CcrrespcnJing autlcrSuk Keun Lee, lepartment ci Crai latlcicgy, Cciiege ci lentistry, Kangnung .

aticnai
Lniversity, Kangnung 210-02, Kcrea,
l-maiiskieeCkangnung,ac,kr, 1ei033-640-2228, lax033-642-6410
1lis stuJy vas suppcrteJ |y tle iunJ ci Kcrean Heaitl anJ eiiare prcject(H\l-00-CH-11-0010,
A seque|a oI prinary growIh cenIer oI hunan nandib|e
during posInaIa| period
Young Joon Lee, Sang Shin Lee, Ryoung Geo| Park, Yeon Sook Kin,
Suk Keun Lee*, Hyock Soo Moon
1
, Je Geun Chi
2
DeparInenI oI Ora| PaIho|ogy, Kangnung NaIiona| UniversiIy Co||ege oI DenIisIry
1
DeparInenI oI PrevenIive DenIisIry, Seou| naIiona| UniversiIy Co||ege oI DenIisIry
2
DeparInenI oI PaIho|ogy, Seou| NaIiona| UniversiIy Co||ege oI Medicine, Seou|, Korea

1le primary grcvtl center (\JlC ci luman ietai manJi|ie vas ccnspicucusiy JistinguisleJ in tle scit X-ray
viev ci ietai manJi|ies,1 As tle periplerai aJaptive grcvtl ci manJi|ie aJvanceJ Juring tle pcstnatai pericJ, tle
\JlC |ecame cverslaJcveJ |y ccnJenseJ ccrticai |cne, Hcvever, in tle veii-prccesseJ raJicgrams ci aJuit
manJi|ie a ccnJenseJ raJicpaue image, measuring 0,5-1,0 cm in Jiameter, can |e c|serveJ |eicv tle apex ci iirst
premciar, ln tlis stuJy ve aimeJ tc trace a scierctic seueia ci manJi|uiar primary grcvtl center Juring pcstnatai
pericJ,
lancramic raJicgrams ci tvc lunJreJs aJuits anJ scit X-ray vievs ci tlirty Jry manJi|ie vere anaiyzeJ |y
statisticai metlcJs, 1le aJuit \JlC vas cieariy Jistinguisla|ie ircm tle mentai icramen, 1le area ci \JlC vas
seiJcm clangeJ in tle ciJer perscns, even in tle eJentuicus manJi|ies, AJJiticnaiiy, tle |enign iesicns ci
cJcntcgenic cysts anJ tumcrs larJiy JestrcyeJ tle criginai structure ci \JlC, vliie tle maiignant tumcrs ci
suamcus ceii carcincma anJ metastatic cancer rapiJiy JestrcyeJ anJ resciveJ tle raJicpaue area ci tle \JlC,
Key crJs\anJi|uiar lrimary rcvtl Center (\JlC, lcstnatai lericJ, lancramic Viev, lry \anJi|ie
I. Introduction
A manJi|ie, as a icng |cne, mainiy ccnstitutes tle
icver jav, 1lis uniue |cny structure prcviJes tiglt
attaclment ci strcng masticatcry muscies anJ
Jeiicate iaciai expressicn muscies, anJ aisc Jeveicps
a jcint vitl tempcrai |cne, sc caiieJ
tempcrcmanJi|uiar jcint, Hcvever, tle vlcie
manJi|uiar structure is JeriveJ ircm tle iirst
|rancliai arcl mesenclyme, tle prenatai
manJi|uiar Jeveicpment is cne ci tle Je|ating
su|jects icr tle mcrplcgenesis ci crc-iaciai
structure, lespite tle simpie manJi|uiar structure
receiving singie manJi|uiar |rancl ci trigeminai
nerve tle plyicgenetic Jeveicpment ci manJi|ie is
greatiy ccmpiex Jue tc its varia|ie aJaptaticn icr tle
Jiiierent iuncticns ccntrciieJ |y Jiiierent neurai
parts, AcccrJing tc tle iuncticnai eiements ci
manJi|ie varicus parts vere Jescri|eJ as muscuiar
part, aiveciar part, neurai part, anJ articuiar part,
2-5
37
Q[\_[[Q[J 200327(1)37-45
lrevicus stuJy cn tle manJi|uiar Jeveicpment las
emplasis mainiy cn tle ccnJyiar grcvtl anJ
symplysis grcvtl, Stiii ncv tlere are nc Jeiinite
manJi|uiar grcvtl pattern tc expiain tle |asic
manJi|uiar Jeveicpment,
\eckeis cartiiage piays an impcrtant rcie in tle
tcpcgraplicai crganizaticn anJ in tle Jiiierentiaticn
ci tle iaciai structure Juring tle em|rycnai anJ
even mucl iater Juring tle ietai pericJ, Cur
c|servaticns cn seriai secticns carrieJ cut in tvc
luman ietuses ageJ 12 anJ 16 veeks inJicate tlat
tle tvc Jcrsai (tympanic anJ ventrai (manJi|uiar
|rancles ci \eckeis cartiiage are periectiy JeiineJ
at 16 veeks, ln tle Jcrsai |rancl, tle primcrJia ci
tle incus anJ ci leaJ ci tle maiieus are stiii
ccmpcseJ cn ncn-cssiiieJ cartiiage, ln tle ventrai
|rancl, it is aisc pcssi|ie tc Jescri|e at 16 veeks
tlree pcstericr, meJiai anJ antericr parts vlicl are
ccmpcseJ ci cartiiage, 1le initiating rcie piayeJ |y
tle ventrai part ci \eckeis cartiiage cn tle
cssiiicaticn ci tle manJi|ie ieaJs Juring tle
em|rycnai pericJ tc tle icrmaticn ci tle
manJi|uiar primary grcvtl center, vlicl is
tlereicre cieariy JeiineJ in cur iirst stage at 12
veeks, 1le partiai ii|rcus evciuticn anJ tle
regressicn ci tle majcr part ci tle ventrai |rancl ci
\eckeis cartiiage cniy start aiter 16 veeks ci
intrauterine iiie,
6
Bcne grcvtl ci tle ietai manJi|ie
is a ccmpiex prccess ccmprising iinguai rescrpticn
anJ |uccai appcsiticn, lnsteaJ, ve icunJ veii
JiiierentiateJ remcJeiing prccesses, representeJ |y
varia|ie pcrticns ci appcsiticn, rescrpticn anJ
resting areas seameJ |y iining ceiis,
, 8
Hcvever, tle aim ci tlis stuJy is tc Jeiine tle
seueia ci tle \JlC Juring tle pcstnatai pericJ
|y raJicicgicai anJ listcicgicai metlcJs, ln tle
previcus stuJy ve JetermineJ tle manJi|uiar
primary grcvtl center in luman ietuses, 1le
\JlC las an impcrtant mcrplcgenetic aiiect icr
tle Jeveicpment ci tle luman manJi|ie, prcviJing
a grcvtl center icr tle tra|ecuiar |cne ci
manJi|uiar |cJy anJ aisc inJicating tle initiai
grcvtl ci enJcclcnJrai cssiiicaticn ci tle
ccnJyie,
1
lrcm tlis series ci resuits, ve lave
suggesteJ tlat tle icur grcvtl centers vlicl
Jemarcate tle maxiiiary trapezciJ are tle |asic
structures ci tle Jeveicping luman maxiiia, lt vas
aisc icunJ tlat tle icur primary grcvtl centers are
tle mcst active sites icr maxiiia icrmaticn untii 20
veeks ci gestaticn anJ tlereaiter tle grcvtl ci tle
maxiiia is enlanceJ |y tle participaticn ci tle
intramem|rancus |cne icrmaticn aicng tle
periplery, 1lis is in ccntrast tc tle centrai primary
grcvtl center tlat lave aireaJy iinisleJ maturaticn
in tle eariy ietai pericJ anJ remains cniy as a
peripleraiiy raJiating arrangement ci tlick
tra|ecuiar |cnes,
9
II. Materials and methods
200 cases ci pancramic raJicgram vere c|taineJ
ircm tle patients visiteJ icr rcutine cleck at
Kangnung Lniversity lentai Hcspitai, anJ vere
anaiyzeJ tle reiative pcsiticn ci \JlC in
manJi|uiar |cJy |y measuring tle prcpcrticnai
Jimensicns ci lcrizcntai anJ verticai scaie, i,e,,
symplysis-\JlC-pcstericr |crJer ci manJi|ie,
icver |crJer ci manJi|ie-\JlC-upper margin ci
aiveciar |cne, respectiveiy, 1le reiative pcsiticns ci
\JlC vere ccmpareJ in Jiiierent age grcups,
ranging ircm 11 tc 9 years ciJ, AnJ tlirty aJuit Jry
manJi|ies vere useJ tc take raJicgrams vitl scit X-
ray iiim (luji, 1ckyc, )apan |y laxitrcn macline
(Heviett lackarJ, Ccrvaiiis, Cl, LSA, 1le
38
raJicgrams vere anaiyzeJ tc Jeiine tle raJicpaue
image ci \JlC in aJuit manJi|ies, AJJiticnaiiy,
icr a signiiicant rcie ci \JlC in tle patlcicgicai
iesicns severai cases ci cJcntcgenic cysts anJ
tumcrs invciving tle manJi|uiar |cJy vere aisc
anaiyzeJ icr tle reiative pcsiticn ci \JlC, anJ
JiscusseJ a|cut tleir patlcgenetic impiicaticns,
III. Results
1) PanIonograns oI adu|I hunan
nandib|es
A iccaiiy ccnJenseJ raJicpaue image ccuiJ |e
c|serveJ |iiateraiiy in tle antericr manJi|uiar |cJy
tlrcugl tle veii-prccesseJ pantcmcgrams, anJ it
usuaiiy appeareJ in raJiating pattern |eicv tle apex
ci permanent premciar anJ vas rcunJ in slape,
measureJ 0,5-1,0 cm in Jiameter, 1le raJicpaue
image vas cieariy Jistinguisla|ie ircm mentai
icramen, vlicl iccateJ mcre Jistaiiy, anJ aisc ircm
tle iinguai tcrus, vlicl usuaiiy iccateJ mcre
mesiaiiy anJ slcveJ rcunJ lcmcgenecus
raJicpacity (lig, 4, 1le reiative pcsiticn ci tle
raJicpaue image, anaiyzeJ |y tle prcpcrticnai
ratic in tle manJi|uiar |cJy, vas nct easiiy
clangeJ tlrcuglcut tle ages, ircm 11 tc 9 years
ciJ (lig, 2,
2) SoII X-ray views oI adu|I dry nandib|es
ln tle Jry manJi|ie tle iccai ccnJenseJ
raJicpacity area ccuiJ |e seen in tle same area as in
tle pantcmcgrams, 1le raJicpaue image slcveJ
raJiating pattern antericr manJi|uiar |cJy area at
vlicl tle mentai icramen anJ iniericr aiveciar
canai vere separateiy JiscicseJ (lig, 3,
39
Fig 1 SchenaIic dinension oI re|aIive posiIion oI MdPGC
3) PaIho|ogica| |esions oI odonIogenic
cysIs and Iunors re|aIed Io Ihe MdPGC
A case ci ii|rcus Jyspiasia slcveJ a Jistinctive
raJicpaue image ci \JlC in pantcmcgram,
vlicl vas JispiaceJ iniericriy |ut nct resciveJ ncr
JestrcyeJ, 1lree cases ci cJcntcgenic cysts
invciveJ tle antericr manJi|uiar |cJy area aisc
slcveJ reiativeiy intact raJicpaue image ci tle
\JlC, lereas tle maiignant iesicns ci crai
suamcus ceii carcincma anJ metastatic cancer
slcveJ viJeiy Jestructive raJiciucency invciving
tle vlcie area ci tle \JlC (lig, 5,
40
Fig 2
IV. Discussion
1le |asic grcvtl pattern ci tle manJi|uiar |cJy
e ccnJyie appeareJ in veek ci iertiiizaticn,
Histcicgicaiiy tle em|rycnai manJi|ie criginateJ
ircm primary intramem|rancus cssiiicaticn in tle
ii|rcus mesenclymai tissue arcunJ tle \eckeis
cartiiage, lrcm tlis initiai cssiiicaticn, tle ramiiying
tra|ecuiar |cnes JeveicpeJ icrvarJ, |ackvarJ e
upvarJ, tc icrm tle symplysis, manJi|uiar |cJy,
ccrcnciJ prccess, respectiveiy,
1
Aitlcugl tle |cny
cssiiicaticn is aiiecteJ |y ccmpiicateJ iactcrs ci
enJcgenecus anJ excgenecus crigins,
10-1
tle
em|rycni |cnes are primariiy JepcsiteJ |y
intramem|rancus |cne cssiiicaticn initiateJ ircm tle
primary grcvtl center,
18-20
ln tle previcus stuJy ci
prenatai grcvtl pattern ci maxiiia anJ manJi|ie ve
c|serveJ antericr anJ pcstericr maxiiiary primary
grcvtl centers (\xlC anJ manJi|uiar primary
grcvtl center (\JlC, vlicl lave claracteristic
raJiating tra|ecuiar patterns |ctl in tle listcicgicai
anJ raJicicgicai c|servaticn,
1,9
AnJ aisc ve
menticneJ tlat tle \xlC anJ \JlC are
em|rycnai eviJence ci initiai cssiiying site anJ tley
are nct ccntinucusiy prciiierative cr ccntinucusiy
renevai in tle iate ietai pericJ, ratler actuaiiy in tle
ietai maxiiia tle prciiierative grcvtl is active in tle
periplery |y tle appcsiticnai cssiiicaticn, Hcvever,
ircm tle eariy em|rycnai pericJ tle manJi|ie las a
ccre cartiiage, i,e,, \eckeis cartiiage, Ccntrary tc
tle ctler icng |cnes tle \eckeis cartiiage |ecame
41
Fig 3
Fig 4
resciveJ entireiy untii iate ietai pericJ, \any autlcrs
suggesteJ tlat tle \eckeis cartiiage, a iirst
|rancliai arcl cartiiage, piays scme rcie tc inJuce
manJi|uiar grcvtl even tlcugl it is ireuentiy
insisteJ tlat tlere is nc Jirect ccnnecticn |etveen
tle \eckeis cartiiage anJ em|rycnai manJi|ie,
1,
21-2
ln tlis stuJy tlere is an eviJence tlat tle
\eckeis cartiiage is cicseiy asscciateJ vitl tle
pericsteum ci tle em|rycnai manJi|ie, anJ tlat tle
genicgicssus muscie is primariiy attacleJ tc tle
\eckeis cartiiage anJ successiveiy reiccateJ tleir
iusicn tc tle cssiiying manJi|ie, But tle Jirect
listcgenetic eiiect ci \eckeis cartiiage icr tle
manJi|uiar Jeveicpment vas ireuentiy Je|ateJ |y
many autlcrs, ln tlis stuJy ve presumeJ tlat tle
eariy mcutl cpen mcvement, primariiy inJuceJ |y
tle Jeveicpment ci tcngue muscuiature vlicl
matures mcst rapiJiy in tle crc-iaciai structures,
28
|egins |eicre tle icrmaticn ci tempcrcmanJi|uiar
jcint, anJ tlis premature mcutl cpening mcvement
causeJ tle reiccaticn ci tle manJi|uiar cssiiying
mesenclyme intc tle cutsiJe ci \eckeis cartiiage
tcgetler vitl tle asscciateJ muscies, resuitantiy tle
manJi|ie is a|ie tc Jeveicp separateiy ircm \eckei
s cartiiage, ln tlis stuJy ve tlcuglt tlat tle \xlC
anJ \JlC are prcJuceJ |y tle em|rycnai
prcgress ci intramem|rancus |cne cssiiicaticn, anJ
tlat |ecame tle primary |ack|cne ci ietai maxiiia
anJ manJi|ie nct aiiecteJ |y seccnJary
appcsiticnai grcvtl ci |cne |y tle tensicn ci
iuncticnai muscuiar icrces, Hcvever, ve c|serveJ
tlat tle seueia ci tle prenatai \JlC vas
ccntinucusiy existeJ in tle antericr manJi|uiar
|cJy in tle viev ci pancramic anJ scit X-ray vievs,
Because tle \JlC is a reiativeiy rigiJ structure ci
ietai manJi|ie, vlicl prcJuces peripleraiiy
raJiating tra|ecuiae tc icrm mcst ci manJi|uiar
structures, inciuJing symplysis, ccnJyie, ccrcnciJ
prccess, anJ even aiveciar |cne, ve presumeJ tlat
tle seueia ci tle \JlC may persistentiy piay a
rcie ci structure maintenance vitl ligliy cssiiieJ
scierctic |cne in tle marrcv space ci manJi|ie, lt is
generaiiy agreeJ tlat muscie icrmaticn aiiects tle
intramem|rancus cstecgenesis, Areas ci iuture
muscie attaclment are sites ci rapiJ |cne icrmaticn
tlrcuglcut tle eariy icrmative stages,
1,29,30
larticuiariy tle manJi|ie is asscciateJ vitl tlree
Jiiierent crigins ci muscie grcups, i,e,, masseter
muscies criginateJ ircm iirst |rancliai arcl, iaciai
expressicn muscies criginateJ ircm seccnJ
|rancliai arcl, anJ iinguai muscies criginateJ ircm
cccipitai myctcme,
31,32
1lereicre, tle Jeveicpment
ci manJi|ie slcveJ letercgenecus mcrplcicgy,
42
Fig 5
vlicl las |een a majcr Je|ating tcpic,
1,33-3
Hcvever, in tlis stuJy ve suppcse tlat tle
\JlC miglt |e a primary cssiiicaticn site ci
em|rycnai manJi|ie anJ it ccuiJ icrm rigiJ area ci
manJi|ie, 1lis lypctlesis ieaJs us tc expicre tle X-
ray pantcmcgrams ci aJuits anJ scit X-ray vievs ci
Jry aJuit manJi|ies, anJ icunJ a scierctic area
slcving iccai ccnJenseJ raJicpacity, vlicl vas
easiiy Jistinguisla|ie ircm mentai icramen anJ
iinguai tcrus anJ usuaiiy iccateJ at sta|ie area in aii
aJuit manJi|ies, e suppcseJ tlat tlis area vlicl
ccnsists ci tlick sciercsing tra|ecuiae is tle
Jeveicpmentai seueia ci \JlC, luring tle
mixeJ Jentiticn, ircm seven tc tveive years ciJ, tle
iccai ccnJenseJ raJicpacity vas nct veii JeiineJ in
tle pantcmcgram, 1lereaiter, tle manJi|uiar |cJy
grcvs rapiJiy, anJ usuaiiy ircm tle age ci iiiteen
years tle increaseJ raJicpacity appeareJ in tle
antericr pcrticn ci manJi|ie, lts tra|ecuiar pattern
vas cieariy Jistinguisla|ie ircm tle surrcunJing
manJi|uiar |cne, ln tle ciJer age grcup tle
raJicpaue image vas graJuaiiy ccnJenseJ in tle
antericr pcrticn ci manJi|ie, ln tlis stuJy ve
inJicate tlat tlis iccai ccnJenseJ raJicpaue area is
a scierctic seueia ariseJ ircm tle \JlC, anJ
suppcse tlat tlis primitive grcvtl center, \JlC,
prcviJes tle iuncticnai grcvtl ci antericr iaciai
muscuiature tc suppcrt tle ncn-masticatcry
manJi|uiar mcvements, i,e,, speecl anJ iaciai
expressicns,
V. Conclusion
lrcm tle tvc lunJreJs pantcmcgrams anJ scit
X-ray vievs ci aJuit Jry manJi|ies ve c|serveJ a
ccnJenseJ raJicpaue image, measuring 0,5-1,0 cm
in Jiameter, |eicv tle apex ci iirst premciar, 1lis
raJicpaue image vas cieariy Jistinguisla|ie ircm
tle structures ci mentai icramen anJ iinguai tcrus,
anJ slcveJ ccnspicucus raJiating pattern, sc tlat
ve suppcseJ tlat it vas a seueia ci tle \JlC ci
prenatai manJi|ie,
Hcvever, tle raJicpaue area ci \JlC vas
seiJcm clangeJ in tle ciJer perscn, even in tle
eJentuicus manJi|ie, anJ tle |enign iesicns ci
cJcntcgenic cysts anJ tumcrs larJiy Jestrcy tle
criginai structure ci \JlC, vliie tle maiignant
tumcrs ci suamcus ceii carcincma anJ metastatic
cancer rapiJiy JestrcyeJ tle raJicpaue area ci tle
\JlC,
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43
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20, .yska \, .yska A, Svissa-Sivan A, Samueicii
SHistcmcrplcmetry ci icng |cne grcvtl
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45