cranial vault

1. GOOD MORNING

2. CONTENTS
INTRODUCTION
PRE-NATAL GROWTH AND DEVELOPMENT
AT BIRTH
POST- NATAL GROWTH AND DEVELOPMENT
CLINICAL IMPLICATIONS
CONCLUSION
REFERENCES

3. INTRODUCTION
Skull At Birth – 45 Bony Elements
In Adult – 22 bones
Face – 14 bones
Cranium - 8 bones

4. INTRODUCTION
CRANIOFACIAL COMPLEX :
COMPRISES OF 4 REGIONS
• CRANIAL VAULT
• CRANIAL BASE
• NASO-MAXILLARY COMPLEX
• MANDIBLE

5. CRANIAL VAULT
The cranial vault is the space in the skull
within the neurocranium , occupied by
the brain.
NEUROCRANIUM is also known as brain case.

6. Neurocranium is the fastest growing region in
craniofacial complex at birth.
NEUROCRANIUM
VAULT OF SKULL OR
CALAVARIA OR
DESOMOCRANIUM
CRANIAL BASE OR
CHONDROCRANIUM
FROMED BY
INTRAMEMBRANOUS BONE
FORMATION
FROMED BY ENDOCHONDRAL
OSSIFICATION

7. OVERVIEW
1. SITE OR LOCATION
2.TYPE OF GROWTH OCCURING AT THAT
LOCATION
3.MECHANISM OF GROWTH
4.CONTROLLING FACTORS IN THAT
GROWTH

8. GROWTH : “Any change in morphology which
is within measurable parameter”- MOSS
DEVELOPMENT : “Considered as a
continuum of causally related events from
fertilization of ovum onwards” –MOSS .

9. CORRELATION BETWEEN
GROWTH AND DEVELOPMENT
• Growth is basically anatomic
phenomenon and quantitative in
nature
• Development is basically physiologic
phenomenon and qualitative in
nature.

10. DEVELOPMENT= GROWTH + DIFFERENTIATION + TRANSLOCATION

11. SITE OR LOCATION
In cranial vault or desmocranium growth is
accomplished by proliferation of
connective tissue between the sutures and
its replacement by bone.
Despite by rapid ossification of the cranial vault
in the terminal stages of fetal life, bones of vault
is separated by fontanelles when child is born

12. TYPE OF GROWTH OCCURRING AT THAT
SITE :
Intramembranous bone formation or
Direct ossification or Membranous
bone formation.
Process of bone formation is by
undifferentiated mesenchymal cells.

13. MECHANISM OF GROWTH
MESENCHYMAL CELLS undergo condensation at site of bone formation
Some lay bundle of the first
fibrous bony matrix
Differentiate into osteoblasts
Fibrous bony matrix gets mineralized and blood vessels
are retained in close proximity to bony trabeculae

14. Some of these cells get enclosed by their own deposits
called osteoid matrix
Deposition of calcium salts into osteoid matrix lead formation of lamella
Osteoblast move away from lamella
Osteoblast entrapped between lamella are called
osteocytes

17. Therefore bone formation comprises of two entities:
OSTEOCYTES
INTRA CELLULAR
MEMBRANE
OSTEOCLASTS
OSTEOBLASTS

18. Resorption and deposition can be observed
continuously , during growth period
deposition overstrips resorption.
Balanced in the adult and reversed in old
age…
Sutures : bones grows towards each
other and in the cranium, the osteogenic
region between them is composed of
connective tissue. This zone is called suture.

19. ENDOCHONDRAL OSSIFICATION
Precurso
r
Cartilage
Largely responsible for elongation of individual
bones, thus constitutes mainly for increase in
Height or Growth.

21. Prenatal growth is characterized by a rapid
increase in cell numbers and fast growth rates
Post natal growth is the first 20 years of growth
after birth
Postnatal growth is characterized by declining
growth rates and increasing maturation of tissues

22. PRENATAL DEVELOPMENT
PRE-
IMPLANTATION
• FIRST 7DAYS
EMBRYONIC
• NEXT 7 WEEKS
FETAL
• NEXT 7 MONTHS

23. GERM LAYERS
• Ectodermal cells will give rise to the nervous
system; the epidermis and its appendages
(hair, nails, sebaceous and sweat glands); the
epithelium lining the oral cavity, nasal cavities
and sinuses; a part of the intraoral glands, and
the enamel of the teeth
• Endodermal cells will form the epithelial
lining of the gastrointestinal tract and all
associated organs.
• The mesoderm will give rise to the muscles
and all the structures derived from the
connective tissue(e.g., bone, cartilage, blood,
dentin, pulp, cementum and the periodontal

24. PRE-NATAL GROWTH OF CRANIAL
VAULT
Normally, cranial vault is derivative of mesenchyme,
which is initially in the form of capsular membrane
around developing brain
Capsular membrane consist of two parts.

25. • Piamater
• ArachnoidEndomeninx
{Neural crest origin }
• Inner duramater
• Outer
membrane with
osteogenic
property
Ectomeninx
{Neural crest and paraxial
mesoderm}

26. Outer membrane
VAULT BASE

27. In somite period embryo, the neural tube’s
covering duramater and its surface
ectoderm are in contact.
The transient maintenance of this contact
during development causes a Dural
projection and extends into future
frontonasal area
Ossification of calvarial bones depends on
presence of brain

28. ECTOMENINX
MESODERMAL ORIGIN NEURAL CREST ORIGIN
•PARIETAL
•SPHENOIDAL
•PETROUS TEMPORAL
•OCCIPITAL
•FRONTAL
•LACRIMAL
•SQUAMOUS TEMPORAL
•MAXILLA
•MANDIBLE
•NASAL
•ZYGOMATIC

29. OSTEOLOGY :
Cranial vault consist :

30. Frontal bone :
The pair of frontal bone
appears from single
primary ossification
centers at 8th week of post
conception
Fusion between these centers occur 6-7th
months of post conception

31. At birth, frontal bone is separated by
frontal suture or metopic suture. Fusion
of these suture occurs 2nd -7th year into
single bone.

32. PARIETAL BONE
• Pair of parietal bone forms roof of
vault
•Two primary ossification centers for
each bone appear at the parietal
eminence in the 8th week of post
conception•Fuse in 4th month of
post conception
•Delayed
ossification
results in sagittal
fontanelle at birth

33. OCCIPITAL BONE
•The supranuchal squamous portion of
the occipital bone ossifies
intramembranously in 8th week post
conception, rest by endochondrally

34. TEMPORAL BONE
•The squamous portion
ossifies intramembanously
at single center, the
tympanic ring ossifies
from four centers in the
3rd month of conception.
•The rest of the bone
endochondrally.

35. SPHENOID BONE

36. • The sphenoid bone is unpaired.
• It forms the middle part of the base of
skull and extend into lateral wall of
vault.
• Ossification is mainly by endochondral
ossification.

37. If any unusual ossification centers develop
between bones, their independent
existence is recognizable as small sutural
or wormian bones

38. AT BIRTH
•At birth, bones of face and jaws are under developed.
•At birth cranium : face= 8:1
later, reduces to 2:1
•The individual calvarial bones are separated by sutures of
variable width and by fontanelles
•Fontanelles : one of the membrane-
covered spaces remaining at the junction of the sutures in
the incompletely ossified skull of the fetus or infant.
•Actually there are two soft spots close together,
representing gaps in the bone structure which will be
filled in by bone during the normal process of growth

39. The anterior fontanelle is diamond shaped and li
es at the junction of the frontal
and parietal bones. This fontanelle usually fills in a
nd closes between the 18th-24th month of life

40. • The posterior fontanelle lies at
the junction of the occipital and parietal
bone, is triangular in shape, and usually clos
es by the 2months after birth.
• The anterolateral fontanelles closes 3
months after birth.
• The posterolaterl closes by 2nd year.
• The flexible membranous junctions
between the calavarial bones allow the
narrowing of the sutures and
fontanelles and the over riding of these
bones when they become compressed
in traversing the pelvic birth canal

41. SUTURES
Coronal suture : Between frontal and 2 parietal
bone

42. Sagittal suture: between 2 parietal bone.
Lamdoidal suture: between parietal and occipital
bone
Squamous suture: between parietal and
temporal bone
Parietomastoid suture: between parietal and
temporal bone
Sphenofrontal suture : between sphenoid and
frontal bone

43. Sphenoparietal suture: between sphenoid and
parietal bones.
Sphenosqamosal suture: between sphenoid and
temporal bones.
Sphenozygomatic suture : between sphenoid and
zygomatic bones.
Zygomaticotemporal suture : between zygomatic
and temporal bones.
Zygomaticofrontal suture : between zygomatic and
frontal bones.

44. VIEWS OF SKULL
NORMA VERTICALIS

45. NORMA OCCIPITALIS

46. NORMA FRONTALIS

47. NORMA LATERALIS

48. There must be a beginning of any great
matter, but the continuing unto the end
until it be thoroughly finished yields the
true glory.
SIR FRANCIS DRAKE {1587}

49. PTERION

50. FACTORS AFFECTING PRE-
NATAL GROWTH
 INTRINSIC GENETIC FACTORS
 EPIGENTIC FACTORS
 ENVIRONMENTAL FACTORS

51. INTRINSIC
GENETIC FACTOR
LOCAL EPIGENTIC
FACTORS
GENERAL
EPIGENTIC
FACTORS
LOCAL
ENVIRONMENTAL
FACTORS
GENERAL
ENVIRONMENTAL
FACTORS
CRANIAL
DIFFERENTIATION

52. RELATED TO THE GROWTH OF
BRAIN
The cranium grows because the brain grows. By the end of
fifth year of life, over 90% of the growth of the brain capsule
or brain vault has been achieved.
This increased in size is achieved by proliferation and
ossification of sutural connective tissue and by appositional
growth of individual bones that make up the cranial vault.
Apposition can be seen on both the internal and external
tables of the cranial bones as they become thicker.

53. The cranial vault increases in width by “fill in”
ossification of proliferating connective tissues in
the coronal, lambdoidal, interparietal, parieto -
shpenoidal sutures.
The mid sagittal sutures between the parietal
bones does not close.
Increase in length of brain may be primarily due
to the growth of cranial base with active
response at the coronal suture .
The brain case grows in height with active
response at parietal sutures along with the
occipital, temporal, and sphenoidal osseous
structures

54. CEPHALOCAUDAL GRADIENT OF
GROWTH

55. POST-NATAL GROWTH
THE CALVARIA
• The endocranial surface of the calvaria is
predominantly depository
• The lining bony surface of the cranial floor is
mainly resorptive.
• Circumcranial reversal line

56. Circumcranial Reversal Line

57. Growth of the cranial vault – direct
influence of Neurocranial capsule

58. NEUROCRANIAL CAPSULE:
This capsule expands in response to a volumetric increase of the
capsular neural matrix.
The embedded bones are passively carried outward, by process of
translative growth

59. • As brain expands separate bones of
calvaria displaced outwardly.
• Passive movement.
• Each separate bone is enmeshed within
connective tissue stroma.
• Primary displacement- tension in sutural
membranes.
• Response-new bone deposition-sutural
edges.
• Each separate bone enlarges-
circumference.
• Endosteal surfaces- resorptive , overall
thickness &expands medullary spaces.

61. Thickening not uniform:
Inner table Brain.
Outer table Mechanical influences and
functional stresses.
Growth of the frontal sinus.

62. Basically it is the combination of
SUTURAL GROWTH
• Sutures are articulation within craniofacial complex.
• Location are genetically determined but
environmentally influenced.
• Firm bond with adjacent bone they allow slight
movement & absorb stresses.

63. • According to
Pritchard 1956
• Suture is composed
of 5 layers: -
(1)Pair of cambian (osteogenic),
(2)Pair of Capsular Layer,
(3)Middle loose connective
tissue layer.

65. • In course of maturation
cambian layer is reduced to
single layer of osteoblast &
capsular layer become thicker.
• Vascularity of middle loose
layer is increased

66. TYPES
• Serrate Sutures: - Saw like/ notched e.g.
Sagittal, coronal ,can withstand force, blow.
• Denticulate Sutures: - Small tooth like e.g.
Lambdoid suture.
• Squamous/ Beveled: - Bone overlaps the other
bone. e.g. temporal & parietal sutures.
• Plane/ battened: - Flat end rough & irregular
e.g. midpalatal suture.

68. • All motion of cranial bones are
interdependent.
• No cranial bones move independently.
• Restrictions in any one part of the cranium
will affect the rest of the cranial mechanism.
• The sphenobasilar junction, also known as
the sphenobasilar synchondrosis (or
symphysis a.k.a. SBS) is the reference point
around which cranial motion patterns are
described

69. APPOSITION & RESORPTION:
• Accretion to the calvarial bones is predominantly
sutural until 4th yr.
• Remodeling of curved bony plates allow for their
flattening out to accommodate the increase
surface area.
• Achieved by combination of endocranial erosion
& ectocranial deposition.
• Angulation between bones changes. In addition
to rotation, the separate bones also rotate within
themselves.

70. CEPHALIC INDEX
Is the ratio of the maximum width of the head to its maximum
length multiplied by 100
female male type
< 75 < 75.9 dolichocephalic 'long-headed'
75 to 83 76 to 81 mesaticephalic
'medium-
headed'
> 83 > 81.1 brachycephalic 'short-headed'

71. CENTRIFUGAL FORCE
• Precocious development of brain determines early
predominance of neurocranium.
• Brain & vault develop very rapidly, very early but
also growth ceases early than face.

72. NEUROCRANIUM: FACE
8:1 Birth
6:1 2nd year
4:1 5th year
2:1 Adult

73. GENERAL FACTORS INFLUENCING CRANIAL
VAULT MORPHOLOGY
RACE
• Vault form is most typical racial expression,
• Dolichocephalic = Northern & Southern European,
• Brachycephalic = Middle Europeans, Asian people.

74. HEREDITY: -
• Vault shows interfamilial correlation than
breadth & length.
NUTRITION: -
• Malnutrition leads to shortened neurocranial
length, width, height (in Rats) “ROBUSTICITY
INDEX” (wt per unit length) of cranial vault
decrease upon protein- calorie malnutrition.

75. VARIOUS THEORIES OF GROWTH,
AND HOW THEY RELATE TO THE
CRANIAL VAULT
Genetic Theory
Sicher’s Sutural Theory
Scott’s Cartilaginous Theory
Moss’s Functional Matrix Theory

76. GENETIC THEORY: -
• Growth was genetically determine.
• Earliest theory to put forward .

77. SICHER’S SUTURAL THEORY: -
• Believes craniofacial growth occurs at the
sutures.
• Local factors, like muscle activity had only
a mild effect.

78. SCOTT’S CARTILAGINOUS THEORY:-
• Inherent growth potential of Cartilages.
• Sutures respond secondarily.

79. MOSS’ FUNCTIONAL MATRIX
THEORY: -
• Postulated the role of functional matrices
which are formed by non osseous tissue.
EEEEEAEXPANDING BRAIN
VAULT
BASE

81. VAN LIMBORGH'S SUMMARIZATION:-
Chondrocranial growth is controlled mainly by
Intrinsic genetic factors.
Desmocranial growth is controlled by few Intrinsic
genetic factors.
Cartilaginous parts of the skull must be
considered as growth centre.
Sutural growth is controlled mainly by influences
originating from the skull cartilage & adjacent
skull structure.

82.  Periosteal growth largely depends upon growth of
adjacent structures.
 Sutural & periosteal growth are additionally
governed by local non genetic environmental
influence.

83. CLINICAL IMPLICATION
DEFECTS IN CLOSURE OF FORAMEN CAECUM: -
• Dura remains in contact with the ectoderm in the
region of the anterior neuropore.
• Ventral bending of the fronto-nasal process brings this
junction close to the future nose.
• Nasal capsule forms around this, and the junction sinks
forming the foramen caecum.
• The dura then separates from the ectoderm, and
foramen caecum closes.
• If this foramen fails to close, dura can herniate in to the
nose. Also formation of dermoid cysts, sinus or
encephalocele.

85. • Altered time closure of sutures-variable
distortions of skull shape.
• Delayed midline ossification of frontal &
sagittal sutures –anterior fontanelle may
remain open.
• Cretinism, progeria, trisomy 21,cleidocranial
dysostosis.
• Premature synostosis – Apert’s syndrome &
Crouzon syndrome.

86. CRANIOSYNOSTOSIS
• Premature fusion of sutures results in the
premature cessation of sutural growth.
• Abnormal intrauterine compression of
the cranium is a factor in causing
premature fusion because it alters the
immature sutural tissue and initiates
mineralization of the sutural ligament
• It is largely confined to the calvaria.

89. Johnny B. D, M.D., John A. Persing, M.D., William C. Broaddus, M.D.,
Ph.D., and John A.Jane, M.D., Ph.D. Cranial vault growth in
craniosynostosis
Journal of Neurosurgery
February 1989 / Vol. 70 / No. 2 / Pages 159-165
The deformities resulting from premature closure of a coronal,
sagittal, metopic, or lambdoid suture can be predicted on the
basis of the following observations:
1) cranial vault bones that are prematurely fused secondary to
single suture closure act as a single bone plate with
decreased growth potential;
2) asymmetrical bone deposition occurs mainly at perimeter
sutures, with increased bone deposition directed away from
the bone plate;

90. 3) enhanced symmetrical bone deposition occurs
along both sides of a non-perimeter suture that is a
continuation of the prematurely closed suture
4) sutures adjacent to the prematurely fused suture
compensate in growth more than those sutures not
contiguous with the closed suture.

91. • Premature sagittal suture closure restricts growth
in a perpendicular plane, thus the head will not
grow sideways and remain narrow.
• This is best seen in a view standing above the
child looking downward at the top of the head.
• Compensatory growth occurs forward at the
coronal suture and backward at the lambdoid
suture giving respectively a prominent forehead,
called frontal bossing, and a prominent back
portion of the head, called coning.
SCAPHOCEPHALY

93. TRIGONOCEPHALY
• Trigonocephaly is a result from the premature
closure of the metopic suture.
• Using Virchow's law again to predict the
resulting deformity, this fusion will result in a
narrow forehead, which is even further
emphasized by ridging of the suture.
• Compensatory growth occurs at both the
coronal sutures, thereby pushing the forehead
forwards.

95. • The resulting shape can best be assessed
from a top view again, which will reveal a
somewhat triangular form of the head.
• Trigonocephaly is also a Greek derived word,
which can be translated as triangular shaped
head.
• A facial feature of metopic synostosis
is hypotelorism; in the frontal view, it can be
seen that the width between the eyes is
smaller than usual.

96. PLAGIOCEPHALY
Anterior plagiocephaly Posterior plagiocephaly
 Anterior plagiocephaly is a clinical
description of unilateral coronal
synostosis.
 Children born with unilateral coronal
synostosis develop due to compensatory
mechanisms a skew head; a plagiocephaly

98.  Unilateral lambdoid synostosis is also called
posterior plagiocephaly, indicating that this
gives, just like unilateral coronal synostosis, a
'skew head'.
 The difference is that this time, the deformity
mostly shows at the occiput.

100. BRACHYCEPHALY
• BRACHYCEPHALY or a 'short head', is the
result of a closure of both the coronal
sutures.
• Following Virchow's law, this will result in a
child's head with a restriction of growth in the
forward direction and in the backward
direction: recessed frontal bones and a
flattened occiput.
• Compensatory growth will occur sideways,
due to the sagittal suture, and upwards, due
to the lambdoid sutures

102. OXYCEPHALY
• Oxycephaly, also known
as turricephaly and high-head syndrome, is a
type of cephalic disorder.
• This is a term sometimes used to describe the
premature closure of the coronal suture plus
any other suture, like the lambdoid suture.

103. PANSYNOSTOSIS
• Pansynostosis can present in several ways. The
appearance can be the same as that seen with
primary microcephaly: a markedly small head, but
with normal proportions.
• However, pansynostosis can also appear as
a Kleeblattschädel (cloverleaf skull), which presents
with bulging of the different bones of the cranial
vault.
• The condition is associated with
thanatophoric dwarfism

105. •Apert syndrome: an abnormal skull shape, small
upper jaw, and fusion of the fingers and toes.
•Crouzon syndrome: A craniofacial birth
abnormalities with bilateral coronal suture
fusion. Anterior and posterior of skull shortness,
flat cheek bones and a flat nose are their
features.
•Pfeiffer syndrome: abnormalities of the skull,
hands, and feet wide-set, bulging eyes, an
underdeveloped upper jaw, beaked nose.

106. •Pierre Robin syndrome : abnormalities in the facial
skeleton, resulting in a smaller than normal lower
jaw or receding chin. The tongue often falls back in
the pharynges causing difficulty breathing.
•Saethre–Chotzen syndrome: short or broad head.
the eyes may be spaced wide apart and have
palpebral ptosis (droopy eyelids), and fingers may
be abnormally short and webbed.

107. Pfeiffer syndrome Apert syndrome

108. Saethre–Chotzen syndrome

109. Pierre Robin syndrome

110. MICROCEPHALY
• Microcephaly is a medical condition in
which the brain does not develop properly
resulting in a smaller than normal head.
• Microcephaly may be present at birth or it
may develop in the first few years of life.
• Sutures and fontanelles close prematurely.

112. • Infants with microcephaly are born with either a
normal or reduced head size. Subsequently, the
head fails to grow, while the face continues to
develop at a normal rate, producing a child with
a small head and a receding forehead, and a
loose, often wrinkled scalp.
• As the child grows older, the smallness of the
skull becomes more obvious, although the
entire body also is often underweight and
dwarfed.
• Development of motor functions and
speech may be delayed

113. HYDROCEPHALUS
• Hydrocephalus is a condition in which
there is an accumulation of cerebrospinal
fluid (CSF) within the brain. This typically
causes increased pressure inside the skull
• Fusion of sutures is delayed.

115. Symptoms of increased intracranial
pressure may include headache,
vomiting, nausea, papilledema,
sleepiness or coma. Elevated intracranial
pressure may result in tonsillar
herniation, with resulting life-threatening
brain stem compression.

116. • Hydrocephalus can be successfully treated by
placing a drainage tube (shunt) between the
brain ventricles and abdominal cavity.
• There is some risk of infection being
introduced into the brain through these
shunts, however, and the shunts must be
replaced as the person grows.
• A subarachnoid hemorrhage may block the
return of CSF to the circulation.
TREATMENT

117. Anencephaly is the absence of a major portion
of the brain, skull, and scalp that occurs
during embryonic development.
ANENCEPHALY

118. CONCLUSION
The evaluation of the growth and
development of the individual patient is an
important part of orthodontics as a basis of
comparison with the normal as a means of
discovering and diagnosing malocclusion,
and as the foundation for planning
orthodontic treatment.

120. FUCTIONAL MATRIX HYPOTHESIS :
Claims that the origin, growth and maintenance of all skeletal
tissues and organs are always secondary compensatory and
obligatory responses to temporally and operationally prior
events or process that occur in specifically related non skeletal
tissue organs or functioning spaces.