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Sagittal Growth of the Nasomaxillary Complexduring Sagittal Growth of the Nasomaxillary Complex during the Second Trimester of Human Prenatal Development ALPHONSE R. BURDI Department of Anatomy, University of Michigan, A nn Arbor, Michigan Numerous investigations have been re- the 24th weeks or the 2d trimester of pre- ported on the embryonic development of the natal development. Only specimens free human cranium and on the sequential ap- from gross cephalic deformations and fixed pearance, number, and location of primary in 10 per cent neutral formalin were used. ossification centers in component bones of Each head was removed from the body the facial skeleton.'-6 In general, these and sectioned parasagittally, immediately studies were exclusively qualitative and lateral to the nasal septum, in order to non-metric in content. Relatively few at- demonstrate the mid-line anatomical rela- tempts, however, have been made to meas- tionships of the cranial base, nasal septum, ure the changes in size, form, and propor- and palate. The anatomy exposed by this tionality of the upper facial region during procedure was strikingly similar to that human development.7-1i observed in lateral roentgen cephalograms. The purpose of the present study is to The specimens were analyzed indirectly describe the patterns of growth in the cra- through photographic recordings. In each niofacial region during the second trimester photograph a plastic metric rule was placed of prenatal development. For this purpose a routinely on the specimen in the plane of the series of linear and angular analyses of the nasal septum. In order to facilitate tracings, cranial base, nasal septum, and palate have measurements, and statistical analyses, pho- been used. In addition to describing pat- tographic prints were enlarged six times the terns of prenatal nasomaxillary growth, the actual size of the specimen. findings of this study were correlated, when- From each enlarged photograph, outlines ever possible, with reported studies of cra- of the following regions were traced on 0.002 niofacial growth during the neonatal and inch frosted acetate film: (1) sella turcica, early childhood periods. Consequently, the (2) the pre- and postsellar segments of the analyses used herein were adapted from cranial base, (3) the hard and soft palates, cephalometric growth analyses currently nasal and (5) crista galli. recognized in orthodontics (Krogman and (4) the septum, Sassouni).12 Furthermore, this study was DEFINITION OF CEPHALOMETRIC LAND- founded on the concept that growth of the MARKS human body and, more specifically, the craniofacial region is a dynamic biological The following landmarks were located on continuum that begins in embryonic de- each tracing (Fig. 1): velopment and continues through senility. Nasion (N).-the most anterior point in the junction of the frontal and nasal bones Materials and Methods Sella (S).-a point, located by inspection, in the center of the concave sella turcica A series of 24 human fetuses ranging in Basion (Ba).-a point marking the greatest size from 70 through 227 mm. crown-rump convexity of the anterior border of foramen length (CRL) were analyzed. Chronological- magnum ly, this sample represented the 12th through Crista galli (CG).-the highest point on the of This investigation was supported (in part) by Research superior contour crista galli Grants DE 01822-01 from the National Institutes of Dental Septal point (SP).-the most anterior point of Research and by HD 00178 from the National Institute of Child Health and Human Development, National Institutes of Health, the nasal septum Bethesda, Md. Anterior nasal spine (ANS).-the tip of the Received for publication February 24, 1964. anterior nasal spine 112 V;ol. 44:, No. I1 tPRENA TAL GROWTH OF THE NASO. XlAXILLARY COMPLEX 113 Posterior nasal spine (PNS).- the tip of the perpendicular to the palatal plane from an- posterior margin of the palatine bone in the terior nasal spine, ANS, to line S N median plane Middle septal height. height of the middle Uvular point (UP).-- the highest point on the portion of the nasal septum represented by a posterior contour of the soft palate located perpendicular to the palatal plane through by inspection crista galli (CG) and read as the distance from the palatal plane to line SON MEASUREMENTS OF THE CRANIAL BASE Posterior septal height.- height of the posterior Line NIS. length of the anterior segment of portion of the nasal septum represented by a the cranial base from nasion to sella perpendicular from the posterior nasal spine Line SBa. -length of the posterior cranial base to line SON from sella to basion Anterior septal. length.-length of the anterior Line NaBa. length of the basicranial axis from portion of the nasal septum represented by a nasion to basion line parallel to the palatal plane passing Line NS -Ba. -total length of the cranial base through septal point (SP) and read as the Angle N-S-Ba.-angular relationship between distance between the anterior septal height the anterior cranial base and the posterior perpendicular and septal point cranial base read at the intersect of lines Middle septal length.--length of the middle N-S and S-Ba portion of the nasal septum represented by a line parallel to the palatal plane passing MEASUREMENTS OF THF' NASA.L SEPTUUM through septal point and read as the distance Anterior septal height.--height of the anterior between the anterior and middle septal portion of the nasal septum represented by a height perpendiculars F.I. 1-Typical fetal specimen indicating the cephalometric landmarks used 114 BURDI J. dent. Res. January-February 1965 TABLE 1 GROWTH IN LENGTH OF THE FETAL CRANIAL BASE REGION A. Regression and correlation analyses Dimension* Regression Formula Correlation Significance y=a+(bXCRL) Coefficient at 0.01 Level Ant. cranial base .=14.38+(0.69XCRL) .972 Yes Post. cranial base. =27.85+(0.38XCRL) .882 Yes Total base length. =42.31+(1.06XCRL) .962 Yes Basicranial axis .= 36. 42+ (0. 98XCRL) .952 Yes B. Results of the l-test determinations of the significance of difference between absolute growth rates of several dimensions of the cranial base Arithmetic Significance Degrees Comparison(s) between: Difference I at 0.01 Level of of b-Values (I = 2.693) Freedom Ant. and post. cranial base ..... .... 0.31 5.607 Yes 44 Post. and total cranial base ......... .68 8.793 Yes 44 Ant. and total cranial base ..... .... .37 5.056 Yes 44 Total base length and basicranial axis 0.08 0.862 No 44 * Values for linear measurements are X6 the actual value. (This enlargement factor pertains to all linear measurements of the nasomaxillary area including the cranial base.) Posterior septal length. length of the posterior base read at the intersection formed by the portion of the nasal septum represented by a posterior projections of lines ANS-PNS and line parallel to the palatal plane through S-N septal point and read as the distance between the middle and posterior septal height per- Linear measurements were recorded to pendiculars the nearest millimeter, whereas all angular Angle S-N-SP.-angular slope of the antero- measurements were measured to the nearest superior border of the nasal septum measured half-degree. Graphs were drawn with the at the intersect of lines S-N and N-SP cephalometric measurements plotted along Angle S-N-ANS.-angular relation of the up- the ordinate and the crown-rump length per face with the anterior cranial base read along the abscissa. The resultant data were at the junction of lines S-N and N-ANS then subjected to group statistical analyses, MEASUREMENTS OF THE PALATE which included tests for linear regression, coefficiency of correlation, significance of Line ANS-PNS.-length of the hard palate correlation, and the Student-Fisher t-test. from the anterior nasal spine to the posterior nasal spine The population size of this study did not Line PNS-UP.-length of the soft palate from warrant a more sophisticated statistical the posterior nasal spine to the tip of the soft model. It is important to note that this palate (UP) empirical treatment of the data provided a Angle ANS-PNS to Ba-N.-angular relation of more easily understood arrangement of the the palatal plane with the basicranial axis formed by the posterior projection of line data and did not allude to the nature of the ANS-PNS and read at the intersect of line growth processes per se. Ba-N Angle ANS-PNS to S-Ba. angular relation of Results the palatal plane with the posterior cranial CRANIAL BASE.-In this study, the length base formed by the intersection of the pos- of the entire cranial base an- teriorly projected line ANS-PNS with line (N-S-Ba), S-Ba terior cranial base (N-S), posterior cranial Angle ANS-PNS to S-N. angular relation of base (S-Ba), and the length of the basicrani- the palatal plane with the anterior cranial al axis (N-Ba) were significantly correlated Vol. 44, No. 1 PRENATAL GROWTH OF THE NASOMAXILLARY COMPLEX 115 at the 0.01 level with increases in crown- found that the anterior cranial base routine- rump length from 70 to 227 mm. (Table 1, ly contributed more than half of the total Fig. 2). base length, i.e., 54 per cent at 70 mm. CRL, The length of the anterior cranial base 60 per cent at 227 mm. CRL. demonstrated a regression coefficient, i.e., No significant correlation was found be- value b of the linear regression formula y = tween increasing crown-rump length and the a + (bx), of 0.69 units increase per unit in- angular relationship between the anterior crease in crown-rump length. More im- and posterior segments of the cranial base portantly, this regression coefficient was (Fig. 3).
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