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The human face. An account of the postnatal growth and development of the craniofacial skeleton
BOOK REVIEW
THE HUMAN FACE. AN ACCOUNT OF THE POSTNATAL GROWTH AND DEVELOPMENT OF THE CRANIOFACIAL SKELETON. By Donald H. Enlow, Ph. D. 303 pages, I33 illustrations. $20. New York, Harper & Row, 1968. Normal development of the body is dependent upon the synchronous coordination of the activities of the growth sites of the skeleton and related structures. The dynamics of the growth and remodeling of bone is a complicated process. Any study must be concerned with one or more of the following questions: What are the sites? What is the amount? What is the rate? Does it vary? When? What is the direction? What are the changes in proportion? A number of different approaches (osteometry, implant markers, vital stains, roentgenography, histochemical, and histologic methods) are available to assess growth of bones. Each, however, has its limitations. One method may yield information about the sites, another about the rate, still another about the direction of growth. A combination of methods will yield more information and, in certain instances, more accurately than one method alone. This monograph deals principally with histologic analyses of the postnatal growth and development of the human craniofacial skeleton. A number of superb photomicrographs support the extensive and detailed work, much of which the author reported previously. Liberal use of well-chosen diagrams and three-dimensional drawings enhance the interpretations and correlations between the microscopic and gross processes. Although the diagrams on pages 234 and 235 appear involved they are but a simplification of the truly complicated processes of facial bone growth. In selected instances animal studies supplement the human material. There are two parts to the text. The first deals with cartilage and bone and the second with craniofacial bone growth. In the first part, in the chapter on cartilage, Enlow clearly distinguishes between interstitial and appositional growth of cartiiage and compares the structure of cartilage and bone. The chapter on bone is well presented and is fundamental to an understanding of what follows. Bone, unlike cartilage, is incapable of interstitial growth. The generalized change in form of a bone is the result of a composite process that involves localized growth changes in all of the regional areas including all of the internal and external surfaces. Graded levels of growth control exist, from systemic to local. The chapter on skeletal morphogenesis is particularly valuable since it considers remodeling, area relocation, the V principle, cortical drift, and differential growth. The second part of the text pertains to craniofacial bone growth. There is a detailed description of the growth of the mandible, nasomaxillary complex, calvaria, and cranial base including the auditory ossicles. The gross changes in size and shape are explained on the histologic basis developed in the first part of the monograph. In the chapter “The Composite Nature of Facial Growth,” the complexity of facial growth is well depicted. The multi-directional growth movements occur in varying patterns. No attempt was made to include all viewpoints pertaining to facial growth since the objective was to provide a specialized reference book. One might wonder why a chapter on elementary principles of cephalometrics is included in this monograph. The proper use of serial cephalometric roentgenography has been the most important discipline added to this field of study in the twentieth century. The clinician and investigator should be acquainted with this valuable tool. Furthermore, it affords the reader an opportunity to compare two different methods, one complementing the other. A third important approach to consider is the use of in viva markers. On April 175
176
BOOK REVIEW
26, 1967, there was a Symposium on “Bone Growth as Revealed by in oiua Markers” at the annual meeting of the American Association of Physical Anthropologists at Chapel Hill, North Carolina. Those reports, together with this monograph, represent important efforts to assess growth, not only of the craniofacial but also of other less complex parts of the skeletal system. The Human Face will serve as an excellent, much needed companion volume to the too few works in the field of craniofacial biology. The basic scientist and research worker will find accepted concepts clearly explained and new concepts to mull over. To the clinician, this monograph is a must for a basic appreciation of the postnatal growth and development of the craniofacial skeleton and as it relates to the human face. With this background, the surgeon will have a more intelligent understanding of the possible effects of various procedures on the face and jaws of the growing person.-BemcETd G. Sarnut.
THE HUMAN FACE. AN ACCOUNT OF THE POSTNATAL GROWTH AND DEVELOPMENT OF THE CRANIOFACIAL SKELETON. By Donald H. Enlow, Ph. D. 303 pages, I33 illustrations. $20. New York, Harper & Row, 1968. Normal development of the body is dependent upon the synchronous coordination of the activities of the growth sites of the skeleton and related structures. The dynamics of the growth and remodeling of bone is a complicated process. Any study must be concerned with one or more of the following questions: What are the sites? What is the amount? What is the rate? Does it vary? When? What is the direction? What are the changes in proportion? A number of different approaches (osteometry, implant markers, vital stains, roentgenography, histochemical, and histologic methods) are available to assess growth of bones. Each, however, has its limitations. One method may yield information about the sites, another about the rate, still another about the direction of growth. A combination of methods will yield more information and, in certain instances, more accurately than one method alone. This monograph deals principally with histologic analyses of the postnatal growth and development of the human craniofacial skeleton. A number of superb photomicrographs support the extensive and detailed work, much of which the author reported previously. Liberal use of well-chosen diagrams and three-dimensional drawings enhance the interpretations and correlations between the microscopic and gross processes. Although the diagrams on pages 234 and 235 appear involved they are but a simplification of the truly complicated processes of facial bone growth. In selected instances animal studies supplement the human material. There are two parts to the text. The first deals with cartilage and bone and the second with craniofacial bone growth. In the first part, in the chapter on cartilage, Enlow clearly distinguishes between interstitial and appositional growth of cartiiage and compares the structure of cartilage and bone. The chapter on bone is well presented and is fundamental to an understanding of what follows. Bone, unlike cartilage, is incapable of interstitial growth. The generalized change in form of a bone is the result of a composite process that involves localized growth changes in all of the regional areas including all of the internal and external surfaces. Graded levels of growth control exist, from systemic to local. The chapter on skeletal morphogenesis is particularly valuable since it considers remodeling, area relocation, the V principle, cortical drift, and differential growth. The second part of the text pertains to craniofacial bone growth. There is a detailed description of the growth of the mandible, nasomaxillary complex, calvaria, and cranial base including the auditory ossicles. The gross changes in size and shape are explained on the histologic basis developed in the first part of the monograph. In the chapter “The Composite Nature of Facial Growth,” the complexity of facial growth is well depicted. The multi-directional growth movements occur in varying patterns. No attempt was made to include all viewpoints pertaining to facial growth since the objective was to provide a specialized reference book. One might wonder why a chapter on elementary principles of cephalometrics is included in this monograph. The proper use of serial cephalometric roentgenography has been the most important discipline added to this field of study in the twentieth century. The clinician and investigator should be acquainted with this valuable tool. Furthermore, it affords the reader an opportunity to compare two different methods, one complementing the other. A third important approach to consider is the use of in viva markers. On April 175
176
BOOK REVIEW
26, 1967, there was a Symposium on “Bone Growth as Revealed by in oiua Markers” at the annual meeting of the American Association of Physical Anthropologists at Chapel Hill, North Carolina. Those reports, together with this monograph, represent important efforts to assess growth, not only of the craniofacial but also of other less complex parts of the skeletal system. The Human Face will serve as an excellent, much needed companion volume to the too few works in the field of craniofacial biology. The basic scientist and research worker will find accepted concepts clearly explained and new concepts to mull over. To the clinician, this monograph is a must for a basic appreciation of the postnatal growth and development of the craniofacial skeleton and as it relates to the human face. With this background, the surgeon will have a more intelligent understanding of the possible effects of various procedures on the face and jaws of the growing person.-BemcETd G. Sarnut.