European Journal of Orthodontics 29 (2007) i96–i101 © European Orthodontic Society.

y. Published by Oxford University Press on behalf of the European Orthodontic Society.

doi:10.1093/ejo/cjl097

The differential roles of periosteal and capsular functional

matrices in orofacial growth
Melvin L. Moss
New York, USA
(Transaction of the European Orthodontic Society 1969 pp. 193–206)

SUMMARY Historically students of craniology believed, erroneously, that only the active processes
of surface deposition and resorption and of interstitial expansion were involved in skull growth. The
introduction of the method of functional cranial analysis placed primary emphasis on the morphogenetic
role of the functional matrix. The two principal types of functional matrices, the periosteal and the
capsular, are defined. The former alter the size and shape of the skeletal tissues while the latter alter
spatial position. The majority of facial skeletal growth is shown to be due to the passive translation of the
skeletal tissues within the orofacial capsule, responding to the prior and primary volumetric expansion of
the oro-nasopharyngeal functioning spaces, acting as capsular matrices.

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Introduction
cartilaginous tissues. Contemporary residual statements
The biological mechanisms of orofacial growth remain a purporting to re-establish these erroneous concepts in
topic of perennial interest to all students of craniology. The orthodontics are due, in part, to the less than satisfactory
skeletal tissues, cartilage and bone, are the usual focus of biological background of some individual investigators and,
both clinical attention and therapeutic intervention, as well in part, to a continued and provincial adherence to earlier
as the primary objects of roentgenographic observation. and incorrect conceptions of cranial growth mechanisms
Further, osseous tissues are the only materials available to long since discarded by the mainstream of modern
the vertebrate palaeontologist and human osteologist. craniological thought. Papers continue to appear written by
For these reasons, among others, it is customary authors who are obviously still entrapped in the spurious
linguistically and conceptually to regard skeletal tissues dichotomy between the data of Brash (1934) and of Massler
as possessing primary and intrinsic growth processes; and Schour (1951) on the mechanism of cranial vault
self-sufficient to account for the observed phenomena of growth; the former describing a thick-skulled mammal and
normal and abnormal orofacial growth. the latter a thin-skulled form. The mutually confirmatory
Two centuries of experimentation on skeletal tissues work of other modern investigators refute such a biologically
with both vital dyes and metallic markers established, unsophisticated thesis (cf: Hoyte, 1966).
very early, that osseous tissues alter their form only by Returning to our discussion, the older, classic, concepts
surface accretion and resorption, while cartilaginous tissues attempt to describe how the size and shape of skeletal tissues
have an additional and significant process of interstitial altered, but not why. Further they do not describe
expansion. Earlier controversy regarding the role of satisfactorily how skeletal organs change their relative
periosteum and perichondrium as vital sources of these positions, not even when we accurately quantify the amount
surface phenomena was resolved finally only four decades of ‘drift’ or ‘translocation’ of bones produced by the
ago (Keith, 1919). Utilizing these data, an attempt was net effect of surface appositions and resorptions. The
made some 25 years ago to describe the biological processes operational method of functional cranial analysis is a
of orofacial growth as follows: a) bone and cartilage significant contribution to the solution of these problems.
alter their size and shape (form) by surface deposition The experimental and theoretical bases of this technique are
and removal; and b) skeletal organs (bones) move relative published extensively elsewhere (Moss, 1962, 1968a,b,
to each other as a result of an expansive, ‘pushing,’ 1969a, b; 1969a,b; Moss and Young, 1960). Succinctly, the
force primarily generated by the interstitial expansion of head is a region in which a number of functions are carried
either sutural or cartilaginous tissues. In this formulation out (respiration, vision, olfaction, digestion, etc.). Each
interosseous sutural tissues were held to be analogous to the function is accomplished completely by a functional cranial
growth plates of long bones; while the nasal septal, component which has two parts. The totality of any function
mandibular condylar and basal cranial synchondroses is performed by a functional matrix, and each such matrix is
were thought to be homologous to such growth plates. protected and supported biomechanically by a skeletal unit.
In recent decades, an increasing corpus of experimental Recent work permits us to define two types of functional
data conclusively disproved the generation of any primary matrices and two related types of skeletal units. The first
expansive force within either sutural or splanchnocranial is the periosteal matrix. Muscles, glands, neurovascular
FUNCTIONAL MATRICES IN OROFACIAL GROWTH i97

bundles and teeth are excellent examples. These matrices secondary, compensatory, manner to translations produced
act directly upon individually related micro-skeletal units. by volumetric expansion of capsular matrices.
Such matrices produce morphological expression of their Complete removal of sutural tissues results only in sutural
operational demands by the active processes of deposition dehisence (i.e., by a local loss of secondary transformation).
and resorption, thus altering the size and shape (i.e., the Similarly, removal of facial cartilages (or their congenital
form) of their micro-skeletal units by the processes of absence) does not interfere with orofacial translative growth.
transformation. In varying degrees, transformative growth The normal translation of the upper jaw in arrhinencephalic
changes produce ‘drift’ or ‘translocation’ of the micro- and bilateral cleft palate infants, as well as those missing
skeletal units. For example, the primary growth of the a septum, are clinical proof that the nasal cartilage is not
medial pterygoid and masseter muscles, of the temporalis a primary site of such translative growth. The normal growth
muscle and of the lateral pterygoid muscle causes a of all non-condylar mandibular micro-skeletal units in
secondary transformative growth change in the mandibular patients with congenital absence of their condylar processes
angular, coronoid and condylar processes respectively. Such establishes the non-translative role of these cartilages.
changes not only alter their form, but also the position of So true is this that young patients with either congenital or
these contiguous micro-skeletal units relative to each other. acquired ankylosis of the temporomandibular joint (unilateral
However none of these processes is responsible for the or bilateral) are treated successfully by bilateral condylectomy
motion of the totality of the mandibular micro-skeletal units (Moss and Rankow, 1968). We can study quantitatively the

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(i.e. of the mandibular macro-skeletal unit) away from role of both translation and transformation (the role of
either the cranial base or from the maxillary skeletal units. periosteal and capsular matrices) in orofacial growth. Using
All microskeletal units are entirely dependent upon the multiple vital staining in the rat, Cleal et al. (1968) provide
morphogenetically primary demands of their functional data on both the magnitude and direction of orofacial and
periosteal matrices for changes in size and shape as well as neuro-cranial transformative bone growth. Comparing these
for maintenance in being. It is established that there is no data with our own, which measures the sum of both translation
direct genetic determination of either the form or position of and transformation, we note the following results of analyzing
any skeletal unit. Morphological genetic activity is directed adolescent vertical growth in the sagittal plane:
primarily to functional matrices and so only indirectly and a) anterior nasal aperture height—transformation 35.4 per
secondarily to skeletal tissues (Grüneberg, 1963). cent, translation 64.6 per cent;
All orofacial micro-skeletal units, together with their b) height from middle of frontal bone to plane of hard palate—
periosteal matrices exist within a series of orofacial capsules transformation 22.5 per cent, translation 77.5 per cent;
(oral, nasal, pharyngeal), which surround and protect the c) height from centre of parietal bone to lower border of
functioning spaces of the oral, nasal and pharyngeal cavities. basi-sphenoid, transformation, 32.4 per cent, translation
Our second type of functional matrix is the capsular; 67.6 per cent.
consisting of these functioning spaces. The neural, orbital
and otic masses are other cephalic capsular matrices. Obviously the ‘drifts’ or ‘translations’ due to direct active
Capsular matrices act indirectly on both the totality of all transformation of micro-skeletal units in response to their
the embedded micro-skeletal units (i.e. on macro-skeletal growing periosteal matrices ranges from 25 to 33 per cent,
units) and on their periosteal matrices. Capsular matrices do while indirect passive translation of macro-skeletal units in
not act by the processes of resorption and deposition. Rather, response to the volumetric expansion of capsular matrices
as the volume of the functioning spaces increases, the ranges from 66 to 75 per cent.
surrounding capsule expands and the embedded macro- The effect of transformative and translative growth are
skeletal units are passively translated in space. Since not always additive. For example, Cleal et al. (1968), note
periosteal matrices simultaneously are translated, they that the cerebral surface of the basi-sphenoid transforms
in turn alter their functional demands, thus producing upwards while being translated downward. Further, the
synchronous transformations of their respective micro- occipital squama transforms anteriorly while being
skeletal units. The apparently simultaneous appearance of translated posteriorly. Recently we demonstrated methods
both translative and transformative growth changes plays a to quantitate both the magnitude and direction of the
major role in creating the confusion now existing concerning vectors of transformative and translative growth (Moss and
the mechanisms of orofacial growth. Salentijn (1969a,b, 1970). Here we introduced two terms
Experimentally and clinically it is possible to isolate requiring clarification. Tracings of successive stages of
these two aspects of growth. We can demonstrate either longitudinal or cross-sectional growth data film can
conclusively that neither nasal septal nor mandibular be superimposed; correctly on the anterior cranial base and
condylar cartilages are primary sites of expansive orofacial alternately and less meaningfully by any cephalometric
growth. As the surfaces of micro-skeletal units respond technique. What is observed is interosseous growth, the
secondarily by transformation to periosteal matrices, so sutural sum of both active transformation and passive translation. It
margins and cephalic cartilages respond transformatively in a is possible now to distinguish between them. Re-registration
i98 M. L. MOSS

of mandibular tracings on the mental foramina has been that passive translation accounts for a significant proportion
shown to be as accurate as that obtained by Björk (1964, of total vertical growth of the hard palate. Transformation is
1968) using metallic implants. Now we observe intraosseous responsible for the posterior ‘relocation’. Continuing work in
growth, which is totally transformative. Superimposition of our laboratory, to be published elsewhere, will deal with this
both sets of tracings permits the visual, biological and verbal topic more definitively.
subtraction of the transformation of intraosseous growth
from the sum of both the transformation and translation
Discussion
of interosseous growth, leaving translation alone. Our
published data indicate that about 66-75 per cent of normal Professor Tulley congratulated Professor Moss on his paper:
vertical mandibular growth is due to the passive translation a great many of the things that had been said he personally
of the mandibular macro-skeletal unit as a secondary had believed for some time. He hated to disagree with
response to the primary volumetric expansion of the orofacial Professor Moss but nevertheless he intended to do so. Most
functioning spaces acting as a capsular matrix. The change people would agree with a great deal of what Professor
in position of ramal micro-skeletal units, as expected, is due Moss had said. They would not agree however that this was
to transformation. A striking example of the dominance of a new concept. The suggestions that were being put forward
capsular matrices in vertical mandibular growth is shown in were at least 50 years old. He agreed that those people who
Figure 1, taken from the data of Björk and Kuroda (1968). are just transplanting bones are not studying the entire

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At this time we present the first similar analogies of concept of growth but many people had been transplanting
mid-facial skeletal growth, with longitudinal growth data limb buds and not just bone structures. He felt that although
published by Björk (1964; 1968), using metallic implants. It 95 per cent of what Professor Moss had put forward was
has become customary to consider the vertical lowering of correct, it was the other 5 per cent that was dangerous. First
the hard palate relative to the anterior cranial base as being of all he would question whether it was reasonable to use
either totally transformative in nature, or having a variable the mental foramen as a landmark on which to superimpose
contribution from supposed expansive forces generated by tracings of the mandible several years apart in growth. We
interstitial growth within the nasal septal cartilages. Having all know that the functional matrix and the way in which
disproved the latter previously (Moss and Greenberg, 1967; nervous structures emerge make the position of the mental
Moss and Bromberg, 1968; Moss and Simon, 1968), we foramen entirely different at these two stages.
turn now to the possible role of capsular matrices. Professor Moss was not a clinician, most of his audience
Graphic analysis of Björk’s data for the mean growth of were clinicians, but he would agree, as a scientist, that it
his sample population shows that on the average almost all would be unwise to place too much emphasis on a single
the vertical growth of the hard palate is translative (Fig. 2). case of absence of the condyles.
In any given case, this generalization is not true. The examples There would be many people in the audience who have
in Figures 3 and 4 make it clear, even as a first approximation, seen numerous cases of early condylectomy without the
success that Professor Moss had claimed for the case that he
had shown. He had said yesterday that we were doing
children a disservice if the condyles were not removed early.
Professor Tulley had had the opportunity to study cases over
15 years - twice as long as those shown in Professor Moss’
paper - but he could not see quite the same end result and no
doubt this would be supported by others in the audience with
a great deal more experience than he had.
We all see a lot of pathological cases and he would like to
ask whether excessive endocrine secretion in certain specific
instances, such as acromegaly, act entirely on the functional
matrix.
Another dangerous point that had been made, and here
Dr Fränkel’s paper is relevant, is the thought that we can
Figure 1 The dominance of capsular matrices and of translative growth
are shown in this case of ‘congenital bilateral hypoplasia’ of the mandibular stimulate both growth beyond its genetic potential. Professor
condyles (after Björk and Kuroda, 1968). a) Interosseous growth is shown Tulley felt that in his paper Professor Moss had given the
in the period from 11 years 5 months to 19 years 5 months. This is the sum ready-made answer to people who believed that this was a
of both translation and transformation. Registration is on the anterior
cranial base. b) Intraosseous growth, totally transformative is shown, with possibility and he would like to ask Professor Moss whether,
resorption in black and deposition with crosses. c) The superimposition of in all honesty, he believed that it was possible to stimulate
(a) and (b) now shows that almost all of the vertical motion here is bone growth to this extent.
translative. The oro-pharyngeal functioning spaces, being unable to express
their normal direction of growth, cause this deformation since the Professor Moss said that he was going to be very blunt. If
magnitude of the growth force of these capsular matrices is unaltered. everyone had known about these concepts for 50 years why
FUNCTIONAL MATRICES IN OROFACIAL GROWTH i99

does not migrate at all and he was perfectly justified in using

it. Furthermore having established that he could reproduce
this tracing accurately he had been able to apply this to
Dr Björk’s magnificent implant study and had produced
the same results. Now, condyles! Why hasn’t everyone else
been able to reproduce these results? The problem is one of
surgical technique. The situation was comparable to the
early days of cleft palate surgery when unfortunate operative
techniques produced extensive scarring and the result on
growth of the mid-face was more serious than was an
unoperated cleft. There are many ways of taking condyles
out and lots of reasons for doing so but the sine qua non of
good results is the absence of post-operative scarring. You
may observe cases for 15 years, or for 50, but it is the first
three weeks that count in terms of results. He hoped that
Professor Tulley did not consider him to be so poor a
scientist as to rely on one case. He showed only one because

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his paper was limited to 30 minutes but he had an extensive
series of cases that had been followed for quite a few years,
both adults and children, and the results have been uniform.
The technique in the United States is being utilised in a
wide number of major surgical centres. The method was a
‘no-scar technique’. The lateral pterygoid is cut and allowed
to retract. All the condylar head is taken off, including the
neck, and provision is made for no scarring, including, at
times, application of a series of plastic films over the cut
edges, but this is a no-scar technique with immediate
Figure 2 The mean growth of the mid-face is shown in this data derived motion – not fixation.
from that of Björk (1964) for a sample of 32 Danish boys. The registrations
are as indicated in Figure (1). See text for details.
Now as to acromegaly, the clinical sign that most patients
will demonstrate first is enlargement of the tongue. The
question is asked from time to time, does growth hormone
hadn’t they done something about it? Why were their affect the cartilage per se or is it acting primarily on the
treatments and their concepts not any better? With respect soft tissues. Everything that he had discussed on functional
to the President and to Professor Tulley, he did not think matrix had made certain assumptions – namely that we
that the things that he was talking about in terms of functional have been dealing within that so-called ‘normal’. The
matrix were the same as what they were talking about. The primary site of somatotrophic hormone action he believed
concepts that he was developing were possibly more was in the soft tissues but this was an interesting point.
sophisticated biologically than many speakers had realised. Dr Logan said he heartily concurred with Professor Moss
He was sorry that the name, Functional Matrix, seemed to when he said that we are not in agreement on the meaning of
have caught on and he was unhappy at the rather facile use Functional Matrix. He felt that Professor Moss was probably
that some people were making of the concepts that he was not informed about what we were thinking in Europe and
developing. The followers of Dr Fränkel claimed that their he would be interested to learn what he thought about the
undoubtedly good manipulative technique was based on his Fränkel cases in the demonstrations later in the programme.
beliefs and theories, but he doubted whether these workers Professor Moss said that Dr Logan should not necessarily
were using either his terminology or concepts and he must assume a state of intellectual provincialism in the speaker. On
disclaim any responsibility for their work on the basis of his the contrary, he was very well informed about anatomical,
own theories. As to the use of the mental foramen, Professor anthropological, and orthodontic thought in the United
Tulley was wrong. He knew, as his audience all knew, that Kingdom, as well as the Continent.
the shape and direction of the mental foramen alters with Concerning Professor Fränkel, his previous comments
growth and development but the position of the original would serve in this instance also.
endosseous site of the foramen, as in any nutrient foramen Professor Baume said that Professor Moss had stated that
in any bone, does not alter and this can be proved by metallic genes do not affect cartilage. Professor Baume quoted the
implant studies. He thought that he and Professor Tulley work of Stockard on cross-breeding of dogs to establish
were talking about different things. He agreed that that the which cartilages were genetically determined; by showing
external position changes but the internal site of the foramen malformations he had indicated that there was some genetic
i100 M. L. MOSS

Professor Moss said in reply that the photographs of

the profile that Professor Baume wished to see had
been published over 18 months previously in the Angle
Orthodontist. In the short paper that he had just given he did
not claim to have presented even a moderate synopsis of the
method of functional cranial analysis and if his theories
were to be fully understood it was necessary to read the
previous relevant literature.
Professor Moss could not accept the work of Stockard on
hybridisation in dogs as scientific data to be used to establish
the role of cartilage in growth in humans. His own work
on functional matrix is not a philosophy, it is the result
of experimental anatomical investigation over a period
of about 15 years. It began as, and still is, experimental
morphology with conclusions derived on the basis of
experimental data only. Professor Moss did not know
Figures 3–4 The original data are those of Björk (1964, 1968) and are originally whether what he was presenting in terms of

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shown in each figure as (a). In both cases (b) shows the amount and functional analysis and functional matrix was good, bad or
direction of active transformation, while (c) shows the vectors of passive indifferent in the clinical treatment of the patient. It was
translation. The original figure did not, unfortunately, show the oral surface
of the hard palate, so that all we can demonstrate are the changes of the never devised with the concept of having anything to do
alveolar borders and of the nasal surface. In both children translation in with clinical techniques. It was originally a craniological
response to capsular matrices accounts for the majority of the totality of investigation. It has, however, proved valuable clinically.
vertical growth.
He could not allow his presentation at this meeting to be
interpreted as an attempt to give the sum and substance of
control of bone growth through cartilages and that these the method. He did believe that dentistry has passed from a
cartilaginous centres were sometimes genetically lacking. restorative to a preventive phase and, in his school at least,
He had previously discussed the chronology of fusion of from a purely technical profession to one with a truly
cartilages in various animals and had referred to the rat scientific basis. He did not believe that orthodontists in any
which Evans had called a genetically dwarfed animal. Some country are adequately trained in the biological sciences and
rat cartilages never fuse and if you administer growth this was as true in the United States as elsewhere. The
hormone they will start to grow again. Professor Moss had scientific basis could only be achieved by individuals who
said that growth hormone acts primarily on the soft tissues with appropriate clinical background are then prepared to
but he would recall that growth hormone was once called devote the major portion of their time as serious scientists
chondrotropic hormone and it was believed that it acted and it was inevitable that such people would have very solidly
initially on cartilage. There is experimental evidence in adult based concepts that would be very disturbing to present
rats and dogs. Evans gave growth hormone to Dachshunds clinically oriented beliefs. They would be rejuvenating and
and they increased in length but not in height because there refreshing, and orthodontists would only benefit from these
were no epiphyseal cartilages in the tibia because the workers if they first got rid of the concept that everything
Dachshund is an achondroplastic dwarf. This is further that they had done in the past was right. Professor Moss said
evidence that the growth hormone acts on cartilage. The that he was something of an educator in dentistry and it was
theory of the functional matrix left a great deal unexplained. his policy to educate by irritation. To judge from the reaction
Professor Moss had not shown the profile of his patient but in the discussion he had taught well today.
we know that ankylosis produces the bird faced profile. He Dr Stockli said that Professor Moss had suggested that
had carried out histological sections systematically during the mandible grows without a condyle and quoted as
growth in monkeys and this had shown that when the evidence the fact that the mandible continues to grow after
mandible grows it grows in width as well as in length. How resection of the condyle. This is not a new observation but
can this occur? There is resorption at the attachment of the the question really is whether it is the same mandible, the
mesial pterygoid and apposition at the attachment of the same size and in the same relation in space as it would
masseter muscle. How could Professor Moss explain this? have been without resection. No-one, as far as Dr. Stockli
The temporal muscle is inserted into the anterior part of the was aware, has ever suggested that we need the condylar
ramus but this part of the mandible resorbs. The initial cartilage for the growth of the alveolar process.
growth centre is the condylar cartilage and this leads and Professor Moss replied that in his series of bilateral
directs the growth in length and width. He would accept that condylectomies the now acondylar mandible did not assume
this might be secondary but, in his view, it undoubtedly ‘the same relation it would have had without resection’
plays an important role in jaw growth. since pre-operative position, obviously, would be abnormal.
FUNCTIONAL MATRICES IN OROFACIAL GROWTH i101

However, in his series, the acondylar mandibles did alter Keith A 1919 Menders of the maimed. J B Lippincott Co., Philadelphia
both their form and position in a manner and to a degree Massler M, Schour I 1951 The growth pattern of the cranial vault in the
albino rat is measured with vital staining with alizarin red ‘S’.
homologous with those of normal patients. Finally, Dr. Anatomical Record 110: 83–101
Moss agreed with Dr. Stockli that the condylar cartilage Moss M L 1962 . The functional matrix. In: Kraus B S, Reidel R A (eds)
was not necessary for the growth of the alveolar process. Vistas in orthodontics. Lea and Febiger, Philadelphia
Indeed, one of the basic points of functional cranial analysis Moss M L 1968a The primacy of functional matrices in orofacial growth.
was precisely the independence of such mandibular Dental Practitioner and Dental Record 19: 65–73
functional cranial components. Moss M L 1968b Functional cranial analysis of mammalian mandibular
ramal morphology. Acta Anatatomica 71: 423–447
Acknowledgement Moss M L 1969a Functional cranial analysis of the mandibular angular
cartilage in the rat. Angle Orthodontist 39: 209–214
My colleague, Professor Letty Salentijn, Department of Moss M L 1969b A theoretical analysis of the functional matrix. Acta
Anatomy, Columbia University, played a major role in this Biotheoretica 18: 195–202
work, which was supported in part by a grant NB 00965, Moss M L, Bromberg B 1968 The passive role of nasal septal cartilage
in mid-facial growth. Plastic and Reconstructive Surgery 41:
National Institutes of Health. 536–542
Moss M L, Greenberg S N 1967 Functional cranial analysis of the human
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