DEVELOPMENT OF DEVELOPMENT OF

FACE AND FACE AND

DEVELOPMENTAL DEVELOPMENTAL
ANOMALIES OF FACE ANOMALIES OF FACE
FRST YEAR MDS FRST YEAR MDS
DEPT. OF PROSTHODONTCS DEPT. OF PROSTHODONTCS
CONTENTS CONTENTS
NTRODUCTON NTRODUCTON
DEVELOPMENT OF PHARYNGEAL ARCHES DEVELOPMENT OF PHARYNGEAL ARCHES
FATE OF PHARYNGEAL ARCHES
DEVELOPMENT OF FACE DEVELOPMENT OF FACE
DEVELOPMENT OF NOSE DEVELOPMENT OF NOSE
DEVELOPMENT OF CHEEK DEVELOPMENT OF CHEEK
&NASOLACRMAL DUCT &NASOLACRMAL DUCT
DEVELOPMENT OF EYE DEVELOPMENT OF EYE
DEVELOPMENT OF EAR DEVELOPMENT OF EAR
DEVELOPMENT OF PALATE DEVELOPMENT OF PALATE
HARE LP HARE LP
OBLQUE FACAL CLEFT OBLQUE FACAL CLEFT
CLEFT PALATE: CLEFT PALATE:
ETOLOGY ETOLOGY
CLASSFCATON CLASSFCATON
PROBLEMS ASSOCATED WTH CLEFT PROBLEMS ASSOCATED WTH CLEFT
TREATMENT TREATMENT
PROSTHODONTC CONSDERATON PROSTHODONTC CONSDERATON
RELATED ANOMALES RELATED ANOMALES
MACROSTOMA MACROSTOMA
MCROSTOMA MCROSTOMA
ABNORMALTES OF NOSE ABNORMALTES OF NOSE
TREACHER COLLNS SYNDROME TREACHER COLLNS SYNDROME
RETROGNATHA RETROGNATHA
HEM FACAL MCROSOMA HEM FACAL MCROSOMA
HERDTARY ECTODERMAL DYSPLASA HERDTARY ECTODERMAL DYSPLASA
HYPERTELORSM HYPERTELORSM
PARTAL OR COMPLETE ANODONTA PARTAL OR COMPLETE ANODONTA
FACAL HEM HYPERTROPHY FACAL HEM HYPERTROPHY
AGNATHA AGNATHA
MALFORMED TOOTH MALFORMED TOOTH
CONGENTAL CRANAL DEFECTS CONGENTAL CRANAL DEFECTS
OTHER ANOMALES OF LP OTHER ANOMALES OF LP
BBLOGRAPHY BBLOGRAPHY
NTRODUCTON NTRODUCTON
CranioIacial development is an extraordinarily CranioIacial development is an extraordinarily
complex process that requires the orchestrated complex process that requires the orchestrated
integration oI multiple specialized tissues, such as the integration oI multiple specialized tissues, such as the
surface ectoderm. neural crest. mesoderm. and surface ectoderm. neural crest. mesoderm. and
pharyngeal endoderm pharyngeal endoderm, in order to generate the , in order to generate the
central and peripheral nervous systems, axial central and peripheral nervous systems, axial
skeleton, musculature, and connective tissues oI the skeleton, musculature, and connective tissues oI the
head and Iace head and Iace
Mesenchyme Ior Iormation oI the head region is derived Mesenchyme Ior Iormation oI the head region is derived
Irom: Irom:
paraxial and lateral plate mesoderm paraxial and lateral plate mesoderm
neural crest neural crest
and thickened regions of ectoderm known as and thickened regions of ectoderm known as
ectodermal placodes. ectodermal placodes.
oo Paraxial mesoderm (Somites and Somitomeres) Iorms Paraxial mesoderm (Somites and Somitomeres) Iorms
the Iloor oI the brain case and a small portion oI the the Iloor oI the brain case and a small portion oI the
occipital region , all voluntary muscles oI the occipital region , all voluntary muscles oI the
cranioIacial region the dermis and connective tissues cranioIacial region the dermis and connective tissues
in the dorsal region oI the head, and the meninges in the dorsal region oI the head, and the meninges
caudal to the prosencephalon. caudal to the prosencephalon.
oo Lateral plate mesoderm Iorms the laryngeal cartilages Lateral plate mesoderm Iorms the laryngeal cartilages
(arytenoid and cricoid) and connective tissue in this (arytenoid and cricoid) and connective tissue in this
region. region.
oo Neural crest cells originate in the neuroectoderm oI Neural crest cells originate in the neuroectoderm oI
Iorebrain, midbrain, and ganglia and hindbrain Iorebrain, midbrain, and ganglia and hindbrain
regions and migrate ventrally into the pharyngeal regions and migrate ventrally into the pharyngeal
arches and rostrally around the Iorebrain and optic arches and rostrally around the Iorebrain and optic
cup into the Iacial region. In these locations, they cup into the Iacial region. In these locations, they
Iorm midIacial and pharyngeal arch skeletal Iorm midIacial and pharyngeal arch skeletal
structures and all other tissues in these regions, structures and all other tissues in these regions,
including including cartilage, bone, dentin, tendon, dermis, pia cartilage, bone, dentin, tendon, dermis, pia
and arachnoid, sensory neurons, and glandular and arachnoid, sensory neurons, and glandular
stroma. stroma.
oo Cells Irom ectodermal placodes, together with neural Cells Irom ectodermal placodes, together with neural
crest, Iorm neurons oI the IiIth, seventh, ninth, and crest, Iorm neurons oI the IiIth, seventh, ninth, and
tenth cranial sensory tenth cranial sensory
DEVELOPMENT OF PHARYNGEAL DEVELOPMENT OF PHARYNGEAL
ARCHES ARCHES
An appreciation oI the development oI the structures An appreciation oI the development oI the structures
oI the head and neck needs to include knowledge oI oI the head and neck needs to include knowledge oI
the the pharyngeal (branchial) arches pharyngeal (branchial) arches. These arches . These arches
Iorm on either side oI the Ioregut and correspond to Iorm on either side oI the Ioregut and correspond to
the primitive vertebral gill bars or branchial arches. the primitive vertebral gill bars or branchial arches.
The pharyngeal arch consists oI a core oI The pharyngeal arch consists oI a core oI
mesenchyme covered externally by ectoderm and mesenchyme covered externally by ectoderm and
internally by endoderm. These arches are separated internally by endoderm. These arches are separated
Irom each other Irom each other externally by a pharyngeal cleft externally by a pharyngeal cleft
and internally by a pharyngeal pouch. and internally by a pharyngeal pouch.
Each pharyngeal arch contains a skeletal element, Each pharyngeal arch contains a skeletal element,
striated muscle supplied by the nerve oI the arch striated muscle supplied by the nerve oI the arch
and an arterial element. and an arterial element.
At Iirst there are 6 pharyngeal arches oI which the At Iirst there are 6 pharyngeal arches oI which the
IiIth later dissappear IiIth later dissappear
FATE OF PHARYNGEAL ARCHES
PharyngeaI PharyngeaI
arch arch
MuscuIar MuscuIar
contributions contributions
SkeIetaI SkeIetaI
contributions contributions
Nerve Nerve Artery Artery
1st 1st mandibular mandibular
arch arch
Muscle of Muscle of
mastication mastication, ,
anterior belly anterior belly
of the of the digastric digastric, ,
mylohyoid mylohyoid, ,
tensor tensor
tympani tympani, ,
tensor veli tensor veli
palatini palatini
Maxilla Maxilla, ,
mandible mandible (only (only
as a model for as a model for
mandible not mandible not
actual actual
formation of formation of
mandible), the mandible), the
incus incus and and
malleus malleus of the of the
middle ear, middle ear,
also also Meckel's Meckel's
cartilage cartilage
Trigeminal Trigeminal
nerve nerve (V2 and (V2 and
V3) V3)
Maxillary artery Maxillary artery
2nd 2nd
hyoid arch hyoid arch
Muscles of facial Muscles of facial
expression expression, ,
buccinator buccinator, ,
platysma platysma, ,
stapedius stapedius, ,
stylohyoid stylohyoid, ,
posterior belly of posterior belly of
the digastric the digastric
Stapes Stapes, , styloid styloid
process process, , hyoid hyoid
( (lesser horn lesser horn and and
upper part of upper part of
body), Reichert's body), Reichert's
cartilage cartilage
laclal laclal nerve nerve
Stapedial Stapedial
Artery Artery
rd rd SLvlopharvnaeus SLvlopharvnaeus
Pvold Pvold ( (areaLer areaLer
horn horn and and lower lower
parL parL of of bodv) bodv)
Lhvmus Lhvmus
Clossopharvnaeal Clossopharvnaeal
nerve nerve (lx) (lx)
Common Common
caroLld caroLld/ /lnLernal lnLernal caroLld caroLld
44Lh Lh
CrlcoLhvrold CrlcoLhvrold
muscle muscle all all lnLrlnslc lnLrlnslc
muscles muscles of of sofL sofL
palaLe palaLe lncludlna lncludlna
levaLor levaLor vell vell palaLlnl palaLlnl
1hvrold 1hvrold carLllaae carLllaae
eplaloLLlc eplaloLLlc carLllaae carLllaae
vaaus vaaus nerve nerve (x) (x)
Superlor Superlor larvnaeal larvnaeal
nerve nerve
8lahL 8lahL 44Lh Lh aorLlc aorLlc arch arch
subclavlan subclavlan arLerv arLerv LefL LefL
44Lh Lh aorLlc aorLlc arch arch aorLlc aorLlc
arch arch
66Lh Lh
All All lnLrlnslc lnLrlnslc muscles muscles
of of larvnx larvnx excepL excepL Lhe Lhe
crlcoLhvrold crlcoLhvrold muscle muscle
Crlcold Crlcold carLllaae carLllaae
arvLenold arvLenold
carLllaaes carLllaaes
cornlculaLe cornlculaLe
carLllaae carLllaae
vaaus vaaus nerve nerve (x) (x)
8ecurrenL 8ecurrenL
larvnaeal larvnaeal nerve nerve
8lahL 8lahL 66Lh Lh aorLlc aorLlc arch arch
pulmonarv pulmonarv arLerv arLerv LefL LefL
66Lh Lh aorLlc aorLlc arch arch
ulmonarv ulmonarv arLerv arLerv and and
ducLus ducLus arLerlosus arLerlosus
TMETABLE OF EVENTS TMETABLE OF EVENTS

nd nd
day day------------- -------------11
st st
& &
nd nd
arches arches

th th
day day------------- -------------33
rd rd
&4 &4
th th
arches arches
55
th th
week week------------ ------------thymus,parathyroid&thyroid thymus,parathyroid&thyroid
glands Iormed glands Iormed
77
th th
week week----------- -----------thyroid reaches its deIenitive thyroid reaches its deIenitive
position position
'PMNT AC 'PMNT AC
AIter the Iormation oI head Iold two prominent AIter the Iormation oI head Iold two prominent
bulgings are seen on the ventral aspect oI bulgings are seen on the ventral aspect oI
embryo: embryo:brain brain and pericardium and pericardium .They are .They are
seperated by seperated by stomatodeum stomatodeum the Iloor oI which is the Iloor oI which is
covered by covered by buccopharyngeal membrane buccopharyngeal membrane
y the 4 y the 4
th th
week,the Iace develops Irom week,the Iace develops Irom
fronto fronto- -nasal process nasal process which is a downward extension which is a downward extension
oI mesenchyme covering the Iore oI mesenchyme covering the Iore- -brain. brain.

st st
pharyngeal or mandibular arch pharyngeal or mandibular arch oI each side. oI each side.
At this stage the mandibular arch gives oII a bud Irom At this stage the mandibular arch gives oII a bud Irom
its dorsum and this bud is called the its dorsum and this bud is called the maxillary maxillary
process process. It grows ventero . It grows ventero- -medially cranial to the main medially cranial to the main
part oI the arch which is now called the part oI the arch which is now called the mandibular mandibular
process process
The ectodermal thickening overlying the Ironto The ectodermal thickening overlying the Ironto- -nasal nasal
process soon show bilateral localized thickening process soon show bilateral localized thickening
above stomatodaeum called above stomatodaeum called nasal placods nasal placods
During the 5 During the 5
th th
week the placods sink below the week the placods sink below the
surIace to Iorm the surIace to Iorm the nasal pits. nasal pits.
The medial raised edge is called the The medial raised edge is called the median nasal median nasal
process process and the lateral edge is called and the lateral edge is called lateral nasal lateral nasal
process. process.
During the Iollowing During the Iollowing
weeks, the maxillary weeks, the maxillary
prominences continue to prominences continue to
increase in size. increase in size.
Simultaneously, they Simultaneously, they
grow medially, grow medially,
compressing the medial compressing the medial
nasal prominences nasal prominences
toward the midline toward the midline. .
Subsequently, the cleIt Subsequently, the cleIt
between the medial between the medial
nasal prominence and nasal prominence and
the maxillary the maxillary
prominence is lost, and prominence is lost, and
the two Iuse. the two Iuse.
ence, the upper lip is ence, the upper lip is
Iormed by the two Iormed by the two
medial nasal medial nasal
prominences and the prominences and the
two maxillary two maxillary
prominences. prominences. The The
lateral nasal lateral nasal
prominences do not prominences do not
participate in Iormation participate in Iormation
oI the upper lip. The oI the upper lip. The
lower lip and iaw Iorm lower lip and iaw Iorm
Irom the Irom the mandibular mandibular
prominences prominences that that
merge across the merge across the
midline. midline.
STAGES OF FACE DEVELOPMENT STAGES OF FACE DEVELOPMENT
DEVELOPMENT OF NOSE DEVELOPMENT OF NOSE
W W The nose is Iormed Irom Iive Iacial prominences: The nose is Iormed Irom Iive Iacial prominences: the the
frontal prominence gives rise to the bridge; the merged frontal prominence gives rise to the bridge; the merged
medial nasal prominences provide the crest and tip; medial nasal prominences provide the crest and tip;
and the lateral nasal prominences form the sides (alae) and the lateral nasal prominences form the sides (alae)
External nares are Iormed when nasal pits are cut oII Irom the
stomodeum due to the Iusion oI maxillary process and medial
nasal process.
Fronto-nasal process become progressively narrower and its
deeper part ultimately Iorms the nasal septum.
Mesoderm heaped up in the median plane to Iorm the
prominence oI the nose.
DEVELOPMENT OF CHEEK DEVELOPMENT OF CHEEK
&NASOLACRMAL DUCT &NASOLACRMAL DUCT
The maxillary and mandibular processes undergo The maxillary and mandibular processes undergo
progressive Iusion to Iorm cheek progressive Iusion to Iorm cheek

Initially, the maxillary and lateral nasal prominences

are separated by a deep Iurrow, the nasolacrimal
groove Ectoderm in the Iloor oI this groove Iorms a
solid epithelial cord that detaches Irom the overlying
ectoderm. AIter canalization, the cord Iorms the
nasolacrimal duct; its upper end widens to Iorm the
lacrimal sac. Following detachment oI the cord, the
maxillary and lateral nasal prominences merge with
each other. The nasolacrimal duct then runs Irom the
medial corner of the eye to the inferior meatus oI
the nasal cavity, and the maxillary prominences
enlarge to Iorm the cheeks and maxillae.
'PMNT 'PMNT
The region oI eye is Iirst seen as an ectodermal The region oI eye is Iirst seen as an ectodermal
thickening, the thickening, the lens placode lens placode which appears on the which appears on the
venterolateral side oI the developing Iorebrain. venterolateral side oI the developing Iorebrain.
The lens placode sinks below the surIace and is The lens placode sinks below the surIace and is
eventually cut oII Irom the surIace ectoderm. eventually cut oII Irom the surIace ectoderm.
ith the narrowing oI the Irontonasal process they ith the narrowing oI the Irontonasal process they
come to Iace Iorward. come to Iace Iorward.
The eyelids are derived Irom Iolds oI ectoderm that The eyelids are derived Irom Iolds oI ectoderm that
are Iormed above and between the eyes and by are Iormed above and between the eyes and by
mesoderm enclosed within the Iolds. mesoderm enclosed within the Iolds.
DEVELOPMENT OF EAR DEVELOPMENT OF EAR
The external ear is Iormed around the dorsal part oI The external ear is Iormed around the dorsal part oI
the Iirst the Iirst ectodermal cleft. ectodermal cleft.
A series oI mesodermal thickenings called the A series oI mesodermal thickenings called the
tubercles or hillocks appear on the mandibular and tubercles or hillocks appear on the mandibular and
hyoid arches, which adioin the cleIt. hyoid arches, which adioin the cleIt.
The pinna or auricle is Iormed by Iusion oI these The pinna or auricle is Iormed by Iusion oI these
thickenings. thickenings.
The pinna is Iormed caudal to the developing iaw and The pinna is Iormed caudal to the developing iaw and
is pushed upwards and backwards to its deIinitive is pushed upwards and backwards to its deIinitive
position due to the enlargement oI mandibular position due to the enlargement oI mandibular
process. process.
DEVELOPMENT OF PALATE DEVELOPMENT OF PALATE
ntermaxillary Segment ntermaxillary Segment
As a result oI medial growth oI the maxillary As a result oI medial growth oI the maxillary
prominences, the two medial nasal prominences prominences, the two medial nasal prominences
merge not only at the surIace but also at a deeper merge not only at the surIace but also at a deeper
level. The structure Iormed by the two merged level. The structure Iormed by the two merged
prominences is the prominences is the intermaxillary segment intermaxillary segment. It is . It is
composed oI (a) composed oI (a) a labial component. which forms a labial component. which forms
the philtrum of the upper lip; (b) an upper jaw the philtrum of the upper lip; (b) an upper jaw
component. which carries the four incisor teeth; component. which carries the four incisor teeth;
and (c) a palatal component. which forms the and (c) a palatal component. which forms the
triangular triangular primary palate . primary palate .The intermaxillary The intermaxillary
segment is continuous with the rostral portion oI the segment is continuous with the rostral portion oI the
nasal septum, which is Iormed by the Irontal nasal septum, which is Iormed by the Irontal
prominence. prominence.
Secondary Palate Secondary Palate
Although the primary palate is derived Irom the Although the primary palate is derived Irom the
intermaxillary segment), the main part oI the intermaxillary segment), the main part oI the
deIinitive palate is Iormed by two shelI deIinitive palate is Iormed by two shelI- -like like
outgrowths Irom the maxillary prominences. These outgrowths Irom the maxillary prominences. These
outgrowths, the outgrowths, the palatine shelves palatine shelves, appear in the sixth , appear in the sixth
week oI development and are directed obliquely week oI development and are directed obliquely
downward on each side oI the tongue. In the seventh downward on each side oI the tongue. In the seventh
week, however, the palatine shelves ascend to attain week, however, the palatine shelves ascend to attain
a horizontal position above the tongue and Iuse, a horizontal position above the tongue and Iuse,
Iorming the Secondary palate Iorming the Secondary palate
W W Anteriorly, the shelves Iuse with the triangular Anteriorly, the shelves Iuse with the triangular
primary palate, and the incisive Ioramen is the primary palate, and the incisive Ioramen is the
midline landmark between the primary and midline landmark between the primary and
secondary palates. At the same time as the secondary palates. At the same time as the
palatine shelves Iuse, the nasal septum grows palatine shelves Iuse, the nasal septum grows
down and ioins with the cephalic aspect oI the down and ioins with the cephalic aspect oI the
newly Iormed palate newly Iormed palate
DEVELOPMENTAL DEVELOPMENTAL
ANOMALES OF FACE ANOMALES OF FACE
HARE LP HARE LP
hen hen one or both one or both
maxillary processes maxillary processes
do not fuse with the do not fuse with the
medial nasal process medial nasal process, ,
it gives rise to deIects it gives rise to deIects
in the upper lip. It may in the upper lip. It may
be unilateral or be unilateral or
bilateral bilateral
hen two mandibular
processes do not Iuse with
each other, the lower lip
shows a deIect in the midline.
This deIect may even extend
to the iaws.
edian (midline) cleft lip edian (midline) cleft lip.. a rare abnormality, is a rare abnormality, is
caused by caused by incomplete merging oI the two medial incomplete merging oI the two medial
nasal prominences in the midline. nasal prominences in the midline. This anomaly is This anomaly is
usually accompanied by a deep groove between the usually accompanied by a deep groove between the
right and leIt sides oI the nose .InIants with midline right and leIt sides oI the nose .InIants with midline
cleIts are oIten mentally retarded and may have brain cleIts are oIten mentally retarded and may have brain
abnormalities that include varying degrees oI loss oI abnormalities that include varying degrees oI loss oI
midline structures. midline structures.
&nilateral incomplete &nilateral complete
ilateral complete
OBLQUE FACAL CLEFT OBLQUE FACAL CLEFT
on fusion of the on fusion of the
maxillary and lateral maxillary and lateral
nasal process nasal process give rise to a give rise to a
cleIt running Irom the cleIt running Irom the
medial angle oI the eye to medial angle oI the eye to
the mouth. the mouth.
The nasolacrimal duct is The nasolacrimal duct is
not Iormed. not Iormed.
CLEFT PALATE CLEFT PALATE
CleIt palate results Irom: CleIt palate results Irom:
a lack of fusion of the palatine shelves. which may a lack of fusion of the palatine shelves. which may
be due to smallness of the shelves. be due to smallness of the shelves.
failure of the shelves to elevate. failure of the shelves to elevate.
inhibition of the fusion process itself. inhibition of the fusion process itself.
or failure of the tongue to drop from between the or failure of the tongue to drop from between the
shelves because of micrognathia. shelves because of micrognathia.
Anterior cleIts vary in severity Irom a barely visible Anterior cleIts vary in severity Irom a barely visible
deIect in the vermilion oI the lip to extension into the deIect in the vermilion oI the lip to extension into the
nose .In severe cases, the cleIt extends to a deeper nose .In severe cases, the cleIt extends to a deeper
level, Iorming a cleIt oI the upper iaw, and the level, Iorming a cleIt oI the upper iaw, and the
maxilla is split between the lateral incisor and the maxilla is split between the lateral incisor and the
canine tooth.Likewise, posterior cleIts vary in canine tooth.Likewise, posterior cleIts vary in
severity Irom cleavage oI the entire secondary palate severity Irom cleavage oI the entire secondary palate
to cleavage oI the uvula only. to cleavage oI the uvula only.
&nilateral cleIt lip and palate ilateral cleIt lip and palate
Incomplete cleIt palate
ETOLOGY ETOLOGY
In most cases, we simply don't know why lip and In most cases, we simply don't know why lip and
palate development go wrong. palate development go wrong.
#ace and gender #ace and gender play a small role. CleIt lips and play a small role. CleIt lips and
palates are palates are most common in Asians most common in Asians. They are less . They are less
common in whites and least common in blacks. oys common in whites and least common in blacks. oys
are more oIten aIIected than girls. are more oIten aIIected than girls.
In some Iamilies, cleIt lip and palate appear in several In some Iamilies, cleIt lip and palate appear in several
Iamily members, so Iamily members, so heredity heredity is important. is important.
Sometimes substances in the environment, called Sometimes substances in the environment, called
teratogens. teratogens. may be associated with cleIts. Includes may be associated with cleIts. Includes
rubella virus, cortsone,valium, dilantin etc rubella virus, cortsone,valium, dilantin etc
ut most babies with cleIts have no known relatives ut most babies with cleIts have no known relatives
with cleIt lip or palate and no known exposure to with cleIt lip or palate and no known exposure to
teratogens. A Iew babies with cleIt lip and palate also teratogens. A Iew babies with cleIt lip and palate also
have other abnormalities. have other abnormalities.
ncreased maternal age ncreased maternal age is also a predisposing Iactor is also a predisposing Iactor
CLASSFCATON OF CLEFT LP CLASSFCATON OF CLEFT LP
&PALATE &PALATE
Includes: Includes:
Davis & Ritchie classiIication Davis & Ritchie classiIication
Veaus classiIication Veaus classiIication
Anderson classiIication Anderson classiIication
Schuchardt & PIeiIer`s classiIication Schuchardt & PIeiIer`s classiIication
LASAL classiIication: paraphrase oI anatomic LASAL classiIication: paraphrase oI anatomic
landmarks aIIected by cleIt. landmarks aIIected by cleIt.
Lip, alveolus, hard palate ,soIt palate, hard palate, Lip, alveolus, hard palate ,soIt palate, hard palate,
alveolus, lip alveolus, lip
ernahan`s stripped y` classiIication ernahan`s stripped y` classiIication
The area aIIected by the
cleIt is marked on the "Y"
and labelled Irom 1 to ,
each oI which represents a
diIIerent anatomic
structure.
Combinations oI the numeric
values represent the
appearance oI the cleIt lip,
alveolus or palate.
PROBLEMS ASSOCATED WTH CLEFTS PROBLEMS ASSOCATED WTH CLEFTS
ental ental- - deIormed teeth, missing or supernumerary deIormed teeth, missing or supernumerary
teeth, dental malocclusion with cross bites and teeth, dental malocclusion with cross bites and
collapse oI arches collapse oI arches
sthetic sthetic
Speech & hearing Speech & hearing
Psychologic Psychologic
TREATMENT TREATMENT
Fabrication oI a passive obturator Fabrication oI a passive obturator
Presurgical orthopedics Presurgical orthopedics
Surgical management oI cleIt lip Surgical management oI cleIt lip
Surgical management oI cleIt palate Surgical management oI cleIt palate
Orthodontic therapy carried out at later stages Orthodontic therapy carried out at later stages
DeIenitive prosthodontic therapy is usually one oI the DeIenitive prosthodontic therapy is usually one oI the
Iinal therapy &attempt to mitigate any anatomic or Iinal therapy &attempt to mitigate any anatomic or
Iunctional discrepency Iunctional discrepency
PROSTHODONTC CONSDERATONS PROSTHODONTC CONSDERATONS
Pre surgical infant orthopedics(PS)/moulding Pre surgical infant orthopedics(PS)/moulding
plate plate
Feeding plates Feeding plates
bturators bturators- -mainly for cleft confined to secondary mainly for cleft confined to secondary
palate &patients with inadequate speech following palate &patients with inadequate speech following
surgical procedure surgical procedure
Pre surgical nasoalveolar moulding(PA) Pre surgical nasoalveolar moulding(PA)
Feeding plate Feeding plate
Obturator Moulding plates Obturator Moulding plates
PA PA includes active moulding oI surrounding soIt includes active moulding oI surrounding soIt
tissue aIIected by cleIt including cartilage oI nose. tissue aIIected by cleIt including cartilage oI nose.
This is accomplished by use oI This is accomplished by use oI nasal stents nasal stents .Stent .Stent
give support and shape to nasal dome and alar give support and shape to nasal dome and alar
cartilage cartilage
In case oI soIt palate deIects a In case oI soIt palate deIects a pharyngeal obturator pharyngeal obturator
or speech aid /speech bulb or speech aid /speech bulb prosthesis used. It prosthesis used. It
seperates nasopharynx and oropharynx seperates nasopharynx and oropharynx
RELATED ANOMALES RELATED ANOMALES
SUBUCUS CLFT PALAT /CCULT SUBUCUS CLFT PALAT /CCULT
SUBUCUS CLFT PALAT SUBUCUS CLFT PALAT
Rarely prosthesis indicated unless their is motor Rarely prosthesis indicated unless their is motor or or
sensory deIiciency oI soIt palate. Then a sensory deIiciency oI soIt palate. Then a palatal lift palatal lift
prosthesis prosthesis used used
PERRE ROBN'S SYNDROME PERRE ROBN'S SYNDROME
Robin sequence alters Iirst-arch structures, with development
oI the mandible most severely aIIected. InIants usually have a
triad oI:
micrognathia.
cleft palate.
glossoptosis (posteriorly placed tongue)
Robin sequence may be due to genetic or environmental
Iactors.
Prosthetic rehabilitaion is needed for cleft palate Prosthetic rehabilitaion is needed for cleft palate
MACROSTOMA MACROSTOMA
nadequate fusion of nadequate fusion of
andibular and andibular and
axillary process axillary process with with
each other resulting in an each other resulting in an
abnormally wide mouth. abnormally wide mouth.
Lack oI Iusion may be Lack oI Iusion may be
unilateral and leads to unilateral and leads to
Iormation oI lateral Iacial Iormation oI lateral Iacial
cleIt. cleIt.
MCROSTOMA MCROSTOMA
This occurs due to, too This occurs due to, too
much Iusion oI the much Iusion oI the
mandibular and mandibular and
maxillary process with maxillary process with
each other. It results in each other. It results in
a small mouth. a small mouth.
ABNORMALTES OF NOSE ABNORMALTES OF NOSE
Bifid ose Bifid ose
Nose may be biIid. Nose may be biIid.
Occasionally one halI Occasionally one halI
may be absent . may be absent .
Proboscis
This is characterized by
the nose Iorming a
cylindrical proiection
iutting out Irom iust below
the Iorehead .It is usually
associated with cyclops
(Iusion oI eyes).
TREACHER COLLNS SYNDROME TREACHER COLLNS SYNDROME
MandibuloIacial dysostosis is MandibuloIacial dysostosis is
characterized by: characterized by:
W W malar hypoplasia due to malar hypoplasia due to
underdevelopment oI the underdevelopment oI the
zygomatic bones, zygomatic bones,
W W mandibular hypoplasia, mandibular hypoplasia,
W W down down- -slanting palpebral slanting palpebral
Iissures, Iissures,
W W lower eyelid colobomas, lower eyelid colobomas,
W W malIormed external ears malIormed external ears
RETROGNATHA RETROGNATHA
Mandible may be small compared to the rest oI the Mandible may be small compared to the rest oI the
Iace, resulting in receding chin. Iace, resulting in receding chin.
HEM FACAL MCROSOMA HEM FACAL MCROSOMA
Oculoauriculovertebral spectrum Oculoauriculovertebral spectrum (Goldenhar (Goldenhar
syndrome) syndrome) includes a number oI cranioIacial includes a number oI cranioIacial
abnormalities that usually involve the maxillary, abnormalities that usually involve the maxillary,
temporal, and zygomatic bones, which are small and temporal, and zygomatic bones, which are small and
Ilat. Ear (anotia, microtia), eye (tumors and dermoids Ilat. Ear (anotia, microtia), eye (tumors and dermoids
in the eyeball), and vertebral (Iused and hemivertebrae, in the eyeball), and vertebral (Iused and hemivertebrae,
spina biIida) deIects are commonly observed in these spina biIida) deIects are commonly observed in these
patients patients
LNE OF TRETMENT LNE OF TRETMENT
Surgery is the main line oI Surgery is the main line oI
treatment treatment
Following surgery Following surgery
prosthodontist may need to prosthodontist may need to
establish establish mandibular mandibular
occlusal plane occlusal plane when when
permenant dentition is permenant dentition is
missing on aIIected side missing on aIIected side
ar prosthesis ar prosthesis is made Ior is made Ior
microtia microtia
HERDTARY ECTODERMAL HERDTARY ECTODERMAL
DYSPLASA DYSPLASA
Ectodermal dysplasia (ED) is a Ectodermal dysplasia (ED) is a
rare, congenital disease that rare, congenital disease that
involves the involves the physical signs of physical signs of
the sweat glands. scalp hair. the sweat glands. scalp hair.
nails. skin pigmentation. and nails. skin pigmentation. and
craniofacial structure craniofacial structure. Oral . Oral
symptoms oI ED include symptoms oI ED include
multiple tooth abnormalities multiple tooth abnormalities
(such as hypodontia, anadontia, (such as hypodontia, anadontia,
impacted teeth, and peg impacted teeth, and peg- -shaped shaped
or conical anterior teeth) and lack or conical anterior teeth) and lack
oI normal alveolar ridge oI normal alveolar ridge
development. development.
TREATMENT TREATMENT
Prosthetic restoration Prosthetic restoration
with implant supported with implant supported
over dentures over dentures
Finished prosthesis are in
the mouth
HYPERTELORSM HYPERTELORSM
The eyes are widely The eyes are widely
separated. separated.
FACAL HEM HYPERTROPHY FACAL HEM HYPERTROPHY
Assymetric overgrowth Assymetric overgrowth
oI one or more Iacial oI one or more Iacial
parts. parts.
AGNATHA AGNATHA
Characterized by hypoplasia or absence oI mandible.
OTOCEPALY:
Agnathiasynotiamicrosomia
PARTAL OR COMPLETE PARTAL OR COMPLETE
ANODONTA ANODONTA
Prosthodontic rehabilitation Prosthodontic rehabilitation done accordingly done accordingly
MALFORMED TOOTH MALFORMED TOOTH
Includes gemination ,Iusion ,amelogenesis Includes gemination ,Iusion ,amelogenesis
imperIecta, dentinogenesis imperIecta etc imperIecta, dentinogenesis imperIecta etc
Prosthetic rehabilitaton is done according to the Prosthetic rehabilitaton is done according to the
Iunctional and esthetic need Iunctional and esthetic need
CONGENTAL CRANAL DEFECTS CONGENTAL CRANAL DEFECTS
Includes PIeiIIer`s, Apert`s ,Crouzen`s syndromes Includes PIeiIIer`s, Apert`s ,Crouzen`s syndromes
Surgery is the line oI treatment Surgery is the line oI treatment
Further augmentation oI Further augmentation oI frontal orbital area frontal orbital area is done is done
with acrylic resin onlay implant with acrylic resin onlay implant
OTHER ANOMALES OF LP OTHER ANOMALES OF LP
congenital pits congenital pits
congenital Iistula congenital Iistula
double lip. double lip.
BBLOGRAPHY BBLOGRAPHY
1) 1) Orban`s Orban`s Oral histology and embryology Oral histology and embryology
) ) ShaIer s textbook oI Oral pathology ShaIer s textbook oI Oral pathology
3) 3) uman Embryology uman Embryology - - I Singh I Singh
4) 4) The Internet The Internet
5) 5) CranioIacial Prosthesis CranioIacial Prosthesis - -Per Per Ingvar Ingvar
ranemark ranemark
6) 6) MaxilloIacial Rehabilitation MaxilloIacial Rehabilitation- -eumer eumer
7) 7) Clinical MaxilloIacial prosthesis Clinical MaxilloIacial prosthesis- -Taylor Taylor
8) 8) Langman`s MedicalEmbryology Langman`s MedicalEmbryology- -T..Sadler T..Sadler