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Clinical application of the Aponeurotic tension model of craniofacial growth

Ein detailliertes anatomisches Diagramm der Muskeln und aponeurotischen Spannungslinien von Kopf und Hals, basierend auf dem aponeurotischen Spannungsmodell, das verschiedene markierte Muskeln zeigt, darunter den vorderen Bauch, den temporoparietalis, den hinteren Bauch und andere. Pfeile markieren Kraft- und CFMAS-Spannungsrichtungen.
Clinical application of the Aponeurotic tension model of craniofacial growth

Standerwick et al. [62] suggest a further, complementary model of craniofacial growth. According to this model, the rotation and growth of the brain influence the superficial musculoaponeurotic systems of the face, on account of the tension of the occipitofrontal muscles and associated fascia. By means of this the craniofacial musculoaponeurotic system (CFMAS) of the cranium has a direct effect on the development of the maxilla and mandible. It forms the basis of the aponeurotic tension model of craniofacial growth. Some aspects of this model are further explained below, supplemented with examples from the literature.

Via the CFMAS, cranial rotation has an effect on the expression of face shape. Tension of the CFMAS not only exerts dorsal, restrictive pressure, but also results in relative cranial tension. This can have an anabolic effect on growth. It is counterbalanced by the craniocaudal tension of the suprahyoid muscles, which have a connection with the growth of the cervical vertebrae via their attachments ([48], [50]).

Genetic factors such as short or long head shape affect the CFMAS and can influence maxillomandibular rotation. CFMAS tension significantly depends on resting muscle tone and suppleness of the connective tissue, and it is greater in broad (leptoprosopic) than in narrow (euryprosopic) faces, on account of their different muscle morphologies ([47], [48]).

The effects of gravity on the viscerocranium are modified by the CFMAS, because muscle growth increases during puberty, along with a densification of the associated connective tissue components. This resistance of the CFMAS relative to the effects of gravity results in an anterior displacement of the mid-face brought about through maxillary contact with the lower jaw and functional occlusion of the teeth.

This divergence of the facial planes in combination with the opposing forces of gravity and of the CFMAS appear to have a wedge effect (Fig. 4.1). As a result, leptoprosopic facial types with a hyperdivergent angle of the mandibular plane normally have an upper jaw that is retrusive in the sagittal direction.

 

Eine Abbildung eines menschlichen Schädels im Profil, die den Einfluss des Somatotyps auf die Oberkiefer-Unterkiefer-Rotation und die Kiefergelenkmodellierung zeigt, wobei das aponeurotische Spannungsmodell einbezogen wird. Das Bild zeigt beschriftete Ebenen: Sella turcica-nasion, Frankfurter Ebene, Gaumenebene, Okklusionsebene und Unterkieferebene.

According to this model, the pivot for the rotation of the lower jaw is the pterygomasseteric sling, formed by the aponeuroses of the masseter and medial pterygoid muscles at the angle of the mandible [23]. The pterygomasseteric sling is seen as the original neonatal site of muscle accumulation that approximates the neutral zone of the mandibular periosteal sleeve, where little periosteal migration occurs [26].

The CFMAS reaches the anterior part of the lower jaw via the modiolus and osteocutaneous ligaments (Fig. 4.3). This causes anticlockwise, forward maxillomandibular rotation ([8], [9]), which brings about a separation of the articular surfaces of the temporomandibular joint, producing a caudad movement of the mandibular angle and raised position of the ramus relative to the anterior height of the face.

 

Ein detailliertes anatomisches Diagramm der Muskeln und aponeurotischen Spannungslinien von Kopf und Hals, basierend auf dem aponeurotischen Spannungsmodell, das verschiedene markierte Muskeln zeigt, darunter den vorderen Bauch, den temporoparietalis, den hinteren Bauch und andere. Pfeile markieren Kraft- und CFMAS-Spannungsrichtungen.

 

In dolichocephaly (long head shape), bite force is often reduced, and there is clockwise, backward maxillomandibular rotation; this may be due to reduced CFMAS tension. Airway obstructions often occur in these individuals, leading to a forward position of the tongue (relative to the pterygomasseteric sling), as a result of which the gravitational effects predominate over the CFMAS effects [18]. This in turn leads to more marked clockwise rotation of the lower jaw, to a narrow, longer face and backward rotation of the nose (dorsal hump). Since there is clockwise rotation around the pterygomasseteric sling, the ramus too does not move dorsally (relative to the pterygomasseteric sling), creating a greater likelihood of tooth crowding.

Fig. 4.4 sets out the modulation of brain growth by cranial rotation and CFMAS tension in the form of an algorithm. Brain growth proceeds both during normal development and consequent to trauma (concussion, drug use) in temporary regional growth spurts. CFMAS tension is influenced by cranial rotation and by the development of the brain and postural control, and CFMAS tension is manifested as a weak or strong phenotype displaying a maxillo-mandibular rotation in the clockwise or anticlockwise direction respectively. There is also increased overbite and progressive limitation of the mandibular dento-alveolar complex [10].

Flussdiagramm, das die Auswirkungen von Hirnwachstum und Trauma auf die kraniofaziale Spannung veranschaulicht. Hirnwachstum führt zu einem starken CFMAS-Phänotyp, der eine Oberkiefer-Unterkiefer-Rotation gegen den Uhrzeigersinn zur Folge hat; eine Schädelrotation führt zu einem schwachen Phänotyp, der eine Oberkiefer-Unterkiefer-Rotation im Uhrzeigersinn verursacht, was mit dem aponeurotischen Spannungsmodell übereinstimmt.

 

Check Liem 2023

 

Cover des Buches „Cranial Osteopathy: Principles and Practice Volume One“ von Torsten Liem, das ein goldenes, stilisiertes menschliches Gesicht mit Details der Faszie des oberflächlichen muskuloaponeurologischen Systems vor schwarzem Hintergrund zeigt.

 

Das Bild zeigt das Cover eines Buches mit dem Titel „Kraniosakrale Osteopathie: Ein praktisches Lehrbuch“. Das Cover zeigt ein Foto einer Person, die eine Craniosacral-Therapie-Behandlung erhält, wobei das aponeurotische Spannungsmodell und ein anatomisches Modell des menschlichen Schädels hervorgehoben werden. Der Name des Autors ist sichtbar.

Modiolus

Palpation of the knot of muscle at the corner of the mouth (Fig. 2.86), the point where the following facial muscles meet: orbicularis oris, levator anguli oris, depressor anguli oris, buccinator, risorius, zygomaticus major.

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