This study evaluated age and gender differences in condylar growth and glenoid fossa displacement in French Canadian children and adolescents over 4-year periods. The results showed that: 1) The mandibular condyle grew superiorly between 9.0-10.7 mm and posteriorly between 0.8-1.3 mm over 4 years, with boys exhibiting greater superior growth during adolescence compared to childhood. 2) The glenoid fossa was displaced posteriorly between 1.8-2.1 mm and inferiorly between 1.0-1.8 mm over 4 years, with greater posterior and inferior displacement during adolescence compared to childhood. 3) Both condyl

1. CONTINUING EDUCATION
Condylar growth and glenoid fossa
during childhood and adolescence
displacement
Peter H. Buschang, PhD, a and Ary Santos-Pinto, DDS, PhD b
Dallas, Texas
This study evaluated age and gender differences in the growth of the mandibular condyle and
displacement of the glenoid fossa. The results pertain to longitudinal samples of untreated French
Canadians, including 118 children and 155 adolescents. Childhood and adolescent growth were
described for girls aged between 6 and 10 years and 9 and 13 years, respectively, and for boys
aged between 8 and 12 years and 11 and 15 years, respectively. Four-year growth changes of the
cephalometric landmarks condylion and articulare were evaluated. Mandibular and cranial/cranial
base structural superimpositions were used to assess condylar growth and fossa displacement,
respectively. The results showed that the condyle grew between 0.8 and 1.3 mm posteriorly and
between 9.0 and 10.7 mm superiorly over the 4-year periods; the articulare landmark showed
significantly more posterior and less superior growth than the condylion landmark. Relative to the
cranial base reference structures, the fossa was displaced between 1.8 and 2.1 mm posteriorly and
between 1.0 and 1.8 mm inferiody. The articulare showed significantly more inferior movement than
the condylion. Boys showed significantly greater superior condylar growth during adolescence than
during childhood. The glenoid fossa demonstrated greater posterior and inferior displacement
during adolescence than during childhood. (Am J Orthod Dentofacial Orthop 1998;113:437-42.)
Orthopedic procedures aimed at improv-
ing the profile by protruding or retruding the mandible
are dependent on mandibular condylar growth and
displacement of the glenoid fossa. The condyle, a well
established mandibular growth site,TM serves as the
primary focus of functional orthopedic therapy to
stimulate5-1~or restrict11-13 mandibular growth. Be-
cause the glenoid fossa determines the posterior/supe-
rior limit of the mandible, it holds important implica-
tions for mandibular displacement. 14-a6Both condylar
growth and fossa displacement must be evaluated to
fully understand mandibular growth changes occurring
with or without therapy.
Although we understand condylar growth better
than fossa displacement, controversies remain and
longitudinal reference data are lacking. Baumrind
and coworkers17 recently suggested that condylar
growth remains relatively constant between 8.5 and
15.5 years for both treated and untreated patients.
In contrast, Bj6rkTM observed condylar growth of 3
mm per year during the childhood period, a slight
From the Department of Orthodontics & Center for Craniofacial Re-
search and Diagnosis, Baylor College of Dentistry,
aAssociate Professor.
bVisiting Professor.
Reprint requests to: Peter H. Buschang, PhD, Department of Orthodon-
tics & Center for Craniofacial Research and Diagnosis, Baylor College of
Dentistry, The Texas A&M University System, 3302 Gaston Ave., Dallas,
TX 75243.
Copyright 9 1998 by the American Association of Orthodontists.
0889-5406/98/$5.00 + 0 8/1/82609
decrease to a prepubertal minimum, followed by an
adolescent spurt peaking at 5.5 mm per year at
approximately 14.5 years of age. In their longitudi-
nal follow-up study of 21 patients, Hfigg and Att-
strom19 observed greater condylar growth before
(11.3 mm/3 years) than after the purbertal peak (9.6
ram/3 yrs). Differences in condylar growth between
untreated subjects with Class I and Class II maloc-
clusion also have been described,a5,2~
Although the glenoid fossa position has been
related to malocclusion,a6'23little is known about its
changes during normal growth and development.
BjOrk24indicated that the distance between the fossa
and nasion increases 7.5 mm between 12 and 20
years of age when the landmark articulate (AR) is
used. Concurrent with the elongation of the poste-
rior cranial base, the fossa and the temporal bone
are displaced inferiorly and posteriorly.15 Such
movements are important because the direction of
fossa displacement in treated patients has been
related to their overall growth patterns. ~4
The available information on condylar growth
and glenoid fossa displacement is limited by the lack
of longitudinal reference data based on valid mea-
sures.19 Sample sizes have typically been small and
the age ranges studied restricted. Moreover, no
systematic evaluation has been made of gender or
age effects, which are essential for refining diag-
noses, formulating treatment plans, and evaluating
treatment outcomes. Finally, the use of AR as a
437

2. 438 Buschang and Santos-Pinto American Journal of Orthodontics and Dentofacial Orthopedics
April 1998
~ o- .......... -4
~. ........... 9
I J J I J J I I
6 7 8 9 10 11 12 13
Age (Yrs)
* } Adolescent
}Childhood
I I
14 15
Fig. 1. Childhood and adolescent age ranges accord-
ing to gender.
Fig. 2. Horizontal (Hod, vertical (Vert), and total (Hyp)
fossa displacement.
surrogate for the condylion landmark (CO) remains
questionable. 25
Considering these factors, the purpose of this
study was to (1) describe the longitudinal growth
changes of CO and AR, on the basis of stable
cranial/cranial base and mandibular references
structures; (2) evaluate age and gender differences
in growth movements of the two landmarks; and (3)
compare the growth changes of AR and CO.
MATERIAL AND METHODS
The data were derived from serial lateral cephalo-
grams collected by the Human Growth Research Center,
University of Montreal. They pertain to French Canadian
children drawn from three school districts representing
the different socioeconomic strata of the larger popula-
tion.26Untreated longitudinal samples of 118 children (54
boys and 64 girls) and 155 adolescents (108 boys and 47
girls) were selected on the basis of available and suitable
serial data.
Childhood and adolescent growth phases were estab-
lished on the basis of the estimated ages of peak adoles-
cent velocity of the samples.27Adolescence was defined as
Table I. Condylar growth (mm/4yrs) based on mandibular
superimposition--age and gender differences
Girl Boy
Gender
Measurement Period Mean SD Mean SD difference
CO horizontal Childhood -1.3 2.3 -1.1 2.3 -0.2
Adolescence -1.3 2.8 -0.8 2.3 -0.5
Age difference 0.3 -0.7
CO vertical Childhood -9.4 1.9 -9.0 2.4 -0.4
Adolescence -9.1 2.8 -10.7 3.0 1.6:~
Age difference -0.8 1.8:~
CO total Childhood 9.8 1.7 9.6 2.0 0.2
Adolescence 9.6 2.6 11.0 3.0 - 1.47
Age difference 0.5 - 1.4:~
AR horizontal Childhood - 1.6 2.0 -1.8 2.4 0.2
Adolescence - 1.7 2.1 - 1.9 2.4 0.2
Age difference 0.5 -0.2
AR vertical Childhood -8.1 1.9 -7.8 2.6 0.3
Adolescence -8.2 3.0 -9.5 3.0 1.3t
Age difference -0.3 1.7:~
AR total Childhood 8.6 1.7 8.5 2.1 0.1
Adolescence 8.7 2.7 10.0 2.8 -1.3t
Age difference 0.4 - 1.55
tP < 0.01; :~p < 0.001.
the period 3 years before and 1 year after peak velocity;
childhood was defined as the period 4 years preceding
adolescence with a 1-year overlap (Fig. 1).
All cephalograms were traced and digitized by the
same technician. The analyses described the growth of CO
and AR. CO was defined as the point tangential to the
most superior aspect of the condyle using a perpendicular
to the ramal plane for orientation; AR was defined as the
intersection of the posterior border of the ramus and the
inferior cranial surface. The average of the right and left
images was used to identify the landmarks. Technical
reliability (method error) has been estimated at 90% (0.7
mm) and 92% (0.6 mm) for the horizontal and vertical
aspects of CO, respectively; the horizontal and vertical
reliabilities (method error) for AR were 97% (0.3 mm)
and 94% (0.5 mm), respectively.
Glenoid fossa displacement was described by the
movements of CO and AR using cranial/cranial base
superimpositions. Condylar growth was evaluated on the
basis of mandibular superimpositions. The serial radio-
graphs of the subjects were superimposed using natural
reference structures. 28 The reliability of the mandibular
superimpositions ranged between 94% and 99%; the
reliability of cranial base superimpositions ranged be-
tween 98% and 99%.29 All measures Were corrected for
radiographic magnification.
Horizontal and vertical growth changes of CO and AR
were evaluated using Cartesian coordinates. A horizontal
reference plane, defined by sella-nasion minus 7~ was
used for orientation with registration on sella (Fig. 2). The
horizontal and vertical reference planes were constructed
on the first tracing of each series and transferred to

3. American Journal of Orthodontics and Dentofacial Orthopedics Buschang and Santos-Pinto 439
Volume 113, No. 4
Table II. Fossa displacements (ram/4yrs) based on cranial/
cranial base superimposition--age and gender differences
Gender
Measurement Period differenc~
CO horizontal Childhood -0.3
Adolescence 0.0
Age difference
CO vertical Childhood 0.2
Adolescence -0.5
Age difference
CO total Childhood 0.3
Adolescence -0.8~
Age difference
AR horizontal Childhood -0.2
Adolescence 0.2
Age difference
AR vertical Childhood 0,1
Adolescence - 1.0~:
Age difference
AR total Childhood 0.0
Adolescence - 1.0:~
Age difference
Gid B~
MeanlSD Mean SD
-2.1 1.4 -1.8 1,1
-2.0 1.5 -2.1 1,8
-0.2 0.2
12 1.5 1.0 1.9
1.3 1.5 1.8 2,4
-0.1 -0.7
2.9 1.1 2.7 1,3
2.8 1,3 3.8 1.8
0.3 -0.3
-1.9 1.1 -1.8 1.1
-2.3 1.3 -2.5 1.3
0.3 0,65
2.5 1.0 2.4 1.4
2.2 1.1 3.2 1.4
0.4 -0.7f
3.3 1.0 3.3 1.0
3.4 1.3 4.3 1.4
0.3 -0.7~
tp < 0.01; ~:p < 0.001.
subsequent tracing after superimposition. Total growth
changes were computed as the hypotenuse of the horizon-
tal and vertical movements of the landmark.
All the variables were normally distributed. Paired t
tests were used to compare age groups. Gender differ-
ences were evaluated using t tests. Paired t tests also were
used to compare the growth changes at CO and AR.
RESULTS
Condylar Growth (Table I)
The total growth changes over the 4-year periods
ranged between 9.6 and 11.0 mm and between 8.5
and 10.0 mm for CO and AR, respectively. Superior
growth of the condyles was approximately 8 to 9
times greater than its posterior growth. A large
proportion of subjects demonstrated more than 15
mm of superior growth over the 4-year periods.
Approximately 30% to 40% of the sample showed
anterior condylar growth; 20% to 30% showed
anterior movements of AR.
Boys showed significantly (p < 0.01) more total
condylar growth than girls during adolescence, be-
cause of greater superior growth. The AR values
showed the same pattern of gender differences as
the CO values. No gender differences were noted in
the horizontal movements of CO or AR. Age group
differences were found only among the boys, who
displayed significantly more vertical growth (approx-
imately 1.5 mm/4 years) during adolescence than
childhood for both CO and AR.
Co
13yrs
Ar
I
Fe/l?ales.... 6yr~
-4 mm -2
tam,. Co~ ~ lS-m
1sin / L
14 14
12 12
10 t0
$
4
2
0 Ma~-2z~ 0
-4 mm -2 0
Fig. 3. Condylar growth for girls aged 6 to 13 years and
boys aged 8 to 15 years.
Table III. Growthdifferences (CO minus AR) between
condylion and articulate
Measurement Period
Girl Boy
Difference SD Difference SD
Condylar growth
horizontal Childhood -0.3t 0.1 -0.7"~ 0.1
Adolescence -0.5~: 0.1 -1.0t 0.1
vertical Childhood 1.3t 0.1 1.2# 0.2
Adolescence 0.9t 0.2 1.1# 0.2
Total Childhood -1.3t 0.1 -1.1t 0.2
Adolescence -0.9t 0.2 -0.9"~ 0.2
Fossa displacement
horizontal Childhood 0.2 0.1 -0.01 0.1
Adolescence -0.2 0.1 -0.4t 0.1
vertical Childhood 1.4t 0.1 1.3t 0.2
Adolescence 0.9# 0.2 1.3t 0.2
Total Childhood 0.5t 0.1 0.63" 0.1
Adolescence 0.55 0.1 0.93" 0.1
tp < 0.001; :~p < 0.01.
Fossa Displacement (Table II)
The CO and AR were displaced posteriorly and
inferiorly approximately 3 to 4 mm over the 4-year
periods. Posterior movements of the CO were twice
as great as its inferior movements. It was not
uncommon for adolescents to show more than 5 mm
of posterior fossa displacement. Fewer than 10% of
the samples showed anterior fossa displacement and
20% to 30% showed superior displacements.
Total adolescent movements for CO were signif-
icantly (p < 0.001) greater in boys than in girls,
because of greater inferior fossa displacement. No
significant gender differences were noted in either
horizontal or vertical movements of the fossa. AR

4. 440 Buschang and Santos-Pinto AmericanJournalof Orthodontics and DentofacialOrthopedics
April 1998
-5 mm -4 -3 -2 -1 0
; .... ; .... ; .... ; .... I ' ''~
Co
Ar Female$
-5 =am -4 -3 -2 -1
0 I .... ; .... ; .... ; .... ;,,~,
-1 r~
-2
-3 Co
-5 Malesmm
Ar
0
0
-1
-2
-3
-4
-5 mm
Fig. 4. Fossa displacements for girls aged 6 to 13 years and boys aged 8 to 15 years.
showed significantly greater inferior displacement in
boys than in girls during adolescence. With the
exception of the AR values for boys, which showed
consistently greater posterior and inferior move-
ments during adolescence than childhood, no signif-
icant age group differences were noted in fossa
displacement.
Condylion Versus Articulare (Table III)
Descriptions of condylar growth on the basis of
the amount and direction of movement for CO and
AR were significantly different (Fig. 3). Total
growth of CO was significantly (0.9 to 1.3 mm)
greater than the total growth at AR, because of
differences in vertical growth. AR showed signifi-
cantly greater (0.3 to 1.0 mm) posterior movements
than CO (Fig. 3).
Fossa displacements on the basis of the AR and
CO also were significantly different (Fig. 4). Total
movements over the 4-year period were 0.5 to 0.9
mm greater for AR than for CO. The differences
were primarily in the vertical plane, with AR dem-
onstrating 0.9 to 1.4 mm more inferior movement
than the CO (Fig. 4).
DISCUSSION
One of the most significant findings was that
posterior fossa displacement was almost twice as great
as posterior condylar growth (Fig. 5). The predomi-
nance of fossa displacement over condylar growth
occurred in more than 61% of the children and 65% of
the adolescents. If fossa displacement is greater than
condylar growth, posterior displacement of the chin
might be expected. Because this does not normally
occur, it is theoretically possible that true mandibular
rotation~s'3~plays a more fundamental role in deter-
mining the anterior-posterior position of the chin than
does condylar growth (Fig. 5).
The only other study to evaluate both condylar
growth and fossa displacement reported 1.5 mm
posterior condylar growth and 1.2 mm posterior
fossa displacement for 50 control subjects with Class
II malocclusions aged between 8.4 and 10.6 years.15
The untreated subjects with Class II malocclusions
in that study had greater posterior and less vertical
condylar growth than expected from the results of
the current study, which implies that at least some of
the subjects with Class II malocclusions had condy-
lar growth problems associated with larger gonial
angles, more posteriorly directed ramal planes, and
shorter ramal heights.
The results of the current study are particularly
relevant for patients with Class II skeletal malocclu-
sion (Fig. 6), who have been reported to show
greater than expected posterior fossa displace-
ments. 14'16'23mWhen the observed patterns of vari-
ation are considered, approximately 16% of our
adolescent subjects might be expected to show more
than 4 mm posterior fossa displacement. Therefore
when planning skeletal corrections, posterior fossa
displacements must be added to any existing anterior-
posterior discrepancies and future growth deficiencies.
The observed changes in fossa position suggest
that the existing literature may need to be reevalu-
ated. Although animal studies report that glenoid
fossa remodeling and relocation occur as an adap-
tation to chronic anterior repositioning of the man-
dible,32-34the available human studies remain equiv-
ocal,5-8'1~perhaps because the results of the human
studies are confounded by posterior fossa displace-
ments. 9,14,~5The functional appliance literature may
also need to be reinterpreted if posterior fossa
displacement masks the therapeutic effects on the
condyles.
The results also help resolve controversies con-
cerning age changes in condylar growth. For boys,

5. American Journal of Orthodontics and Dentofacial Orthopedics Buschang and Santos-Pinto 441
Volume 113,No. 4
Childhood
Adolescence
Childhood
Adolescence
-2.5 -2
I I
L__
~ Males
--~ Females
I__
] T
-1.5 -1 -0.5 0
mm / 4 years
[3Condylar Growth 9 Fossa Displacement ]
Fig. 5. Posterior condylar growth and fossa displacement.
the results were consistent with longitudinal studies
reporting greater mandibular growth rates during
adolescence than childhood, as These differences re-
sulted from vertical rather than horizontal growth.
In contrast, no clear age effects were noted for girls.
Baumrind et al.17reported relatively constant rates
of condylar growth between ages 8.5 and 15.5 years
for a sample of 31 subjects, most of whom were girls.
Buschang and coworkers35also showed that rates of
mandibular growth during the preadolescent and
adolescent spurts were comparable for girls.
The vertical condylar growth of our study subjects
was approximately nine times greater than the hori-
zontal condylar growth, as previously suggested.24The
ramus heights showed greater absolute35-37and rela-
tive27 size increases than the corpus length. This im-
plies that previous growth studies38-4~conducted on
the basis of mandibular length, for example, Co-Gn
(gnathion), Co-Pg (pogonion), and Ar-Pg, were pri-
marily describing vertical growth changes at the con-
dyles. Because the efficacy of functional appliance
therapy is commonly assessed on the basis of changes
in mandibular length,71~ the growth vector most im-
portant for a favorable response may not have been
adequately addressed. Assuming a relationship be-
tween growth potential and treatment response,41 a
much greater vertical than horizontal treatment re-
sponse might be expected.
Sexual dimorphism was restricted to vertical
condylar growth. Superior condylar growth and in-
ferior fossa displacement were both greater in ado-
lescent boys than girls. Previous studies describing
condylar growth and fossa displacements have com-
bined boys and girls,5,14-16making comparisons dif-
Fig. 6. Pretreatment and posttreatment tracings of
Class II high-pull headgear patient. Condylar growth
was masked by fossa relocation with minimal anterior
chin displacement.
ficult. Greater vertical facial growth in boys than
girls, however, has been reported37'4a-44and can be
partially explained by the combined effects de-
scribed above.
Finally, the results showed that AR should not
be used to describe either condylar growth or fossa
displacement. On the basis of its proximity, the
condyle serves as a better reference for the glenoid

6. 442 Buschang and Santos-Pinto American Journal of Orthodontics and Dentofacial Orthopedics
April 1998
fossa than does AR. Using AR rather than CO
values will systematically overestimate inferior dis-
placements (Fig. 4). Because of the inclination of
the occipital bone where it intersects with the ramus
to define AR, any posterior movements of the ramus
are necessarily interpreted as posterior and inferior
movements at AR. Similarly, AR underestimates
vertical condylar growth and overestimates posterior
condylar growth (Fig. 3). Such discrepancies will be
most pronounced for individuals showing the great-
est posterior displacement of the glenoid fossa.
Because the glenoid fossa has been shown to be
positioned more posteriorly in patients with Class II
malocclusions than in patients with Class III maloc-
clusions, 16we might expect growth studies using AR
to systematically overestimate condylar growth in
Class III patients and underestimate condylar
growth in Class II patients. Studies using AR rather
than CO to describe condylar growth or fossa dis-
placement may also need to be reevaluated. 45
CONCLUSIONS
1. Posterior glenoid fossa displacement was almost
twice as great as posterior condylar growth.
2. Vertical condylar growth was approximately nine
times greater than posterior condylar growth.
3. Superior condylar growth and inferior fossa dis-
placement were greater in adolescent boys than in
girls.
4. Articulare (AR) systematically overestimates infe-
rior fossa displacements, underestimates superior
condylar growth, and overestimate posterior con-
dylar growth.
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