Anjixss
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Detailed report and guide on Craniofacial development from infancy to adulthood
Full report - Craniofacial development from infancy to adulthood with a deep focus on vertical/backward mandibular and maxillary rotation, its causes, mechanisms, frontal and lateral effects, and evidence based ways to prevent or treat it (including post puberty options)
Short executive summary;
The face grows due to a combination of intrinsic genetic programs which includes suture growth, condylar cartilage activity and the genetic cranial base and environmental/mechanical inputs such as muscle imbalances and weakness, oral habits, breathing and occlusion.
Many may believe lateral downward growth of the maxilla is purely environmental however it is not; some dimensions such as length and vertical proportions show substantial heritability, meaning genetic, while functional and dental traits are more environmentally modifiable. Maxillary and mandibular development differ greatly in the sense that the maxilla is mainly genetic and will follow sutures, and the maxilla is genetic but also environmental and will develop according to oral habits.
More in depth;
Maxillary development: the maxilla grows and forms through intramembarenous bone attached via circummaxillary sutures, for example the zygomaticmaxillary, the frontomaxillary and the transverse palatine. The growth of the bone itself occurs by bone deposition within the sutures and the surface modelling of the bone; the vector off maxillary growth is commonly dictated by the cranial base, usually forward and slightly downward from it, this downward growth is what is commonly referred to as maxillary vertical growth.
What drives this growth?
Drivers: Intrinsic sutural expansion which is completely genetic and biological, functional matrix influences such as breathing or septum growth, and tooth eruption. These sutures can open and growth direction can be induced to change via mechanical forces such as RME or MSE.
Mandibular development: The mandible grows primarily by a process called condylar cartilage endochondral growth (posterior/superior condyle addition) and by respiration on cortical sources, in other words remodelling of the lower border and ramus. Condylar growth is exactly what pushes the chin forward, and the remodelling is what alters shop and rotation. In other words, if your mandible is completely straight and still recessed, its unlikely you will ever achieve any more growth, however that is not the case for many people, rather instead of short mandibles a large majority of the population loses out on forward development due to clumping and vertical growth.
Rotation: There is two types of rotation. The first being the true skeletal rotation which is genuine rotation of the mandibular corpus RELATIVE to the cranial base, this genuine rotation is caused by differential growth (e.g, more posterior vertical growth = cw rotation, essentially downgrowth). The second being mandibular plane rotation which is changes due to bone modelling at the lower border which can mask the true rotation.
What drives this growth?
The mandible grows differently to almost all other bones (which grow purely due to intramembranous ossification) because it is partly endochondral. Basically the condyle contains a secondary cartilage which then grows via enchochondral ossification like long bones in your body, this is the lengthening of the bone as well as forward movement. The body, ramus and symphysis grow by surface modelling, which is intramembranous deposition and resorption, this is the shape, rotation, height and even chin position. This mixed system means mandible growth has two independent drivers, both being equally as important.
Dentition and eruption:
When teeth erupt they carry something called alveolar bone with them, so the occlusal plane and facial height can be modified via compensatory eruption of these teeth. Ill keep this one short, excessive eruption of the posterior set of teeth will rotate the mandible downwards and backwards, meaning clockwise rotation of the face, this causes what many call long face syndrome, conversely control of posterior eruption can encourage the exact opposite, forward and upward development, meaning counterclockwise rotation.
What is down growth?
In clinical/orthodontic terms it is an increase in vertical facial dimension due to the backward-rotated mandible relative to the cranial base. This produces a much longer mid face, uneven facial thirds, recession within the infraorbital, higher gonial angle, a dorsal hump (dependent on nasal bridge projection but increases probability), retruded and recessed chin as well as a shorter mandible. The difference between maxillary and mandibular growth is that maxillary growth is governed by sutures, however the mandibles growth is largely condylar endochondral growth plus surface modelling. It is this balance that determines how your face looks, not only laterally but also frontally.
Causes for down growth:
Genetics: multiple studies consistently support the idea that many craniofacial skeletal dimensions like cranial base length, total maxillary length, total mandibular length and several vertical measures are genetic. Verticable variables like total anterior facial height and lower anterior facial height often have high heritability in most studies, so yeah, large part is genetic, but don’t get your tits in a huddle yet, heritability doesn’t mean immutability, environment still matters.
Environmental/habitual factors
Mouth breathing/Nasal obsutrctuon: Ah good old mewing and posture, back to the basics, a large body of evidence links chronic mouth breathing to things like increasing lower face height, hyper divergent pattern, and a LARGE tendency for backward mandibular rotation. But everybody knows this so why mention it right? Well that’s because you all blame it purely on bad oral habits, that’s retarded. There is many mechanisms which can be attributed to clockwise rotation, when it comes to specifically mouth breathing and nasal obstruction it is, altered posture, lowered tongue, altered muscle tone and increased vertical dental eruption.
DO NOT SUCK YOUR THUMB FOR GODS SAKE
Dental/occlusal: Premature loss of teeth, posterior crossbites or prolonged eruption of posterior teeth can all change the occlusal plane and route your mandible to sub 5 heaven.
Quantitative split: You want me to stop with the bullshit and tell you exactly how much is genetic and how much is environmental right? Well sorry dipshit, there is no single percentage that applies universally, but what I can tell you is that twin studies indicate SUBSTANTIAL genetic influence especially for skeletal linear measures, while environmental factors like breathing, muscle function and oral habits do have measurable and sometimes large effects on your mandibular plane don’t assume it will push you past the genetic threshold of your body, you can straighten your growth, but you cannot make new growth, that’s beyond your scope without the use of peptides. Think of your genetics as your maximum power level and your habits how close you can get to that maximum power level.
Extra: Step by step chain of how down growth happens so you can realise where you messed up.
Primary driver - Chronical nasal obstruction - habitual mouth breathing
Postural compensation - head extends and mandible lowers to keep the airway open
Muscle imbalances and altered forces - your lips and tongue no longer provide the necessary stabilising pressure needed for the maxilla, and the masseyter muscle develops improperly - altered bone modelling
Dental compensation - posterior teeth erupt more vertically to maintain occlusion leading to increased posterior facial height and tipping occlusal plane
Mandibular rotation - the increase posterior facial height from before induces clockwise rotation of the face and the condylar growth stimulus your brain needs to keep the bone growing is reduced or redirected
In short its a series of unfortunate events, but that’s not what were here for, enough wallowing in self misery.
Why go on that tangent? Its irrelevant to know all this right, what matters is that its happened. Well this was necessary context for me to get into how to prevent or change.
Time for the good part, how do I prevent or change?
Guide for counterclockwise rotation of the mandibular plane.
This isn’t pseudoscience, this isn’t your average guide, this is how you scientifically maximise everything you can, before you start doing things that might not work. Im not claiming you will reshape your entire jaw at will that is atrocious, but this is the first and foremost step to a better world. CCW rotation depends heavily on anatomy, growth stage and biomechanics, that is undeniably true, but many mechanisms CAN be influenced and some can even be altered, EVEN as an adult, yes for you oldcels its not completely over.
A guide for the guide I guess
The guide is divided into three categories, each catering to a different age group because the sciences are vastly different in each.
Understanding CCW: CCW it requires 3 conditions
My guide isn’t some underground surefire way for
you to achieve major CCW rotation, it is the basics, it is what should be common knowledge, but it isn’t. Someone has to make this thread for the better, and that is what I will do, if you are a kid, don’t avoid effort. You could be searching for easy ways to improve the growth vector of your face but I guarantee you that you haven’t even looked in to the basics, I am not guaranteeing life changing results, this is a guide for you to decide whether you want confirmed change, or if you want to waste your time doing random facial exercises in the hopes of a complete craniofacial transformation
Just a rough guide nun too special
Full report - Craniofacial development from infancy to adulthood with a deep focus on vertical/backward mandibular and maxillary rotation, its causes, mechanisms, frontal and lateral effects, and evidence based ways to prevent or treat it (including post puberty options)
Short executive summary;
The face grows due to a combination of intrinsic genetic programs which includes suture growth, condylar cartilage activity and the genetic cranial base and environmental/mechanical inputs such as muscle imbalances and weakness, oral habits, breathing and occlusion.
Many may believe lateral downward growth of the maxilla is purely environmental however it is not; some dimensions such as length and vertical proportions show substantial heritability, meaning genetic, while functional and dental traits are more environmentally modifiable. Maxillary and mandibular development differ greatly in the sense that the maxilla is mainly genetic and will follow sutures, and the maxilla is genetic but also environmental and will develop according to oral habits.
More in depth;
Maxillary development: the maxilla grows and forms through intramembarenous bone attached via circummaxillary sutures, for example the zygomaticmaxillary, the frontomaxillary and the transverse palatine. The growth of the bone itself occurs by bone deposition within the sutures and the surface modelling of the bone; the vector off maxillary growth is commonly dictated by the cranial base, usually forward and slightly downward from it, this downward growth is what is commonly referred to as maxillary vertical growth.
What drives this growth?
Drivers: Intrinsic sutural expansion which is completely genetic and biological, functional matrix influences such as breathing or septum growth, and tooth eruption. These sutures can open and growth direction can be induced to change via mechanical forces such as RME or MSE.
Mandibular development: The mandible grows primarily by a process called condylar cartilage endochondral growth (posterior/superior condyle addition) and by respiration on cortical sources, in other words remodelling of the lower border and ramus. Condylar growth is exactly what pushes the chin forward, and the remodelling is what alters shop and rotation. In other words, if your mandible is completely straight and still recessed, its unlikely you will ever achieve any more growth, however that is not the case for many people, rather instead of short mandibles a large majority of the population loses out on forward development due to clumping and vertical growth.
Rotation: There is two types of rotation. The first being the true skeletal rotation which is genuine rotation of the mandibular corpus RELATIVE to the cranial base, this genuine rotation is caused by differential growth (e.g, more posterior vertical growth = cw rotation, essentially downgrowth). The second being mandibular plane rotation which is changes due to bone modelling at the lower border which can mask the true rotation.
What drives this growth?
The mandible grows differently to almost all other bones (which grow purely due to intramembranous ossification) because it is partly endochondral. Basically the condyle contains a secondary cartilage which then grows via enchochondral ossification like long bones in your body, this is the lengthening of the bone as well as forward movement. The body, ramus and symphysis grow by surface modelling, which is intramembranous deposition and resorption, this is the shape, rotation, height and even chin position. This mixed system means mandible growth has two independent drivers, both being equally as important.
Dentition and eruption:
When teeth erupt they carry something called alveolar bone with them, so the occlusal plane and facial height can be modified via compensatory eruption of these teeth. Ill keep this one short, excessive eruption of the posterior set of teeth will rotate the mandible downwards and backwards, meaning clockwise rotation of the face, this causes what many call long face syndrome, conversely control of posterior eruption can encourage the exact opposite, forward and upward development, meaning counterclockwise rotation.
What is down growth?
In clinical/orthodontic terms it is an increase in vertical facial dimension due to the backward-rotated mandible relative to the cranial base. This produces a much longer mid face, uneven facial thirds, recession within the infraorbital, higher gonial angle, a dorsal hump (dependent on nasal bridge projection but increases probability), retruded and recessed chin as well as a shorter mandible. The difference between maxillary and mandibular growth is that maxillary growth is governed by sutures, however the mandibles growth is largely condylar endochondral growth plus surface modelling. It is this balance that determines how your face looks, not only laterally but also frontally.
Causes for down growth:
Genetics: multiple studies consistently support the idea that many craniofacial skeletal dimensions like cranial base length, total maxillary length, total mandibular length and several vertical measures are genetic. Verticable variables like total anterior facial height and lower anterior facial height often have high heritability in most studies, so yeah, large part is genetic, but don’t get your tits in a huddle yet, heritability doesn’t mean immutability, environment still matters.
Environmental/habitual factors
Mouth breathing/Nasal obsutrctuon: Ah good old mewing and posture, back to the basics, a large body of evidence links chronic mouth breathing to things like increasing lower face height, hyper divergent pattern, and a LARGE tendency for backward mandibular rotation. But everybody knows this so why mention it right? Well that’s because you all blame it purely on bad oral habits, that’s retarded. There is many mechanisms which can be attributed to clockwise rotation, when it comes to specifically mouth breathing and nasal obstruction it is, altered posture, lowered tongue, altered muscle tone and increased vertical dental eruption.
DO NOT SUCK YOUR THUMB FOR GODS SAKE
Dental/occlusal: Premature loss of teeth, posterior crossbites or prolonged eruption of posterior teeth can all change the occlusal plane and route your mandible to sub 5 heaven.
Quantitative split: You want me to stop with the bullshit and tell you exactly how much is genetic and how much is environmental right? Well sorry dipshit, there is no single percentage that applies universally, but what I can tell you is that twin studies indicate SUBSTANTIAL genetic influence especially for skeletal linear measures, while environmental factors like breathing, muscle function and oral habits do have measurable and sometimes large effects on your mandibular plane don’t assume it will push you past the genetic threshold of your body, you can straighten your growth, but you cannot make new growth, that’s beyond your scope without the use of peptides. Think of your genetics as your maximum power level and your habits how close you can get to that maximum power level.
Extra: Step by step chain of how down growth happens so you can realise where you messed up.
Primary driver - Chronical nasal obstruction - habitual mouth breathing
Postural compensation - head extends and mandible lowers to keep the airway open
Muscle imbalances and altered forces - your lips and tongue no longer provide the necessary stabilising pressure needed for the maxilla, and the masseyter muscle develops improperly - altered bone modelling
Dental compensation - posterior teeth erupt more vertically to maintain occlusion leading to increased posterior facial height and tipping occlusal plane
Mandibular rotation - the increase posterior facial height from before induces clockwise rotation of the face and the condylar growth stimulus your brain needs to keep the bone growing is reduced or redirected
In short its a series of unfortunate events, but that’s not what were here for, enough wallowing in self misery.
Why go on that tangent? Its irrelevant to know all this right, what matters is that its happened. Well this was necessary context for me to get into how to prevent or change.
Time for the good part, how do I prevent or change?
Guide for counterclockwise rotation of the mandibular plane.
This isn’t pseudoscience, this isn’t your average guide, this is how you scientifically maximise everything you can, before you start doing things that might not work. Im not claiming you will reshape your entire jaw at will that is atrocious, but this is the first and foremost step to a better world. CCW rotation depends heavily on anatomy, growth stage and biomechanics, that is undeniably true, but many mechanisms CAN be influenced and some can even be altered, EVEN as an adult, yes for you oldcels its not completely over.
A guide for the guide I guess
- Airway management
- Occlusal vertical dimension control
- Myofunctional sciences
- Orthodontic biomechanics
- Orthognathic possibilities
- Muscle driven remodelling
- Posture and functional patterns
The guide is divided into three categories, each catering to a different age group because the sciences are vastly different in each.
- Natural growth phase (NGP): Ages 5-17 - most potential for change
- Late growth (LG): Ages 17-24 - Limited skeletal, moderate dental + functional change
- Adulthood (AH): Ages 24+ - Dental, muscular, orthopedic and surgical options
Understanding CCW: CCW it requires 3 conditions
- Reduced posterior vertical height: If posterior teeth erupt excessively - mandible grows downwards, that’s why they need to be intruded (orthodontically or posture change, ur choice) - mandible grows upwards and forwards
- Proper airway + mandibular posture: Nasal breathing, high tongue posture (hard mewing every now and then) and closed lips to lift the mandible upwards.
- Sufficient condylar loading: Condylar cartilage responds to compressive loading - strengthens upward and forward growth vector
Guide for NGP:
This is the golden window, it varies depending on puberty but in general you should be good in this window, your condylar cartilage is highly active, your muscles adapt quickly, your dental eruption is ongoing, your sutures still respond to forces, they aren’t concrete yet. Your young, soft and malleable.
AIRWAY-ASSESS-AID-ASCEND (do this please)
Steps
Ways to achieve this
Palatale suction
Tongue pops
Lingual-palatal swallowing retraining
STOP anterior tongue thrust during swallowing
Soft palate elevation drills (As salludon says, say king)
CHEWING-C|REATES-CREDIT
You bastards refuse hard chewing because it hurts, what a mess, anyways.
Hard chewing increases masseyter/temporal thickness which leads to more forward mandibular modelling
Methods
CONTROL OF POSTERIOR ERUPTION (this is the good part)
Tools and appliances
SUPRAHYOID HYPERTROPHY
The supra hyoid is the muscle right above your hyoid, and if trained can elevate your hyoid significantly, which is not only a plus in of itself but also promotes upwards mandibular development. “Muh but hyoid is a bone u can’t train it” yes rxtard, obviously, but the hyoid is also the only bone which is not locked in place, it moves, and if you train the adequate muscles, you can control where it moves.
Ways to train suprahyoid
EXTREME PSEUDOSCIENCE (extreme force on bones, risky and dumb, but potentially good way to increase condylar load)
POSTURE-PATIENCE-POSSIBILITIES
This is the golden window, it varies depending on puberty but in general you should be good in this window, your condylar cartilage is highly active, your muscles adapt quickly, your dental eruption is ongoing, your sutures still respond to forces, they aren’t concrete yet. Your young, soft and malleable.
AIRWAY-ASSESS-AID-ASCEND (do this please)
Steps
- ENT evaluation, if your parents reject make up an excuse
- Assess adenoids, tonsillar hypertrophy, deviated septum, turbinate hypertrophy
- Treat allergic rhinitis
- Encourage nasal breathing via saline rinses, breath dilation and buteyko-inspired CO2 tolerance training
- Tip at the inclusive papilla
- Dorsum suctioned to palate
- Posterior third elevated
Ways to achieve this
Palatale suction
Tongue pops
Lingual-palatal swallowing retraining
STOP anterior tongue thrust during swallowing
Soft palate elevation drills (As salludon says, say king)
CHEWING-C|REATES-CREDIT
You bastards refuse hard chewing because it hurts, what a mess, anyways.
Hard chewing increases masseyter/temporal thickness which leads to more forward mandibular modelling
Methods
- Sugar free gum, has to be hard
- Mastic gum (after your muscles are warmed up and ready to grow)
CONTROL OF POSTERIOR ERUPTION (this is the good part)
Tools and appliances
- Posterior bite blocks
- Functional appliances
- Vertical control retainers
- Twin-block class II
- Herbst or MARA
- High pull headgear
- Palatal expansion (RMF, MSE, MARPE) if transverse deficiency exists
SUPRAHYOID HYPERTROPHY
The supra hyoid is the muscle right above your hyoid, and if trained can elevate your hyoid significantly, which is not only a plus in of itself but also promotes upwards mandibular development. “Muh but hyoid is a bone u can’t train it” yes rxtard, obviously, but the hyoid is also the only bone which is not locked in place, it moves, and if you train the adequate muscles, you can control where it moves.
Ways to train suprahyoid
- Chin tucks (trains whole neck in general but still great for the suprahyoids)
- Individual suprahyoid activation via swallowing, remember the “hullo method”? Yeah well that’s actually him just engaging his suprahyoid, and the way to do it is by swallowing halfway. The best way I can explain it to you is for you to try swallowing while touching your hyoid and stopping exactly when you feel your hyoid raise, keep it in that positionn for as long as possible
- Neck curls, duh
- Hard mewing is VERY good for suprahyoid hypertrophy, ideally you would want to hard mew constantly, its an all rounder, your supra hyoids might feel sore afterwards but that’s a good thing
EXTREME PSEUDOSCIENCE (extreme force on bones, risky and dumb, but potentially good way to increase condylar load)
- Beltpulling,
- Thumbpulling
- Towelpulling
POSTURE-PATIENCE-POSSIBILITIES
- Glute and hamstring strengthening (dramatically improves posture, good if you have anterior pelvic tilt)
- Neutral cervical posture (CCW thrives in this kind of environment
- Training muscle imbalances (if you notice one side of your face is less developed, train all neck and facial muscles on that side)
Guide for LG
Growth slows down significantly but its still not over, the mandible can still adapt via condylar cartilage (reduced but still responsive), alveolar bone remodelling, muscle hypertrophy and orthodontic tooth movement.
POSTERIOR INTRUSION VIA TADS
The single most powerful non surgical CCW method after puberty.
What is it?
2-4 mm molar intrusion - 3-6 degree mandibular plane rotation - 3-8 mm increase in chin projection WITHOUT surgery, isn’t that crazy?
MYOFUNTIONAL THERAPY (isn’t completely erased from the equation)
Everything I said when it comes to posture, chewing and habits for NGB matters for you too, don’t ignore it
CERVICAL AND TMJ POSTURE THERAPY
Exercises
Growth slows down significantly but its still not over, the mandible can still adapt via condylar cartilage (reduced but still responsive), alveolar bone remodelling, muscle hypertrophy and orthodontic tooth movement.
POSTERIOR INTRUSION VIA TADS
The single most powerful non surgical CCW method after puberty.
What is it?
- Miniscrews inserted near the molars
- Intrusive elastics or coil springs pull molars upward into the bone
- Posterior vertical height decreases - mandible rotates upwards and forward
2-4 mm molar intrusion - 3-6 degree mandibular plane rotation - 3-8 mm increase in chin projection WITHOUT surgery, isn’t that crazy?
MYOFUNTIONAL THERAPY (isn’t completely erased from the equation)
Everything I said when it comes to posture, chewing and habits for NGB matters for you too, don’t ignore it
CERVICAL AND TMJ POSTURE THERAPY
Exercises
- Mandibular protrusion holds (basically jutting, ur already good at this aren’t u little fraudster)
- Gentle isometric jaw closing (IN PROPER ALIGNMENT)
- SCM and deep neck flexor strengthening
Guide for AH
At this stage you are basically out of non surgical options, but there is still hope
TAD POSTERIOR INTRUSION
Woah, it still works, even at your grown age, don’t worry, you won’t gain as much but the results are still great
Adults can gain
1-3 mm molar intrusion - 2-4 degree ccw rotation - 2-5 mm increase in chin projection
This is MORE than enough to meaningfully change facial structure
MMA/ORTHOGNATHIC SURGERY
This is the most surefire way, it doesn’t get much better than surgery does it
Surgeries
10-20 degree ccw rotation - 8-15 mm increase in chin projection, more than anything else
At this stage you are basically out of non surgical options, but there is still hope
TAD POSTERIOR INTRUSION
Woah, it still works, even at your grown age, don’t worry, you won’t gain as much but the results are still great
Adults can gain
1-3 mm molar intrusion - 2-4 degree ccw rotation - 2-5 mm increase in chin projection
This is MORE than enough to meaningfully change facial structure
MMA/ORTHOGNATHIC SURGERY
This is the most surefire way, it doesn’t get much better than surgery does it
Surgeries
- Maxillomandibular Advancement
- Bimax
10-20 degree ccw rotation - 8-15 mm increase in chin projection, more than anything else
My guide isn’t some underground surefire way for
you to achieve major CCW rotation, it is the basics, it is what should be common knowledge, but it isn’t. Someone has to make this thread for the better, and that is what I will do, if you are a kid, don’t avoid effort. You could be searching for easy ways to improve the growth vector of your face but I guarantee you that you haven’t even looked in to the basics, I am not guaranteeing life changing results, this is a guide for you to decide whether you want confirmed change, or if you want to waste your time doing random facial exercises in the hopes of a complete craniofacial transformation
Just a rough guide nun too special
@Fridx @Jason vorhees @Sailor @turkcelfatcel
