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    Learning Objectives 1 The Study of Physical Growth

    1. Understand the definitions for growth, development, differentiation, translocation, maturation, physical

    growth, anthropometric measurement.

    Growth- normal dimensional changes in the amount of living substance that is measured in units of change per

    units of time

    Development- all the naturally occurring unidirectional changes in the life of a species from its existence as asingle cell to its elaboration as a multifunctional unitDifferentiation- the change from generalized cells or tissues to more specialized units during development

    ranslocation- change in position eg. he chin point moves downward and forward with growth

    !aturation- "ualitative changes that occur in tissues, organs, and structures in an orderly and predictablefashion during growth.

    #hysical Growth- he study of everything that happens in an organism from conception to full body growth and

    maturation$nthropometric !easurement- measurements of the body in terms of dimensions of bone, muscle, and adipose

    tissue.

    %. Understand the methods used to study physical growth, and an example of how each is used.

    &pinion- o loo' at something and extrapolate information from what you are able to see. (ee that two things

    are different or the same.&bservation- o loo' at a set of information that is provided and produce a finding from the information

    eg. )-1*+ of U( children will have at least 1 primary molar become an'ylosed before it finally resorbs and

    exfoliatesatings and an'ings- lassify things. eg classify faces, teeth, teeth development

    uantitative !easurements - either direct or indirect measurement /!ost important0

    !ethods for measurement

    $nthropometry- he measurements of s'eletal structures on a living individual. hese measurements are madeusing common landmar's over certain landmar' structures and compared to dry s'ulls to determine degree of

    development. hese measurements can be compared to a ban' of statistical data or to an individuals previousmeasurements. eg. 2ody !ass 3ndex

    ephalometric adiography- #recisely orient the patients s'ull and ta'e a radiograph. his allows you to ta'e

    direct measurements of the dimensions of the bone tissue without having to ta'e into account the variations ofsoft tissue thic'nesses. $lso due to the precise cephalic orientation, you can overlay the radiographs and show

    the location and amount of growth.

    4D imaging- #erformed using $ scans and !3 images, enable you to observe the three dimensional growthof the s'ull. (ignificantly more difficult to overlap and compare to a previous image but new technology is

    ma'ing this possible. his is primarily used in planning surgical treatments for patients with facial deformities.

    4. Understand the differences between direct and indirect "uantitative measurements.

    Direct !easurements- 3nformation that is derived from measurements ta'en on a living person, cadaver, or

    s'eleton by means of calipers, scales, measuring tapes, and any other measurement instruments.-$nthropometry

    3ndirect !easurements- 3nformation derived from images or reproductions of the actual person eg. #hotos or

    radiographs-$ scans, 5and-wrist scans determining s'eletal age, measurement of teeth from a stone model

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    6. 7hat is the general approach to determine s'eletal tissue maturation used in hand-wrist radiographs. 7hat

    sex differences are observed in the timing of s'eletal maturation8

    $ radiograph is compared with standard radiographic images in an atlas of hand-wrist development. he main

    points that are trying to be observed is the se"uence of ossification of the bones in the hand and wrist /4*bones0, which often occurs in a regular se"uence. $lso observe the size of the epiphyseal growth plates in the

    long bones of the fingers /phalanges, metacarpals, and radius.0 $lso the adductor sesamoid bone originally is a

    piece of cartilage that ossifies during adolescence and is a 'ey mar'er for the growth spurt.here are several sex differences in timing of s'eletal maturation. Girls often precede boys in regards to growthspurt, dental calcification, ossification of carpel bones /hand-wrist radiograph0

    -he maturity indicator-##% stage

    -Growth disc has same width as proximal phalanx of %nd/index0 finger

    -( stage-he sesamoid bone of the thumb begins to calcify

    -1*.) years for girls, 11.) years for boys

    -(!#4cap

    -apping of the middle phalanx of the 4rd/middle0 finger-1 year after ( stage

    -U stage

    -9piphysis of the radius fuses-3ndirect measurements of an x-ray of a patient:s hand- an measure epiphyseal growth plates

    -Generally, girls are 1 year ahead of boys in development

    -7hich means that you can start orthodontic treatments earlier in girls

    ). Understand the differences between height and velocity growth plots for stature, weight and sex.

    5eight- !ales have a tendency of having a later growth spurt then female. !ales also usually go on to grow to

    be taller and grow for a longer period of time.

    7eight- !ales are usually heavier and have a period of increased weight gain that occurs on average two years

    later than females.

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    ;. 2e able to discern the differences between growth pattern, age e"uivalence and growth timing as aspects

    which affect physical growth variability.

    Growth pattern- the change in proportional relationships with time. ertain patterns emerge in development that

    are seen almost universally.

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    !ental age- age based on the mental maturity of an individual. #erformed using an intelligence test and

    extrapolated to an external information set.

    Growth timing- &ne ma=or growth landmar' in a person>s development is the growth spurt. his occurs when

    the body produces a significant enough supply of growth hormone and is an important point because it is usedas a mar'er for the timing of other growth events. his is based somewhat in genetics but several patterns have

    been observed such as the fact that taller children tend to reach the adolescent spurt later than short-legged

    stoc'y children. $lso females begin their growth spurt earlier than males. he next "uestion identifies many ofthe variables that affect growth timing.

    ?. 2e able to list and understand the variables which affect the timing of growth.

    5eredity- genetic control of the size of body parts, the rate of growth, and the onset of growth events.@utrition- malnutrition delays growth and may affect the size of body parts, proportions and "uality and texture

    of some tissues li'e teeth and bones

    3llness- systemic diseases

    ace- gene pool differences affect s'eletal maturity at birth

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    because they happen at different times for different individuals, individual variations

    are important for

    onset of pubescence

    onset of the adolescent growth spurt

    %. 2e able to define, compare and contrast craniometry, anthropometry and cephalometric radiology.

    Cranio!etryB techni"ue of measuring bonesof the s'ull to determine physical characteristics as related to

    sex, race, age, individual history or body type.- used in the 1C4*>s

    o used a tool called a craniostat

    o based on measurements from human s'eletal material

    - today, used for the study ofo evolution of a species

    o contemporary human craniofacial growth

    - advantageso precise measurements of s'ulls

    o can study different populations and species /extinct or living0o can study the "attern of growth

    - disadvantageo measurements are crosssectionalsince sub=ect is dead

    #nthro"o!etryB the study of measurements of the body in terms of dimensions of bone, muscle, and adiposetissue.

    - refers to the measurement of living individuals- 2!3 is the most common measurement- Goal is to find soft tissue land!ar$swhich represent the underlying s'eletal structure- #dvantage

    o an now follow individual growth directly, by measuring soft tissue points repeatedly atdifferent times /longitudinal0

    ongitudinal studies provide more precision

    Ce"halo!etric %adiologyB indirectmeasurement of bony s'eleton and soft tissue.- most common techni"ue used today- images allow you to see s'eleton and soft tissue at the same time- advantages

    o combines advantages of craniometry and anthropometry

    o can be used for both longitudinal and cross-sectional studies

    - disadvantageso re"uires radiation

    o %D image of a 4D head

    o patient must be reliably positioned to obtain comparable images

    - 4D imaging is an emerging area

    4. 2e able to describe, and give an example for vital staining, molecular biological techni"ues, autoradiography

    and implant radiography as experimental methods used in studying craniofacial growth.

    &ital Staining

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    - $lizarin red is in=ected into the sub=ect at e"ual time intervals.- he red is incorporated into the soft tissue before it is mineralized.- 3n the rat mandible, it can represent growth in thic'ness of the periosteum if located around the

    length of the bone- 3n the rat mandible, growth up near the condyle represents changes in the dimensions /length0 of the

    cartilage of the mandibular condyle

    'olecular (iological Techni)ues- &steoblast ranscription

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    - the mandible grows up and bac'wards888 towards the cranial cavity rather than down and forward

    ). ompare and contrast intramembranous and endochondrial bone growth, including the terms, apposition and

    remodeling.

    -ntra!e!branousB bone formed by direct ossification of embryonic connective tissue- process

    o formation of ossification centero calcification

    o trabeculae formation

    o final maturation

    - periosteum is formed from the surface mesenchyme- superficial layers of spongy bone are replaced by compact bone- spongy bone remains in the center this is where the roots of teeth are found along with the

    periodontal ligament- found

    o s'ull calvarial bones and cranial sutures

    o all bones of maxilla

    o all of mandible except for the condyles

    o alveolar bone

    .ndochondrialB re"lace!entof hyaline cartilage cartilage is resorbed and the bone replaces it.- #rocess

    o mesenchymal cells differentiate into cartilage

    o cells undergo hyperplasia and hypertrophy

    o cartilage matrix calcifies and cells degenerate

    o disintegrating cartilage is replaced by osteogenic tissues

    -

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    - remaining cartilage is used for growth- Growth zones

    o esting B cartilage attaches to epiphysis

    o #roliferation B chondrocytes divide on the e"i"hysial sideof the plate to form cartilage

    o 5ypertrophy B chondrocytes mature and enlarge

    o alcifiation B chondrocytes die, matrix is calcified

    o &ssified bone B bone has replaced cartilage

    ;. Describe differences between accretionary, multiplicative and dimensional cell growth.

    ?. 7hen does interstitial growth and appositional growth occur in bone formation8

    -nterstitial GrowthB growth types that ta'e place throughout the entire tissue- happens during fetal growth- #ccretionary GrowthB increase in intercellular substance. here is no increase in size or number

    of the cells.- 'ulti"licative Growth increase in number of cells.- *i!ensional 3ncrease in size of cells.- esults in a separation of internal structures

    #""ositional GrowthB growth only on the surface of the tissue- happens at neonatal period

    - is really =ust !ulti"licativegrowth at the epiphysis and periosteum

    - internal structures remain in the same relative locations

    ?. Define the anatomical units which constitute the craniofacial s'eleton.

    *es!ocraniu! boney portion of neurocranium formed by intramembranous ossification- frontal bone

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    Learning Objectives ,

    1. 2e able to list the sites of new bone growth in the craniofacial s'eleton.

    - ondylar cartilages of the mandible

    - (ynchondroses of the cranial base--- (pecifically the spheno-occipital and occipito-mastoid synchondroses

    - $lveolar !argins /#D and tooth root0

    - !embranous anatomic surfaces of bones /periosteum and endosteum0- (utures in the s'ull

    %. 2e able to describe the different types of positional movements of bone in the craniofacial s'eleton during

    growth and give an example of each different type of movement.- @ote 9nlow defines positional movement of bones as egional responses to remodelingprocesses.emodeling is the basis of bone growth, whereby there is continuous deposition of bone on one

    surface balanced by resorption on the contralateral surface. 6 types, can have multiple going on at once.

    a/ Cortical *rift he movement of an entire cortical surface of a bone.

    --- 9xamples are the lateral movement of the zygomatic arch, and theposterior movement of the coronoid

    processof the mandible. he surface facing the direction of movement gets built up by deposition of new

    cortical bone, while the contralateral surface is resorbed.b/ *is"lace!ent/ n totomovement0 e"uires two attached anatomic units /bones or soft tissues.0 7hen onetissue grows it pushes the other tissue, thus displacing it in the direction of the growth. he displaced tissue

    doesn't grow and change its own position, it getspushed.--- 9xample is the downwardIforward displacement of the maxilla and midface due to the growth of the middle

    cranial base. here isn:t any growth going on in the maxilla or midface, they:re =ust getting pushed along by

    growth going on behind them.------ @ote he bric' wall cartoon shows how this can be balanced by cortical drift. he bric' wall represents

    the maxilla experiencing cortical drift in one direction, while the movement of the cart represents the middle

    cranial base growing and displacing the maxilla in the opposite direction.

    c/ %elocation $ change in the position of a region within a bonedue to remodeling of the surrounding regions

    /of the same bone.0 hin' about cutting a dec' of cards. $ card in the middle of the dec' becomes the top cardafter the cards above it are moved to the bottom. @obody moved the middle card, but its position in the dec'

    changed.JJJJJ @&9 here are three ares in the mandible that remain stable over time. 3nternal aspect of symphysis,

    3nferior alveolar nerve canal, 3nferior border of 4rd molar crypt.

    d/ .0"anding Princi"le 3n U or V shaped bones /eg. mandible, and maxillaryImandibular dental arches0show a specific pattern of length growth. hey get deposition on the internal aspect of the K, and resorption on

    the outeraspect. hin' of duc'sIgeese flying bac'wards. his causes an increase in length and widthof thearches.

    --- 9xample !andibular 4rd molars might be impacted in a child:s mouth, but the impaction is relieved after

    this K growth because the increase in length and width results in more room for them to erupt. $lso happens inepiphyseal growth plates of long bones. here is deposition at the endosteal surfaces and resorption at theperiosteal surface.

    4. 2e familiar with each of the ; craniofacial growth patterns.- @ote (ize, form, and =aw relationships are trac'ed by lateral and frontal cephalometric growth studies using

    either cross sectional or longitudinal data. Kertical facial growth is mostly due to mandibular condylar growth

    resulting in a downward and forward shift of the mandibular ramus. &cclusal plane angle and mandibular planeangle decrease with age due to this shift.

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    1 Growth of the neurocranium closely parallels the growth of the brain. 3t:s C*-C)+ done by age ; /don:t buy

    your 'id a baseball hat until he:s ;.0

    2

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    --- Crouzan "yndrome#$utosomal dominant cranial synostosis, mutation in

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    Learning Objectives

    1. 7hat are the relative proportions of midfacial structures at birth8

    $t birth the midface is relatively wide due to the precocious development of the eyes. he growth of the

    midface primarily occurs in a downward and forward movement.%. 7hich midfacial bones develop from intramembranous bone formation and which develop from

    endochondral bone formation8

    endochondral bone formationLong bones associated with !ovable joints5

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    !ost of !andible

    $ll bones of upper face!axilla

    palatine

    alvarial bones2one deposited by the periosteum

    #eriodontal !embrane

    ranial (utures

    4. Understand the contribution of different bones to the development of the maxilla, including which teeth form

    in the different areas of bone.

    his "uestion was not covered thoroughly at all in either the handout or the lecture slides. 3 will attempt toanswer it the best 3 can given the information available.

    !axillary tuberosity his is the postierior portion of the maxilla and is the site of molar eruption.

    #remaxilla he derivation of the human maxilla form premaxilla and maxilla is indicated by the incisivefissure, visible in young s'ulls on the palate, extending from the incisive foramen to the alveolus of the canine.

    his indicates that the insicors all derive from the permaxilla.

    6ow does growth of the anterior cranial base cartilage and nasal se"tu! contribute to growth of the!idface7

    $nterior cranial base cartilage (pheno-ethmoidal synchondroses interstitial cartilage growth moves the maxilla

    forward. Growth until age ?.@asal septum cartilage !axilla moves downward and forward. Growth until age ?.

    3 6ow do tensile or co!"ressive forces affect suture growth7

    ensile forces cause bone apposition at the suture.ompressive forces ause bone absorption at the suture.

    ;. Fnow which boney surfaces of the midface are areas of bone apposition or bone resorption.

    'a0illa5

    8acial9 "alatine9 and nasal growth "atterns5

    @ow note in more detail what 'ind of remodeling is occurring. he whole maxillary complexis being translated forward as the maxilla moves away from the cranium. $t the same time

    he floor of the nose is a resorptive area, he roof of the mouth is an appositional area, and this also moves thebone of that area down and forward. (o the pattern of apposition and resorption serves to augment the

    translation of the roof of the mouth. 2ut the contour of the anterior part of the alveolar process is a resorptive

    area, so here removal of bone from the surface tends to cancel some of the forward growth due to translation ofthe entire maxilla. emodeling of the palatal vault /which is also the floor of the nose0 moves it in the same

    direction as it is being translated bone is removed from the floor of the nose and added to the roof of the mouth

    &n the anterior surface, however, bone is removed, partially canceling the forward translation. $s the vaultmoves downward, the same process of bone remodeling also widens it.

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    $nterior facial periosteal surface resorption

    $nterior facial endosteal surface apposition

    audial palatine bone /roof of the mouth0 apposition(uperior palatine bone /floor of the nasal cavity0 resorption

    'a0illary tuberosity and $ey ridge growth "atterns5

    !axillary tuberosity posterior periosteal surface apposition

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    Orbial floor of the !a0illa5

    he periosteal surface is depository in character, and the opposite endosteal surface overlaying

    the maxillary sinus is resorptive. he lateral growth of the floor in each orbit moves them away from each other

    thereby increasing the breadth of the nasal cavity.

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    :ygo!atic "rocess and the !alar area5

    he forward facing anterior side of the zygomatic process forms part of the chee' bone. heperiosteal surface on this anterior facing part is resorptive while its contra lateral endosteal surface is

    depository. he bac'ward facing posterior side is depository and the opposite endosteal surface of its cortex is

    resorptive. his produces a posterior growth movement of this laterally pro=ecting zygomatic process.

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    he posterior side of the malar protuberance is depository while the anterior surface is

    resorptive. his posterior enlargement maintains the relationship with posterior growing maxillary arch. hepatterns of zygomatic and malar growth maintain the chee'bone in proportionate relationships to the face, =aws,

    and masticatory musculature.

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    ?. 7hat movements in midfacial bones help produce crowding or impaction of maxillary canines8he lecture slides only give a brief explanation

    - here is a mean transverse rotation of the two maxillary bones during growth. his results in the shortening of

    the dental arch in the midsagittal plane.

    E. Understand the general concepts presented in the research information that finds associations between musclesize and craniofacial development.

    he lecture sides are incredibly vague on this topic and the handout is completely mute. 2ased on the slides, 3con=ecture that the evolutionary loss of large muscles of mastication allowed the homo species to develop a

    larger cranium. hus the larger the muscles the smaller the craniofacial development. @ 239H 79$F

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    Learning Objectives 3

    1. Understand general aspects of the human genome, including definitions of the gene, D@$, transcription

    and translation, chromosomes and genetic variation.

    5uman genome-3 billion base pairs-23,000 genes

    -23 chromosomes (with 2 copies of each per cell)-1 human cell has 2 meters of DNA-50 is repetiti!e DNA ("un#$)-%nl& 30 of the genome co'es for genes

    -%nl& 15 co'es for proteins-his is because 1 gene can co'e for 100*s of proteins

    +ene-he functional unit of here'it&.-/an inclu'e promoters, enhancers, introns, an' eons

    DNA-Nucleoti'e sugar phosphate base

    ranscription

    -DNA is rea' b& NA pol&merase to ma#e a complementar& stran'-he *s in DNA are replace' with 4*s in NA

    NA splicing-N%N6 (not eons) are remo!e'-esult is a functional mNA

    ranslation-mNA is turne' into proteins

    /hromosomes-7oose DNA is wrappe' aroun' histones to ma#e nucleosome units

    -7i#e bea's on a string-Nucleosomes con'ense to form a fiber-he fiber ben's bac# an' forth on itself to form loops

    -he loops con'ense an' form the chromosome

    +enetic !ariation between in'i!i'uals-/an be cause' b& se!eral things

    -6wapping out a single base pair (6N8 single nucleoti'epol&morphism)

    -6mall insertions or 'eletions of DNA-earrangement of DNA se9uences-nsertions or 'eletions of entire genes

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    -:tra copies of genes (cop& number !ariation)

    2 4n'erstan' the 'ifferences between autosomal 'ominant an' autosomal recessi!emen'elian inheritance patterns ;e able to estimate the number of normal, carrier, an'affecte' people in net generation for inheritance of a men'elian trait

    -Autosomal 'ominant (not carrie' on the < or = chromosomes)-f the trait is 'ominant an' inherite' from a parent, it will be seen in theoffspring e!en if the recessi!e cop& is inherite' too-uns in the famil&.-Affecte' parent has 50 chance of ha!ing an affecte' chil'

    -Autosomal recessi!e->i' must get recessi!e copies from both parents to manifest-2 carrier parents ha!e a 25 chance of ha!ing an affecte' chil'

    -Normal siblings have a 67% chance of being a carrier-?e sai' this might be a test 9uestion-easoning is

    -2 carrier parents ha!e @ chil'ren-1 chil' is AA, 2 chil'ren are Aa, an' 1 chil' is aa (affecte')-3 normal #i's but 2 are carriers

    -23 BC

    3 4n'erstan' the genetic terms penetrance an' epressi!it&-8enetrance

    -f the gene is present, will it be seen$-f it*s 'ominant with 5 penetrance, &ou*ll see the trait in 5 of people-A 'isor'er can be both rare an' highl& penetrant

    -:pressi!it&-?ow is the gene epresse'$

    ->in' of li#e if there*s a gene to ma#e people turn blue-:pressi!it& is the sha'e of blue that is seen

    @ 4n'erstan' how traits for cleft lip an' palate are inherite', inclu'ing 'ifferences in theempiric recurrence ris#s to relati!es

    -!an 'er Eou'e 6&n'rome (FDE6)-/auses cleft lip an'or palate

    -his is an eample of !ariable epressi!it&-Autosomal 'ominant with high penetrance-/ause' b& a mutation in GB gene

    -A single nucleoti'e pol&morphism in this gene triples the ris#

    -Host cleft lippalate problems ha!e non-men'elian inheritance non-s&n'romic.-/omple inheritanceI-As &ou go through a pe'igree, &ouJll either see /78 or /8 but &ou wonJt seethem mie' up through the famil&

    -/8 is less common than /78-Gor bilateral /78, males are affecte' more fre9uentl& than females

    -ecurrence ris# for relati!es-is# goes up for future #i's if more members in the famil& are affecte'-ncrease' ris# for others if the first person (proban'.) affecte' is se!erel& ill-is# 'rops as the proban' becomes more 'istant in the pe'igree-Gor actual ris# percentages for /78, see sli'e K@2 on lecture 5

    -%ther ris# factors-H6

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    -Haternal cigarette smo#ing-GB mutation is the most important factor

    5 4n'erstan' the 'ifferences in inheritance patterns between monoL&gotic an' 'iL&gotictwins for men'elian 'iseases an' comple trait 'iseases

    -/oncor'ance-he presence of a trait in both twins

    -raits can either be influence' b& genes or the en!ironment-f there is a higher concor'ance in HM twins than in DM twins, &ou can

    assume the cause is probabl& genetic-HonoL&gotic (HM) twins

    -'entical twins-6hare 100 of the same genes (100 concor'ance)

    -DiL&gotic (DM) twins-Graternal twins-6hare 50 of same genes-50 concor'ance if trait is autosomal 'ominant-25 concor'ance if autosomal recessi!e

    B 4n'erstan' the properties of the multifactoral threshol' mo'el of inheritance for cleft lipan' palate as a comple unit-+oo' for un'erstan'ing quantitativeinheritance

    -ie height, bloo' pressure, -/an help to eplain cleft lippalate inheritance

    -An eample of a 'iscontinuous trait.-Hultifactorial hreshol' mo'el implies that things a'' up until a threshol' isreache' an' then &ou ha!e the 'isor'er (or cleft lippalate)

    -his can account for genetic an' en!ironmental !ariables-he ris# for cleft lip ma& be below threshol' but if the mother smo#es'uring pregnanc&, the threshol' is crosse' an' the bab& will ha!e the'eformit&

    -here is some variability but for the most part, you either have it or you don:t

    Lecture 4 and P(L

    1 ;nderstand the basic !echanis!s involved in !olecular biology including re"lication9 transcri"tion9

    and translation

    a. eplicationma'ing new copies

    b. transcriptionD@$ @$

    c. ranslation@$ protein

    %. ;nderstand the different for!s of genetic variation

    a. (ingle nucleotide polymorphisms /(@#0 base pair substitution on a chromosomeb. small insertions or deletions of D@$few base pairs

    c. D@$ se"uence rearrangements

    d. Gene insertion or deletion few base pairse. opy number variations

    f. chromosomal mutations

    JJmutations cause a clinical problem, variants do notJJ

    ,

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    a. $utosomal dominant affected parent has )*+ chance of having affected child

    i. one affected allele results in clinical phenotype

    b. autosomal recessive% carrier parents have a %)+ chance of having affected child

    i. normal sibs have %I4 chance of being a carrier

    ii. two affected alleles result in clinical phenotype

    ;nderstand twin outco!e studies and how genes = environ!ent interact to "roduce variability in

    craniofacial "henoty"esa. !onozygotic twins

    i. 3dentical

    ii. zygote splits

    iii. share 1**+ of genesiv. differences due &@O to environment

    v. 1**+ concordance in mendelian diseases

    vi. complex diseaseless than 1**+ concordance due to environmentb. Dizygotic twins

    i. fraternal

    ii. % sperm fertilize % eggs

    iii. share )*+ genes /li'e sibs0iv. differences due to genes $@D environment

    v. )*+ concordance in mendelian diseases

    a. concordance occurance of trait in both twins

    b. discordance occurance of trait in one twin

    c. !P Q DP concordance genes

    3 (e able to define the genetic ter!s >"enetrance? and >e0"ressivity?

    a. penetranceinherit alleledisease phenotype

    b. expressivity

    great variability in what phenotype loo's li'e

    4 @hat are the recurrent ris$s for cleft li" = "alate and cleft "alate for both syndro!ic and non

    syndro!ic for!s

    8888

    A @hat dental ano!alies are associated with facial clefting

    a. enamel hypoplasia due to surgical treatment of the cleft. (een in upper incisor of

    both dentitions

    b. hypodontia highest incidence in syndromic cleftingc. delayed erutption of permanent dentition

    d. smaller size of permanent teeth

    B 6ow are facial clefts classified and when do they develo"

    a. unilateral vs bilateral

    b. complete vs incompletec. syndromic vs nonsyndromic

    i. cleft lip)thA;thwee'the frontonasal and maxillary process fuse to form theupper lip.

  • 8/13/2019 Midterm Lerning Objectives

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    a. ateral palatine processes form and tongue distends as mandible forms lac'

    of this causes a problem