Underdevelopment of lateral orbital and zygomatic areas.
Facial asymmetry is always seen. Cause is loss of neural crest cells during migration. Cells with longest migration path are most affectedNCCs migrating to lower regions are responsible for the development of major vessels (pulomonary artery, aortic arch, aorta) and therefore they are also affected by failure of migration. For this reason, defects in great vessels is common in children with craniofacial malformation.
Usually accompanied by a cleft palate because the restriction on displacement of the mandible forces the tongue upward and prevents normal closure of palatal shelves.
Not a syndrome with defined cause.Because pressure against the face would not be present after birth, there is possibility of normal growth thereafter and perhaps a complete recovery
Muscular dystrophy ,cerebral palsy ,muscle weakness syndromes lead :to increased anterior facial height.distortion of facial proportions & mandibular form.excessive eruption of the posterior teethnarrowing of the maxillary arch.anterior open bite.
Specific causes of malocclusion
A malocclusion is an incorrect relationship
between the maxilla (upper arch) and the
mandible (lower arch), or a general
misalignment of the teeth.
Malocclusion is said to result due to the
following factors occurring alone or in
1. Specific causes of malocclusion
2. Genetic influences
3. Environmental influences
Disturbances in embryologic development
Growth disturbances in fetal period
Progressive deformities in childhood
Disturbances arising in adolescence
Disturbances of dental development
Defect in embryologic development usually .
result in death of the embryo
Although most defects are of genetic origin, effects
from environment are also important
Chemicals and other agents capable of producing
embryologic defects are called teratogens.
Stages of Embryonic Craniofacial Development
Time in humans
(post-fertilization) Related syndromes
Germ layer formation and
Initial organization of structures
Day 17 Fetal alcohol syndrome (FAS)
Neural tube formation Day 18-23 Anencephaly
Origin, migration and interaction of
Day 19-28 Craniofacial microsomia
Formation of organ systems
Cleft lip and/or palate, other facial
Final differentiation of tissues Day 50-birth Achondroplasia
Synsostosis syndromes (e.g. crouzon’s)
FAS can be traced to the very early first and second
stages of craniofacial development.
Occurs due to deficiencies of midline tissue of the
neural plate very early in embryonic development
caused by exposure to very high levels of ethanol.
Although extreme intoxication is required, the
resulting facial deformity and developmental delay
occur frequently enough to be implicated in many
cases of mid-face deficiency.
Most craniofacial anomalies
are related to neural crest cell
origin and migration.
Since most structures of the
face are derived from
migrating neural crest cells,
interferences with their
migration produce facial
Altered development of
cells derived from neural
crest cells has also been
It is characterized by
generalized lack of
Formerly called hemifacial
characterized by a lack of
development in lateral
Typically there is
deformation of external
ear and ramus of the
associated soft tissues.
Most common congenital defect involving
the face and jaws
Exactly where these clefts appear is
determined by the locations at which fusion
of various facial processes fail to occur
Occurs during the final stage of facial
Arises due to prenatal fusion of the superior
and posterior sutures of maxilla along the
wall of the orbit.
Characterized by severe underdevelopment
of midface and eyes that seem to bulge from
Pressure against the developing face prenatally can
lead to distortion of rapidly growing areas.
For instance, an arm may be pressed across the face
in utero, resulting in severe maxillary deficiency at
Occasionally, a fetus’ head is flexed tightly against
the chest in utero, preventing the mandible from
growing forward normally.
Result is an extremely small mandible at birth.
deficiency at birth
Reduced volume of the
oral cavity can lead to
respiratory difficulty at
One-third of the patients
have a cartilage forming
defect alongwith pierre
robin syndrome, this is
known as Stickler
Use of forceps to assist in delivery might
damage either or both of temporomandibular
Heavy pressure in the area ofTMJ can cause
internal hemorrhage, loss of tissue and a
subsequent underdevelopment of the
Childhood fractures of the jaw
Condylar neck is
particularly vulnerable and
fracture of this area is
Condylar process tends to
regenerate well after early
Problem arises when the
more severely affected side
lags behind in growth or
scarring aroundTM joint
restricts translation of
Facial muscles can affect jaw growth in two
1.Formation of bone at points of muscle
attachment depends upon muscle activity
2.musculature is an important part of the total soft
tissue matrix whose growth normally carries the
jaw downward and forward
Loss of part of musculature is
most likely to result from
damage to motor nerve
Result is underdevelopment
of that part of face with a
deficiency of both soft and
Excessive muscle contraction
can also restrict growth
Conversely, a major decrease
in tonic muscle activity allows
the mandible to drop
Occasionally, unilateral excessive growth of the
mandible occurs in metabolically normal
individuals. Proliferation of condylar cartilage is a
Release of excessive amounts of growth hormone
from an anterior pituitary gland tumor resulting in
excessive growth of mandible.
Congenitally missing teeth
Malformed and supernumerary teeth
Traumatic displacement of teeth
Results from disturbances during the initial stages of
formation of a tooth, that is, initiation and
Total absence of teeth
absence of many but not all teeth
absence of only a few teeth
Abnormalities in tooth size and shape result
from disturbances during the
morphodifferentiation stage of development.
Most commonly malformed tooth is maxillary
Supernumerary teeth also result from disturbances
during the initiation and proliferation stages of
Most common supernumerary tooth appears in the
maxillary midline and termed as mesiodens.
Presence of an extra tooth disrupts normal occlusal
Multiple supernumerary teeth are associated with
Cleidocranial dysplasia, a congenital syndrome.
Trauma to teeth during their formative phase occurs
very commonly in children.
Trauma to primary tooth displaces the underlying
permanent tooth bud.
If trauma occurs during the stage of crown
formation, a permanent tooth with defective crown is
If trauma occurs after the completion of crown, the
crown is displaced relative to the root.