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Presented byDr Sarita Chaudhary

Definition Development of Face Development of Palate Development of Tongue Anomalies Conclusion References

Aristotle (384 embryology

322

BC)Founder

of

human

Wilhelm His Senior (1831 1904) Vesalius of human embryology Karl Ernst Von Baer (1828) Gave the term Germ Layer. Hertwig Brothers (1879-1883) All animals above the level of coelentrates are derived from 3 embryonic layers- ectoderm, mesoderm & endoderm. Franklin P. Mall First person to stage human embryo in 1914
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1. The self multiplication of living substance. ( J.S. Huxley) 2. Increase in size, change in proportion and progressive complexity. (Krogman) 3. An increase in size. (Todd) 4. Entire series of sequential anatomic and physiologic changes taking place from the beginning of prenatal life to senility. (Meridith) 5. Quantitative aspect of biologic development per unit of time (Moyers) 6. Change in any morphological parameter which is measurable. (Moss)

Scammons curve of growth

Cephalo- caudal gradient of growth

 Genetic Sutural

theory theory- By Sicher Growth theory- By James Scott theory- By Von Limborgh

Cartilaginous

The

Functional Matrix Concept- By Melvin Moss

Expanding V Principle- By Enlow

Multifactorial Enlows

1.

Development is increase in complexity. (Profitt 1986) 2. Development refers to all the naturally occurring unidirectional changes in the life of an individual from its existence to its elaboration as a multifunctional unit. (Moyer 1988) 3. The process of natural progression from a lower embryonic stage to a later, more complex or adult stage. (Stedman 1990) 4. Development addresses the progressive evolution of tissue. (Pinkham 1994)
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Prenatal Development Prenatal life may be divided into 3 periods: 1. The period of the ovum (from fertilization
to 14th day).
2.

Period of the embryo (from 14th day 56th

day).
3.

Period of the fetus (from 56th day birth).

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 Cleavage

of the ovum

Attachment

to the uterine wall.

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 DIVIDED

INTO THREE PERIODS 1] PRESOMITE (8 21 DAYS)

FORMATION OF GERM LAYERS & FETAL MEMBRANES.

2] SOMITE (21 31 DAYS)

FORMATION OF DORSAL METAMERIC SEGMENTS,BODY SYSTEMS & ORGANS.

3] POST SOMITE (32 56 DAYS)

FORMATION OF BODYS EXTERNAL FEATURES.

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 Between

8th to 12th weeks, the fetus triples in length from 20 to 60 mm.

Eyelids

and nostrils form and close and there is a great increase in mandibular size.

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 Growth

of face and skull in the immediate post natal period is a direct continuation of embryonic and fetal processes.

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Face develops between 24th38th day of gestation. Frontal prominence Cardiac bulge Stomatodeum Buccopharyngeal membrane Fronto nasal process

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At the end of 4th week The frontonasal prominence forms upper border of stomatodeum. Maxillary laterally. process present below

Mandibular process stomatodeum.

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At 24 days, mandibular arch forms maxillary and mandibular process.

At 28 days, forms nasal placodes which sink to form the nasal pit.

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 DEVELOPMENT

OF MAXILLA DEVELOPMENT OF MANDIBLE DEVELOPMENT OF NOSE DEVELOPMENT OF PALATE DEVELOPMENT OF EAR DEVELOPMENTOF EYE DEVELOPMENT OF LIP DEVELOPMENTOF TONGUE

Derivatives of Facial Components

The frontonasal prominence forms the: Forehead and the bridge of the nose Frontal and nasal bones

The maxillary prominences form the: Upper cheek regions and most of the upper lip Maxilla, zygomatic bone, secondary palate

The mandibular processes fuse and form the: Chin, lower lip, and lower cheek regions Mandible
The lateral nasal prominences form the ala of the nose

The medial nasal prominences fuse and form the intermaxillary segment

The development of the face occurs mainly between 5 8 weeks The lower jaw (mandible) is the first to form (4th week) The facial proportions develop during the fetal period (9th week to birth) During infancy & childhood, following the development of teeth and paranasal sinuses, the facial skeleton increases in size and contribute to the definitive shape of the face

THE FACE and ORAL REGION

stomodeu m maxillary process mandibular arch 5 weeks 4 weeks

a. Face consists of a few primordial tissue masses partially surrounding the future oral region. b. The oral cavity (stomodeum) is an ectodermal depression separated from the foregut by the Oral plate formed of ectoderm on one side and endoderm on the other. c. The face is dominated by the frontal prominence of the overhanging forebrain. d. Laterally, the maxillary processes of the 1st branchial arch are visible.

5.5 weeks

6 weeks

7 weeks

8 weeks

1. On either side of the frontal prominence are horseshoe-shaped elevations are found around the nasal placodes. a. Medial limbs are nasomedial processes b. Lateral limbs are nasolateral processes 2. Growing toward midline are the maxillary processes, approaching mandibular arches and merging with them at the angle of the mouth. a. Maxillary processes grow to crowd the nasal processes closer together. b. Nasomedial processes grow quickly, pushing the frontal prominence , then fuse with the maxillary processes to complete the arch of the upper jaw. c. Nasomedial tissues give rise to philtrum

stomodeu m maxillary process mandibular arch 5 weeks 4 weeks nasomedi al process

5.5 weeks

6 weeks philtrum

7 weeks

8 weeks

 The single frontonasal prominence ventral to the forebrain The paired maxillary prominences develop from the cranial part of first branchial arch The paired mandibular prominences develop from the caudal part of first branchial arch
Lateral view

During the initial 2 weeks the maxillary prominences continue to increase in size .

Simultaneously they grow in a medial direction thereby compressing the medial nasal prominences toward the midline.

The cleft between the medial nasal prominences and the maxillary prominence is lost.

Initially the maxillary and the lateral nasal prominences are separated by a deep furrow ,the nasolacrimal groove. The nasolacrimal duct then runs from the medial corner of the eye to the inferior meatus of the nasal cavity. The maxillary prominence then enlarge to form the cheek and maxillae .

NASOLACRIMAL DUCT - Develops as solid connects cord anterior eye to from medial angle nasal cavity of eye to nasal cavity Obstructed Duct - failure of duct to - becomes canalize; is opened surgically for tearscanalized. to

The Human Mandible Has No One Design For Life . Rather It Remodels Through The Stages Of Life ,From The Slim Arbiter Of Things To Come In The Infants ,Through The Powerful Dentate Machine And Even Weapon In The Full Flesh Of Maturity ,To The Pencil-thin Parcelain Like Problem That We Struggle To Repair In The Adversity Of Old Age. - E Poswillo,1988

The first structure to develop in the region of the lower jaw is the mandibular division of the trigeminal nerve.

The prior presence of the nerve has been postulated as requisite for inducing osteogenesis by the production of neurotropic hormones.
MECKELS CARTILAGE ,of the first branchial arch is responsible for the formation of mandible.

Single ossification centre for each half of the mandible arises in the 6th week i.u. Ossification begins below and around the Inferior Alveolar Nerve and its Incisive branch and upwards to form a trough for the developing teeth. Spread of intramembranous ossification dorsally and ventrally forms the body and the Ramus of the mandible . The shape and size of he fetal mandible undergo considerable transformation during its growth and development .

The ascending ramus of the neonatal mandible is low and wide ;the coronoid process is relatively large and projects well above the condyle ;the body is merely an open shell containing the buds of the deciduous teeth. The initial separation of the right and left bodies of the mandible at the midline SYMPHYSIS MENTI is gradually eliminated between the 4th and 12th months postnatally. The main sites of postnatal mandibular growth are at the condylar cartilages ,the posterior borders of the ramii and the alveolar ridges

 By the end of 4th week, bilateral oval-shaped ectodermal thickenings called nasal placodes appear on each side of the lower part of the frontonasal prominence Nasal placodes are primordia of the nose and nasal cavities.

Nasal placode Nasal placode Frontonasal prominence

 Mesenchymal cells proliferate at the margin of the placodes and produce horse-shoe shaped swellings around these. The sides of these swellings are called medial and lateral nasal prominences The placodes now lie in the floor of a depression called nasal pits

Each lateral nasal prominence is separated from the maxillary swelling by nasolacrimal groove

Embryo: 6 weeks

 With the formation of the medial and lateral nasal prominences, the nasal placodes lie in the floor of depressions called the nasal pits By the end of 6th week, nasal pits deepen and form nasal sacs

 Initially the nasal sacs are separated from the oral cavity by oronasal membrane. The oronasal membrane ruptures by the 6th week, communicating the primitive nasal cavities with the oral cavity

 These communications are called the primitive choana and are located posterior to the primary palate

After the development of the secondary palate, the choana change their position and become located at the junction of nasal cavity and the pharynx

 The nasal septum develops as a downgrowth from the internal parts of merged medial nasal prominences

Fuses with the palatine process in 9-12 weeks, superior to the hard palate

 The superior, middle and inferior conchae develop on the lateral wall of each nasal cavity The ectodermal epithelium in the roof of each nasal cavity becomes specialized as the olfactory epithelium

 The olfactory cells of the olfactory epithelium give origin to olfactory nerve fibers that grow into the olfactory bulb

1.Eye placode 2.Nasal placode 3.Oronasal membrane 4.Nasal cavity 5.Tongue 1 2 3 4 6.Primary palate 7.Secondary palate

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Intermaxillary Segment: As a result of medial growth of the maxillary prominences ,the two medial nasal prominences merge not only at the surface but also at a deeper level. The structure formed by the two merged prominences is called as the intermaxillary segment. It is composed of : A)Labial component which forms the philtrum of the upper lip. B)Upper jaw component which carries the four incisor teeth. C)Palatal component-which forms the triangular primary palate

The medial nasal swellings enlarge, grow medially and merge with each other in the midline to form the intermaxillary segment

Human embryo: 7 weeks

 Begins at the end of the 5th week Gets completed by the end of the 12th week The most critical period for the development of palate is from the end of 6th week to the beginning of 9th week

The palate develops from two primordia: - The Primary palate -The Secondary palate

The Primary Palate

Begins to develop:
Early in the 6th week From the deep part of the intermaxillary segment, as median palatine process

Lies behind the premaxillary part of the maxilla

Fuses with the developing secondary palate

The primary palate represents only a small part lying anterior to the incisive fossa, of the adult hard palate
Primary palate

Hard palate

Secondary palate

Soft palate

The Secondary Palate

Is the primordia of hard and soft palate posterior to the incisive fossa
Begins to develop:
Early in the 6th week From the internal aspect of the maxillary processes, as lateral palatine process

 In the beginning, the lateral palatine processes project inferomedially on each side of the tongue With the development of the jaws, the tongue moves inferiorly.

During 7th & 8th weeks, the lateral palatine processes elongate and ascend to a horizontal position above the tongue

Tongue

 Gradually the lateral palatine processes:

Grow medially and fuse in the median plane Also fuse with the: Posterior part of the primary palate & The nasal septum

 Fusion with the nasal septum begins anteriorly during 9th week, extends posteriorly and is completed by 12th week

Bone develops in the anterior part to form the hard palate. The posterior part develops as muscular soft palate

Changes in Face during Fetal period

Mainly result from changes in the proportion & relative positioning of facial structures

In early fetal period the nose is flat and mandible underdeveloped. They attain their characteristic form during fetal period
The enlargement of brain results in the formation of a prominent forehead Eyes initially appear on each side of frontonasal prominence ;move medially Ears first appear on lower portion of lower jaw, grow in upper direction to the level of the eyes

The three parts of the ear-External -Middle and -Internal ,arise from separate ,diverse embryonic origins .

The external ear forms around the first branchial groove which deepens to become the external acuostic meatus . Malleus and Incus are derived from the dorsal end of the first branchial arch cartilage MECKELS CARTILAGE. Stapes arise from the dorsal end of the second branchial arch cartilage- REICHERTS CARTILAGE . This is the first sensory organ to begin development .

The light sensitive portion of the eye retina ,is the outgrowth from the forebrain ,projecting bilaterally as the optic vesicles which are connected to the brain by the optic stalks, this results in a thickening called as lens placodes. These placodes invaginates in its centre by the development of peripheral folds . The optic vesicles invaginate partly to form the double layered optic cusps and the optic stalk becomes the optic nerve . The outer layer of the optic cup acquires pigmentation to become the pigmented layer of the retina.

Lower lip :The mandibular processes of the two sides grow towards each other and fuse in the midline ,they form the lower margin of the stomatodeum . Upper lip :Each maxillary process now grows medially and fuses, first with the lateral nasal process and the with the medial nasal process.

 The mesodermal basis of the lateral part of the lip is formed from the maxillary process. The overlying skin is derived from the ectoderm covering this process.

The mesodermal basis of the medial part of the lip(PHILTRUM)is formed from the frontonasal process .
The muscles of the face (including those of the lips)are derived from the 2nd branchial arch and are supplied by the facial nerve.

The tongue appears in the embryo of approximately 4 weeks in the form of two lateral lingual swelling and one medial swelling TUBERCULUM IMPAR . The three swellings orginate from the 1st pharyngeal arch. As the 3 swellings increase in size ,they overgrow the tuberculum impar and merge with each other thus forming the anterior two thirds or the body of the tongue.

At the junction of the anterior 2/3rd and the posterior 1/3rd is a groove called as the SULCUS TERMINALIS. Sensory innervation-2/3rd Mandibular branch of Trigeminal nerve Glossopharyngeal nerve . Hypoglossal nerve Chorda tympani branch of

Sensory innervation-1/3rd Motor innervation Special sensory innervation Facial nerve

Development of lower lip- By the fusion of mandibular process.

Development of upper lip- at 6-7th wk By the fusion of maxillary process and medial nasal process.

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Lateral part of lipMesoderm- Maxillary process Ectoderm- Maxillary process

Medial part of lipMesoderm- Frontonasal process Ectoderm- Maxillary process

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Scanning electron micrograph of embryo at 7 wks

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 Maxillary

and mandibular processes undergo progressive fusion to form cheeks

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Develops between 27th 38th day of gestation.

Odontogenic epithelium formed on inferior border of maxillary process and superior border of mandibular process.

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Also on lateral aspect of median nasal process.

On 37th day, processes fuse, a single plate of thickened epithelium, primary epithelial band formed.

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Develops
Receives

by 4th week.

contribution fromFrontonasal process, median nasal process, and lateral nasal process of right and left side.
External

pits are formed when nasal pits are cut off from stomatodeum by fusion of maxillary process with median nasal process.
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Frontonasal

becomes narrower.
Its

process progressively

deeper part forms nasal septum.

Mesoderm

becomes heaped up in median plane and form the prominence of nose

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Groove

appear between the region of nose and bulging forebrain.

As

nose becomes prominent, the external nares come to open downwards instead of forwards.

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Lens

placode thickening.
Seen

are

ectodermal

on ventrolateral side of developing forebrain, lateral and cranial to nasal placode.

Lens

placode sink below the surface and cut off from surface ectoderm.
Developing

eye ball produces a bulge in this situation.

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Bulging

of eyes- first directed laterally and lie in the angles between maxillary process and lateral nasal process.
With

the narrowing of frontonasal process they come to face forward.

Eyelids

are derived from folds of ectoderm formed above and below the surface and by mesoderm enclosed within the folds.

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Development of ear at 6th wk of gestation. It

begins

is formed by fusion of auricular hillocks.

Three

auricular hillocks present on first pharyngeal arch and three on second arch.

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By

8 wks the fused auricular hillocks are located on each side of the first pharyngeal groove, the primordium of external auditory meatus.
At

32 wks, as the jaw develops, the auricles move from neck to the side of head, due to great enlargement of the mandibular process.

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PROMINENCE
1 Frontonasal

STRUCTURES FORMED
Forehead, Bridge of nose, Medial & Lateral nasal prominences Cheeks, lateral portion of upper lip & UPPER JAW

2 Maxillary (P)

3 Medial nasal (P) Philtrum of upper lip, Crest &tip of nose 4 Lateral nasal (P) Alae of nose 5 Mandibular(P) Lower lip & LOWER JAW
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Types

of facial clefts-

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Hypertelorism with broad nasal bridge

Cleft nose

Cleft lip with bifid nose

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Absence of intermaxillary process

CebocephalySingle nostril

Cyclops with proboscis

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Small mucosal invaginations at the corner of mouth on vermillion border. Due to failure of fusion of maxillary and mandibular process. Are blind fistulas 1-4 mm in depth.

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Redundant fold of tissue on mucosal side of lip. Associated with Aschers syndrome

Macrostomia

Microstomia

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Formed by the extension of nasal pit. Pit at first in open communication with stomatodeum. Primitive palate forms the partition. Pits then deepen to form nasal sac. Dorsal part of sac separated from stomatodeum by bucconasal membrane, which soon breaks down. The nasal sac has an anterior and posterior nasal aperture.

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nasal sac separated by frontonasal process, which becomes narrower. Nasal sac continue to enlarge. Intervening tissue forms nasal septa. After the disappearance of bucconasal membrane, the nasal cavity is separated from mouth by palate. Lateral wall of nose derived from lateral nasal process. Nasal conchae appear as elevation on lateral wall of each nasal cavity. Olfactory placodes form the olfactory epithelium.

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Atresia
At

of nasal cavity-

anterior nasal aperture At posterior nasal aperture Cavity proper

Congenital

defect in cribriform plate of ethmoid bone, leading to communication between cranial cavity and nose.
Deviated Nasal

nasal septum

cavity may communicate with mouth.

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 The

palate begins to develop early in week 6, but the process is not complete until wk 12.
critical period of palatal development being the end of 6th week to the beginning of ninth week

Most

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Formed by merging of the 2 medial nasal processes

It is composed of a) Labial component- forms PHILTRUM b) Upper jaw componentcarries 4 MAX.INCISORS

c) Palatal component- forms PRIMARY PALATE

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Closure of Secondary Palate

Depends onIntrinsic force in palatine shelves. High conc. Of GAG which attract water and make shelves turgid. Presence of contractile fibroblast. Displacement of tongue from between palatine shelves by the growth pattern of head.

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 As

2 palatine shelves meet, adhesion of epithelia occurs. DNA synthesis ceases within 24-36 hrs before epithelial contact. Basal cells have carbohydrate rich surface coat, permits adhesion. Surface epithelial cells are sloughed off.

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 The

median palatine raphe is a clinical remnant of fusion between the palatine shelves and the incisive foramen is present at the junction of the primary palate and lateral palatine shelves. The lateral palatine shelves also fuse with the nasal septum proceeds in an anteroposterior direction beginning in the ninth week i.u.

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 (i)

Tensor veli palatini 40th day (ii) Palatopharyngeus 45th day (iii)Levator veli palatini- 8th wk (iv)Palatoglossus 9th wk ; attached to soft palate at 11th wk (v) Uvula 11th wk.

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a)
b) c)

A. Arteries Greater palatine, branch of maxillary artery. Ascending palatine branch of facial artery. Palatine branch of Ascending pharyngeal artery.

B. Veins -Drains into pterygopalatine and tonsillar plexus.

C. Lymphatics - Drain to deep cervical lymph nodes. D. Nerves - Sensory nerve supply from greater and lesser palatine, nasopalatine & glossopharyngeal.
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 Etiology

Interference with forces which elevate the

vertical shelves into a horizontal position Excessively small palatal shelves and/or excessively wide intershelf distance Tongue obstruction preventing shelf contact Failure of epithelial fusion and/or breakdown Failure of mesodermal penetration Post fusion rupture
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Begins to develop at about 4 wks. The tongue develops from several different sources. Body of the tongue or anterior two third -the first branchial arch.

Base of the tongue or posterior one third -the third branchial arch.
Root of tongue- the fourth brachial arch

The skeletal muscle- from myoblasts that migrate into the tongue from occipital somites.

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Arise

from occipital somites.

Supplied

by hypoglossal nerve (12th cranial nerve).

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The innervation of the tongue can be explained by its embryologic origin. Sensory innervation to mucosa of body of tongue- nerve of Ist branchial arch i.e. trigeminal nerve. (5th cranial nerve). Post trematic nerve of I arch- lingual nerve Pre trematic nerve of I arch- chorda tympani (special sensory nerve) Sensory innervations to mucosa of base of tongue- nerve of third arch i.e. glosspharyngeal nerve (9th cranial nerve). Skeletal muscles of tongue bring their nerve supply with them in the form of hypoglossal nerve (12th cranial nerve).

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MicroglossiaAssociated with oromandibular limb hypogenesis syndrome

Macroglossiacrenated lateral border of tongue Associated with BeckwithWeidemann Syndrome, Down Syndrome

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Ankyloglossia / tongue tieLimitation of tongue movement

Hairy tongueAccumulation of keratin on filliform papilla of tongue

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Fissured tongueGrooves 2-6 mm in depth Associated with Melkersson Rosenthal Syndrome

Bifid tongue

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Ectopic thyroid tissue may be found between foramen caecum and epiglottis.

Causes dysphagia, dyspnea, dysphonea.

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 Arises

from the tissue of first branchial

arch.
Mandible

arise from mandibular process.

Maxilla

arise from the maxillary process.

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5 principle stages in craniofacial development1] Germ layer formation & initial craniofacial structures
Neural Tube oropharynx formation &

organization of

17th day Fetal alcohol syndrome

initial formation of

2]

18th 23rd day Anencephaly

3] Origins, Migrations & interactions of cell populations especially neural crest cells 19th 28th day Hemifacial micro somia

Treacher collins syndrome

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4]

Formation of organ systems pharyngeal arches and palate

especially

the

28th 38thday Primary palate Cleft lip &/or palate and other Facial Clefts 42nd - 55thday Secondary palate Cleft palate
5] Final differentiation of tissues(Skeletal, Muscular and nervous elements)

50th day Birth Achondroplasia Synostosis, Syndromes (Crouzons, Apert etc.)

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 Franceschetti

& Klein in 1940 - MFD Affects structures developing from 1st and 2nd branchial arch Convex facial profile Mandibular and midface hypoplasia Retrusive chin Deformed pinna

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 Apert

in 1906 summarized 9 cases acrobrachycephaly (tower skull)

Produces Mid

face hypoplasia of II, III and IV digits

Syndactyly Trapezoid

shaped lips

Cleft

of soft palate and uvula

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 Crouzon Occular

in 1912 craniosynostosis

proptosis

Premature Leads

to brachycephaly, scaphocepaly,

trigonocephaly
Maxillary
Curved

hypoplasia

Parrot like nose

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Atrophy of skin and subcutaneous tissue in a localized area. Osseous hypoplasia

Coupe de sabre
Enophthalmous Nose and mouth deviated towards affected side.

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 Cleft

palate, Micrognathia and glossoptosis of mandible Bird facies

Hypoplasia

Air

way obstruction by lower, posterior displacement of tongue

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 Sex

M:F = 3:2 Unilateral Asymmetry of the face Malar hypoplasia Maxillary hypoplasia Hypoplasia of mandible (ramus and condyle) Hypoplasia of TMJ Macrostomia Hypoplasia of facial musculature

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Small mouth Micrognathia Hypoglossia Mandibular hypodontia Cleft palate Broad nose Lower eyelid defect Facial asymmetry
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Flat face

Large anterior fontanelle

Open sutures Small slanting eyes with epicanthal folds Open mouth Prognathism Sexual underdevelopment Cardiac abnormalites Macroglosia High arched palate
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ANTONIO NANCI, TEN CATE: Oral Histology - Development, structure and function, edition 6,2003 Mosby. BISHARA SE, : Text book of orthodontics, 2001, Saunders. BHASKAR S.N. : Orbans oral histology and embryology, edition 10, 1990, CBS. GRABER TM : Orthodontics, edition 3, Philadelphia, 1972, WB Saunders. MOORE KL, PERSAUD TVL, SHIOTA K, : Color Atlas of Clinical Enbryology, editoion 2, Philadelphia 2000, WB Saunders. PROFFIT WR, : Contemporary Orthodontics, edition 3, 2000, Mosby. ROCK W P , GRUNDY M C , SHAW L . Diagnostic picture tests in Pediatric dentistry . 1st edition , 1988, Wolfe medical publications . GRAYS ANATOMY: The anatomical basis of medicine and surgry; 38th edition Brad W. Neville, Douglas D. Damm, Carl M. Allen, Jerry E. Bouquot; Textbook of Oral And Maxillofacial Pathology; 2nd edition, W.B. Saunders.

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