Pre-natal Growth of Craniofacial Complex

Dr. Munizeh Khan

Embryology

How much do you know about these??

Ectodermal Dysplasia Syndrome Treacher-Collins

Cleft Lip & Palate

Significance of Embryology

Weeks 4 through 8 are very important Major tissues and organ systems are developing from the original three germ layers during this time

Exposure of embryo to teratogens, such as viruses and drugs, may result in congenital abnormalities

Pre-natal Growth & Development

Dynamic phase in the development of a human being

During this period, the height increases by almost 5000 times as compared to only a threefold increase during the post-natal period. The pre-natal life can be arbitrarily divided into three periods
1. Period of the Ovum 2. Period of the Embryo 3. Period of the Fetus

Pre-natal Stages

Period of ovum: from fertilization to 14th day

Cleavage & attachment of ovum to intra-uterine wall

Period of embryo: from 15th to 56th day

Major development of craniofacial region

Period of fetus: 57th day to birth

Accelerated growth of craniofacial structures resulting in increase in size and change in proportions

Week 1 of development

Fertilization = zygote

Zygote undergoes cleavage

Blastomeres form ball of cells called morula Cells =

Trophoblast (outside) Embryoblast (inside)

Week 2 of development

Two important events occur in the beginning of the second week after fertilization.

Implantation begins. The inner cell mass forms bilaminar germ disk, and so called the bilaminar disk stage. These two layers are called epiblast and hypoblast.

Week 3 of development

Gastrulation The bilaminar disk is converted into a trilaminar disk. Also called the trilaminar disk stage. The three embryonic germ layers are formed:

Ectoderm, Endoderm Mesoderm

All germ layers formed by Epiblast cells

Derivatives of the 3 germ layers

Neurulation

Process of development of neural plate, neuroectoderm and folding to produce neural tube Neural tube is primordium of CNS Anterior region enlarges to form:

Forebrain Midbrain Hindbrain

Neural crest cells arise from neural folds and migrate throughout the body Provide mesenchyme for craniofacial development Express the Homeobox (HOX) genes

Week 4 of development

A prominent bulge appears on ventral aspect of embryo corresponding to the developing brain Below the bulge a shallow depression appears called STOMODEUM = corresponds to the primitive mouth The floor of the stomodeum is formed by the buccopharyngeal membrane which separates the stomodeum from the foregut

Week 4 of development

Trilaminar embryonic disk folds in two planes to form a cylindric, C-shaped embryo The buccopharyngeal membrane separates the foregut and the primitive oral cavity (stomodeum) Rupture of buccopharyngeal membrane occurs

Clinical Scenario
An 8 year old child is brought to you at the Orthodontic Clinic. His medical reports reveal a diagnosis of ECTODERMAL DYSPLASIA.

What structures would you expect to be abnormally developed in this child?

Pharyngeal Arches

Begin to develop during 4th week Consists of a series of bilaterally paired arches, pouches (clefts), grooves and membranes

Pharyngeal arches develop as a result of migration of neural crest cells into the head and neck region At end of 4th week, 4 distinct pairs of pharyngeal arches seen. Arches V and VI are poorly developed in humans. The 5th arch completely regresses. Arch VI results due to fusion of arches IV and VI

Each pharyngeal arch is externally covered by the ectoderm and internally by the endoderm The pharyngeal arches are separated externally by deep ectodermal clefts called pharyngeal clefts (grooves) Pharyngeal pouches partially separate the arches on the internal aspect

Significance of Pharyngeal Arches

Each of these arches gives rise to following structures of the future face and neck regions:

skeletal components muscles connective tissue vasculature neural components

Derivatives of the Pharyngeal Arches

Derivatives of the Pharyngeal Arches

Derivatives of Pharyngeal Pouches, Grooves and Membranes

Derivatives of Pharyngeal Pouches, Grooves and Membranes

Development of the Face

Development of face occurs primarily between weeks 4-8 IUL

Five facial swellings (processes) appear at 4th to 8th week around stomodeum:
Fronto-nasal A pair A pair

prominence pharyngeal

of maxillary swellings

of mandibular swellings

arch 1

Facial Development

Development of the Nose

On infero-lateral portion of the frontonasal process, bilateral areas of surface ectoderm thicken to form nasal placodes

Development of the Nose

The mesenchyme around placodes proliferate to form horseshoe shaped ridges called Medial & Lateral nasal processes

Nasal placodes eventually become nasal pits (nostrils & nasal cavities)

Development of the Maxilla

Maxillary swellings proliferate & migrate medially MNP fuse in the midline and form the intermaxillary segment, This intermaxillary segment gives rise to: Philtrum of upper lip Four incisor teeth Alveolar bone & gingivae

Primary palate

Development of the Palate

Development extends from weeks 6-12 IUL Palate develops from 2 structures:

1) Primary palate:

Triangular-shaped, anterior to incisive foramen Originates from intermaxillary segment (MNP)

2) Secondary palate:

Gives rise to hard and soft palate Arises from paired lateral palatine shelves of maxilla

Development of the Palate

Lateral palatine shelves orient horizontally Shelves fuse with each other Lateral palatine shelves fuse with primary palate and nasal septum (9th week)

Fusion of processes

Fusion of prominences/processes involves:

Breakdown of surface epithelium at area of contact Underlying mesenchymal cells merge with one another

Fusion

Facial prominences fuse between weeks 7-10 IUL

Maxillary prominences fuse laterally with Mandibular prominences MNP fuse with Maxillary prominences MNP fuse with LNP LNP fuse with Maxillary prominences Lateral palatine shelves fuse with each other Lateral palatine shelves fuse with primary palate and nasal septum

Disturbances of Fusion

Defective or incomplete fusion between various processes result in clefts

Questions?