Craniofacial Development: Connection to Other Diseases and Syndromes?
Our lifestyle had a big change in recent years due to rapid technology advancements. However, despite the improvement of certain life conditions, changes always come with drawbacks. We are an extremely sedentary and lazy society, surrounded by a polluted environment, eating highly processed food missing many key nutritional elements. Many disorders spread in recent years and some of them are completely missing in other species, making to blame our current lifestyle for the insurgence and spread of many diseases. Probably we live longer, but do we live healthier?
Our lifestyle does not include only nutrition and physical activity, but also many other actions that are totally underestimated by the community. Jaw problems are one of those disorders labelled as genetic, however Weston A. Price largely proved that malocclusion is present only in modernized groups (Figure 1) [1].
Figure 1 – On the left, tribe in Belgian Congo. Note the breadth of the dental arches and the finely proportioned features. Their bodies are as well built as their heads. On the right, first generation, after the adoption of modernized lifestyle. Note the deformities: the extreme protrusion of the upper teeth with shortening of the lower jaw in the upper pictures and the marked narrowing with lengthening of the face in the lower views. The injury is not limited to the visible structures. (From [1])Malocclusion is the direct mapping of the cranial situation, meaning that it is a symptom of a poor craniofacial development. So, what went wrong in our modern days? In a simplistic view, maxilla is primarily remodeled by forces coming from tongue and teeth (through masseter muscles). So, the causes of malocclusion have to be found in the modern lifestyle, in particular in:
Increasing of bottle-feeding over breast-feeding that influences the swallowing pattern and all oral muscles [2,3,4,5].
Use of the pacifiers/dummies that mainly affects tongue posture [6,7,8,9].
Trend towards industrial soft high-calorie food that hits chewing effort and muscles action [10,11,12].
Reduced nasal airways, increasing of allergies and nasal congestion that leads to mouth breathing affecting both tongue posture and muscles action [13,14,15,16,17].
Trend towards an earlier or too early weaning, influencing swallowing pattern [18,19].
In modern days, we are assisting to a down-siding of the entire craniofacial structure, with the maxilla that drops down and back (vertical growth). This reduces the eye support, flattens the cheekbones, narrows the nasal airway, lengthens the mid facial third, and lowers the palate, which narrows and create malocclusion [20]. Notice in Figure 2 the difference of a prehistoric skull against a modern one: the difference in the palate shape and airways size is massive. Temporomandibular Disorder (TMD) is a problem of modern society and it directly depends on the craniofacial structure. Also, a reduction of nasal airways impairs nasal breathing, with airways exposed to chronic irritation: this can result in enlarged adenoids and tonsils in children, easily obstructing the already narrowed nasal airways and promoting mouth breathing, asthma and rhinitis [21,22,23,24,25,26,27,28]
Figure 2 – On the left, prehistoric skull: notice the large flat U-shaped palate and bigger airways. On the right, a modern skull with narrow high v-shaped palate and reduced airways. (From [29])Furthermore, a vertical growth of the maxilla forces the mandible to swing back, restricting the pharynx (Figure 3). As compensatory mechanism, a retruded mandible causes the head to tilt forward in a forward head posture, freeing in this way the airways in the erect posture [30,31]. Restriction of the upper respiratory tract, including narrowing of both nasal cavity and pharinx, is a key element in the development of snoring and obstructive sleep apnoea [32,33,34], while forward head posture creates reduced neck mobility [35], neck pain [36,37], migraine [38] and tension-type headache [39]. To find the center of gravity, the body then compensates with increased kyphosis, lordosis and pelvic anteversion, causing back pain [40].
Figure 3 – Two patients from study [41]: subject HB003 shows vertical growth of maxilla, with facial retrognathism and large mandibular inclination. Notice the forward head posture and the reduced airways’ space. Subject HB092 shows forward growth of maxilla, with facial prognathism and small mandibular inclination. Notice the head posture aligned with the cervical column and the bigger space for the airways.Asymmetrical faces are another sign of a poor craniofacial development. In particular the skull is twisted in what is called cranial distortion and the head is tilted on one side [42]. Also in this case the body compensates, creating a scoliotic curve [43,44].
If you think that all these compensations have no other consequences, then you are totally wrong. We have muscle chains that run throughout our body that tighten to maintain a stable posture and bones that can twist or rotate, like in the case of vertebrae rotation. And there are blood vessels, nerves, glands, organs that can be compressed by either overtightened muscles or by vertebrae misalignment. When this happens many syndromes of modern days arise.
Hair loss exponentially spread in last decades, so that it is considered almost normal to become bald when ageing. Current medicine is not able to explain the causes, but what happens when neck muscles are overtightened? On top of our head we have the galea aponeurotica that can be stretched by the forces of muscular contraction, in particular of the occipitofrontalis and temporalis muscles that are attached to it. When neck muscles are in continuous tension, their action propagates to the head, stretching and tightening the galea against the underlying layers of the scalp (Figure 4) [45]. The underlying structure is reach of blood vessels that are compressed, impeding blood flow to the hair follicles, causing reduced availability of nutrients and inadequate removal of metabolites [46,47]. The hair dies, with following baldness.
Figure 4 – Drawing explaining muscles action on the galea aponeurotica. When the galea is stretched and tightened, blood vessels are compressed impeding blood flow to reach the hair follicle. (From [62])Similarly, we have blood vessels running superficial to muscles and the fascia, like the ones in the neck. Large blood vessels going to the brain can be compressed by neck muscle tension [48,49]:
Multiple Sclerosis has been linked to CCSVI (chronic cerebrospinal venous insufficiency) [50,51], that is a reduced blood flow from the brain and spinal cord due to narrowing of veins in the neck, in particular of the jugular veins (Figure 5).
Patients with mild cognitive impairment, dementia and Alzheimer’s disease have a reduced cerebral blood flow [52,53], with the entire brain that is degraded, resulting in tissue loss (Figure 6).
Severity of schizofrenia can be predicted by meaning of blood flow within the brain [54].
People with stuttering have a lower regional cerebral blood flow in Broca’s area [55].
Figure 5 – The jugular veins are veins that take deoxygenated blood from the head back to the heart via the superior vena cava. The external jugular vein runs superficially to sternocleidomastoid, while the internal jugular vein runs in the carotid sheath, that is a connective tissue part of the deep cervical fascia. (From [63])Figure 6 – Brain atrophy in advanced Alzheimer’s Disease. In an Alzheimer’s patient, the entire brain is degraded resulting in tissue loss. The cortex of the brain shrivels up, which damages the ability of the brain to think, plan, and remember. (From [64])We also have nerves throughout our entire body that exploit two functions: 1) signal for muscles and 2) sensory information for the central nervous system. The spinal cord is a bundle of nervous tissue that begins at the base of the brain, high in the neck, and terminates between the first and second lumbar vertebrae, low in the back, running from top to bottom through the spinal column (Figure 7). When the spine is not aligned, the spinal cord can be compressed (Figure 8), with following neurological disorders, as in the case of dystonia [56].
Figure 7 – Our spine is surrounded by many blood vessels and nerves. The spinal cord is a long, thin, tubular bundle of nervous tissue from which all the nerves propagate. It passes through the vertebral canals from the occipital bone to the lumbar vertebrae. (From [65,66])Figure 8 – Example of spinal misalignment with vertebral dislocation compressing the spinal cord. (From [67])Postural compensations can also lead to compression of organs. This is the case of lungs that have decreased capacity with an increased kyphosis [57,58], or of the duodenum that can be compressed as a consequences of increasing lordosis or scoliosis [59]. The stomach is surrounded by abdominal and psoas muscles: they can eventually tighten and compress the stomach in cases of pelvic anteversion. Knowing that 80% of women with chronic pelvic pain suffers of IBS [60], could be this the cause of Irritable Bowel Syndrome (IBS)?
Figure 9 – A forward head posture is caused by a vertical growth of the maxilla. Body compensates increasing kyphosis and lordosis, with perlvic anteversion. This can tighten muscles surrounding the stomach (psoas and abdominal muscles), that is then compressed. (From [68])Fibromyalgia is a disorder characterized by widespread musculoskeletal pain accompanied by fatigue, sleep, memory and mood issues. Associated symptoms are tension headaches, temporomandibular joint disorders, irritable bowel syndrome and bladder pain. Current medicine is not able to explain causes of fibromyalgia, however, all of these symptoms can be brought back to a spinal misalignment [61], deriving from a poor craniofacial development.
Despite the recent technological advancements, the current medicine is still unable to identify the causes of many disorders that spread only in modern times. Many of them are labelled with unknown or unclear causes that makes genetic and psychological factors easy to blame. This is the perfect scenario on which the medical world can lucre on: long-term diseases with unknown causes make people purely rely on medical treatments and drugs that treat the symptoms for a lot of time. So, does the current medicine really want to discover and cure the causes? If that would be the case, they will discover that many problems derives from the craniofacial development.
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