EMBRYOGENESIS OF CLEFT LIP AND PALATE

Ocky Pranata

Cleft
abnormal opening or a fissure in an anatomical structure that is normally closed.

Clefts of the lip and/or palate are common birth defects

with an incidence of 1/500 to 1/1000 births worldwide

Cleft lip and/or alveolus

Orofacial cleft Cleft palate

Combined

 Cleft lip with or without cleft palate occurs about twice as often in males than in females and is usually more severe in males Cleft palate occurs about twice in females as in males

 It has been speculated that it could be related to differences of the lip and the palate in the embryo. In the male human embryo, the horizontal positioning and subsequent closure of the secondary palate occurs earlier than in the female embryo. Because the palatal shelves are open longer in the female, there is greater period of time during which there is susceptibility to environment teratogens

Stage

EMBRYOLOGICAL DEVELOPMENT OF THE LIP AND ALVEOLUS

begins at around 6 to 7 weeks of gestation and starts at the incisive foramen. Fusion begins at the incisive foramen and then proceeds in an anterior direction to form the alveolus through the fusion of the bilateral incisive suture lines. Closure the proceeds to form the base of the anterior nose and finally the upper lip. The median and two lateral lip segments are then fused, forming the philtrum and philtral lines which completes the formation of the upper lip.

EMBRYOLOGICAL DEVELOPMENT OF THE LIP AND ALVEOLUS

During 4th week of gestation, as the maxillary and mandibular processes of the first pharyngeal arch are developing and growing anteriorly, a median bulge covering the brain enlarges and grows forward. This frontonasal prominence, with its two lateral thickened areas, the nasal placodes, develops just above the stomodeum. Later, the medial and lateral rims of the nasal placodes grow around the placode, leaving a depression, the nasal pit. Continued anterior growth of these rims through the fifth week causes a thinning and rupture of the epithelium covering the floor of the nasal pit.

EMBRYOLOGICAL DEVELOPMENT OF THE LIP AND ALVEOLUS

At this point, as this bucconasal membrane ruptures, a communication is established with the roof of the developing oral cavity. The lateral rims of the nasal placodes the lateral nasal swellings, which will become the alae of the nose. The medial rims of the nasal placodes, (the median nasal swellings), fuse together to form the intermaxillary segment form the bulbus of the nose Continued growth of this intermaxillary segment anterior and inferior to the nose will give rise to the inferior aspect of the nasal septum, columella of the nose, philtrum of the upper lip, labial tubercle, and primary palate (premaxilla).

EMBRYOLOGICAL DEVELOPMENT OF THE LIP AND ALVEOLUS

teeth and their supporting structures as well as the gingiva will also develop from the intermaxillary segment During this approximately 2-week period, the maxillary swellings have moved anteriorly, meeting the intermaxillary segment and fusing with it to seal the nasolacrimal groove, a deep furrow running between the medial aspect of the eye and the primitive oral cavity on the face. The epithelium lining this groove separates from the surface ectoderm, finally forming the nasolacrimal duct (tear duct) opening into the nasal cavity

EMBRYOLOGICAL DEVELOPMENT OF THE LIP AND ALVEOLUS

During this period, the mandibular processes have fused anteriorly, forming the mandible, thereby reducing the size of the primitive mouth. Also at this time, mesoderm of the second arch has invaded the area, forming the muscles of facial expression over the entire face

EMBRYOLOGICAL DEVELOPMENT OF THE PALATE

starts at around 8 to 9 week of gestation. The palatal shelves are vertical and positioned on each side of the tongue. Around the 7th or 8th week of gestation, the tongue begin to gradually drop down the palatal shelves move slowly from a vertical to horizontal position and fuse, first with the premaxilla at the incisive foramen and then with each other.

EMBRYOLOGICAL DEVELOPMENT OF THE PALATE

The process of fusion begins and the incisive foramen and then proceeds between the palatal shelves, moving in a posterior direction along the median palatine suture line. This completes the formation of the hard palate. The vomer forming a portion of the nasal septum, moves downward and fuses with the superior surface of the hard palate, thus completing the separation of the nasal cavity. Once the hard palate is formed, the velum and finally the uvula are formed. This process is usually complete by 12 weeks of gestation.

Direction of growth and resorption of the facial bones at various sites

CAUSES OF CLEFT

due to disruption or delays in cell migration or palatal shelf movement include chomosomal disorders and genetic disorders. Older parental age has also been linked with an increased risk for both cleft lip and palate. In addition cleft can be caused by environmental teratogens or by mechanical factors in utero. Environmental teratogens include cigarette smoke, phenytoin, thalidomide, valium, virus (including rubella and even influenza), lack of maternal vitamin b6

THANK YOU