudinal study was to assess the levels of serum Bone-specific alkaline phosphatase (BALP) and serum Insulin like growth factor-1 (IGF-1) in different cervical vertebral maturation index (CVMI) stages and observe their association with the mandibular growth. Blood samples and lateral cephalograms of 63 subjects (age group of 11–17 years) were obtained at two time points, 12 months apart. On the basis of CVMI, all subjects were divided into six groups based on whether the subjects remained in same CVMI stage or transitioned to the next CVMI stage. Annual mandibular length was related with serum BALP and serum IGF-1 levels estimated using ELISA. Serum IGF-1 and BALP attained highest levels at CVMI stage 3 with peak BALP levels observed earlier than IGF-1. Although a positive correlation was determined between IGF-1 and BALP but BALP followed skeletal growth pattern more precisely. Overall IGF-1 and BALP were negatively correlated with mandibular length with notable growth in CVMI groups 3–3 (P < 0.01), 3-4 (P < 0.01), 4-4 (P < 0.001) and 5-5 (P < 0.001). In conclusion, BALP is a potential biomarker for skeletal growth assessment. However, the mandibular growth pattern was independent of changes in IGF-1 and BALP.

Is Temporomandibular Joint Disc Displacement without Reduction a Plausible Cause of Condylar Hypoplasia? A Case Report

Background:

The causes of mandibular condylar hypoplasia can be congenital or acquired in nature. Cited local causes of acquired hypoplasia include trauma, infection and irradiation. We report a case of hypoplastic condyle that was attributed to temporomandibular joint (TMJ) disc displacement without reduction (DDwoR).

Clinical Presentation:

A 16-year-old male presented with restricted mouth opening and right TMJ pain for 6 months. He was subsequently diagnosed with DDwoR. Conservative treatment comprising self-care and moist-heat therapy was administered and he was followed for 27 months without any further interventions. During this period, transitions from “normal” morphology to condylar flattening / erosion, and eventually a re-modeled smaller “normal” right TMJ were observed.

Conclusion:

The present case provided initial support that DDwoR could be a plausible cause of condylar hypoplasia in adolescents / young adults.

Prenatal intrauterine maxillary development - An evaluation with three-dimensional ultrasound

OBJECTIVES

The aim of this prospective study was to investigate normal fetal maxillary development with volume ultrasound during the prenatal phase, for a better estimation of maxillary growth processes.

METHODS

Some 210 3D volumes were obtained in two measurement series from 38 healthy women (gestational age: 19⁺² to 31⁺⁴ weeks) using a GE Voluson™ E10 ultrasound system. Maxillary length and width were determined in the axial and sagittal planes. Clearly defined, reproducible landmarks were used for measurements. The results were correlated with gestational age and compared with previously reported studies.

RESULTS

Total maxillary length ranged from 10.30 to 24.75 mm, total maxillary width from 13.65 to 37.30 mm in an observation period during the second trimester, with high reproducibility for all landmarks. All evaluation results showed steep growth with exponential character. Length growth was determined to be more dominant than width growth. Intra-rater correlation was evaluated to be almost perfect (ICC (3) > 0.8).

CONCLUSION

This study presents measurements of physiological fetal maxillary development. The defined landmarks proved to be representative for further investigations. This study serves as a baseline for a better understanding of fetal maxillary growth processes, and may be useful for standardising detection of malformations or intrauterine growth restrictions.

The ontogeny of Robin sequence

The triad of micrognathia, glossoptosis, and concomitant airway obstruction defined as "Robin sequence" (RS) is caused by oropharyngeal developmental events constrained by a reduced stomadeal space. This sequence of abnormal embryonic development also results in an anatomical configuration that might predispose the fetus to a cleft palate. RS is heterogeneous and many different etiologies have been described including syndromic, RS-plus, and isolated forms. For an optimal diagnosis, subsequent treatment and prognosis, a thorough understanding of the embryology and pathogenesis is necessary. This manuscript provides an update about our current understanding of the development of the mandible, tongue, and palate and possible mechanisms involved in the development of RS. Additionally, we provide the reader with an up-to-date summary of the different etiologies of this phenotype and link this to the embryologic, developmental, and genetic mechanisms.

Chondral ossification centers next to dental primordia in the human mandible: A study of the prenatal development ranging between 68 to 270mm CRL

The human mandible is said to arise from desmal ossification, which, however, is not true for the entire body of the mandible: Meckel's cartilage itself is prone to ossification, at least its anterior part in the canine and incisor region. Also, within the coronoid and in the condylar processes there are cartilaginous cores, which eventually undergo ossification. Furthermore, there are a number of additional single cartilaginous islets arising in fetuses of 95mm CRL and more. They are located predominantly within the bone at the buccal sides of the brims of the dental compartments, mostly in the gussets between the dental primordia. They become wedge-shaped or elongated with a diameter of around 150-500μm and were also found in older stages up to 225mm CRL, which was the oldest specimen used in this study. This report is intended to visualize these single cartilaginous islets histologically and in 3-D reconstructions in stereoscopic images. Although some singular cartilaginous tissue within the mandible may be remains of the decaying Meckel's cartilage, our 3-D reconstructions clearly show that the aforementioned cartilaginous islets are independent thereof, as can be derived from their separate locations within the mandibular bone. The reasons that lead to these cartilaginous formations have remained unknown so far.

The imbalance of masticatory muscle activity affects the asymmetric growth of condylar cartilage and subchondral bone in rats

OBJECTIVE

To examine the effects of imbalance of masticatory muscle activity of the rat mandible on the condylar cartilage and subchondral bone during the growth period.

DESIGN

Forty 5-week-old male Wistar rats were randomly divided into experimental (n=20) and control (n=20) groups. In the experimental group, the left masseter muscles were resected. The rats were sacrificed at 7 or 9 weeks of age in both groups. Microcomputed tomography was used to determine the three-dimensional morphology and cancellous bone structure. For histological and histochemical examination, 5-μm-thick serial frontal sections of the condyle were stained with toluidine blue and immunostained with asporin and TGF-β1 to evaluate the promotion and inhibition of chondrogenesis.

RESULTS

In the experimental group, microcomputed tomography analysis showed asymmetric growth; the resected side condyles showed degenerative changes. Histological analysis showed that the total cartilage in the central region of the resected side was significantly thinner than in the non-resected side in the experimental group, as well as in the control group. Compared with the control group, the expression of asporin was significantly higher in the resected side, and significantly lower in the non-resected side. In contrast, the expression of TGF-β1-immunopositive cells in the non-resected side was significantly higher than in the resected side and the control group.

CONCLUSIONS

These findings imply that lateral imbalance of masseter muscle activity lead to inhibition of chondrogenesis and induce asymmetric formation of the condyle during the growth period.

Intrauterine temporomandibular joint dislocation: prenatal sonographic evaluation

Congenital temporomandibular joint (TMJ) diseases are very rare disorders and are usually diagnosed in childhood. Developmental disorders of the TMJ such as hypoplasia, hyperplasia, and aplasia of the TMJ compartments are characterized by TMJ dysfunction. In childhood, these patients experience recurrent dislocation, pain, and malocclusion. We present the case of a 25-week fetus with unilateral TMJ dislocation with fluid retention in the joint diagnosed by ultrasonography. To the best of our knowledge, this is the first case of TMJ dislocation diagnosed by ultrasonographic evaluation during the prenatal period.

Análise do crescimento das dimensões da mandíbula em diferentes idades fetais

OBJETIVO: verificar se há assimetria de crescimento entre as hemimandíbulas esquerda e direita, durante o 2º e início do 3º trimestre de gestação. MÉTODOS: foram utilizadas 68 hemimandíbulas (34 mandíbulas) de fetos conservados em solução de formalina a 10%, sendo 20 femininos e 14 masculinos, e realizadas as seguintes mensurações: Côndilo-Processo Coronoide (Co-PC), Gônio-Processo Coronoide (Go-PC), Gônio-Gnátio (Go-Gn), Côndilo-Gnátio (Co-Gn), Altura da Sínfise (AS) e Ângulo da Mandíbula (AM). Os dados foram coletados, tabulados e analisados com auxílio do programa SPSS, versão 11.0, 2005, onde foi realizado o estudo One Way Anova para a comparação entre as médias dos valores das medidas anatômicas das hemimandíbulas direita e esquerda, sendo a idade dividida entre segundo trimestre (Período 1: 13-18 semanas e Período 2: 18-24 semanas), e início do terceiro trimestre (Período 3: 24-30 semanas) de gestação. RESULTADOS: houve discreta assimetria no ritmo de crescimento das medidas Go-Gn, Co-PC, Co-Gn, Go-PC e AS, comparando-se os lados direito e esquerdo, entre o 2º e início do 3º trimestre gestacional, apesar de não estatisticamente significativa (p > 0,05). Constatou-se, também, que houve redução da medida AM, com discreta assimetria, no mesmo período pré-natal, sendo estatisticamente significativa (p < 0,05). CONCLUSÃO: não foram observadas diferenças estatísticas significativas quanto ao crescimento das hemimandíbulas direita e esquerda no período estudado. Por outro lado, houve redução da medida do ângulo da mandíbula no mesmo período, apresentando significância estatística.

Effects of bisphosphonate on the endochondral bone formation of the mandibular condyle

The development of the mandibular condylar cartilage is important for the overall growth of the mandible. However, there have been a few researches into medical approaches aimed at controlling condylar growth. This study examined the effects of bisphosphonate on the growth of the condylar cartilage. Alendronate (3.5 mg/kg/week) was administered to postnatal day 1 SD rats for 7 and 10 days. The thickness of each chondrocyte layer and the level of MMP-9 expression were measured. The anteroposterior diameter of the developing condyle was unaffected by the alendronate treatment for 7 days (P > 0.05). The total thickness of the cartilage layers was also unaffected by the treatment for 7 days (P > 0.05). In particular, there was no change in the thickness of the perichondrium and reserve cell layer at the measured condylar regions (P > 0.05). However, the thickness of the proliferating cell layer was reduced significantly, whereas the thickness of hypertrophied cartilage layer was increased (P < 0.05). The number of chondroclasts engaged in hypertrophied cartilage resorption was reduced significantly by the alendronate treatment (P < 0.05). The level of MMP-9 expression was reduced at both the transcription and translation levels by the alendronate treatment for 7 and 10 days. These results indicate that alendronate (>3.5 mg/kg/week) inhibits the longitudinal growth of the mandibular condyle by inhibiting chondrocyte proliferation and the resorption of hypertrophied cartilage for ossification.

Congenital deformities and developmental abnormalities of the mandibular condyle in the temporomandibular joint

The temporomandibular joint (TMJ) consists of the mandibular condyle and the articular eminence of the temporal bone. The morphological development of the TMJ during prenatal life lags behind other joints in terms of both the timing of its appearance and its progress. At birth, the joint is still largely underdeveloped. There are many causes of the various growth disturbances and abnormalities of the mandibular condyle and related structures. Growth disturbances in the development of the mandibular condyle may occur in utero late in the first trimester and may result in disorders such as aplasia or hypoplasia of the mandibular condyle. Meanwhile, hyperplasia of the mandibular condyle is not visible at birth and seems to be gradually acquired during growth. In the present review article, the congenital abnormalities of the mandibular condyle are classified morphologically into three major groups and two subgroups from a clinical standpoint: (1) hypoplasia or aplasia of the mandibular condyle, including (i) primary condylar aplasia and hypoplasia, (ii) secondary condylar hypoplasia; (2) hyperplasia; and (3) bifidity. In addition, the molecular-based etiology of anomalies of the mandibular condyle is also discussed.

Immunohistochemical identification of TGF-beta1 at the maxillaries in growing Sprague-Dawley rats and after muscle section

Growth factors are currently being extensively studied in the literature to ascertain their role during maxillofacial development. Taking into account that few investigations refer to the functions of growth in the maxillaries, our aim was to identify the TGF-beta1 immunohistochemical expression pattern in the maxillaries of growing rats. A secondary aim was to identify this pattern after orofacial function inhibition by muscle section. In the palate and the mandibular symphysis and body, we found that bone was formed through an endomembranous pathway with intense TGF-beta1 staining inside chondroid cells during the maximum development stages. At the midpalatal suture and the mandibular symphysis and condyle, endochondral ossification was detected with an intense expression of TGF-beta1 inside the chondrocytes when major growth occurred. After the muscle had been sectioned, at the mandible the maturation process was accelerated, this change being transitory until muscular function was recovered. However, at the palate, the intervention caused a greater disturbance of the growing pattern, which did not recover normality.

The Pediatric Mandible: I. A Primer on Growth and Development

LEARNING OBJECTIVES

After studying this article, the participant should be able to: 1. Describe embryonic and fetal mandibular development. 2. Summarize the aggregate changes in mandibular form from birth to puberty. 3. Describe the eruption and maturation of the deciduous and permanent mandibular dentition.

BACKGROUND

In this, the first of two articles addressing the surgical management of pediatric mandibular fractures, the authors provide a detailed discussion of mandibular development and anatomy during the fetal period, infancy, and childhood.

METHODS

A review of the pertinent literature was performed. The changing structure of the developing mandible is discussed, with particular attention to surgically relevant anatomical structures.

RESULTS

Throughout development, key anatomical structures with relevance to surgical therapy change markedly in position. The mandible undergoes significant change in its bony structure and the composition of its surrounding soft tissues. The mandible's bony structure becomes more robust, with an increasingly acute gonial angle and enlargement of the ramus and body. Furthermore, the mandible provides the bony structure from which tooth buds erupt as the deciduous and permanent dentition--a process that generates significant growth of the alveolar process. As a consequence, the distance between the developing dentition and the inferior mandibular border increases. While the canal of the inferior alveolar nerve undergoes significant superior displacement, the mental foramen becomes positioned more posteriorly over time. In addition, the ligamentous and muscular attachments that surround the temporomandibular joint become increasingly robust. Throughout childhood and adolescence, the blood supply of the mandibular body changes little, with the buccal periosteal plexus and inferior dental artery making significant contributions.

CONCLUSIONS

Mandibular growth provides the basis for normal occlusal relations and the generation of increasingly large masticatory force. Although the exact mechanisms of bone remodeling during mandibular development remain unclear, the process likely receives contributions from primary growth centers and the response to local alterations in biomechanical force produced by surrounding soft-tissue structures. A working knowledge of the changing mandibular anatomy is a prerequisite for effective clinical management of traumatic injury.

Assessment of the facial features and chin development of fetuses with use of serial three-dimensional sonography and the mandibular size monogram in a Chinese population

OBJECTIVE

Our purpose was to evaluate whether the application of serial three-dimensional (3D) sonography and the mandibular size monogram can allow observation of dynamic changes in facial features, as well as chin development in utero.

STUDY DESIGN

The mandibular size monogram has been established through a cross-sectional study involving 183 fetal images. The serial changes of facial features and chin development are assessed in a cohort study involving 40 patients.

RESULTS

The monogram reveals that the Biparietal distance (BPD)/Mandibular body length (MBL) ratio is gradually decreased with the advance of gestational age. The cohort study conducted with serial 3D sonography shows the same tendency. Both the images and the results of paired-samples t test (P<.001) statistical analysis suggest that the fetuses develop wider chins and broader facial features in later weeks.

CONCLUSIONS

The serial 3D sonography and mandibular size monogram display disproportionate growth of the fetal head and chin that leads to changes in facial features in late gestation. This fact must be considered when we evaluate fetuses at risk for development of micrognathia.

A histomorphological investigation of the effect of cyclosporin on trabecular bone of the rat mandibular condyle

The effect of cyclosporin A (CSA) on the condylar trabecular bone was evaluated by microscopy. Twenty, 5-week-old male Sprague-Dawley rats were divided into a treated and a control group. Animals in the treated group received CSA, 15 mg/kg body weight, by gastric feeding daily for 4 weeks; controls received the vehicle only. Five animals from each group were killed at the end of weeks 2 and 4. After histological processing, 10 tissue sections from the mid-part of the mandibular condyle were examined. Generally, a histopathological osteopenia was observed around the condyle after CSA treatment, especially at the end of week 4. In the control animals, the trabecular bone volume steadily increased from weeks 2 to 4 (from 0.46+/-0.07 to 0.61+/-0.07 mm(3)/mm(3)). However, the bone volume was significantly less in the CSA group than in the control group at both times (0.33+/-0.02 vs 0.46+/-0.07 and 0.26+/-0.07 vs 0.61+/-0.07 mm(3)/mm(3) for CSA vs control group at the end of weeks 2 and 4, respectively). Conversely, an increased marrow volume was observed in the CSA group at both these times (0.60+/-0.02 vs 0.42+/-0.08 and 0.71+/-0.06 vs 0.31+/-0.06 mm(3)/mm(3) for CSA vs control group at the end of weeks 2 and 4, respectively). Decreases were also observed in trabecular thickness, osteoid seam width, osteoid volume and cortical bone width. Because trabecular bone mass, osteoid mass and cortical bone thickness all showed a decrease after CSA at both times, an inhibitory effect of CSA on trabecular bone formation in the mandibular condyle is proposed.

Prenatal development of the human mandible

In an effort to better understand the interrelationship of the growth and development pattern of the mandible and condyle, a sequential growth pattern of human mandibles in 38 embryos and 111 fetuses were examined by serial histological sections and soft X-ray views. The basic growth pattern of the mandibular body and condyle appeared in week 7 of fertilization. Histologically, the embryonal mandible originated from primary intramembranous ossification in the fibrous mesenchymal tissue around the Meckel cartilage. From this initial ossification, the ramifying trabecular bones developed forward, backward and upward, to form the symphysis, mandibular body, and coronoid process, respectively. We named this initial ossification site of embryonal mandible as the mandibular primary growth center (MdPGC). During week 8 of fertilization, the trabecular bone of the mandibular body grew rapidly to form muscular attachments to the masseter, temporalis, and pterygoid muscles. The mandible was then rapidly separated from the Meckel cartilage and formed a condyle blastema at the posterior end of linear mandibular trabeculae. The condyle blastema, attached to the upper part of pterygoid muscle, grew backward and upward and concurrent endochondral ossification resulted in the formation of the condyle. From week 14 of fertilization, the growth of conical structure of condyle became apparent on histological and radiological examinations. The mandibular body showed a conspicuous radiating trabecular growth pattern centered at the MdPGC, located around the apical area of deciduous first molar. The condyle growth showed characteristic conical structure and abundant hematopoietic tissue in the marrow. The growth of the proximal end of condyle was also approximated to the MdPGC on radiograms. Taken together, we hypothesized that the MdPGC has an important morphogenetic affect for the development of the human mandible, providing a growth center for the trabecular bone of mandibular body and also indicating the initial growth of endochondral ossification of the condyle.