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 (SPs). So it's difficult to really gain a good understanding of this by doing the type of cephalometric analyses 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 temporalis muscle—I mean, the masseter muscle, probably in a similar direction to the tongue.

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 hyoid 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 craniofacial dystrophy, the back of the tongue bulges back into the airway.

It's often the response the compensatory mechanisms for maintaining an airway that lead to the various different types of malocclusion 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 indicating the um, the mandible, 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 maxilla will grow forwards.

Well, of course, if these forces change, these forces will drop down, the maxilla will drop right the way down, and of course, the growth will be more vertical.

And as the growth is 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 the midline of the head and neck.

So it's interesting how the um, temporomandibular joint is pretty much on the midline, but also so a lot of the points where the um, uh, the sling, the hyoid is hung from.

So the stylohyoid um, ligaments are 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 hyoid is held up very centrally, very stably.

And the tongue then sits on top of the hyoid, and the tongue's then pushing up the maxilla.

Then, of course, the muscles of mastication are attached to various points around the skull. So, the reciprocal forces, the equal and opposite motions in your attempt to, when you bite together and also hold the maxilla up, they're dissipated over a range of different places from the temporalis muscle up here to the masseter muscle here.

So that these two principal forces, the direct and the indirect forces of the tongue and the biting forces are holding the maxilla 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

The Founders of Mewing: Dive into the Authentic Guide to a Natural Jawline

Orthotropics, founded by Dr. John Mew, is a branch of orthodontics focused on guiding natural facial growth for optimal function and aesthetics. "Mewing," a related technique, is also attributed to the Mew family.

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

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