Impact of conflict-induced stress on the length of craniofacial growth

In this study, we investigated the effect of chronic environmental stress, due to long-term residence in a conflict zone, on the lengths of the anterior and posterior cranial base, maxilla, and mandible in healthy children and adolescents. A retrospective cohort of 158 Israeli children (mean age: 13.42 ± 1.41 years) was divided into two groups: children from Gaza envelope (n = 82), with chronic exposure to security threats, and their counterparts from central Israel (n = 76), with low exposure. Cephalometric measurements were obtained from lateral radiographs using standardized protocols. The children's skeletal and dental maturation stages were assessed via cervical vertebral maturation and Demirjian's tooth development index. Compared with children in the central Israel, Gaza envelope children presented significantly shorter lengths of both the anterior (mean difference: 3.37 mm, p = 0.008) and posterior cranial bases (mean difference: 2.92 mm, p = 0.005). No significant differences were found in mandibular body length, ramus height, effective mandibular or maxillary length, or the maxillomandibular differential. Correlation analyses revealed weakened associations among craniofacial measurements in the conflict-exposed group, suggesting environmental disruption of coordinated craniofacial growth. Notably, female children in the Gaza envelope group were more affected, with significantly smaller measurements across most craniofacial parameters. Chronic exposure to conflict-related stress is associated with reduced cranial base growth in children, particularly in females. These findings underscore the vulnerability of endochondral growth structures to environmental stress, especially anterior cranial base, and suggest a potential link between psychosocial factors and altered craniofacial development.