What is holding the maxilla up? Well, the seat of most malocclusions is the maxilla, which is, I think, unfortunately overlooked within much of orthodontic conceptualization and teaching. But as the maxilla drops down, it takes the mandible with it, and it changes the whole facial shape. Unfortunately, of course, it takes some of what we refer to as stable points (SP), so it's difficult to really gain a good understanding of this by doing the type of cephalometric um or the analyzation of x-rays because you don't see as much as is going on, which clouds thinking, unfortunately. Now, the maxilla is held up principally by two things. The first thing is the tongue up, which I refer to as the direct forces on the maxilla, and the second is the biting of the teeth, which are referred to as the indirect forces on the maxilla. So, by both the direct and indirect forces, their intensity and their duration, and we don't fully understand the details of this, but that's how the maxilla is held.

up so on the diagram here. I've written in the action of the tongue moving up and forwards, and then just sketched in there roughly the action of the um temporalis muscle. I mean the master muscle probably in a similar direction to the tongue um, and you can see the tongue highlighted, the volume, the size of the tongue. I mean, we forget that the tongue occupies this space all the way down to the high bone, and of course, one of the great problems in malocclusion is that as soon as the face drops down, as soon as it's affected by cranial facial dystrophy, the back of the tongue bulges back into the airway is often the response, the compensatory mechanisms for keeping maintaining an airway that lead to the various different types malus types of patterns that we see. Now one important thing here that I've drawn in, and it's worth sort of comparing the image I've got on the left-hand side here where the um, the dark line is IND indicating the um, the

mang the um the blue lines were indicating the forces with the resultant forces pushing forwards because of course you can't push your maxilla straight up into your head. As you push up and slightly forward, the maxilla will tend to come forwards, and that's how you get good growth of the maxilla when both of these forces are working, causing a tight space. So if you only have this area in which to grow, the max will grow forwards. Well, of course, if these forces es change, these forces will drop down, the Mao will drop right the way down, and of course, the growth will be more vertical. And as the growth vertical, you have less horizontal, which is the space where you have the teeth, the airway, and the tongue. Now one important line I've drawn here is the midline. So this line here is the midline um of the structure, so midline of the head and neck. So it's interesting how they um temper joint is pretty much on the midline, but also so a lot of the points where the um uh the sling, the hyid is hung.

from so the sty of hyid um ligaments and very centrally located. So if you're taking your Central Point as your um purchase point, then you're you're not pulling the head forwards or you're not trying to rotate the head. And the high I is H up very centrally, very stably. And the tongue then sits on top of the high, and the tongue's then pushing up the maxilla. Then, of course, the muscles of mastication are attached to various points around the skulls. So the reciprocal forces, so they equal and opposite motions in your attempt to when you bite together and also hold the max up, they're dissipated over a range of different places, from the temporalis muscle up here to the massive a muscle here. So that these two principal forces, the direct and the indirect forces of um the tongue and the biting forces, are holding the maxel up and forwards to a greater or larger extent, controlling the pattern of growth of the whole face.

How the Tongue & Dental Biting Forces Hold the Upper Jaw/ Maxilla Up & Forward by Dr Mike Mew

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How the Tongue & Dental Biting Forces Hold the Upper Jaw/ Maxilla Up & Forward by Dr Mike Mew

How the Tongue & Dental Biting Forces Hold the Upper Jaw/ Maxilla Up & Forward by Dr Mike Mew

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