CRANIAL BASE DEVELOPMENT

A FOLLOW-UP X-RAY STUDY OF THE INDIVIDUAL VARIATION IN GROWTH OCCURRING

BETWEEN THE AGES OF 12 AND 20 YEARS AND ITS RELATION TO
BRAIN CASE AND FACE DEVELOPMENT

ARNE BJ~~RK, PROFESSOR,D. ODONT., COPENHAGEN, DENMARK

URING the latter period of the prenatal stage the cranial base, which de-
D velops essentially from the chondrocranium, consists of a number of indi-
vidual bones which possess a certain amount of mutual freedom of movement,.
Because of the articulation between these various bones, the shape of the cranial
base during this developmental period may vary considerably, with a general
tendency to straighten out, which will continue up to the time of birth. Dur-
ing the first years of childhood there is a gradual bending of the cranial base
which continues up to the age of 10 or thereabouts. At this stage, the brain
case has practically reached its final volume and the cranial base is usually
considered to have reached its final shape.lg, =, 23 Considerable age changes
in shape, however, take place also during adolescence, as I have shown previ-
ously.”
Although the literature deals extensively with the variation in shape of
the face and skull, comparatively few investigations have been made to deter-
mine the variations of the cranial base formation in human being+ 2, I6120,29131
and very few deal with the individual development with age,3Tg despite the
general recognition of the phylogenetic importance of the shape of the cranial
base6, 1%12,25,28 Longitudinal studies of human growth have often been treated
in much the same manner as cross-sectional material and hence the individual
variations in development have not been given the prominence they deserve.
The aim of the investigation is to obtain a quantitative estimate of the
magnitude of the individual growth changes during the adolescent period as a
whole and their correlation with the development of the brain case and the
facial structure.
Shape is a function of growth, and the connection between variations in
shape and variations in growth is a question about which relatively little is
known. The present article also takes up this matter for discussion.
MATERIAL AND MODE OF ANALYSIS

The present analysis of the individual variations in the growth pattern of

the cranial base is restricted to the adolescent growth period. The investiga-
Read in summary at the Eleventh International Dental Congress, Scientific Section,
London, July 19 to 26. 1952.
198
 CRANIAL BASE DEVELOPMENT 19!)

tioll is based 011measurementsobtained from orieat,at.edlateral head x-ray films

covering an arbitrary selection of 243 12-year-old Swedish boys who were latet
sub;jtct,ed to a follow-up study using the same method at the age of 20.
A detailed description of the x-ray method employed will be found in
earlier publicationsl~ 2
In order to obtain a well-defined picture of the soft tissues of the profile,
a wedge-shaped aluminum filter was placed between the patient and the film
at the re-examination. A similar filter also may be placed horizontally at, the

Fig. i.-Reference points on lateral head x-ray photographs within the cranial base and thv
brain case.

level of the neck to increase the contrasts of the larynx. A method developed
in order to bring out the soft tissues of the mouth on the film involves the use
of tantalum powder. An application of a suspension of this powder in water to
the tongue and gums serves to produce a sharply defined outline of these parts
on the film, without in any way impeding the function of lips and tongue.
200 ARiVE I,JijRK

E’ollowing is a set of definitions of the rcfcrence l)oi& on the cranial base

and in the brain ca,sewhich I have used for the purpose of s-ray measurements
in this study (Fig. 1).
Art&dare (ar)-Point at the junction of the contour of the external cranial base and
the dorsal contour of the condylar process. (The mid-point is used at double contouring
of the condyles).
Ba~ion. (ha)-The perpendicular projection of the anterior border of foramen magnum
(endobasion) on a tangent through the lower contour of the foramen.
Bregma @)-The junction of sagittal and coronal sutures on the surface of the vault.
Ethmoidale (ethj-The lowest median point of the contour of the anterior cranial
fossa, corresponding to the cribriform plate of the ethmoid bone.
Frontale (f)--h point on the surface of the frontal bone defined by a line projected
at right angles from the mid-point of a line connecting nasion and bregma.
Lambda (Z)-The junction of lambdoid and sagittal sutures on the outer surface of
the vault.
Nasion (n)-The most anterior point of the nasofrontal suture.
Opisthocranion (op)-The most posterior point in MSP on the outer surface of the
vault, defined as the largest distance from nasion (excluding the external occipital pro-
tuberance).
Sella (s)-The center of the bony crypt forming the sells. tureica. The surface of
the sella turcica is determined independently of the contours of the clinoid processes, and
is limited upward by a line from tuber&urn sellae to dorsum sellae. The center is de-
fined as the mid-point of the greatest diameter from tuberculum sellae.
Sphenoidale (sphen)-The uppermost point of tuberculum sellae in MSP.

The shape of the cranial base has been defined in terms of the angles
formed by nasion-sella-basion and nasion-sella-articulare. The slope of the
forehead is expressed by the angle formed by lines joining the reference points
frontale-nasion-sella. The head balance axis is drawn perpendicular to a tan-
gent to the lower contour of the anterior and posterior border of foramen mag-
num, the foramen line. The balance of the head is given by the foramen angle,
formed by the head balance axis and the n-s line (Fig. 1). Linear x-ray meas-
urements are defined in terms of their reference points.
In order to obtain some idea of the development in width, the follow-up
study included dental casts and direct measurements of head and face by con-
ventional methods.
AVERAGE GROWTH PATTERN

For the purpose of growth and developmental studies, the head may be
divided into four distinct zones. These are the brain case, the upper facial
structure, the mandible, and the intermediate zone formed by the cranial base.
In the case of the brain case, the rate of growth of the inner structure is gov-
erned by the growth of the brain. After the age of 10 or 12 years the increase
in size is slight, whereas the facial skeleton, comprising the bones of the upper
facial structure and the mandible, continues its growth up to the age of 20
and beyond. The cranial base, which from a functional point of view may be
regarded as the border between brain and facial structure, is obliged, there-
fore, to develop in conformity with the different growth patterns of the brain
 CRANIBL BASE DEVELOP~IEhT 201

ease and facial structure and, consequently, must follow two different growth
rates, one along its internal surface and another along its external surface.
The mode of growth of the cranial base emerges quite clearly from the
series of cephalometric x-ray pictures, representing the same selection of indi-
viduals at various ages.
Figs. 2 and 3 illustrate the growth mechanism of the cranial base, showing
a comparison of x-ray films taken at different stages of development in which
the nasion-sella line is coincident and commences at the center of sella tur-
cica 8, 9

BU 116 0
3yr ----
8yr __

a 6
Fig. 2.--Growth pattern of the cranial base during childhood, exemplified by two cases: (a)
from 3 to 8 years, (b) from 5 to 10 years of life.

Fig. 3.-Variations in growth pattern of the cranial base during adolescence 12 to 20

years, illustrated by two cases (a) with decreasing and (b) with increasing defleckon of thv
cranial base during growth.

During childhood the anterior portion of the cra,nial base gains in length
by a process of sutural growth and thus keeps step with the growth of the
brain. As the extension of the anterior cranial fossa gradually ceases around
t.he age of 10, the continued longitudinal growth of the upper facial structure
is compensated mainly by the formation of bone tissue on the outer surface
of the frontal bone.
The differentiated growth mechanism of the anterior portion of the cranial
base during the early and late periods of postnatal development is illustrated
in Figs. 2 and 3. The progressive increase in length of the anterior cranial
202 ARNE BJ6Rli

fossa during childhood is the result of a ventral displacement of the frontal

bone as a whole (Fig. 2, a and b). Jt will be seen from the x-ray drawings that
there is a ventral displacement of the outer and inner contours of the frontal
bone, as well as those of the frontal sinuses.
The appositional growth of the bone structure in the glabella region, which
occurs subsequently in order to compensate the continued longitudinal growth
of the upper facial structure during adolescence,is illustrated in Fig. 3, a and
B. The median contour of the anterior cranial fossa will, therefore, largely
remain unaltered between the ages of 12 and 20 years. However, this state-
ment, which will be re-examined later on, is valid only for the ethmoid part.

Fig. 4.-The general growth pattern of the cranial base and the brain case from 12 to 20
years of age in the same individuals. The sample comprises 243 cases.

The ventral bodily displacement of the frontal bone appears to have ceased
at this stage, and the distance between sella and nasion is increased only by
the process of frontal apposition, resulting in the development of the glabella
region and of the frontal sinuses, at the same time as the forehead becomes
recessive. The angle of the forehead, given by the angle frontale-nasion-sella,
has been found to diminish in all the 243 cases examined, with an average
diminution of -3.6 degrees (Fig. 4) and a standard deviation of 1.3 degrees.
Of all the angles measured in the head and face, this is the only one which
exhibited individual changes in the same direction only with age.
All the other angles within the cranial base and the facial structure showed
individual changes with age in both directions, as already indicated in a pre-
 CRANIAL BASE DEVELOPMENT 203

liminary report on the investigation.3 This matter will be brought up for dis-
cussion again in the present article, but it can be stated here that the mean
values of the changes that take place with age will be relatively small, despite
the fact that the individual changes may be considerable.
The growth mechanism relating to the dorsal part of the cranial base is
of a different nature, however. Here the medial region increases in length
due to the growth at the spheno-occipital synchondrosis, the basilar part of
the occipital bone, being displaced dorsally with the result that the distance
between sella and foramen magnum or the reference point basion increases.
The elongation of the frontal and dorsal portions of the external surface of the
cranial base is therefore found to remain sensibly proportional during the
growth period from 12 to 20 years, on an average 5 and 4 mm., respectively, al-
though the increments are due to a different growth mechanism. The relevant
statistical figures are to be found in Table I and are illustrated in Fig. 4.

TABLE I. MEAN VALUES FOR CRANIAL BASE AND BRAIN CASE MRasuREnfENTs AT THE 12-Y1c~r:
(M,?) AND 20-YEAR LEVELS (&J IN THE SAME INDIVIDUALS, THE MEAN OF THE AGE
DIFFERENCES(M,) , AND THE STANDARDDEVIATIONS (s)
____-.--.- .~--~ - ~_..
VARIABLES: I nh I s,, I iv 1 ix,, I s2, / N I M,kt A~.(M) i s,, 1 N ! s,,/s,~
Cmnial base angles (in degrees):
n-s-ba 130.8 4.2 223 131.6 4.5 234 0.7 kO.13 1.9 223 0.45
n-s-ar 123.1 4.6 243 124.2 5.1 243 1.2 ?I 0.14 2.2 243 (I.48
Forehead angle (in degrees):
f-n-s 88.1 3.1 137 84.5 3.2 243 -3.6 + 0.11 1.3 137 0.42
Foramen angle (in degrees):
(head balance 90.4 4.7 171 91.8 5.1 224 1.2 t 0.17 2.2 171 0.47
axis to n-8 line)
Cranial hase dimensions (in millimeters) :
11-s 68.X 2.8 243 73.7 3.3 243 4.9 !I 0.09 1.4 243 0.5u
s-ha 45.2 2.6 219 48.9 3.0 234 3.82 0.12 1.8 219 0.69
Il-I):1 103.9 3.8 219 112.0 4.4 234 8.1+ 0.15 2.3 219 0.61
s-w 34.4 2.9 243 37.6 3.1 243 3.2 C 0.10 1.6 243 0.55
n-ar 92.0 3.8 243 99.5 4.4 243 7.5 2 0.13 2.0 243 0.53
Rrflin ease dimensions (in millimeters) :
f-s 92.3 3.8 13i 94.9 4.3 243 1.5 + 0.10 1.2 137 0.3%
Ilr-s 103.8 9.8 134 106.5 4.6 243 1.3 2 0.12 1.4 134 0.5n
125.6 243
143.i 4.0 121 149.5 E 234 4.0 2 0.20 2.2 1x1
115.4 5.0 138 121.6 5i 243 4.3 -f- 0.15 1.8 138
II-op 196.2 7.2 242
br-1 128.4 7.4 243
N-Number of cases.

The growth increment which takes place in the spheno-occipital synchon-

drosis only serves to elongate the clivus. As a result of sutural growth, how-
ever, a dorsal elongation of the lateral portions of the cranial base and of the
brain case also occurs, parallel with the elongation of the clivus. The sutural
growth appears to remain active in greater or lesser degrees as long as the
facial structure continues to grow. According to Biichi,l* growth of the facial
structure continues beyond adult age, alt,hough the rate of growth may be very
slow. The temporal bone, s.nd with it the glen&l fossn and the mandible, thus
204 ARNE B.JiiRIi

suffers a dorsal displacement in relation to the frontal portion of the cranial

base, effecting a rearward extension of the junction between the cranial base
and the facial structure. The net result of this is a ventral and dorsal increase
in the junction between the cranial base and the facial structure, which causes
the distance between nasion and the jaw joint to increase, on an average by
7.5 mm. The dorsal elongation of the lateral regions of the cranial base has
the effect of bodily displacing the mandible backward, on an average 3 mm.
The posterior and the two median cranial fossae increase considerably in size
in relation to the anterior one, as will be seen from the age changes in the cranial
radii (Table I and Fig. 4). The effect is also to lower the median and posterior
cranial fossae in relation to the frontal part of the cranial base, that is, to the
anterior fossa. The height of the brain case, measured from bregma to basion
thus increases on an average by 4 mm. The marked change in the cranial radii
which takes place during the growth period is too big to be attributed merely
to a thickening of the calva. Comparing the x-ray films reveals that the in-
ternal measurements vary in a corresponding degree, although it is difficult to
establish these measurements for practical reasons. This displacement of the
posterior and median cranial fossae during the growth period may be described
as a lowering of the cranial base periphery around the sella region.131 29 The
petrooccipital and sphenopetrosal synchondrosis may be assumed to have an
effect on the elongation and lowering of the posterior fossa, and also to in-
fluence the growth in width. The lowering of the occiput usually is not ac-
companied by a marked change in the cranial base form (only 0.7 degree +
0.13 degree) as expressed by the angle nasion-sella-basion. This parallel lowering
of foramen magnum produces only a slight increment in the foramen angle
(1.2 degree) so that the balance of the head on an average does not change
appreciably with age. However, there appears to be some racial difference in
this respect.2
The changes in the shape of the cranial base do not appear, in any ap-
preciable degree, to be the result of a raising or lowering of the sella itself
during the growth period, although movement of this kind of the sphenoidale
bone appears quite feasible during earlier growth periods.
The development is also accompanied by a more or less pronounced en-
largement of the sella contour and a raising of the tuberculum sellae on an
average by 1.2 mm., in relation to the n-s line, that is, the center of the sella.
A comparison of the s-ray films of 12- and 20-year-old individuals seems
to indicate less displacement of the head and face outlines with age, if the
center of the sellae is taken as origin, than is the case if they are compared with
tuberculum sellae as origin. It would appear, therefore, that tuberculum sellae
and dorsum sellae increase in size with age by appositional growth, simul-
taneously with the increment in the area of the sellae. This means, in effect,
that the reference line n-s yields less displacement with age than a correspond-
ing line drawn through nasion and tuberculum sellae.
The radius of the brain case, as measured from the center of the sellae to
frontale, shows an average increase of 1.5 mm. and the radius to bregma an
 CRANIAL BASE DEVELOPMENT 205

average increase of 1.3 mm., which indicates that the anterior cranial fossa
also continues to increase somewhat in size beyond the age of 12. This is also
borne out by the fact that the height of the frontal bone, from nasion to bregma,
increases by a greater amount than can be accounted for by apposition at the
glabella (Fig. 4), which results in a posterior displacement of bregma. This
displacement, however, does express itself differently in different individuals,
and in certain cases the previously mentioned radii are found actually to di-
minish in connection with the rotation of the various parts of the brain case,
as will be seen from Table I which gives the sta.ndard deviation of these growth
changes.
An important question in this connection is whether the accumulation of
bone on the outer layer of the frontal bone is accompanied by a displacement
of the nasofrontal suture, upward or downward, resulting in a corresponding
displacement of the n-s line during the growth of the individual. The effect of
this kind of deviation, when added to the variations in the development of the
sellae, cannot be disregarded in individual cases. In 90 per cent of the cases
examined, only a very small change could be detected in the relative position
of the contour of the ethmoid plate (reference point ethmoidale) and the
n-s line, while in the remaining cases the growth change amounted to plus or
minus 1 mm., with only two exceptions, where the difference was 2 mm. This
means in fact that the position of the n-s line is remarkabIy stable in relation
to the deepest median contour of the anterior cranial fossa during this develop-
mental period. The latter contour is found to lie at an average depth of 2.2
+ 0.15 mm. below the n-s line, and its variation from that position, expressed
as a, standard deviation, is 2.4 mm. As this deviation is considerable and the
adolescent growth variation in this case is negligible, it can be explained only
hy variation in growth during fetal life and childhood.
Suumnzary.-The average growth increase in the cranial base between the
ages of 12 and 20 is illustrated by the diagram in Fig. 4, which is based on the
values given in Table I. Summing up these growth changes, we find that thr
cranial base is elongated ventrally, due to a frontal apposition at the glabella
region, but without any appreciable increase in the length of the anterior
cranial fossa. There is a dorsal elongation of the cranial base due to an in-
crement in the length of the clivus, which is accompanied by a dorsal displace-
ment caused bp a sutural growth of the lateral portions of the cranial base and
brain case, forming the two median cranial fossae and the posterior one, together,
with a simultaneous lowering of these regions. In effect, this means that the
temporal bone, and hence the socket for the jaw joint and the mandible, sut
fer a rearward and downward displacement. The over-all flattening of t,he
cranial base is insignificant and the lowerin, e of foramen magnum is virtuall)
,
parallel.
DEVELOPMENT IN A CASE OF ACHONDKOPLASIA

The differential effect of the growth mechanism between the medial anti
lateral regions of the cranial base in a dorsal direction may be illustrated. 11~
a case of an achondroplast,ic dwarf, whose development was followed during
the same period as for the normal sul)jr!cts, that is, I~twccn the ages of 12
and 20 years (Figs. 5 and 6).
In this case the growth in the spheno-occipital synchondrosis had com-
pletely ceased during the growth period in question, with the result that the
clivus had not increased in length. The growth of the lateral regions of the
.

Fig. 5.-An achondroplastic dwarf, 20 years of age.

cranial base have remained active, however, and the temporal bone, and hence
the socket of the jaw joint, has suffered a downward and backward displace-
ment due to sutural growth. The most notable feature of this case is the posi-
tion of the mandibular condyles and the articular tubercle on the one hand and

Fig. L-The growth pattern of the cranial base from 12 to 20 years in a case of achondroplasia,
shown in Fig, 5.

the contour of the clivus at adult age on the other (Fig. 6). The length of the
cranial base from nasion to the condylar head at adult age was only 1 standard
deviation less than the average. The angle formed by sella-nasion-basion is
2 standard deviations less than the average value ; clivus’ length and the over-
all length of the cranial base, however, are 4 standard deviations less.
 CRANI$L BASE DEVELOPMENT 207

This case, therefore, serves clearly to illustrate the concepts of the dif-
ferential development of the various parts of the cranial base. Normal growth
and development of the spheno-occipital synchondrosis is essential for a har-
monious development of the cranial base, whereas its influence on the develop-
ment of the cranial base as a whole in my opinion is greatly overrated.

INDIVIDUAL GROWTH VARIATIONS

The general growth pattern described in the preceding is particularly

useful when comparing the development tendencies of different populations.
However, comparing average values based on figures obtained from different
age groups will not provide any information about the dynamic development’,
which can be ascertained only by analyzing individual development, that is,
the growth pattern of the individual.3y I51w
Form.-The cranial base has been considered to remain constant, in shape
from the age of about 10 or 12 years and onward. As already pointed out,
however, individual age changes in the shape of the cranial base also take
place during adoIescence up to adult age, and are quite marked. According
to Table I, the age changes which take place in the cranial base angle nasion-
sella-basion from 12 to 20 years have a standard deviation of no less than 1.9
degrees, with a variation range of 10.5 degrees. In other words, the cranial
base angle tends to widen in some cases and in others it closes (Fig. 3, II
and b).
The individual development in form of the cranial base from I2 to 30
years for t,he whole sample studied is illustrated by t,hc regression diagram
in Pig. ‘7. The regression coefficient b 2,,,12is 0.98 degree, which value does not
significantly differ from 1.0 degree. This means that the age changes are
the same, irrespective of the shape of the cranial base at 12 years. The
individual variation in development within the limits plus or minus 2 standartl
tleriations ilroulid the regression line is denoted by the dotted lines in the
tliagram.
Age changes in cranial base form may be expected to take place as long as
the growth process of the head and face continues, as discussed in t.he pre-
vious se&ion of this article.
The range of this age change constitutes 45 per cent of the range of variation
at the age of 12 and is given by t,he quotient, ~n/s,~ in Table T, expressed in per
cent. Expressed by this quotient, the age changes in the cranial base form ar(
proportional to those calculated within the facial struct,ure.
Size.-It, will be seen from Table I that the individual range of the varia-
tion in linear increment with age in cranial base and brain case dimensions is
proportional to the range of variation in size at the 1% yea.rs of age level, bum;
to a varying magnitude for different groups of determination. The quotient
su/slZ is used as a handy expression for this relation. The quotient is smallest
for the radii within the brain case, measured from sella to frontale and tc,
bregma, as might be expected due to the early development of the brain, the
values bring 32 per cent and 36 per cent, respectively. Within the cranial base
the JNOSt marked individual variation in growth is in the length of the c+livus
(69 per rent), while t,hat of the measurement sella-nasion amounts to 50 I)et
cent (Table I).

Cranial base angle 1,’ 1

zoyr n-s -ba 4 1
Degrees
142 - ---I- ,’ ” ’
243 cases I/ 1
,'
1,
140 __
I,/'1 1 1
,
132 ,'1 2 i
J
I
I/ 4 3 1 1 ,I'
/
1.34 / I 2 3 1 3 /'
/
1' 5 4 2 1 1 A'
/ ,
134 / ' 1 1 3 I'

,A 8 2 e 1 1 /:
I
132 /I' , 133 , 41 2/'

4 743 5 3 ,'
I
160 1 ,4 1 2 6 5 2.'
/ I 3 1 1 1 I’
/
/
128 / 2 1 2 2 3 A' I
_

/ 2 1 r = 0.31
I
, b - 0.93
124 _
1 1
,

122

Fig. i.-Distribution of the cranial base angle, nasion-sella-basion, at 12 and at 20

years of age in the same individuals. The dashed lines indicate the dispersion of the age
changes around the regression line within the limits txvo times the standard deviation
(s,/x = sy. \/ l-r’).

The thickness of the frontal bone at the glabella is, on an average, 10 mm.
at I2 years and 15 mm. at 20 years, with a standard deviation of 2.2 mm. and
2.8 mm., respectively. The gain in thickness with adolescence is considerably
greater in cases where the thickness exceeds than where it is less than average
at 12 years. This is borne out by the fact that, the regression coefficient, bzo,Iz,
calculated from the regression of the values at 20 on the values at 12 years,
is 1.12 mm., which figure differs significantly from 1.0 mm. This mode of
periosteal growth at the glabella region will reflect also the gain in length of
the anterior cranial base. The coefficient bno,Ia for the distance n-s is ea.]-
 CRANIAL BASE DEVELOI’MES’I 209

culated to be 1.09 mm., which value also differs significantly from 1.0 mm.
The adolescent gain in length of the dorsal portion of the cranial base (s-ba.
s-ar) or of the total length (n-ba, n-ar) is, on the other hand, independent 01
the prepubescent size.
Summary.-The analysis of the individual growth changes indicates that
changes in the shape of the cranial base with age are a norma, occurrence alsta
during adolescence and that in individual cases such changes may assume im.
portant proportions and that they may differ individually as regards magni,.
t,ude and direction. The shape of the skull and facial structure is influence{1
by a multitude of variation factors, all of them correlated in great*er or lesser*
degree. The growth pattera of the individual is determined by the mannr~*
in which t,hese growth variations are correlated. In a following section thr
coordination in shape of the cranial base and that of t.he brain case and the
facial structure will be discussed. As the relation between age changes in for*r:t
and size is of great interest, this relation will 1~ analyzed in more detail an<I
on a broacler hasis in the following s&ion.

GROWTH ASD l?ORJL

Individual Variation.-A numerical value of the individual growt,h vari-

ation in the sample studied is to be found in the standard deviations of t,he
calculated age changes (sn). It will be seen from Table I that these values
are appreciable for all the features studied in the cranial base and the braiti
case. This applies in general to both angular and linear measurements. ai-
though the values do vary for different regions.
For the sake of completeness, the same values relating to the facial strm-
ture have also been included in the following discussion, and also det~ermina-
tions of the bite development (Figs. 8, 9, and loj. For the face and bite the
variations of the different determinations are given in the diagrams only. In
the case of the cranial base angles, the foramen angle, and the various facial
angles, the value of the quotient sn/sIZ lies between 0.45 and 0.65. The range
of the variation in form with growth thus roughly amounts to 55 per cent
(45 to 65 per cent) of the range of variation in form at 12 years, as far as the
cranial hase and the face are concerned. The magnitude of the variation in
forrn (slZ). in other words, is definitely related to the magnitude of the indi-
vidual age changes in form (sn), as illustrated in Fig. 8, u (heavy line). If
the variation of a certain feature is known, it is therefore possible to assess
the range of the individual growth variation with a fair degree of accuracy,
as indicated by the regression calculations. The figures related to the bite (1~
velopment (dotted line) will be discussed lat,er.
The relationship between variat,ions in size and variations in linear growl h
increment within the cranial base and the facial structure is illustrated in a
diagram in Fig. 8, b. The quotient sn/sls for linear determinations within the
cranial base and face is, on an average, 0.65 (0.50 to 0.83). This denotes that
the range of the increment in size with age during adolescence is roughly 65
per cent of the range of variation in size at 12 years of age, varying from IX)
to 83 per cent. It will be noted from the regression calculations in Fig. 8, 1)
210 ARNE RJijRK

/
6 Form /L/

/
/
x /
/

/
x /

a95 Px’ 0.97

b.9 0.52 b,3 0.89
s
( 12

2 3 4 5 6 7 8
fig. 8:

2 3 4 5 6
fig. 8k
Fig. %-The relationship between the Standard +w.iation for different determinations
at the 12 years of age level (sn) and the Standard flevlatlons for the individual age ch+geS
between 12 and 20 years for the same determinations (SD) : (a) angular and (b) lmear
determinations. Determinations within the face and cranial base are denoted by dots ( ) :
within the bite by crosses (x).
that the relation between variation in linear increment (SD) and variation in
size (sl,) is as reguIar as was the case for the form, as discussed previously.
Average Change in Form and Size.-If the range of the age changes in form
during growth tends more in one direction than in the other the average form
will change somewhat with age. For instance, the jaw angle in the present
material is found to decrease on an average by 3.4 degrees between the ages of
12 and 20. The range of the individual age changes, however, was found to
vary between +5 and -12 degrees, with a calculated standard deviation of 3.1
degrees (1‘ig. 14). In one case there was found to be an extreme openin? of
the jaw angle, amounting to 11 degrees.
If, on the other hand, the growth changes are uniform in magnitude 51
both directions, t,he mean value will remain unaffected with age. It does not
follow that the individual variation in form with age is less for that reason.

SD Form sD Size

x
*

*I

.X x .
. .* l

.
x I-= 0.86

b= 0.76

, MD (yp
f 2 3 4 -. 2 4 6 8 10 f2 I4 16
fig. 90 fig. 9b
Fig. 9.-Relationship between the displacement of the mean values from 12 to 20 year:;
(MU) and the standard deviations for the individual age changes (SD) : (a) angular ano
Cb) linear determinations. Determinations within the face and cranial base are denote<1 b)
dots ( . ) ; within the bite by crosses (x).

The independence of the magnitude of the individual age changes in form (SD’)
and the change in average form with age (MD) is illustrated in the diagram on
Fig. 9, u.
The range of the linear increment with age (SD), on the other hand, is, as
expected, directly proportional to t,he average increment in size (MD) as shown
in Fig. 9, b.
 086

014

a,2

0'
*r -xc
-0,2 x c: 0.83 ‘x’ (0.56)

-O? x

2 3 4 5 6 7 2 3 4

Fig. lO.-Relationship between the standard cleviations for individual age changes (sn)
and the increasing variation from 12 to 20 years (SW - 812). CL, Form (angles) ; b, size (lineal
(leterminations). Determinations within the face and cranial base are denoted by dots ( . ) ;
within the bite by crosses (x).

Increased Variation With Age.-Because of the individual difference in

growth change, as regards both form and size, the standard deviation increases
somewhat with age for all measurements within the cranial base and the facial
structure. Thus, the values of sZoare in all determinations greater than those
for sI?, for both linear and angular measurements. This means that the varia-
tion in form and size increases somewhat with age and that this increase is cor-
related with the magnitude or range of the individual age changes. The con-
nection between the range of the age changes in form (sn) and the increase
in variation in form with age (s~,,-s,~) is illustrated by the regression calcula-
tion based on angular measurement in Fig. 10, a. The same relation is found
also for linear measurements, as illustrated diagrammatically in Fig. 10, 71.
The increment in the variability with age in form as well as in size is not
very pronounced, but nevertheless significant, as sample differences are here
excluded.
Afodification in Form With Age.-Age changes in the bite are, as referred
to previously, of a totally different order of magnitude, as regards both form
and size (angular measurements to the occlusion plane, of the inclination of
the incisors, etc., and the dimensions of dental and alveolar arches). The
range of the age changes in the bite form in relation to the variation at the age
of 12 for different determinations is found to vary between 55 and 85 per cent.
The regression diagram in Fig, 8, a (dotted line) illustrates clearly that the
range of the age changes t,hat occur in the bite form is out of proportion to
 CRAKIAL BASE DEVELOPMEiST “13

those in the facial structure as a whole, and indicates that changes in the bite
with age lie outside the regression for age changes in the facial structure and
the cranial base. It serves clearly to indicate t,he fact that the development
of the dental and the alveolar arches not only reflects the general growth
tendency of the case in question, but that this development is also to be in-
terpreted as the result of modifications or secondary changes in the shape.
;Modifications of this kind, both dysplastic and compensatory, occur in all di-
mensions of the bite and their effect is to increase considerably both the varia-
tion in form and the range of its age changes. This may explain the tendency
toward positive excess in the distribution of some bite determinations. It Sol-
lows, therefore, that variation in bite or dental arch form is not only a direct
consequence of variation in growth and therefore cannot be analyzed as such.
as has often been done.
It already has been pointed out in recent publications that in the case
of certain properties of the bite the previously mentioned compensatory
changes are greater than the dysplastic ones during the adolescent, period in
question.‘, 5 As a result of this, a certain skewness becomes evident in the
distributions. The increased variation in bite form with age is, for the same
reason, proportionally smaller than for facial determinat,ion and in the case ot’
certain properties the variation is even found to diminish, as illustrated irk
Fig. 10, n (for example, for the sagittal relation of the alveolar arches, expressed
by the angle prosthion-nasion-infradentale) . This can be explained as an ef-
feet of compensatory modification.
These notes on the development of the l)ite have been included because
they serve to illustrate the influence of functional forces, especially those g,f
the soft tissues, on the development of the alveolar a,nd dental arches.I’ Th(b
extent to which such factors influence the normal development of the head ant1
face as a whole is not easy to determine. although it is appreciable in certain
cases of dysplastic facial growth.
DEFLECTIONAL CHANGES IN CKASIAI, BASE FORM

The growth mechanism of the cranial base has been examined in the pres-
ent article with special reference to deflectional changes, as this is a questiorl
which, in addition to its general interest, is of prime importance in uncles..
standing the occlusal age changes that take place in the bite.
Fig. 3 illustrates the growth pattern of the cranial base in those eases
which show the greatest increase in the cranial base angle (5 degrees) anti
t,he great,est decrease in the same angle (-5.5 tlegrees). In both cases the con-
t,ours of the anterior cranial fossa on the x-ray films are found to be coinci-
denl at the ages of 12 and 20, whereas the clivus in the first case is found t,o
ha.ve swung backward and in the second case forward. The increased forwarcl
inclination of the clivus (Fig. 3, b) is also ac*companied by displacement of tht!
temporal bone and hence of the glenoid fossw. in a ventral direction, which i!I
the diagram is marked by the points articulare ant1 by the contour of the :)I”-
ticnlar tubercle. There also ha.s been a concurrent lowering of foramen map-
11utn, tlntb to a lowering of the occ4pital botlcl which has eft’ected the balance’
of the head on the spinal column. E’ig. 3, o illustrates the opposite sequence
of events, in which the clivus has been deflected rearward, accompanied by
a rearward and upward displacement of foramen magnum and of the glenoid
fossa.
Relation to Brain Case.-The cases mentioned previously represent the ex-
treme variants in the material. In order to obtain a more generally valid pic-
ture of the deflection of the cranial base and the manner in which it varies with
the development of the brain case, the age changes in the cranial base angle
nasion-sella-basion have been correlated in Table II with the age changes for

TABLE II. RELATIONSHIP BETWEEN CRANIAL BASE DEFLECTION AND IIEAD FORM

VARIABLES, CORRELATED WITH AGE CHANGES BETWEEN 12

THE NASION-SELLA-BASION AT 20 YEARS AGE LEVEL AND 20 YEARS
ANGLE r20 ID
Cranial base angle:
n-s-ar 0.89 0.86
Forehead angle:
f-n-s 0.26 0.28
Foramen angle:
(head balance axis 0.38 0.22
to n-s line)
Cranial base dimensions :
n-s ‘yg’ (-0.12)
s-ba ‘-cg’
n-ba 0:22
s-ar -0.25 '-pi'
n-ar 0.22
Brain case dimensions:
f-s ‘“,.“1f$’ (0.01)
br-s (0.01)
I-s 0:21
br-ba -0.19 -0.20
n-hr (-0.12)
II-0p ‘%~’
hr.1 (-0.10)
The deflection of the cranial base, expressed by the angle nasion-sella-basion. is in the
first column correlated with the head form at the 20 years of age level (rzo). The second
column gives the correlation between the age changes in the cranial base angle and the age
changes for the different head determinations between 12 and 20 years (ml.
Insignificant values (P>O.O1) are in brackets.

each of the determinations which here have been selected as expressions of the
development of the cranial base and the brain case (m). The appropriate
correlations between the values of the cranial base angle nasion-sella-basion
at the age of 20 and the other determinations made for the same age are also
given in the same table (rZO). It should be noted that the values for rD and
rZO agree remarkably well and it may be concluded from this that the cor-
relation between values representing a certain stage of development is also
an expression of an interdependence in development during growth. It should
be noted from Table IV that values of rn and rZo for different variables within
the facial structure exhibit comparable agreement. Coordinated variation in
shape is an expression of the coordinated variation in growth. A more thor-
ough knowledge of this relationship would be particularly valuable for the pur-
pose of analyzing the craniums of extinct populations in order to get an es-
timate of the individual variation in development. It is also a.ppropriate to
 CRANIAL BASE DEVELOPMElVT 215

mention here that the functional modifications in form already referred to

will be found to complicate the correlation analysis of the development of the
lGte.5
The diagram in Fig. 11 has been specially constructed in order to illus-
trate the way in which variations in the shape of the cranial base are tied up
with the development of the brain ease,in this case at the 20 years of age level.
In this diagram the general shape of the cranial base and the brain case for
the twenty-three cases showing the greatest flattening of the cranial base,
expressed by the angle nasion-sella-basion, is compared with the average shape
of the twenty-three cases in which the cranial base shows the greatest degree

Fig. Il.-The covariation between cranial base deflection and brain case rotation. The
drawings are constructed from mean value calculations at the 20 years of age level, from
cases with pronounced deflection compared with cases where the cranial base is flattened,
each group comprising twenty-four cases (10 per cent of the sample).

of bending. Each of these groups represents 10 per cent of the material col-
lected. The significance of this interdependence in development of cranial base
and brain case has been further determined by correlation calculations, based
on the entire material (Table II). Fig. 11 illustrates the tendency of this
interdependence and, according to Table II, it is of the same order for the 20”
year stage as for the growth changes. Consequently, the diagram is also
indicative of the interaction during growth.
It will be seen from Fig. 11 that the shape of the brain case varies con-
siderably in relation to the shape of the cranial base. A flattening of the
216 ARNE BJiiRli

cranial base is usually accoml)anied by reduced height of the brain case, as

measured from basion to bregma. On the other hand, the radius of the brain
case, measured from sella to bregma, is greater, whereas the radius from sella
to basion is greatly reduced. The posterior and median cranial fossae arc
therefore raised in relation to the anterior one. It should be noted that the
distance measured from the reference point ethmoidale to the n-s line does not
vary in relation to the angular deflection of the cranial base (rzO = 0.0). Ro-
tation of the brain case, therefore, does not appear to cause any raising or
lowering of the anterior cranial fossa. This rotation of the bones of the brain
case results in a rearward and upward displacement of the foramen magnum
and causes the foramen a,ngle to widen. As the natural balance of the head on
the spinal column ‘depends on the location of the foramen magnum, a flattening
of the cranial base usually will have the effect of tilting the face upward. In
a similar way, Negroid races, such as the Bantus, carry the face tilted up more
than Europeans, which gives the impression of greater facial prognathism than
is actually the case.2 The alveolar prognathy, on the other hand, is more
marked in Negroes.
The change in the shape of the cranial base is more intimately correlated
with the development of the posterior and median cranial fossae than with
that of the anterior. The radii of the anterior cranial fossa (n-s, s-f, s-br) do
not show any statistical evidence of significant correlation with the shape of
the cranial base. The angle of the forehead, however, shows positive correla-
tion with the cranial base angle (r2,, = 0.26, rn = 0.28) which, as will be seen
in Fig. 11, indicates that the rotation of the bra,in case to some degree also re-
flects the position of the frontal bone.
The interaction in the rotation of the cranial base is evident in its medial
and lateral regions. The two cranial base angles, nasion-sella-basion and
nasion-sella-articulare, are thus closely correlated, as regards both magnitude
and growth changes (Table II) and are both associated with a rotation of the
brain case and the facial structure. The center of this rotation is in the medial
part of the cranial base to be found in the clivus region, the chondral growth
of which may be regarded as a structurally essential feature, allowing the
synchondrosis to act as a joint (Fig. 3, a and b) . The rotation due to sutural
growth of the side elements of the cranial base, on the other hand, does not occur
around any fixed center, as it is the result of a mutual displacement of the
individual parts concerned. Its effect is a downward and backward movement
of the temporal bone in relation to the frontal bone.
Direct anthropologic measurements of the head and face are available
only at the 20 years of age level. It will be seen from Table III that there is
no correlation between the cranial base angle, measured from the x-ray plates,
and the direct measurement of the length or breadth of the head, width of the
cranial base, or width of the facial structure. On the assumption that inter-
dependence in the development of shape signifies interdependence in growth,
it therefore may be concluded that growth changes which ta,ke the form of
cranial base deflection during the period of adolescence are not related with
variations in development in width of the cranial base, in every case not to any
marked degree.
 CRANIAL BASE DEVELOPMENT 2117

TABLE III. DIRECT DETERMINATIONS AT TIIE 20 YEARS OF AGE LEVEL

-_~ I__.
.-.. -
VARIABLES (MM.) I rzo __~__ MZO I %J ! N
.-
Head :
Length : glabella-opisthocranion 196.9 i.0 243
Height: porion-apex, projected in MSP 131.3 6.1. 241
Width : euryon-puryon 0.0 151.3 5.5 24:‘;
Cranial Rase :
Width : biauricular $0 133.0 4.i 180
Pace :
Width : bizygomatic 0.0 137.3 4.9 243
higonial 0.05 107.0 a.
-6 t’4:!
bicondylar 0.0 131.6 6.1 231
____-_-
~_.__ ____
Mean (Mzo) and Standard Deviation (SW). The correlation between the different determi-
nations and the cranial base angle, nasion-sella-basion. is given by the value of t%.
N-Number of cases.

Belntion to Head BaZances.-The rotation of the cranial base is also inter-

linked with a rotation of the facial structure. The facial prognathism suffers
an average reduction, as regards both the maxilla and the mandible, when th(A
crania.1 base flattens 0ut.l In the present article this interaction is indicated
by the correlation calculations given in Table IV and by the example of actual
cases in Fig. 12. In retrognathic cases the cranial base is often found to by
flattened with the effect that the head is carried with the face tilted upward

cl b

” 29

Fig. 12.-X-ray tracings of two 20-year-old individuals reDresenting : (a) maximum and (7))
minimum facial prognathy. The drawings are oriented with the n-s line horizontally.

and with the forehead in a recessive position. The balance of the head, there-
fore, is largely determined by the location of foramen magnum, as shown
in Fig. 13. However, it should be noted that in the case of retrognathy the
forehead is not recessive in relation to the cranial base, rather the contrary
 218 ARNE BJijRIi

TABLE IV. CORRELATIONS BETWEEN CRANIAL BASE FORM AND ANULES OF FACIAL PROG~ATI~Y

MAXILLARY PROGNATHY MANDIBULAR PROGNATHY

(SELLA-NASION-SUBSPINALE) (SELLA-NASION-POGONION)
__- --
CRANIAL BASE ANQLES rD rzo rD rm
n-s-ba -0.37 -0.35 -0.33 -0.37 -.
n-s-ar -0.34 -0.37 -0.31 -0.36
--
x+-Between-age changes: r-220,= at the 20 years of age level.

(Table I). Retrognathy and bulging forehead are two properties that are as-
sociated with flattening of the cranial base, although they do not appear to be
mutually closely coordinated. The angle of the forehead and the angle of
maxillary prognathism, sella-nasion-subspinale, are negative but not signifi-
cantly correlated (rzO = -0.14, rD = 0.04).

Fig. %-Photographs of the same persons as in Fig. 12, with the heads in free or natural
balance.

It may be concluded from the preceding that the rotation of the cranial
base is associated with the rotation of both the brain case and the facial struc-
ture, a development which appears to be the result of interaction between a
number of growth processes and which appears to have a wide range of indi-
vidual variation.
ASSOCIATION WITH THE FACE AS A WHOLE

Mandible.-The shape of the cranial base is related to the protrusion of

uboth the upper and lower jaws, which is indicated by the correlation figures
given in Table IV, as mentioned previously. As far as the mandible is con-
cerned, this is readily evident, as any change in the shape of the cranial base
will have the effect of displacing the glenoid fossa in one direction or another
in relation to the frontal part of the cranial base, and this movement will di-
rectly affect the degree of protrusion of the mandible (Fig. 3). The marked
change in the shape of the cranial base that occurs during the fetal stage is
quite evidently related to the change in mandibular protrusion, but this rela-
tionship has not yet been analyzed in detail.
 CRANIAL BASE DEVELOI’MENT 219

The total protrusion of the mandible in the profile is dependent on its

growth increment in length at the condylez4* 26 and its direction, as well as on its
bodily displacement,l> 3 due to sutural growth of the cranial base.
The growth direction at the condyles will influence the general shape
of the mandible (Fig. 14). An upward direction will increase the ver-
tical height (E‘ig. 14, a). A backward direction will increase the sagittal length
(Fig. 14, b). The changes which take place in the gonial angle with age will
depend on the amount of condylar growth, as well as on its growth direction.
in relation to the amount of appositional growth at the genial angle. Tht
gonial angle is thus more varying in shape with age than any other of the
facial structures analyzed in this sample.

(v U7) !2yr---- (V 198)

a 2Oyr - b
Fig. 14.-Individual variation in mandibular growth pattern ; a illustrates a case with a
vertical direction of the condylar growth (1) ; (b) a case with horizontal growth direction
The amount of growth at the condyle (1) and at the gonial angle (B) is about the
k%e in both cases In a, the gonial angle is closed with age ; in b, it is opened. The reduced
alveolar prognathy’in b is a compensatory effect due to soft tissue modeling.

Maxilla.-The relationship between cranial base form and maxillary pro-

trusion is more complicated. In human beings, the premaxilIary suture does
not appear to influence the longitudinal growth of the maxilla, its body in-
creasing in length mainly in the dorsal direction, toward the vertical pla,te of
the palatine bone, while the maxillary tuberosity is simultaneously incre-
mented by apositional growth. This sutural growth brings about a forward dis-
placement of the maxillary body. The ventral displacement of the maxilla is ac-
companied by a posterior lowering of the maxillary corpus due to the growth be-
tween the palatine bone and the pterygoid processes. The palatine bone therefore
appears to play the role of a growing wedge between the maxilla and the
sphenoid bone, having for its chief function a dorsal lowering of the maxilla.
The rear end of the maxilla is lowered almost vertically. on an average.l, ‘JlJO
However, individual variations are to be found in both directions so that in
some cases the vertical growth has a forward, and in others a rearward, com-
ponent3 These differences in development are illustrated by the extreme
variants in the present sample (Fig. 14, a and b), from which it will be seen
that this development is associaterl with the cha.nges in t,he shape of the eraniial
Imse.
220 ARX‘E RJiiRK

On x-ray films the rear end of the maxilla is usually marked by a well-
defined reference point which may be termed pterygomaxillwre (pm) and
which can be seen in Fig. 15. The sagittal displacement of the maxilla may be
measured from this point parallel with the n-s line. The sagittal displacement
with growth, measured in this way, is correlated with the age changes in
the cranial base angle nasion-sella-basion (rn = -0.33). The int,erdependence
between the rotation of the clivus and the direction of the growth of the max-
illa is to be regardecl more as a coordination in growth than as a result of
mechanical interaction. The lowering of the maxilla is partly a process of
apposition and resorption of the nasal floor7 and partly connected with the
sutural growth of the upper facial structure.‘4J *I, x Rotation of the lateral

V 1328 v 1776
Y22yf---- 12yr -=--
2OYf -
‘\

a b
Fig. 15.-Growth pattern from 1 2 to 20 years in two cases, representing (a) downward-
backward and (b) downward-forward growth direction of the maxillary corpus. (The measur-
ing point pterygomaxillare [pm1 is deflned as a lateral point, representing the dorsal contour
of the maxilla at the nasal floor level, projected in MSP. The point is located on the dorsal
contour of the maxilla, upwards forming the anterior border of the pterygopalatine fossa,
where it intersects the contour of the hard and soft palate.)

parts of the cranial base, however, may be transmitted through the zygomatic
bone of the maxilla and have a direct mechanical influence on the direction
of this vertical lowering of the upper facial structure.l
The general configuration is thus related to the cranial base development
of the face as a who1e.l
The manner in which the amount and direction of growth of the cranial
base! the mandible, and the upper face are accommodated varies in different
primates. In the baboon the dorsal elongation of the cranial base is not very
marked and the condylar growth of the mandible is directed backward. The
protrusion of the mandible, therefore, increases considerably with growth. In
the gorilla, on the other hand, the dorsal part of the cranial base increases
considerably in length with growth in combination with a marked flattening.
This mode of growth retracts the mandible. As the condylar growth is di-
rected upward, the protrusion of the mandible is less marked.
 CRANIAL BASE DEVEIJOP~~EST 221

THE N-S LINE AS A REFERENCE LINE

For the purpose of comparing, on a uniform basist the variations in shape

of the facial bone structure and the skull in different, individuals and racial
groups, a multitude of reference lines have been employed by different au-
thors, these lines being drawn within the facial structure or through the
cranial base, or through both.” Provided that the object is to establish :I
reference line which may be readily defined anatomically and which will serve
for comparison of the shape of the skull and face, the choice of such a lint,
may be made fairly arbitrarily. This has been the case in classical anthropol-
ogy and t,he best known of such reference lines is undoubtedly the Frankfort
horizontal which may be readily identified on craniums.
If, on the other hand, the primary ohjwt is to choose a reference limb
which is suitable as a starting point in the study of individual facial develop-
ment, the problem assumes a different character. A line must be so chosen t.haf:
it conforms as far as possible to the growth zones of the skull.
Cephalometric x-ray films taken at different stages of development in the
individual reveal structural changes in each separate detail. The manner in
which the x-ray films are collated to yield a growth pattern embracing all the
various regions will depend materially on the choice of re-ference line. The
cranial base seems to be an obvious starting point for the purpose of com-
paring different stages of development, from both an ontogenetic and a phylogen-
etic viewpoint. Representing the cranial base as a straight line drawn from
nasion to some point in it.s dorsal region, such as articnlare, basion, the Bolton
point, porion, or opisthion, is nevertheless too liberal an interpretat,ion of
its shape. All the dorsal points just enumerated suffer in upward and
rearward or downward and forward displacement with growth in relatiou
to the anterior cranial fossa. This means, in effect, that, a reference
plane drawn through any of these points does not register those growth
changes in the shape of the cranial base, which is of prime importance in irt-
terpreting the development of the facial structure in both its sagittal. and WV-
tical growth.
A description of the cranial base necessitates dividing it up into dorsal
and ventral, as well as medial and lateral, regions. According to my methogl:
the medial region is registered by means of the reference points nasion-sell:t-
basion, whereas the lateral development is expressed in terms of the points
nasion-sella-articulare. The point articulare has been selected for purely pra.c-
t,ieal reasons. Some other point, chosen w&h reference t,o t,he jaw joint might
serve the purpose better.”
As already mentioned, the possibility of making a comprehensive analy-
sis of the growth pattern as a whole will depend on the stage of developmel&.
During the prenatal stage, when all the bones of the skull have a considerable
freedom of movement, it is difficult to establish any suitable reference line
and during the subsequent postnatal stage the sutural growth of the how
*In a recent study by Lindegbrd of head and face form in relation to body build, the
lateral cranial base bending was measured from the n-s line to the condylar head. (LindegB.rd,
B.: Variations in Human Body Build, Acta psychiat. et neural., suppl. 86, 1953.)
222 ARNE BJ6RIC

forming the anterior cranial fossa may be 80 pronounced i1S to cause an ap-
preciable displacement between the frontal, cthmoid, and sphenoid bones.
Throughout the period of development with which t>hepresent investigation
is concerned (that is, between the ages of 12 and 20), the n-s line may be con-
sidered as remaining sensibly constant.
The age changes in the facial pattern which emerge from an analysis of
this kind become significant only through an appreciation of the regional
growth changes and mutual displacement of the bone and it is my hope that
this article will serve as a contribution toward the solution of these problems.
A clear understanding of the principles governing t,he mechanism of
growth must be considered a first essential before embarking upon a study of
the biologic factors which determine the variations in growth.

The purpose of this investigation is to analyze the growth mechanism of

the cranial base during the period of adolescence in Swedish boys. The ma-
terial on which the investigation is based consists of two series of standard-
ized lateral head x-ray pictures of 243 individuals, who were first examined at
the age of 12 and later subjected to a follow-up study at the age of 20.
The investigation takes the form of a quantitative estimate of the mag-
nitude of the individual growth changes within the cranial base during the
growth period in question and the extent and manner in which these growth
changes are coordinated with the development of the brain case and the facial
development. Other questions that have been analyzed are the relation be-
tween variations in form and changes in form during the growth period and
the relation between size and linear growth. The results of the investigation
have been summarized as follows:
1. The general growth pattern which has been calculated by comparing
the mean values for the two stages of development, 12 and 20 years, shows
that the cranial base is elongated rentrally by frontal apposition in the
glabella region, without any appreciable longitudinal, sutural increment of the
anterior cranial fossa. The dorsal elongation of the cranial base, in the medial
region due to enchondral growth of the clivus, is accompanied by a dorsal
displacement due to sutural growth of the lateral regions of the cranial base
and the brain case, forming the median and the posterior cranial fossae and a
simultaneous lowering of these regions in relation to the anterior cranial fossa.
There is, on an average, an insignificant straightening of the cranial base and
there is a virtually parallel lowering of foramen magnum (Fig. 4).
2. The general growth pattern does not give any clue to the dynamic de-
velopment, which becomes evident only through analysis of the individual
growth patterns.
Variations in the individual growth with age have been expressed through
the standard deviations for the individual age changes (SD). The discussion
includes the variation in the cranial base and face as a whole.
 CRANIAL BASE DEVELOPMENT 223

.4. The individual variation in form with age (sD) is found definitely to
be correlated with the range of variation in form (s12). The individual vari-
ations of the age changes in form of the cranial base and the facial structure
between the ages of 12 and 20 amount roughly to 55 per cent of the variation
in form at the age of 12 (Fig. 8, a). A similar relation is found to exist between
the variation in linear increment (sD) and the variation in size (sl,) (Fig. 8, b) .
B. The individual age changes in form vary in magnitude irrespective of
whether or not the average form for a given feature changes with age (Fig.
9, a). On the other hand, the average size increases with age in proportion to
the variation in linear growth (Fig. 9, b) .
C. The variation in form increases somewhat with age and in definite
proportion to the individual variations in the growth changes (Fig. 10, a).
The variation in size is also proportional to the variation in linear increment
(Fig. 10, b).
D. A coordination in form or size also espresses a coordination of the in-
dividual age changes.
E. The relation between shape and its change with age in the bite departs
in many ways from the corresponding relation in the facial structure and the
cranial base. The reason for this is that the age changes within the bite arc
due largely to functional modifications that occur with age.
3. The shape of the cranial base may be considered on an average, to re-
main stable with age. It shows, however, a marked individual variation with
age as rega.rds increased or diminished bending in individual cases; that. is.
it varies in either direction.
,4. Rotation of the medial regions of t,he cranial base has for its center the
spheno-occipital synchondrosis. This rotation is coordinated with a rotation
due to sntural growth of the lateral regions nf the cranial base and the brain
case.
B. The shape of the brain case varies greatly in relation to t,hc shape oE
the cranial base. A flattening of the cranial base usually has, as a result, a
low brain case, the total height of which, measured from basion to bregma, is
low. The radius of the brain case, measured from sella to bregma, is increased,
however. and this is accompanied by a marked reduction in the radius, meas-
ured from sella to basion, causing the posterior and median cranial fossae to
be raised in relation to the anterior one. Rotation of the cranial base and t~he
brain case does not result, however, in any raising or lowering of the anterior
cranial fossa. Foramen magnum is displaced backward and upward and the
foramen angle increases, resulting in an upward tilt of the face (Fig. 11). The
rotation of the cranial base seems not to be coordinat,ed with the growth in
width of the head and facial structure.
4. In coordination wit.h the rot,ation of tht> (~1~anii~lbase and the brain
case, there is also a rotation of the facial stru&ure.
Zl. The temporal bone, and hence the glenoid fossa, is displaced dowel-
ward and forward or backward and upward as a result of the cranial. base
224 ARNlC BJiiRK

rotation and consequently brings about changes in the mandibular position.

The direction of growth at the condyle will influence the general shape of the
mandible. A more upward direction will increase the vertical height; a back-
ward direction will increase the sagittal length. The size of the genial angle
will depend on the amount of condylar growth as well as on its direction in
relation to the amount of appositional growth at the gonial angle (Fig. 14).
B. The body of the maxilla increases in length toward the palatine bone
and is lowered as a result of the growth which occurs between the palatine
bone and the pterygoid processes. In the individual this lowering may be for-
ward and downward or rearward ancl downward, a variation in the growth
direction of the maxilla which is coordinated with the cranial base rotation
and with the sutural growth of the upper facial structure (Fig. 15).
5. During the period of adolescence, the relation between the nasion-sella
line and the deepest median contour of the anterior cranial fossa remains
noticeably constant, whereas tuberculum sellae and dorsum sellae appear to
be raised in relation to the center of the sella. For this reason, the n-s line
appears to be particularly suitable as a reference line during the adolescent
period in man. Its suitability as a reference line for investigations into earlier
growth periods remains to be investigated.

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 CRANIAL BASE DEVELOPMENT 225

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