EARLY STAGES OF

DEVELOPMENT
 EMBRYONIC DEVELOPMENT
• Nearly all tissues of face and neck come from surface ectoderm

• This includes muscles and skeletal elements that elsewhere are derived from mesoderm

• Most of these tissues develop from neural crest cells that migrate under the surface
ectoderm.

• There are 5 principal stages in Craniofacial development

 NEURAL CREST CELL PROBLEMS
• Many craniofacial anomalies arise in the third stage of development

• This is the neural crest cell origin and migration stage.

• Most of the facial structures are derived from migrating neural crest cells, so any
interference in this stage produces facial deformities.

• At the end of the 4th week of human embryonic life, neural crest cells form all the loose
mesenchymal tissue in the facial region between the surface ectoderm and the mandibular
arch (later differentiate into skeleton, teeth etc)
• In the 1960’s the drug thalidomide was implicated in the causing congenital defects and
facial anomalies in many children

• The drug accutane was also reported to cause similar developmental defects

• Both drugs affect the formation and or migration of neural crest cells
• Altered neural crest migration has also been implicated in mandibulofacial dysostosis such
as Treacher Collins syndrome and hemifacial microsomnia.

• Treacher Collins – underdeveloped maxilla and mandible due to a general lack of

mesenchymal tissues
• Problem is due to excessive cell death in trigeminal ganglion(unknown cause)
• Secondarily affects neural crest derived cells
• Hemifacial microsomnia – unilateral and asymmetrical problem

• Characterised by a lack of tissue on the affected side

• External ear is deformed

• Ramus of mandible and associated soft tissues are deficient or missing.

• Believed to occur due to early loss of neural crest cells with or without bleeding of the Stapedial
artery.
• Neural crest cells with the longest path of migration (lateral and lower facial areas) are most
affected

• neural crest cells migrating to the lower region play a role in the formation of the great vessels.
Hence patients with hemifacial microsomnia also have defects in the great vessels (tetralogy of
 FACIAL CLEFT PROBLEMS
• Most common congenital defect involving the face and jaws is clefting of lip, palate and less
commonly other facial structures

• Clefts arise during the fourth developmental stage

• Clefting occurs because of failure of fusion of the median and lateral processes and the maxillary
prominence in the 6th week of development

• Clefts of the lip occur lateral to the midline on one or both sides

• Closure of the secondary palate follows that of the primary palate by almost 2 weeks
• Approx. 60% of individuals with cleft lip will also have a palatal cleft

• Isolated cleft of the secondary palate arise due to interference after lip closure is complete

• Bifid uvula (notch in uvula) is due to incomplete closure of secondary palate due to late
appearing interference .

• Macrostomia – exceptionally wide mouth, is due to incomplete fusion of the maxillary and
mandibular processes. This can also produce an oblique clefting of the face
 SYNOSTOSIS PROBLEMS
• Cranial synostosis – are a result of early closures of sutures between the cranial and facial
sutures between the cranial and facial bones.

• Normal cranial and facial development depends on growth adjustments at the sutures in
response to the growing brain and facial soft tissues

• Early closure of a suture (synostosis) leads to characteristic distortions depending on the

location of the early fusion
• Crouzons syndrome – most frequently appearing craniosynostosis.

• Arises due to prenatal fusion of the superior and posterior sutures of the maxilla along the wall of
the orbit.

• This premature fusion prevents the maxilla from translating downward and forward resulting in
severe midface deficiency

• Eyes appear to bulge outward because the are underneath them is underdeveloped.

• Surgery to release sutures is necessary at an early age.

 LATE FETAL DEVELOPMENT
• During third trimester of intrauterine life the fetus which weighs about 1kg, undergoes rapid
growth and triples its weight in the last 3 months

• Dental development begins and proceeds rapidly thereafter. Development of all primary
teeth and first molars begins well before birth

• At birth the head is still nearly half of the total body mass and is the largest impediment to
passage through the birth canal.

• Making the head longer and narrower would make passage through the birth canal easier
• Large uncalcified fontanelles which persist between the flat bones make the distortion of the
head possible, decreasing the width of the brain case and increasing the length.

• Relative lack of growth of the lower jaw also makes birth easier.

• The trauma of the birth process leads to a cessation of growth and often there is a decrease
in weight during the first 10 days of life.

• This produces a physiologic effect in skeletal tissues disturbing the orderly sequence of
calcification leading to visible lines across bones and teeth that were forming at the time
• Nearly all children have neonatal lines across the surface of primary teeth.

• In most instances the lines are very faint and are visible only with magnification

• More visible lines are associated with a stormy or traumatic neonatal period, and an area of
stained, distorted or poorly calcified enamel may result
THE END