BASICS

PERTINENT

EMBRYOLOGY

ARE

MANY

MISSING

LINKS

AND

MUCH

IS

STILL

UNKNOWN

ABOUT THE EMBRYOLOGY OF THE

CIENCY
IS

HUMAN MUCH

FACE

AND HEAD THIS

IN

NOT SURPRISING

WITH SO

HAPPENING

SUCH

SHORT

PERIOD OF TIME
IF

ANATOMIST

ROBERT

BEAN

CALCULATED

THE

RATE OF

GROWTH OF

THE

FIRST

MONTH OF EMBRYONIC
INDIVIDUAL

LIFE

WERE TO BE
TO

MAINTAINED
THE

UNTIL

ADULTHOOD
LIGHT

THE

RESULTANT

WOULD BE 128350

1100

POWER

YEARS IN

LENGTH

THE

DICKSONS
THAT

CLARIFIED

THE PERSPECTIVE
RATE

OF

THIS IF

FIGURE

WHEN THEY
WOULD
YEARS

DETERMINED PRODUCE

SUCH

OF GROWTH

CONTINUED

PERSON

WHOAT

YEARS

WOULD SPAN
ADULT

THE GALAXY BY

WOULD SPAN
IN
HIS

THE UNIVERSE LIKE GRAIN

AND

AS AN

COULD HOLD THE UNIVERSE

HAND

OF SAND

YE
IN 1938

VEAU PROPOSEDAND HE WAS SECONDED BY

STREETER

IN

1951THAT

MASSES OF MESODERM MIGRATE BETWEEN TWO CONTINUOUS COVERING THE ADDED

IN FACE AND THAT ROOF OF THE
THIS
IT

SHEETS OF ECTODERM ORAL CAVITY STARK

PRIMITIVE
IS

1954
LAYER

UNLESS

ECTODERM

SUPPORTED BY AN INTERVENING BREAK

OF MESODERM
DEGREES TO THE

WILL

EVENTUALLY

DOWN AND

GIVE

RISE

TO VARIOUS POSTERIOR
PALATAL

OF CLEFTING FORAMEN
ARE
IS

THE

SECONDARY PALATE
FUSION

INCISIVE

FORMED BY

OF THE TWO

PROCESSES

WHICH
AT

VERTICAL

OUTGROWTHS OF THE MAXILLAE

THE

LYING

AT FIRST

VERTICALLY

EACH SIDE OF

TONGUE

THESE PALATAL

FOLDS ASCEND AS THE NECK EXTENDS AND THE

TONGUE DESCENDS

THEN

BETWEEN

SEVEN AND EIGHT

WEEKS

IF

ALL

EACH OTHER AND WITH GOES WELL THEY FUSE WITH

THE INFERIOR

BORDER

OF THE SEPTUM FROM BEFORE BACKWARDS TO FORM MOST OF THE HARD AND
ALL

OF THE
CLEFTS

SOFT

PALATE

FAILURE

OF FUSION

OF COURSE PRODUCES

VARIOUS

OF THE SECONDARY PALATE

STARK
IN

1971

AT

THE

MELBOURNE CONGRESS RICHARD

STARK

REVIEWED THE
THE PALATE

EMBRYOLOGICAL DEVELOPMENT

OF THE FACE INCLUDING

HE

NOTED
THE SECONDARY
PALATAL PROCESSES AS THE RESULT

PALATE

DEVELOPS

OF THE

POSITIONAL

CHANGE OF
FINALLY

OR SHELVES

THEN BY THEIR GROWTH AND ADHERENCE AND

MERGING

OF THEIR

MESODERM

AT
THE

THE SEVENTH

WEEK

THE HEAD
IS

IS

ACUTELY

FLEXED AND TURNED TO THE

RIGHT

THE TONGUE
WHICH
THE EARS OF

THUS

PUSHED

CEPHALAD BETWEEN
EITHER SIDE

PALATAL

SHELVES
LIKE

HANG DOWNWARDON HOUND DOG SLOWLY

OF THE
TO

TONGUE

AS THE AT

HEAD BEGINS

EXTEND THE TONGUE BEGINS TO DROP STARTING

ELEVATION

FIRST

THE BASE OF THE

TONGUE POSTERIORLY

THE

PALATAL

SHELVES

SEIZE

THIS

OPPORTUNITY
FIRST

TO

OVERCOME THE TONGUE

THEN FORWARD
POSITIONING
AS

RESISTANCE UNTIL

AND

START

TO RISE

POSTERIORLY

WAVE

THE ANTERIOR

PORTION COMPLETES THE

OF SHELVES
THE SHELVES
FIRST

ABOVE THE

TONGUE

NOW
ADHESIVE

GROW
THE

MEET

AND

IF

THEY

ARE

SUFFICIENTLY

FUSE

AT

ANTERIOR

ONETHIRD

OF THE HARD PALATE BACKWARD TO THE

THEN FORWARD TO THE INCISIVE

FORAMEN AND

LASTLY

UVULA

IN

THE

TRANSACTIONS

OF THE FIFTH
STARK

INTERNATIONAL

CONGRESS OF PLASTIC

AND

RECONSTRUCTIVE

SURGEIY

POSTULATED
CAN CAUSE THIS
INCREASING
SERIES

NUMBER OF
TAKE

THINGS

CAN OCCUR WHICH

CLEFT

OF EVENTS

NOT TO

PLACE WITH

RESULTANT

PALATE

UPWARD RESISTANCE OF

THE

TONGUE SUCH
IS

AS

IN

PIERRE

ROBIN

SYNDROMEWHERE

THE JAW

IS

SMALL
IS

AND THE

TONGUE
NITY

PUSHED UPWARD BETWEEN THE PALATAL SHELVES

RISE

THERE

NO OPPORTU THE

THEN FOR THE SHELVES TO

OVER THE

TONGUE TO MEET AND FUSE

SHELVES

THEMSELVES MAY BE SO DEFICIENT

OF MESODERM THAT THEY CANNOT GROW

THE SHELVES

AND MEET EACH OTHER

AS
IS

THE
TREATED

FORCE TO LIFT

UP MAY NOT BE PRESENT

VITAMIN
OR

TRUE IN

ANIMALS

BY EXCESSIVE

DOSES OF CORTISONE

XRAY
SHELVES PRESENCE TO

BROAD HEAD AS IN OXYCEPHALY MAY PROVE TOO WIDE

FOR NORMAL

MEET

THERE MAY BE POSRFUSION

RUPTURE AS SUGGESTED BY THE MARGIN BY KRAUS

IS

OF EPIRHELIAL

PEARLS FOUND ALONG THE CLEFT IN

THE
PUSHED
NASOMEDIAL FOR
PROCESS

HEAD MAY NOT EXTEND OR STAY FLEXED

WHICH

CASE THE TONGUE

UPWARD AND THE PALARAL SHELVES

FUSION THIS

ARE UNABLE TO GET INTO

PROPER POSITION

WOULD BE

TRUE IN

KLIPPELFEIL PROVING

SYNDROME

AN

ENCEPHALOCELE OBSTACLE

MEDIAL

PALATAL

MAY HANG BETWEEN

THE

SHELVES

AN INSURMOUNTABLE

LATERAL SHELF

PALARAL

PATTEN
MPP
BRADLEY
LZT PARREN

OF THE UNIVERSITY BY

OF MICHIGAN

NOTED IN

CEFR
LPS

AND PAATE EDITED

PALATE
IS

GRABB

ROSENSTEIN AND BZOCH IN FROM

IS

LPS

1971
DEEPER
IRIS TO

THE

CONTRIBUTED

TO BY THE NASOMEDIAL

PROCESSES

THEIR

PORTIONS
THIS

THE

SMALL TRIANGULAR
OF THE PALATE PART THAT

MEDIAN

PART OF THE PALATE

FORMED

PORTION

WOULD RESTRICT
IS

THE USE OF THE

TERM PRIMAIY OF THE UPPER

EYE NISAL

AATE THE MAIN

JAW WHICH
ARISES

OF THE PALATE

DERIVED PLOCESSES

FROM THAT PORTION

SHELFLIKE

FROM THE MAXILLAN

SIDE DURING THEYES FOIM THE

OURGROWRHS OF THESE
THE

PUIRN TONGUC
LATCIAL PALATAL FIORN SHELF

PROCESSCS ASISE

ON EITHER

THE SEVENTH THE

WEEK AND GROWTOWARD

PAATE
THE

INAXILLA

MIDLINE
SHELVES DIRECTED EITHER POSITION

THESE
FIRST

PAA TA

TECONAARY
LIES

PALARAL ARC

IECKCL
CARTILAGC

START

TO DEVELOP

TONGUE

BETWEEN

THEM

AND THEY

DOWNWARDSO
SIDE OF THE

THAT THEIR OF THE

MARGINS

LIE

ALONG THE FLOOR OF THE MOUTH ON

PROGRESSES THE NASAL SCPTUM
LATERAL PALARAL SHELVES

ROOT
IS

TONGUE AS DEVELOPMENT DOWNWARDAND

THE

OF THE TONGUE

SHIFTED

MARGINS OF THE PALARAL

SHELVES ARE FREE TO SWING UPWARD AND TOWARD THE MIDLINE

MUCH MORE
OF THE BEST

TONGUE

INFORMATION
AVAILABLE

IS

NEEDED CONCERNING THIS PROCESS DATA

THIS
AS

ON

THE BASIS

AGELENGTH

PLACES

THE

WITHDRAWAL

OF THE

TONGUE FROM

BETWEEN THE PALARAL SHELVES PRESUMPTIVE

FERTILIZATION
FIRST

OCCURRING TOWARD THE END OF THE EIGHTH

WEEK

AGE
THE
IS

WHEN THEY
MEET
EACH

MOVE UP

SHELVES

ARE NOR SUFFICIENTLY

DEVELOPED
THE

TO

OTHER THEIR

GROWTH

VIGOROUS

HOWEVER AND BY

EIGHTH

WEEK
PART

THEY HAVE MADE CONTACT THEREAFTER

FUSION THAT

PROGRESSES FROM THE ROSTRAL THE TYPICAL FUSION OF THE

TOWARD THE

UVULA

BURDI

IS

CONVINCED

PALARAL SHELVES WITH THE CHARACTERISTIC

INCARNATION

OF EPIRHELIAL

REMNANTS DOES
THE

NOR EXTEND TO THE UVULA END OF THE SOFT PALATE

EPIRHELIAL

HE

REGARDS

ABSENCE OF OF THE

REMNANTS IN THIS TERRITORY

AS

INDICATING

THAT THE LENGTHENING

THE

OFT

PALATE

AND THE

FORMATION

OF THE

UVULA TIME

IS

BROUGHT ABOUT BY MERGING

THE PALATE
IT
IS

RATHER

THAN FUSION
THE NASAL

AT

THE

SAME

THAT

THUS BEING

FORMED
FUSED

SEPTUM GROWS DOWNWARD TOWARD

AND SOON BECOMES

TO ITS

UPPER FACE

PATTEN CHAMPIONED
FUSION

THE

THEORY BRINGS

THAT

GROWTH OF MESENCHYMAL
SEPARATE STRUCTURES

MASSES BENEATH
TOGETHER IN

THE

SURFACE

ORIGINALLY

THE LIP IN

BY PUSHING
THE PROCESS

THE EPITHELIUM

OUT FROM BETWEEN

IN THE PALATE

ELEVATIONS

OF MERGING
THE

YET

HE

ACCEPTED THE FUSION

THEORY EXCEPT IN

UVULA

ONE

OF THESE

IS

FAMILIAR
IS

IN

THE

FORMATION OF THE PALATE

FOR THIS PROCESS THE

USUAL TERM FUSION

ENTIRELY

APPROPRIATE AS THE TWO PROCESSES COME TOGETHER CONTACT SHORTLY THEREAFTER THE

THE COVERING EPITHELIAL

LAYERS ARE BROUGHT INTO HAS AN EXTERNAL THIS PROCESS

EPIRHELIUM

THAT

NO

LONGER
IN

EXPOSURE BEGINS TO REGRESS BY BARRY

THE

EPITHELIAL

CHANGES

HAVE BEEN WELL DESCRIBED

MERGING

POSWILLO
DAVID
CLEFT IN LIP

POSWILLO HAS LONG BEEN INTERESTED AND PALATE

IN

THE PATHOGENESIS OF
ORAL

UPON

COMPLETION
TO

OF HIS
IN

SURGERY TRAINING
AS SENIOR

ENGLAND
AT

HE RETURNED
THE PLASTIC

NEW ZEALAND
UNIT

1953

ORAL

SURGEON

SURGICAL CLINIC

CHRISTCHURCH

AND CODIREC HE GOT STARTED

TO FIND

TOR OF THE

CLEFT

PALATE

HE

EXPLAINED
BECAUSE

HOW

IN GOT INTO PALATAL STUDY DAVID

POSWIILO

NEW ZEALAND

WAS ATTEMPTING

AN

ANIMAL MODEL IN WHICH OF THE PALATE

REASONABLE IRONICALLY

COULD DO CONTROL EXPERIMENTS ON THE SURGICAL REPAIR

SOME
LIP

YEARS AFTER PALATE

HAD BEEN STRUGGLING

TO FIND

MODEL OF CLEFT

ANDOR

MY WORK BECAME

WELL

KNOWN AS

RESULT OF

NEWSPAPER ARTICLE RANG

LADY ALL THE

WHO LIVED
TIME

ONLY

FEW HUNDRED YARDS

FROM

MY

HOSPITAL

ME UP
LIP

HAD BEEN WORKING TO PRODUCE

TRYING TO BREED THE

AN ANIMAL

MODEL

OF CLEFT

AND PALATE

SHE HAD BEEN

SAME MALFORMATION
SHE

OUT OF HER PEDIGREE THEN FOR

CARRIED

COLONY OF DACHSHUND
YEAR OR

DOGS

LUCKILY SURGICAL THE

HAD

NOT SUCCEEDED AND

TWO MY

PLASTIC

COLLEAGUE JOHN

ROY
AT

AND

OUT FURTHER

EXPERIMENTS

ON

DOG

MODEL

AT

HOME

OUR EXPENSE

POSWILLOS
SECRETARY

WORK WAS RECOGNIZED BY

MEDICAL
TO

SIR

HAROLD

HIMSWORTH
BRITAIN
BRITISH

OF THE

RESEARCH COUNCIL HIS

OF GREAT

DURING

SEARCH VISIT

NEW ZEALAND
MOST
EXCITING CARRIED

THE REPORT TO

GOVERNMENT STATED
HIS

THAT THE

RESEARCH HE HAD SEEN

ON

ONEMONTH

VISIT

BEING

OUT

AT

THE

BOTTOM OF
POSWILLO

GARDEN IN IN 1968

CHRISTCHURCH BY POSWILLO
PALATE

YOUNG MAN
HIS
FIRST

CALLED

DAVID

DEVOTED

HUNTERIAN
THE

LECTURE TO THE
IS

ISOLATED

CLEFT

AND PARTICULARLY
ENTITLING

FORM

THAT

ASSOCIATED

WITH POSTURAL

MOLDING

THE LECTURE

THE

AETIOLOGY

AND

SURGERY OF CLEFT PALATE

WITH MICROGNATHIA
IN

POSWILLO EVENTUALLY

BECAME

PROFESSOR

OF TERATOLOGY
ORAL

THE

ROYAL COLLEGE OF SURGEONS

AT

OF ENGLAND
PITAL EAST THE

AND CONSULTANT GRINSTEAD

SURGEON

QUEEN

VICTORIA

HOS
HE

IN

MAY

1974

THE PROCEEDINGS OF

ROYA

SOCIETY

OF AL EDICINE

WROTE

FOR THOUSANDS OF YEARS MANKIND

PHYSICAL

HAS BEEN INTRIGUED

BY DISTURBANCES
DESCRIPTIONS

IN

THE

DEVELOPMENT

OF THE HUMAN BODY EVEN BEFORE

OF SUCH

DEFORMITIES

WERE RECORDED
IN

ON THE CLAY TABLETS OF BABYLON IN 3000

CAVE DWELLERS

BC
BUT
IT

THEY

WERE ILLUSTRATED NOT UNTIL

STUDY

THE ROCK DRAWINGS OF PRIMITIVE

WAS

THE TIME

OF HARVEY IN THE SEVENTEENTH

CENTURY THAT THE SCIENTIFIC OF THE

CELL

OF MALFORMATION

BEGAN

AFTER

THE

DEVELOPMENT

THEORY

THE

SIGNIFICANCE

OF THE FOLDINGS

AND INVAGINATIONS WAS POSSIBLE

TO

OF THE THREE GERM LAYERS CAME

TO BE UNDERSTOOD

AND

IT

COMPREHEND MANY ANOMALIES

FOR EXAMPLE OF THE
CLEFT LIP

OF AND

DEVELOPMENT
PALATE ESSES

IN

TERMS OF MECHANICAL RECOGNIZED

AS

DIFFICULTIES

BECAME

FAILURE

OF FUSION

MAXILLARY

PROC

CLEFTS OF THE IN

POSTERIOR

PALATE

MAY BE

CLASSIFIED

INTO

TWO PRINCIPAL WHICH

GROUPS

ONE THERE ARE THOSE CLEFTS BOTH UNILATERAL

LIP IN THE OTHER ARE THE SOLITARY CLEFTS EASILY BE DISTINGUISHED ENTITIES

AND BILATERAL

ACCOMPANY
CLINICALLY THAT THESE

CLEFT

OF THE SECONDARY PALATE

THESE

TWO GROUPS MAY

ARE DISTINCT

MOST
IN

AUTHORS

AGREE

TWO GROUPS

THE

DIFFERENCE

INCIDENCE

SEX PREDISPOSI

TION
CLEFT

AND PREVALENCE
LIP

OF ASSOCIATED
CLEFT

ANOMALIES

ALL

SUPPORT THIS

DIVISION

INTO

AND ISOLATED
FREQUENT

PALATE OF CLEFT PALATE

THE

ASSOCIATION

WITH

THE

CLEFT

LIP

ANOMALY

HAS

BEEN INVESTIGATED

BY MANY WOTKERS AS HAS ALREADY BEEN DESCRIBED

TO CLEFT
LIP

ANIMAL

EMBRYOS SUSCEPTIBLE
FRASER

HAVE

LARGE MEDIAN

NASAL PROCESS TRASLER

AT

1963

HAVE SHOWN THAT IN SUCH CIRCUMSTANCES

THE

THE

COMMENCEMENT
LIPS

OF PALATAL SHELF CLOSURE

AS IS USUALLY THE MEDIAN SHELVES

TONGUE DOES NOT MOVE FORWARD BETWEEN THE

THE TIP OF THE THE

THE CASE INSTEAD

TONGUE REMAINS PRESSED

NASAL CAVITY

AGAINST

PROCESS AND ARCHES

UP

INTO SHELF

BETWEEN THE PALATAL MIDLINE

IS

THUS MOVEMENT
IN

OF THE

OR SHELVES
CLEFT LIP
IT

TOWARDS THE
IS

IMPEDED THEREFORE
RESULTS DELAYED BECAUSE

AN EMBRYO WITH
OF THE

LIKELY

THAT CLEFT TO

PALATE
IS

MOVEMENT
INTERVENING UNLIKELY TO TAKE FIGURES

SHELVES
IF

FROM VERTICAL
THE

HORIZONTAL

BY THE
IT IS

TONGUE

EVENTUALLY

SHELVES

DO BECOME

HORIZONTAL THUS FUSION

THAT THEY WILL MEET EACH OTHER

OR THE NASAL

SEPTUM

FAILS

PLACE
FOR ISOLATED
CLEFT RACIAL

THE
CLEFT LIP

PREVALENCE

PALATE

ARE LOWER THAN THOSE

IS

FOR IN

AND PALATE
IT

BUT THE RATIO OF ONCE OF

IN

INCIDENCE

MUCH

THE

SAME

CAUCASIANS MALES
IN

OCCURS RATIO

3000

LIVE

BIRTHS IN

AN

EXCESS
CLEFT

OF FEMALES

OVER

THE

60

40

EXISTS
AS

ISOLATED

PALATE
CLEFT

ASSOCIATED
AS

CONGENITAL

ANOMALIES OCCUR TWICE

LIP

OFTEN WITH

ISOLATED HAS

PALATE

WITH

COMBINED

AND PALATE
CLEFT

CLEFTS

MICROGNARHIA

VELY

HIGH

ASSOCIATION

WITH ISOLATED

PALATE THE

DUE IN PART TO THE SIMULTANEOUS OCCURRENCE OF THE ROBIN

TWO ANOMALIES NORMAL

IN

PIERRE

SYNDROME
BETWEEN GROWTH

PALATE FUSION OF THE

INVOLVES

SYNCHRONI7ED INTERACTION

AND CONVCRGENE
ACTIVIT STEADY

PALATAL PROCESSES

TONGUE WITHDRAWAL AND MUSCULAR

CRANIAL BASE AND CRANIAL FLEXURE
IT

MANDIBULAT
INCREASES IN

GROWTH CHANGES IN
THE

AND

WIDTH

OF THE

DEVELOPING HEAD

CAN

BE POSTULATED COULD AND AND

THAT ANY SIGNIFICANT LEAD TO INCOMPLETE THE NASAL

INTERFERENCE FUSION

WITH THESE TIMESPECIFIC

SHELVES

INTERACTIONS EACH THE

OF THE PALATAL IN

BOTH WITH
AFFECTING

OTHER FUSION

WITH

SEPTUM

ADDITION

CHANGES

SUBSEQUENT BREAKDOWN
SHELVES

OF THE EPITHELIAL

SEAM COULD INDUCE

LATER

MALFORMATION BY ABNORMAL BRIDGING

IS

WHICH

MERGE AND FUSE COULD BE

OR

DISRUPTED
IF

EITHER

MECHANICAL INCOMPLETE

PRESSURES

BY GROWTH

TRACTION

MESODERMAL

SUCH PHENOMENA COULD LEAD TO PALATAL FISTULA OF THE PALATE

SUBMUCOUS CLEFTS
THEREFORE THAT

OR EVEN COMPLETE RUPTURE

CLEFT

ONE

CAN HYPOTHESIZE

PALATE THE

MAY

ARISE

FROM ONE OR MORE OF THE FOLLOWING CAUSES INTERFERENCE HEAD WIDTH

OR DIMINUTIVE PALATAL PALARAL

WITH

INTRINSIC EXCESSIVE

SHELF FORCE EXCESSIVE RESISTANCE

SHELVES

FROM

THE

TONGUE NONFUSION

OF THE

SHELVES AND FUSION

OF THE PALATE

WITH

SUBSEQUENT BREAKDOWN
FIRST

WALKER AND
INTRINSIC

FRASER

1956

WERE THE
THEY

TO PROPOSE THE TO THE PRESENCE

EXISTENCE

OF AN
FIBRES

SHELF FORCE

WHICH

ASCRIBED

OF

ELASTIC

WITHIN
INTRINSIC

THE

SHELF

MESODERM
AROSE

POSWILLO

AND ROY

1965
OF THE

BELIEVED

THAT

THE

SHELF FORCE

FROM
MIRORIC

COMBINATION
ACTIVITY

EXPANDING

FIBRILLAR

MESODERM AND
SHELF

INCREASED

ALONG THE

LOWER MARGIN

OF THE

THIS

LATTER

HYPOTHESIS

WAS REINFORCED
THAT THE

BY THE WORK OF ANDERSEN

MITOTIC IN ACTIVITY

AND

MARTHIESSEN IMPORTANT
TISSUES

1967

WHO SHOWED
TO

INCREASING OVERALL
RISE

WAS AN
SHELF

FACTOR CONTRIBUTING

TENSION

OF THE

VERRUSIO

1970

PROPOSED THAT

GRADUAL

DECREASE IN SHELF

THE
IT
IS

ANGULARION LIKELY IN

OF THE CRANIAL BASE COULD PROVIDE THE INTERNAL

MULTIFACRORIAL

FORCE

SYSTEM SUCH

AS

PALATE CLOSURE THAT INTERFERENCE WILL CONTRIBUTE

WITH THE CRANIAL OF PALATE

BASE BE
CLOSURE

IT

MECHANICAL

OR BIOCHEMICAL

TO FAILURE

SMALL PALATAL SHELVES MAY ALSO CONTRIBUTE PRODUCES REDUCED MIRORIC AND PRIMATES
TO DO LIKEWISE
AFFECT

TO PALARAL CLEFTING PALATAL SHELVES IN

XIRRADIATION BOTH RODENTS

ACTIVITY

AND SMALL

OTHER RERAROGENS INCLUDING

GLUCOCORRICOIDS

HAWE BEEN SHOWN

ARISE WILL OBVIOUSLY

MESENCHYMAL DEFICIENCY
PALARAL SHELF

HOWEVER

IT

MAY

THE

DEVELOPING

MECHANISM WITH

CONSEQUENCES LEADING

TOWARDS MALFORMATION

THE

ROLE OF THE

TONGUE

IN

PALATE

CLOSURE

IS

STILL

MATTER FOR DEBATE CAN PRODUCE

COMPLETE
CLEFT

TONGUE OBSTRUCTION
IN

OVER

TIMESPECIFIC

PERIOD

100

PALATE

RODENTS ACCOMPANIED

BY

HIGH

PROPORTION OF MOULDING POSWILLO

DEFECTS OF THE PIERRE

ROBIN

TYPE

WHEN INDUCED BY AMNIOCENTESIS

ROY 1965
HARRIS IN

1967

HAS

SHOWN

THAT GLUCOCORRICOIDS

PRODUCE OLIGOHYDRAMNIOS WITH

ROLE HAS

MICE WITH POSTURALTYPE

OF THE CRANIAL IN THE

DEFECTS OF THE PALATE CAUSED BY INTERFERENCE

ANGULATION

BASE AND SUBSEQUENT TONGUE WITHDRAWAL

THE
IT

OF CORRICOSREROIDS
OFTEN COLD

INDUCTION

OF

CLEFT

PALATE

IS

STILL

NOR CLEAR

BEEN DEMONSTRATED THAT PREGNANT MICE

OR TRANSPOIRARION INCIDENCE OF CLEFT NEAR THE IN
CRITICAL

EXPOSED TO STATWARION
CLOSURE WILL

NOISE HAVE

RIME FOR PALATE

OFFSPRING

HIGH

PALATE AIE

THEIR

DISTURBANCES OF FUSION
CLEFT

BELIEVED

BY SMILEY

1972
BIFID CLEFT

TO BE RESPONSIBLE

FOR

PALATE
CLEFT

SUBMUCOUS
MICROFORM
IN THE

PALATE
CLEFT

IN

ASSOCIATION PALATE

WITH

UVULA
PALATE

IS

LIKELY

TO BE

OF POSTERIOR
THE

SUBMUCOUS

CAN

BE INDUCED
12 OF

MOUSE BY
IT

ADMINISTRATION DELAY IN

OF PHENOBARBIRONE
THE CENTRIPERAL FLOW

ON DAY
OF PALARAL

DEVELOPMENT
OSSIFICATION UNREINFORCED PRESSURES

RESULTS IN

SHELF

OF INCREASING

MAGNITUDE

FROM BEFORE BACKWARDS WHICH LEAVES AN UNDER GROWTH TRACTION

ACROSS THE MIDLINE FORCE IN THE OR TONGUE

PALARAL VAULT PRONE TO RUPRUTE

THE ABSENCE OF BONE REINFORCEMENT

WITH
DEFICIENT TO THE OSSEOUS FAILURE INDUCTIVE

OF THE VAULT
OF THE

COMBINED
PALATE

MIDLINE

CONTRIBUTES

OF THE VELAR

MESENCHYME
WITH

TO MERGE

AND

ELONGATE THUS BIFID

UVULA EITHER

ALONE OR COMBINED

SUBMUCOUS CLEFT

PALATE

MAY

RESULT

FROM DISTURBANCES
PLACE

IN

THE

PROCESSES

OF OSSIFICATION WEEKS OF

AND

MERGING WHICH DEVELOPMENT

TAKE

BETWEEN THE SEVENTH

AND TENTH

HUMAN

SMILEY
GARY
CAROLINA

SMILEY
AT AS

RESEARCH ORTHODONTIST

AT THE UNIVERSITY

OF NORTH
AS

CHAPEL

HILL

WHO

RAISES

RINGNECK

DOVES

HOBBY
DURING

WORKED
THE

LABORATORY

TECHNICIAN

WITH

AN EMBRYOLOGIST

SUMMER OF HIS
IN

FRESHMAN YEAR IN DENTAL SCHOOL AFTER BY

GRADUATE
TO JOIN

TRAINING THE
TIVE

ORTHODONTICS HE WAS INVITED

WARREN
AND

UNIVERSITY

OF NORTH CAROLINA ORAL FACIAL

COMMUNICA
FOR

DISORDERS PROGRAM AND WAS THUS PROVIDED OF THE SECONDARY PALATE

RESEARCH TIME

STUDY

HE

BEGAN WORK WITH

ELECTRON

ANATOMIST

DIXON
AIDED PALATE
HIS

AND FROM HIM

LEARNED

MICROSCOPY WHICH
NOTED
AT

INVESTIGATION

OF PALATE

FUSION
EPITHELIAL ORAL

HE

THAT
THEIR

AS

THE

HALVES

COME

TOGETHER THE
AS

EDGES

UNION

MUST BREAK DOWN

NASAL

AND
GIVES THE THICK

ACCUMULATION
LYTIC

OF EPITHELIAL
TO

GA

SMILEY

CELLS

WITH

LYSOSOME BODIES
ACROSS
CELLS

WAY BY
MIDLINE
AT

ACTIVITY

ALLOW PLATE

MESENCHYMAL UNION WHICH

THE
IS

THE

EPITHELIAL

FOUR

TO

SIX

TIME

OF CONTACT

SEPARATES

APPROACHING

MESODERM AND BY DEGENERATION AND DESQUA

THICKNESS
AT

MATION
FUSION
IT

GOES TO ONECELL

THE

PRESUMPTIVE

AREA OF

DOES NOT TAKE

CONTACT

TO CAUSE

THIS

EPITHELIAL

BREAKDOWN
BEFORE

SMILEY

NOTES THAT EPITHELIAL

IS

DEATH

IS

PROGRAMMED

CONTACT
CLEFT

SO IF TIMING WILL

OFF FOR ANY REASON THE KERATINIZED

EDGES OF THE

NOT JOIN

EACH OTHER IF FOR INSTANCE THE

TO THEIR HORIZONTAL

PALATAL

PLATES ARE LATE

EPITHELIAL
ITS

GETTING

UP

POSITION

PROGRAMMED

DEATH ALONG THE

CLEFT

EDGES

MAY
LATE

PROCEED ACCORDING TO
TO BE ACHIEVED

OWN

SCHCDUK BUT
TIME IN
THE

IT

WILL

BE TOO

FOR UNION

BY THE

PALATAL

HALVES

ACTUALLY

TOUCH EACH OTHER

THAT

1968

POURROIS ASCERTAINED

FUSION OF PALARAL PROCESSES

AFTER THE
CRITICAL

IS

TIMECRITICAL FUSION

THAT IS
WILL

IF

THE PALATAL SHELVES

MEET

PERIOD

FOR FUSION

NOT TAKE

PLACE

10

IN

1972

SMILEY

NOTED

STUDIES

WHICH
EASILY

INDICATE THE
CLEFT

THAT

THE

SOFT PALATE
BIFID

FORMS BY UVULA
ORAL

PROCESS

OF MERGING
THE

COULD
TYPICAL

EXPLAIN

OCCURRENCE OF

BUT CANNOT EXPLAIN AND

NASAL

SUBMUCOUS

WHICH
TO REACH

HAS THE

AN INTACT MIDLINE

EPITBELIUM

COVERING
DEFICIENCY

MUSCLE FAILING
OF BONE
AT

OF THE VELUM AND USUALLY

THERE
IS

THE POSTERIOR

BORDER OF THE HARD PALATE

OF THE SUBMUCOUS CLEFT

NO SAZISFACTOIY SINGLE EXPLANATION

ALL CLEFTS

FOR THE ETIOLOGY

OR EVEN FOR

OF THE SECONDAIY PALATE

ITS

NEVERTHELESS

AN ABNORMAL

EPIRHELIAL

SEAM

EITHER IN FOR

FORMATION OR BREAKDOWN SEEMS TO BE

CLEFT

MOST LIKELY

EXPLANATION

SUBMUCOUS

PALATE

IN

THE

ARCHIVES

OF ORAL BIOLOGY

SMILEY

NOTED

IN

1975

THERE ARE MANY STUDIES ON THE MIDLINE BUT FEW HAVE DISTINGUISHED BURDI AND FAIST

EPIRHELIAL

SEAM DURING PALAROGENESIS HARD AND SOFT PALATES

BOLLERT

BETWEEN THE PRESUMPTIVE

1967

AND BURDI

1968
THE

IN

MAN AND

AND HENDRICKX
THE HARD AND

1971
RATHER PALATE

STUDYING BABOONS DESCRIBED

DEVELOPMENT

OF BOTH

SOFT PALATE SUGGESTING

THAT THE SOFT PALATE DEVELOPS

BY MESENCHYMAL MERGING
IN THE SOFT

THAN FUSION

BECAUSE EPIRHELIAL

REMNANTS ARE NOR FOUND

HOWEVER SHAH AND CHAUDHRY

PROCESS

1974

INDICATED OF THE

THAT THE SOFT PALATE IN EPIRHELIA

HAMSTERS FORMED BY THE

INCONSISTENCY THIS

OF FUSION
SOFT

OPPOSING

THIS

AND LACK OF STUDIES ON ON NOIMAL

MICE PROMPTED PALATE FORMATION IN

TO DETERMINE

INVESTIGATION

PALAROGENESIS

WHETHER THE SOFT

OR BY

PALATE FORMS PRIMARILY

BY EPITHELIAL

ADHERENCE AND MESENCHYMAL FUSION

MERGING

HE CONCLUDED
WAS OBSERVED IN
RELATIVELY THE REGION PERIOD

MIDLINE
PALATE THAT

SEAM OF EPITHELIUM
RODENTS

OF THE FUTURE SOFT

INDICATING

IN

AND

MAN

FOR

SHORT

OF TIME

EPITHELIAL

ADHERENCE AND MESENCHYMAL

FUSION RAPID

WAS OCCURRING AND NOT

IN THE

MERGING
SUMPTIVE THAN IN

EPITHELIAL SOFT PALATE THE

BREAKDOWN WAS MORE

AND ALONG THE JUNCTION
OF THE FUTURE

AND COMPLETE
NASAL SEPTUM

PRE

OF THE

AND PALATE

MIDLINE

HARD PALATE

IN SMILEY

HIS

1975

HISTOLOGICAL

STUDY

IN

ARCHIVES

OF ORAL BIOLOGY OF

PRESENTED

SOME CONVINCING
THE

MICROSCOPIC SECTIONS
EPIRHELIAL

HUMAN

FETUSES WITH

AND WITHOUT

MIDLINE

SEAM

11

II

HUMAN
EARLY

10WEEK

FOETUS

FUTURE HARD PALATEMIDLINE AND EPITHCLIUM

IS

EPIRHELIUM
NASAL

IS

INTACT

EXCEPT FOR AND PALATE

BREAKDOWN N4SALLY
GLOSSOPALARINE

PRESENT

BETWEEN THE
SEPARATION
IS

SEPTUM

NOTE
THE

EPIRHELIUM

ADHERENCE AND PARTIAL

OF THE NASAL SEPTUM FROM AND APPEARS

TO BE IN

PALATE

FUTURE SOFT PALATEMIDLINE

EPITHELIUM

PRESENT

CLUMPS IN

SOME

AREAS

HUMAN
ORAL
IS

12 WEEK FOERUS POTENTIAL HARD PALATE MIDLINE EPIRHELIUM IS INTACT NEAR THE GROOVE AND HAS BIOKEN DOXVN NASALLY EPIRHELIUM BETWEEN THE NASAL SEPTUM AND PALATE ABSENT POTENTIAL SOFT PALATEMIDLINE EPIRHELIUM IS ABSENT AND THE UVULA HAS

FUN

OW

BASED

UPON

THESE

OBSERVATIONS
IS

THE

HYPOTHESIS
IS

IS

PROPOSED THAT
DIFFERENTLY IN

THE THE

MEDIAL PALATAL EPIRHELIUM

ANTERIOR BESIDES

DIFFERENT

ANDOR

ACTED

UPON

AND

POSTERIOR

REGIONS

OF THE
COVERING
ITSELF
IS

DEVELOPING

SECONDAIY

PALATE THE

THE PALARAL EPITHELIUM

THE ORAL AND NASAL SURFACES DIFFERENT DIFFERENTIAL

HARD

AND SOFT PALATE ORAL EPIRHELIUM

DEVELOP

MENT

ALSO OCCURS IN

THE UNDERLYING PALARAL

MESENCHYME

EG

HONE FORMS IN

12

THE HARD PALATE AND MUSCLE IN

THE SOFT PALATE

THE

PALATAL

MESENCHYME

THAT

DEVELOPS INTO THESE DIFFERENT TISSUES COULD SIGNIFICANTLY EPITHELIUM

EPITHELIAL

INFLUENCE THAT THE PER

THE MIDLINE DIFFERENCE IN

OF THE

RESPECTIVE

REGIONS
RESIDE IN

SUGGESTING
THE

BREAKDOWN MAY NOT

EPIRHELIUM

SE

IN

VITRO

STUDIES
IN

OF

PALATAL
OF THE PALATE OF COURSE

DEVELOPMENT
INFORMATION BEING
GREATER

MICE
DEVELOPMENT
IS

ON

THE

EMBRYOLOGICAL
LABORATORY EVENTUALLY

GLEANED

FROM

STUDIES

AND

EVEN

KNOWLEDGE

WILL

BE GAINED

FROM SUCH INVESTI

GATIONS

COMPARISON OF SECONDARY PALATE DEVELOPMENT

VITRO

WITH DIFFERENT AND

IN

TECHNIQUES
IN

REPORTED

BY

GARY

SMILEY

WILLIAM

KOCH

1975

SUGGEST
PLAY

THE MESENCHYME MAY

AN IMPORTANT

ROLE IN

EPITHELIAL

DEGENERATION
DID

ALONG THE MEDIAL EDGE OF PALARAL PROCESSES OCCUR IN

THE ABSENCE OF VIABLE

SINCE

EPITHELIAL

DISRUPTION

NOT

UNDERLYING

SUBJACENT

PALARAL

MESENCHYME OF NORTH

MARY

TYLER

AND WILLIAM

KOCH

OF THE UNIVERSITY
PALATAL

CAROLINA SCHOOL OF MEDICINE

FOUND THAT

PROCESSES CULTURE

REMOVED

FROM 12DAY MOUSE EMBRYOS UNDER

PARTICULAR

CONDITIONS

WERE ABLE TO CONTINUE THEIR DIFFERENTIATION

THESE RESEARCHERS TO

THE

DISCOVERY

ENABLED

MAKE

CERTAIN

INTERESTING

DEDUCTIONS

THEY CONFIRMED
TIP

THE

ASSUMPTION

THAT THE EPITHELIUM

AT

THE

OF THE

VERTICALLY

ORIENTED

PALATAL PROCESS WAS INDEED POSITIONED

TIP

THE FUTURE

MEDIAL
IT

EPITHELIUM
ALWAYS
THIS

OF THE HORIZONTALLY EPITHELIUM

AT

PROCESS BECAUSE
VERTICAL

WAS

THE

OF THE

PROCESS

WHICH UNDERWENT REGRESSION

THEIR 1972
REPORT
RESULTS ALSO

CONFIRMED FOR 12DAY AND

PALATAL PROCESSES

THE THAT

BY SMILEY

KOCH
PALATAL

FOR

14DAY
IS

MOUSE
NOT

PALATES

CELLULAR

CONTACT

BETWEEN

PROCESSES

PREREQUISITE

FOR MIDLINE

EPITHELIAL CLARIFIED

DISRUPTION
THE
AS

THEY COMES ARCH

PROBABILITY RIDGES CAPABLE

THAT PROJECTING

THE

TIME

IT

BE

IDENTIFIABLE

TWO
IS

FROM THE

MAXILLARY

THE

MOUSE

PALATE

OF IN

VITRO

DEVELOPMENT

AND

EVENTUAL FUSION

13

FINALLY

AS

SUITABLE

IN

VITRO

ENVIRONMENTAL

CONDITIONS

MAY

BE PROVIDED
GENESIS PRIATE

WHICH

ARE FULLY

ADEQUATE FOR SUPPORTING

PALATAL TISSUES
CIT

MORPHO

AND HISTOGENESIS

OF

EARLY

SEEMS APPRO

TO SUGGEST THEREFORE POTENTIAL FOR FUSION IN

THAT THE

CONCEPT OF THE ACQUISITION

SPECIFIC

OF
PERIOD

DOES NOT IDENTIFY

THE

IN

VIVO

OF DIFFERENTIATION

ONTOGENY

OF THE

MAMMALIAN

SECONDARY PALATE

THE
ANIMALS
CLEFT

ADMINISTRATION

OF EXCESS VITAMIN

TO PREGNANT LABORATORY

HAS BEEN USED EXTENSIVELY IN OFFSPRING

TO PRODUCE

HIGH

INCIDENCE

OF

PALATE

GIROUD AND
AND

MARTINET EXPLANATIONS
LEADS

KALTER
DIFFER
CLEFT

WOOLLAM
HOWEVER
PALATE THE
AS

MILLEN

TO

HOW

MATERNAL VITAMINOSIS

TO FETAL

RAVINDRA

NANDA
AND
IN

FORMERLY OF THE UNIVERSITY

AT

OF

NYMEGEN

NETHERLANDS

NOW

THE
CLEFT

UNIVERSITY

OF CONNECTICUT
THAT HIS RECENT

HARTFORD REPORTED
STUDIES VITAMIN QUENTLY THE

THE 1974

PAATE JOURNAL

SUGGEST
RETARDS THE

GROWTH OF THE DO NOT COME IN TIME

PALATAL

PROCESS

IN

VIVO

AND

SUBSE
AT

PROCESSES

CONTACT

WITH
THE

EACH OTHER

THE

MORPHOGENERICALLY DETERMINED

THE GROWTH OF
DOES

HEAD SUBSEQUENTLY

MOVES
PALATAL

THE

PROCESSES

APART

AND FUSION
POTENTIAL

NOT TAKE PLACE

VITRO IN

HOWEVER
THE

THE

PROCESSES

RETAIN

THEIR

TO FUSE IN

ABSENCE OF

CRANIOFACIAL FURTHER

STRUCTURES THAT EVENTS

AND MATERNAL METABOLISM VITAMIN OF FUSION PROBABLY

DOES

AND ENVIRONMENT THIS NOR IRREVERSIBLY

DISTURB

SUGGESTS IN VIVO

NORMAL

MECHANISM

OF COURSE
SINCE THERE

IN

VITRO

STUDIES

IN

THE

HUMAN

ARE

MORE ENLIGHTENING
OF THE RODENT PRI AND THE

ARE VARIATIONS

FROM DEVELOPMENT

MARILY RELATED TO DIFFERENCES IN BEHAVIOR OF THE EPITHELIUM

AREA OF FUSION ALASTAIR
CLEFT

GOSS OF ADELAIDE
IN

SOUTH

AUSTRALIA

NOTED IN

THE

PALATE JOURNAL
FOETUSES

1975
METHODS
ARE SUITABLE FOR PALATAL

ONLY

OBTAINED

BY OPEN SURGICAL

CULTURE

HIS

FIVE

SUCCESSFUL IN

HUMAN
FUSION

CULTURES

INDICATED

THAT

IT

IS

POSSIBLE

TO

STIMULATE

VIVO

AND

IN

VITRO

EPITHELIAL

PURE FORMATION HIS

CASE

AND

TO

INVESTIGATE

ASPECTS VITRO

OF POSTFUSION
FUSION

RUPTURE
PALATES

DEMONSTRATED THAT IN

OF

HUMAN

DOES OCCUR

14

THE FUSED AREA SHOWING RAPID AND IV

HEALING

MESENCHYMAL PENETRATION
THE INTACT PALATE
IS

CASES

III

DEMONSTRATED THAT BY EPITHELIAL

THE
CLEFT

IF

RUPTURED

NORMAL

COVERING OF THE EXPOSED MESENCHYME OCCURS

PREVIOUSLY PALATE IN FUSED PALATE

AS RUPTURE OF MECHANISM GOSS

IN
IS

WAS

POSTULATED IN

AS

OF

HUMANS BY

KITAMURA

1966

IN IN

THE PROCESS OF

SHOWING

THAT CLEFT PALATE INTACT PALATE

CAN BE INDUCED

VIVO

THE

RAT

BY RUPTURE OF THE

HE

REPORTED

WITH
THE
SIZES

SOME

TYPES

OF PALATAL RUPTURE CONTINUED

THE

GROWTH OF

THE

FACE DISTRACTS
SITES

RUPTURED PALATE THUS INCREASING OF PALATAL RUPTURE HEAL WITH

WIDTH
SO THAT

OF THE CLEFT OTHER

THE PALATE HAS

AND

TIME

REFORMED BY

BIRTH

MARK
OF THE TROUBLED PATHOLOGY
CLEFT

FERGUSON OF

QUEENS

UNIVERSITY IN

OF BELFAST
PHILATELY

CENTER

ZONE WHO IS

INTERESTED
RAT

AND PALEO
THOSE WITH THE

HAS STUDIED

NORMAL WISTAR

FETUSES

AND

PALATE

INDUCED

BY 5FLUORO2DESOXYURIDINE
SHELF ELEVATION

TO ELUCIDATE THE

MECHANISMS OF
CLEFT

PALATAL

AND

PATHOGENESIS

OF

PALATE

IN

1977

HE WROTE
AL ARK FERGUSON

THE FOLLOWING
BUILD PALATAL

THEORY

IS

ADVANCED TO ACCOUNT FOR SHELF ELEVATION PREDOMINANTLY

HYALURONIC

THE
ACID

GRADUAL IN THE

UP

OF MUCOPOLYRSACCHARIDES

SHELVES FORCE

FROM DAY

14

TO DAY

163

PRODUCES AN INCREASINGLY
ASSOCIATED

POWERFUL

ELEVATING

BECAUSE OF THE

TURGOR

WITH
DAYS THIS

THE

STRONG WATER
REACHES THE
IS

BINDING
THRESHOLD RESISTANCE PASSIVELY

TENDENCIES
LEVEL

OF THESE SUBSTANCES AT 163

FOICE

TURGOR

AND THE ELEVATING

BECOMES SUFFICIENT

TO OVERCOME

OFFERED BY THE

TONGUE

SO ENABLING FLIP
ITS TIP

UP

TO OCCUR

THE TONGUE

DEPRESSED FLATTENED
FOR THE

AND

PROTRUDED OUT OF THE ORAL CAVITY

SO

MAKING ROOM
SITION

COMMON NASAL
FIRSTLY

PASSAGE OTHER FACTORS AID THE TRANSPO OF THE UNDERSIDE OF THE SECONDLY
TO THE

OF THE PALATAL SHELVES BY EPITHELIUM AND PALATINE AND AFFORD

SHELVES THE

THE UNDERCUTTING

SHELF BASE MAXILLAIY SHELVES THE

PROVIDES

FULCRUM FOR SHELF ELEVATION

BLASREMARA ARE PRESENT

OSREOGENIC

JUST EXTERIOR

FIRM

BASE FOR FLIP

UP THE

SUBSEQUENT RAPID

INVASION

OF

ELEVATED

BY THESE BLASTEMARA AND THE ENSUING

PALARCX POSTULATES

OSSIFICATION

SOON

CONSOLIDATE

ELEVARCD THEORY

THE

PRESENT

OF SHELF ELEVATION

CONFRONTATION
IT IS

BETWEEN
THAT
AT

SHELF ELEVATING DEPRESSION 14

FORCE AND TONGUE RESISTANCE

AND SO

NOT SURPRISING

OF THE
IT

TONGUE SHOULD LEAD TO PREMATURE SHELF ELEVATION

PALATE IS THEORETICALLY

EVEN

DAYS

FOLLOWS THAT CLEFT

PRODUCIBLE IN FETUSES

AT LEAST

TWO

WAYS
IN

BY DECREASE IN
RESISTANCE

SHELF FORCE

AS

IN

FUDR
IN PIERRE

BY INCREASE ANOMALIES

TONGUE

AS SEEMS PROBABLE

ROBINLIKE

15

PRODUCED POSWILLO

BY

AMNIOCENTESIS

AND

CONTRACTION

OF THE

FETAL

MEMBRANES

1968
AT LEAST DEPRESS

THE AVOIDANCE
DRUGS

DURING THE

FIRST

TWELVE WEEKS OF PREGNANCY

SYNTHESIS
IS

OF

KNOWN 1978

TO

MUCOPOLYSACCHARIDE

RECOMMENDED

IN

AS

THE

WINSTON

CHURCHILL

FELLOW

LECTURING

AT

THE

UNIVERSITY

OF MIAMI

SCHOOL OF MEDICINE
OF THE PALATAL SHELVES
FIRST

FERGUSON ADDED
THE FUTURE
SOFT

THE

POSTERIOR

ONEFIFTH

IE

PALATE

ARE

RW

HORIZONTAL ELEVATE OTHER

FIVE
TILL

FROM THEIR

APPEARANCE AT DAY 15
PALATE

AND SO DO NOT HAVE TO DO NOT APPROXIMATE EACH

FURTHERMORE THESE SOFT DAY

SHELVES

175
FLIP

WHEREAS THE FUTURE HARD PALATE SHELVES HAVE FUSED WITHIN

HOURS OF
ALL THE

UP WHICH

OCCURS

AT

DAY

FUDR

164

INDUCED ABNORMALITIES AND WITH

IT IS

ARE READILY EXPLICABLE

BY DEPRESSED
PALATE IN

MUCOPOLYSACCHARIDE SYNTHESIS

INTERESTING

TO NOTE THAT CLEFT

MAN

IS

FREQUENTLY

ASSOCIATED

SUCH ANOMALIES

OSSIFICATION

CENTERS

OF

THE

MAXILLOFACIAL
ACCORDING THE PRIMARY
APPEARS

REGION

TO PATTEN

SUPPORT OF THE
THE

MANDIBULAR

ARCH

IS

MECKELS

CARTILAGE

WHICH
THE OF

LATE IN

SEVENTH WEEK BY THE EARLY PART OF THE EIGHTH

STARTS

WEEK NUMBER

MANDIBULAR
RRABECULAE

BONE
LATERAL

TO BE INTRAMEMBRANOUSLY CARTILAGE

FORMED

AS

TO

MECKELS
BONE

AS OSSIFICATION MECKELS

SPREADS THE NEWLY

FORMED MANDIBULAR

TENDS

TO ENCLOSE

CARTILAGE
AS

THE

MAXILLA

ALSO APPEARS IN THE

EARLY IN

THE EIGHTH

WEEK

INTRAMEMBRANOUSLY PROCESS
JR

FORMED RRABECULAE
RAPIDLY UNTIL

MESENCHYME OF THE MAXILLARY

INTO THE PALATAL SHELVES

EXPANDS APPEAR HAVE

BUT

ITS

EXTENSIONS

DO NOT ORDINARILY
THE PALATAL

TOWARD THE

END OF THE
INITIAL

EIGHTH WEEK WHEN

POSITION

SHELVES

MOVED UP FROM
THE NINTH

THEIR

ON EITHER SIDE OF THE TONGUE DURING AND BY THE END OF THE TENTH EXTENDING
THE OR

WEEK OSSIFICATION
OF THE
ELEVENTH

PROGRESSES RAPIDLY

BEGINNING
OSSIFICATION

WEEK

RRABECULAE

FROM THE

PRIMARY

AREAS OF THE

MAXILLAE

HAVE

LAID

FOUNDATION

FOR THE

BONY

SUPPORT OF THE

HARD PALATE
PORTION
LATE

THE MORE MEDIAL

TEETH ARISES CENTERS

OF THE MAXILLARY EIGHTH OR NINTH

ARCH WHICH

CARRIES THE

INCISOR

DURING THE

WEEK FROM
IS

SEPARATE OSSIFICATION

FORMED IN

THE PART OF THE ORIGIN

UPPER JAW WHICH

INCISIVE PORTION

OF NASOMEDIAL

ORIGIN
MAXILLA

THIS

INDEPENDENT
ITS

OF THE

OF THE
IS

HUMAN

EMPHASIZES

HOMOLOGY WITH
PREMAXILLA

WHAT

IN

LOWER FORMS

SEPARATE

BONE

KNOWN AS

THE

16

THE

CARTILAGE

PRIMORDIA BY THE
PAIRED

OF THE NASAL END OF THE

SEPTUM

AND THE

NASAL

CAPSULE

ARE TO

CLEARLY DIFFERENTIATED 20

SEVENTH WEEK EMBRYOS OF 18

MM CR THE

OSSIFICATION

CENTERS FOR THE

VOMER APPEAR ON

EITHER

SIDE

OF THE LOWER PART OF THE

CARTILAGINOUS

SEPTUM TOWARD THE CLOSE OF THE

EIGHTH OR THE BEGINNING

OF THE NINTH WEEK EMBRYOS OF 28 TO 32

CENTERS ARE UNITED

MM CR
THE

BY

THE ELEVENTH

WEEK THE TWO OSSIFICATION

LATER THE PROGRESS

BELOW THE SEPRAL

CARTILAGE

WEEK

OF OSSIFICATION
THAT

EXTENDS SO THAT

PERIOSTEUM
THEIR

OF THE VOMER MERGES WITH EACH OTHER

IN

WITH
THE

OF THE PALARAL BONES JUST ABOVE

MEETING

MIDLINE

HERE
THE

ARE SCHEMATIC RELATIONS

DIAGRAMS
AT LIP

SHOWING
IN

IN

THE

HORIZONTAL

PLANE

CHANGING PATTEN

LEVEL

THE

DEVELOPING
FACIAL

UPPER JAW

FROM

NORMAL DEVELOPMENT
ANOMALIES OF

OF THE

REGION

IN

PRUZANSKYS TURES

CONGENITAL

THE FACE

AND

ASSOCIATED

STRUC

ORAL CAVITY

ORAL PLATE

ENRODERM
FOREGUR

OF

ORAL PLATE

REMNANTS 465

PROMINENCE NASAL
PIT

SROMODEUM
MAXILLARY PROJECTED PROCESS OUTLINE

MAXILLATY PROCESS

OF
AREA

OVERHANGING FRONTONASAL

MANDIHULAR HYOID
ARCH

FOUR WEEKS

312

MM
PHARYNGEAL

FIVE

WEEKS 6 MM
NASOMEDIAL
PROCESSES ASOLATET OCESS
AL

P1 NIAXILLAL FIOJECTION NASOLATETAL PROCESS

NASO

OPTIC

OF
PROCESS

FURROW
MAXILLAR PROCESS

NASOMCDIAL

HYOMANDIBULAR

LIVE

AND ONE

HALF WEEKS

MM
OF

CLEFT

SIX

WEEKS 12

MM

PROJECTION PALARAL

SHELF
956

MARGIN
PROJECTION NASAL MAXILLARY

OF

SEPTUM
PROCESS

I1
PHILTRUM

MERGED NASOMEDIAL
PROCESSES

INTERMAXILLARY

SEVEN WEEKS 19

MM

UPPER JAW

EIGHT

WEEKS 28

MM

AS NOTED BY PARTEN
THE YOUNGEST
STAGE REPRESENTS BEFORE RELATIONS THE
AT

THE LEVEL OF THE

ORIGINALLY

SHALLOW
EXTENT TO

STOMODEAL DEPRESSION

RUPTURE OF THE ORAL PLATE

THE

17

WHICH
BROKEN

THE LINE

STOMODEUM THE
ACTIVE IN

IS

OVERHUNG BY

THE

FRONTAL

AREA IS THE

INDICATED

BY
IS

DOWNWARD COMPONENT OF
NASOMEDIAL
IS

GROWTH WHICH THEM

INTO

PARTICULARLY PLANE

THE

PROCESSES

SOON BRINGS

THE

OF SECTION

THEIR

UNION

NORMALLY

MATTER OF MERGING RATHER THAN OF

FUSING

OF
CIAL

BASIC

IMPURTANCC IN

UNDCRSTANDING THE DEVELOPMENT OF THE NASOMEDIAL

FACE VIEWS

OF THE MAXILLOFA THEIR MERGING

TO THE
AT

REGION

ARE THE RELATIONSHIPS

IS

PROCESSES

IN

THE MIDLINE

READILY

SEEN IN

THEIR

DEEP RELATIONS
IS

NASAL

SEPTUM ARE BEST SEEN WHEN THE DEVELOPING UPPER JAW

IN

LOOKED

FROM
THE
AT

BELOW

SUCH VIEWS THE DEEP CONTINUITY

NASAL

OF NASOMEDIAL

PROCESSES WITH
LIE

PRIMORDIAL SLIGHTLY

SEPTUM
LEVELS

IS

CLEARLY EVIDENT

BECAUSE THESE PRIMORDIA

DIFFERENT

THIS IMPORTANT SECTIONS

RELATIONSHIP

CAN ONLY BE SUGGESTED IN BY DOTTING IN THE ACCOMPANYING

DIAGRAMS OF HORIZONTAL
POSITION

AT THE LEVEL OF THE UPPER LIP

AS

OF THE

NASAL

SEPTUM

HAS

BEEN

DONE IN

THE

DIAGRAM SJ

18