Development of Face and its applied aspects

CONTENTS

 Introduction

 Pharyngeal Arches

 Development Of Face

 Lower Lip

 Upper Lip

 Nose

 Cheeks

 Eye

 External ear

 Palate

 Mouth

 Tongue

 Thyroid gland

 Teeth

 Development Of Facial Skeleton

 Prenatal and Postnatal Development Of Maxilla

 Prenatal and Postnatal Development Of Mandible

 Defects Of Oro-facial Development

 Applied Anatomy

 Conclusion
 Development of Face and its applied aspects

INTRODUCTION
Knowledge of development is a precious key to grasp the anatomical
finished products. Although this principle holds true to all parts of the body, it
is probably true to say that it is most valid for head and neck. The study of the
development of the face is one of the most fascinating aspects in human
embryology.
• EMBRYOLOGY is the study of the formation and development of the
embryo from the moment of its inception up to the time when it is born as
an infant.

• The total life span of a human is divided into 3 phases.

 Prenatal (I.U.) before birth (280 days)

 Natal
 Postnatal (E.U.) after birth
The period of prenatal development can be further subdivided.
 Pre-embryonic development begins at fertilization and continues through
cleavage and implantation.
 Embryonic development extends from implantation to the end of the 8th
developmental week.
 Fetal development begins at the start of the 9th developmental week and
continues up to the time of birth.

THE PHARYNGEAL ARCHES:

During the late somite period (i.e. 4th week of intrauterine life) a series
of distinct bilateral mesenchymal swellings, initially of mesodermal origin,
later augmented by the invasion of neural crest cells, develop on the ventral
aspect of embryo just caudal to head fold in the future mandibulo-cervical
region, these are called as pharyngeal arches.

A coronal section through the foregut, before the appearance of

pharyngeal arches. At this stage the endodermal wall of the foregut is
separated from the surface ectoderm by a layer of mesoderm. Soon, thereafter
the mesoderm comes to be arranged in the form of six bars that run

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 Development of Face and its applied aspects

dorsoventrally in the side wall of the foregut. Each of these bars grows
ventrally in the floor of the developing pharynx and fuses with the
corresponding bar of the opposite side to form the pharyngeal arches. In the
internal between any two adjoining arches, the endoderm extends outwards in
the form of a pouch to meet the ectoderm which dips into this interval as an
ectodermal clefts.

The first arch is also called the mandibular arch, the second arch called
as hyoid arch, the third, fourth and sixth arches do not have special names, the
fifth arch disappears soon after its formation.

In the mesoderm of each arch, the following structures are formed.

i. A skeletal element : This is
cartilagenous to begin with it may
remain cartilaginous, may develop
into bone or may disappear.
ii. Striated muscle : This is supplied
by the nerve of the arch. In later
development, this musculature may
or may not, retain it attachment to
the skeletal elements derived from the arch.
iii. In arterial arch: Ventral to the foregut, an artery called as the ventral
aorta develops, dorsal to foregut another artery develops called dorsal
aorta. A series of arterial arches connect to ventral and dorsal aorta.

Each pharyngeal arch is supplied by a nerve. In addition to supplying

the striated muscle of the arch, it supplies sensory branches to the overlying
ectoderm and endoderm. In some lower animals, each arch is supplied by two
nerves, the nerve of arch itself which runs along the cranial part of the arch is
called Post-traumatic nerve, each arch also receives a branch from the nerve of

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 Development of Face and its applied aspects

the succeeding arch called as 'pre-traumatic nerve. However in human embryo

double innervation is seen only in the first pharyngeal arch.

Derivatives of the skeletal elements:

1. The cartilage of first arch is called 'Meckel's cartilage'. The incus and
malleus of the middle ear are derived from its dorsal end. The ventral part
of the cartilage is surrounded by the developing mandible, and is absorbed.
2. The cartilage of the second arch forms the following.
a) Stapes
b) Styloid process
c) Stylohyoid ligament
d) Superior part of body of hyoid
3. From the cartilage of third arch
- Greater cornucopia of hyoid bone
- Lower part of body of hyoid bone
4. The cartilage's of the larynx are derived from 4th and 6th arch.

Nerves and muscles of the arches :

Arch Nerve of Arch Muscles of Arch
First Mandibular Tensor tympani, Tensor palatini,
Lateral Pterygoid, Masseter,
Temporalis anterior belly of digastric
muscle.
Second arch Facial Stapedius, stylohyoid, muscles of
face auricular muscles, occipito-
frontalis, posterior belly of digastric
muscle.
Third arch Glossopharyngeal Stylopharyngeus
Fourth arch Superior laryngeal Muscles of pharynx, cricothyroid
Sixth arch Recurrent All intrinsic muscles of larynx except
laryngeal cricothyroid

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 Development of Face and its applied aspects

DEVELOPMENT OF FACE:
After the formation of the head fold, the developing brain and the
pericardium form two prominent bulgings (Figure 1) on the ventral aspect of
embryo these bulgings are separated by stomatodaeum, the floor of the
stomatodaeum is formed by buccopharyngeal membrane, which separates it
from the foregut. Soon mesoderm covering the developing fore brain
proliferates and forms a downward projection that overlaps the upper part of
stomatodaeum, this downward projection is called frontonasal process. The
pharyngeal arches are laid down in the lateral and ventral walls of the cranial
most part of foregut, which are in close relationship to the stomatodaeum.
It will now be readily appreciated that the face is derived from the
following structures that lie around the stomatodaeum.
Figure 1
 The frontonasal process
 The first pharyngeal arch

At this stage each mandibular arch forms

the lateral wall of stomatodaeum; this arch
gives of a bud from its dorsal end. This bed is
called maxillary process and it also grows ventromedially cranial to the main
part. It is called as mandibular process.

The ectoderm overlying the frontonasal process soon shows bilateral

localized thickenings, that are situated little above the frontonasal process
called nasal placodes, these soon sink below the surface to form nasal pits.

The nasal pits are continuous below with stomatodaeum, the edges of
each pit are raised above the surface, the medial raised edge is called medial
nasal process and lateral edge is called lateral nasal process.

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 Development of Face and its applied aspects

Development of Various parts of face:

Lower Lip:
The mandibular processes of the two sites grow towards each other and
fuse in the midline. They now form the lower margin of the stomatodaeum, if
it is remembered that mouth develops from the stomatodaeum, it will be readily
understood that fused mandibular processes give rise to the lower lip and the
lower jaw.

Upper Lip:
a) Each maxillary process now grows medially and fuses, first with the lateral
nasal process and then with the medial nasal process. The medial and
lateral nasal process also fuses with each other. Due to this the nasal pits
now called as external nares are cut off from the stomatodaeum.
b) The maxillary processes undergo considerable growth, and a the same time
the frontonasal process become much narrower from side to side, with the
result that the two external nares come closer together.
c) At this stage stomatodaeum is now bounded above by the upper lip which is
derived as follows.
i) The mesodermal basis of lateral part of the lip is formed from the
maxillary process.
ii) The mesodermal basis of median part of the lip is formed from the
frontonasal process. The ectoderm of the maxillary process however
overgrows this mesoderm to meet that of the opposite maxillary
process in the midline. As a result the skin of the entire upper lip is
from the maxillary process.
d) The muscles of the face are derived from mesoderm of the second branchial
arch and therefore supplied by the facial nerve.

Development of Nose:
The nose receives contributions from the frontonasal process, and from
the medial and lateral nasal process of the right and left sides.

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 Development of Face and its applied aspects

We have seen that the external nares are formed when the nasal pits are
cut off from the stomatodaeum by the fusion of the maxillary process with the
medial nasal process.

This is a result of the fact that the frontonasal process becomes

progressively narrower and its deeper part ultimately forms the nasal septum.
Mesoderm becomes heaped up in the midline to form the prominence of the
nose. Simultaneously a groove appears between the region of the nose and the
bulging forebrain. As the nose becomes prominent the external nares come to
open downward instead of forwards. The external form of nose is thus
established.

Development of Cheeks:
After the formation of the upper and lower lips, the stomatodaeum i.e.
the mouth is very broad. In its lateral part, it is bounded above by the maxillary
process and below by the mandibular process, these undergo progressive fusion
with each other to form the cheeks.

Front nasal prominence Forehead, bridge of the nose, primitive

Maxillary prominences
Mandibular prominences
Lateral nasal prominences
Medial nasal prominences
palate, frontal and nasal bones.
Upper cheek regions and most of the upper
lip, maxilla, zygomatic bone and secondary
palate
Chin lower lip and lower cheek regions and
mandible.
Alae of the nose
Inter-maxillary segment ,median ridge and
tip of nose

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 Development of Face and its applied aspects

DEVELOPMENT OF FACIAL SKELETON:

The face may be conveniently divided into thirds - the upper, middle and
lower third, their boundaries being approximately the horizontal planes passing
through the pupils and rima oris. The three parts generally correspond to
embryonic frontonasal, maxillary and mandibular processes. The upper third
of face is predominantly of neurocranial composition, with the frontal bone of
calvaria primarily responsible for forehead. The middle third of face is
skeletally the most complex and incorporating both the nasal extension of the
upper third and part of the masticatory apparatus the lower third of the face
complete the masticator apparatus being composed skeletally of the mandible
and its dentition.

The upper third of face initially grows rapidly, in keeping with its
neurocranial association and the precocious development of the frontal lobes of
the brain.

The upper third also achieves its ultimate growth potential at an early
age, practically ceasing to grow significantly after the 12 th year of age. In
contrast, the middle and lower third grows more slowly over a prolonged
period not ceasing growth until late adolescence. Completion of the
masticatory apparatus by the eruption of third molars marks the cessation of
growth of the lower third of the face.

The facial bones develop intramembranously from the ossification

centers in the neural crest mesenchyme of the embryonic facial processes. An
interaction between the ectomesenchyme of the facial processes and the
overlying epithelium is believed to be a prerequisite to the differentiation of the
facial bones.

The ossification centres for the upper third of the face are those of the
frontal bone, which contributes also to the anterior part of the neurocranium.

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 Development of Face and its applied aspects

In the frontonasal process, the intramembranous single ossification

center appears in the third month for each of the nasal and lacrimal bones in the
membrane covering the cartilagenous nasal capsule.

A primary intramembranous ossification center appears for each maxilla

early in the 8th week at the termination of the infraorbital nerve just below the
canine tooth dental lamina. Secondary cartilages appear at the end of the 8 th
week in the region of the zygomatic and alveolar processes that rapidly ossify
and fuse with the intramembranous centre two further intramembraneous
premaxillary centres appear anteriorly on each side in the 8 th week and fuse
rapidly with primary maxillary centre.

Single ossification centre appears for each of the zygomatic bones and
the squamous part of the temporal bones in the 8th week of I.U. life. In the
lower third of the face the mandibular processes develop bilaterally single
intramembranous centres for the mandible and 4 minute centres for the
temporal bone.

The attachment of facial skeleton antero-inferiorly to the calvarial base

determine the chondrocranial influence on facial growth. The zygomatic bone
of the face is attached to the calvarial skeleton at the temporozygomatic and
frontozygomatic sutures. The maxillary and nasal bones of the anterior aspect
of the face are attached to the calvaria at the frontomaxillary and frontonasal
sutures the interposition of 3 sets of space occupying sense organs between the
neural and facial skeletons complicates the attachments of these two skull
components to each other and influences the growth of facial skeleton in
particular.

The eye, the nasal cavity and its septum and the external ear situated
along the approximate boundaries of the upper and middle third of face, act to a
greater or letter extent as functional matrices in determining of some aspects of
the growth. Similarly tongue, teeth and oromasticatory musculature are
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 Development of Face and its applied aspects

similarly interposed between the middle and lower third of the face and their
functioning is also influential in facial skeleton growth.

Growth of eyes provides an expanding force separating the neural and

facial skeleton, particularly at the frontomaxillary and frontozygomatic sutures,
thereby contributing to skulls height.

The eyeballs initially grow rapidly following the neural pattern of

growth and contributing to rapid widening of the fetal face. The orbits
complete half their postnatal growth during the first two years after birth, and
attain their adult dimensions at about seven years of age.

The nasal cavity and in particular the nasal septum have considerable
influence in determining facial form. In the fetus, a septomaxillary ligament
arising from the sides of the nasal septum, and inserting into the anterior nasal
spine transmits septal growth pull upon the maxilla. Fascial growth is directed
downwards and forwards by the septal cartilage that between the 10 th and 40th
weeks grows sevenfold in vertical length.

Growth of maxilla is dependent upon a number of functional matrices

acting upon different areas of the bone that theoretically allows its subdivision
into skeletal units. The basal body develops beneath the infraorbital nerve later
surrounding it to form the infraorbital canal.

The orbital unit responds to the growth of the eyeball. The nasal unit is
dependent upon the septal cartilage for its growth, while the teeth provides the
functional matrix for the alveolar unit. The pneumatic unit reflects maxillary
sinus expansion.

The overall effect of this diverse direction of growth is osseous

accession predominantly on the posterior and superior surfaces of facial bones.
Bone deposition on the posterosuperior surfaces of the maxilla and the
maxillary tuberosity results in the displacement of the maxilla and the
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 Development of Face and its applied aspects

maxillary tuberosity results in the displacement of the maxilla away from the
retromaxillary fat pad. With the fat pad and chondrocranium acting as a base
against which bone growth takes place, the result is that the middle third of the
face moves in a marked downward and forward direction in relation to cranial
base. Growth at these sutures occurs most markedly upto 4th year postnatally.

DEVELOPMENT OF THE MANDIBLE:

The first structure to develop in the primodium of the lower jaw is the
mandibular division of the trigeminal nerve that precedes the mesenchymal
condemnation forming the first brachial arch. The prior presence of the enrage
has been postulated being necessary to induce osteogenesis by the production
of neurotrophic factors. The mandible is derived from ossification of an
osteogenic membrane formed from ectomesenchymal condensation at 36-38
days of development. The mandibular ectomesenchyme must initially interact
with the epithelium of the mandibular arch before primary ossification occurs.
The resulting intramembranous bone sites lateral to Meckel's cartilage of the
first arch.

A single ossification centre for each half of the mandible arises in the 6 th
week I.U. in the region of the bifurcation of the inferior alveolar nerve into
mental and incisive branches.

The ossifying membrane is located lateral to Meckel's cartilage.

Ossification spreads from the primary centre below and around the inferior
alveolar nerve and its incisive branch and upwards to form a trough for the
developing teeth. Spread of the intramembranous ossification dorsally and
ventrally forms the body and ramus of the mandible.

The major portion of Meckel's cartilage disappears, parts of the cartilage

transform into the sphenomandibular and anterior malleolar ligaments.

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 Development of Face and its applied aspects

Secondary accessory cartilages appear between the 10 th and 14th week of

I.U. to form head of condyle, part of coronoid process and the mental
protuberance. The secondary cartilage of the coronoid processes is believed
not to be self-different, but represents a developmental response following
difference of temporalis muscle within which coronoid process appears.

The condylar secondary cartilages appear during the 10 th week of

development as a cone shaped cartilage developing in the ramal region. This
condylar cartilage is the primordium of the future condyle. The condylar
cartilages serve as an important centre of growth for the ramus and body of the
mandible. Condylar growth rate increases at puberty, peaking between 12 /12
to 14 years of age and ceases at 20 years of age. Continued presence of
cartilage thereafter provides a potential for growth, which is realized in such
abnormal growth conditions as acromegaly.

While the mandible appears in the adult as a single bone, it is

developmentally and functionally divisible into several skeletal subunits, the
basal bone of the body forms one unit to which is attached alveolar process
coronoid processes, angular processes, condylar processes. Each of these
skeletal units is influenced in its growth pattern by a functional matrix that acts
upon the bone. The teeth act as a functional matrix for the alveolar unit, the
action of temporalis influences the coronoid processes, the masseter and medial
pterygoid muscles act upon the body and ramus of the mandible.

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 Development of Face and its applied aspects

Limited growth takes place at the symphysis menti until fusion occurs.
The main sites of post natal growth are at the condylar cartilages, the post
border of the rami, and the alveolar ridges.

DEFECTS OF OROFACIAL DEVELOPMENT:

Microstomia / Macrostomia: Merging of mandibular and maxillary processes
beyond or short of the site for normal mouth. Also developmental cysts like
Nasolabial cysts, Globulomaxillary cysts, median mandibular cysts.

Ectodermal dysplasia: Displays a dished face due to defective ectodermal

neural crest induction mechanism.

Downs syndrome: Its features are proclaimed and shortened or even absent
nasal bones, accounting for saddle nose. The maxilla is much smaller than
normal being reduced almost in width.

Cyclopia: Inadequate diencephalic brain development at a very early stage

result sin primordial optic vesicles developing close to each other and fusing to
form a single median eye.

Hypertelorism: It is characterized by abnormally great interorbital distance

separating the eyes tending to confer a wide eyed appearance. It is due to
embryological morphogenetic arrest that leaves the orbits in fetal position.

EYE:
The region of the eye is first seen as an ectodermal thickening, i.e. lens
placode which appears on the ventro-lateral side of the developing fore brain,
lateral and cranial to the nasal placode. The lens placode sinks below the
surface and is eventually cut off from the surface ectoderm the developing
eyeball produces a bulging in this situation. The bulging of the eyes are at first
directed laterally and lie in the angles between the maxillary and the lateral
nasal process, with the narrowing of frontonasal process they come to face
forwards. The eyelids are derived from folds of ectoderm that are formed
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 Development of Face and its applied aspects

above and below the eyes and by mesoderm enclosed within the folds. About
the middle of the third month their ridges come together and unite over the
cornea, they are usually said to remain united until about the end of sixth
month.

External Ear:
The external ear is formed around the dorsal part of the first ectodermal
clef. A series of mesodermal thickening (often called tubercle or hillocks)
appear on the mandibular and hyoid arches where they adjoin this cleft. The
pinna is formed by fusion of these thickenings, when first formed the pinna lies
caudal to the developing jaw, it is pushed upwards and backwards to its
definitive position due to greater enlargement of the mandibular process.

Lacrimal Apparatus:
The epithelium of the alveoli and ducts of the lacrimal gland arise as a
series of tubular buds from the ectoderm of the superior conjunctival fornix.
These buds are arranged in two groups, one forming the gland proper and other
its palpebral process.

It is a serous gland situated chiefly in the lacrimal fossa (on the anterior
lateral part of the roof of the bony orbit) and partly on the upper eyelid. Small
lacrimal glands are found in conjunctival formina.

Developmental Anomalies of the Face:

It has been seen that the formation of various parts of the face involves
fusion of diverse components. This fusion is occasionally incomplete and
gives rise to various anomalies.
i) Hare lip: The upper lip of the hare normally has a cleft. Hence the term
have lip is used for defects of the lips.
a) When one or both maxillary processes do not fuse with the medial
nasal process, this gives rise to defects in the upper lip. These may
vary in degree and may be unilateral or bilateral.
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 Development of Face and its applied aspects

b) Defective development of the lower most part of the frontonasal

process may give rise to a midline defect of the upper lip.
c) When two mandibular processes do not fuse with each other, defect
will be in the lower lip.
ii) Oblique facial cleft: Non fusion of the maxillary and lateral nasal
processes gives rise to a cleft running from medial angle of the eye to
the mouth. There is no formation of nasolacrimal duct and there is no
drainage of tears.
iii) Inadequate fusion of the mandibular and maxillary processes with each
other may lead to an abnormally wide mouth (Macrostomia). Too much
fusion may result in a small mouth (Microstomia).
iv) The nose may be bifid; occasionally one half of it may be absent. Very
rarely the nose forms a cylindrical projection or proboscis, jutting out
form just below the forehead.
v) The entire first arch may remain under developed on one or both sides
affecting lower eye lid, maxilla, mandible this condition is called
Mandibulo-facial dysostosis or first arch syndrome.
vi) One half of the face may be underdeveloped or overdeveloped - angle of
the mouth deviates to the affected side.
vii) The lips may show congenital pits or fistulae. The lip may be double -
Ascher's syndrome.

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 Development of Face and its applied aspects

CONCLUSION
Embryology especially development of face is very important
to us. Many parts of the body develop from different regions and finally unite
together to form a structure. In contrast some develop in close proximity to
each other and later separates as the foetus grows.
Just as the clinician needs the medical history to make a logical
diagnosis, so too the growth and development of face is essential for a logical
explanation of any structural and functional imbalances.

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 Development of Face and its applied aspects

REFERENCES:
1. Gray Anatomy: The Anatomical Basis of Medicine and Surgery, 37 th
Edition, Churchill Livingstone Publication.
2. B.D. Chaurasia – Human Anatomy, vol.3, 3rd Edition, CBS Publication.
3. Singh I. Human Embryology.10thEdition. New Delhi: Jaypee; 2014.

4. Sadler T.W. Langman’s Medical Embryology. 14th Edition.

Philadelphia: Wolters Kluwer; 2019.

5. Dudek.R.W. High Yield Embryology.4th Edition. Philadelphia: Wolters

Kluwer; 2010.

6. Martini, Timmons, Tallitsch. Human Anatomy: Embryology and Human

Development.6th Edition. San Francisco: Benjamin Cummings; 2009.

7. Kumar. G.S. Orban’s Oral Histology and Embryology. 13th Edition.

Haryana: Elsevier; 2011.

8. Shafer W.G, Hine M.K, Levy B. M. Shafer’s Textbook of Oral

Pathology. 8th Edition. Haryana: Elsevier; 2016.

9. Bhalaji. S.I. Orthodontics The Art and Science. 6 th Edition. New Delhi:
Arya Medi Publishing House; 2016.

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