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DEVELOPMENT OF FACE AND ANOMALIES

PRESENTED BY DR. GOPI

Contents
Introduction Embryology & Prenatal growth Post natal growth Anomalies Conclusion

PRENATAL GROWTH The development of head depends on


Prosencephalic centre Rhombencephalic centre

Prosencephalic centre -migrates from the primitive streak


Induces

Visual and inner ear apparatus Upper 1/3 of face Caudal Rhombencephalic centre Induces middle and lower 1/3 of face and middle and ext ears.

Formation of the Human Face


1st characterized by an invagination in the ectoderm below the forebrain. As it deepens,it forms an outline of the oral cavity.
Prechordal Plate demarcates the site of the stomodeum( 14th day) endodermal thickening contributes to- oropharyngeal membrane.

Ectoderm forms mucosa of mouth. Endoderm forms mucosa of pharynx. Mesoderm does not intervene.

Face develops from 5 prominences surrounding the stomodeum


Frontonasal

Two maxillary processes


Two mandibular processes

1st Arch Derivatives

All prominences and arches arise from neural crest cells-caudal stream

Frontonasal prominence
4th week iu
Develops from Cranial

stream of neural crest cells

proliferate downwards to form FN process.

It surrounds the developing forebrain Nasal placodes arises inferolaterally

The frontal portion of the prominence b/w the eyes forms the Forehead.

At the infero-lateral corners, thickened ectodermal nasal placodes arise

These placodes induced by the underlying olfactory nerves Invaginate Demarcate the medial and lateral nasal prominences. Nasal pits Precursors to Anterior nares

Post. Merging of Medial nasal processes

Median primary palate


Premaxilla Future site of 4 upper incisors

Midline merging of the paired mandibular prominences Lower jaw + Lower lip -- First to get definitely established.

Lateral merging of maxillary and mandibular prominences. Commisures of mouth

All the regions of the face grow in proportion each other and equally.

to

i.e. any malproportioning at this time may a basis for craniofacial defects.

form

Maxilla
Acc to Jacobson it develops from a condensation of embryonic

mesenchyme within the maxillary process of the mandibular arch


1 ossification centre-7th wk iu- at termination of infra orbital

nerve just above the canine tooth dental lamina.


2 ossification centers zygomatic

orbitonasal nasopalatine intermaxillary

Growth of maxilla depends upon several

functional matrices that act on different areas and thus allowing for its subdivision into skeletal units.
a) Basal body b) Orbital unit c) Nasal unit d) Alveolar unit e) Pneumatic unit

The complexity of action of forces results in different

effects on different sutures


TZ suture - A-P horizontal growth - brain and s-o

synchondrosis.
F-M, F-Z, F-N, E-M,F-E suture - vertical growth - eyeball

and nasal septum expansion


N-M suture-A-P growth-nasal septum

Eyes
Its growth provides an expanding force separating

neural and facial skeletons at FM and FZ sutures therefore increasing the height.

They migrate medially due to expansion of frontal and

temporal lobes of brain

Eye balls
Grow rapidly following neural pattern of growth and

contributing to rapid widening of the face.


half of postnatal growth- 2 years adult dimensions- 7 years.

Nasal Cavity and Septum


A septomaxillary ligament arises from nasal septum

and inserts into Anterior nasal spine. It transmits septal growth pull on the maxilla.
Facial growth is directed downwards and forwards by

the septal cartilage

Palate Derived from


two lateral max palatal shelves primary palate of F-N prominence

initially vertically oriented

8th week iu transformation from vertical to horizontal considerable sex difference in timing. Earlier in male than female embryos.

Factors influencing change of orientation


Biochemical transformations in physical consistency of

connective tissue matrices.

Variation in vasculature and blood flow Sudden increase in tissue turnover. Rapid mitotic activity Intrinsic shelf force Muscular movements Withdrawl of face from heart prominence

Fusion occurs initially - anteriorly in hard palate,

combination of degenerating epithelial cells, and a surface coat accumulation of glycoproteins and desmosomes facilitates epithelial adherence

The fusion initially produces a flat, unarched roof.

Junction of components -incisive papilla.

Line of fusion- mid Palatine suture.

This fusion seam is minimized in soft palate by

invasion of extra territorial mesenchyme.

Ossification - 8th week iu


Anteriorly-primary ossification centre of maxilla Posteriorly- primary ossification centre of palatine

bones.
Mid palatal suture 10 1/2 weeks-fibrous layer in the midline. infancy Y shape in coronal section childhood - T shape adolescence - Interdigitated

Tongue : Ant 2/3rd : -- Median triangular elevation in the floor of the primitive pharynx ant. to foramen caecum termed as Median tongue bed. ( Tuberculum Impar) -- Mesenchyme of the 1st arch give rise to 2 distal tongue beds on either side of median tongue bed.

Median and distal tongue beds rapidly increase in size and fuse together to form ant.2/3rd of the tongue. 2 elevations copula and the hypobranchial eminence form the posterior 1/3rd of the tongue.

the

External ear :

1ST Brachial groove -- External acoustic meatus

Auricle derived from the auricular hillocks i.e. the mesoderm of the 1st and 2nd Branchial arches.

PRENATAL GROWTH OF MANDIBLE


During 3rd & 8th week of development, a period known as the embryonic period, each of the 3

germ layers (endoderm, ectoderm & mesoderm) give rise to a number of specific tissues & organs.

Meckels cartilage
Inferior Alveolar Nerve Center of ossification

Canal for the nerve


Compartments for tooth germs Fibro cellular capsule Sphenomandibular ligament

FURTHER DEVELOPMENT
Secondary cartilages (Three)
Condylar cartilage Coronoid cartilage

Symphysial cartilage

DEVELOPMENT OF TMJ
Formation of Articular disc and Joint cavity
Formation of Condyle Growth of the Condyle

Formation of Joint capsule

POSTNATAL GROWTH
General Methods of Growth :
Remodelling. Displacement

Relocation

Remodeling is a process of reshaping and resizing a

growing bone as it is relocated to new levels.

Relocation- while parts of bone are moved; it

maintains the form of the whole bone and causes its enlargement.

Displacement the whole bone is carried by a mechanical force Site -Articular contacts 1 displacement the physical carry takes place in conjunction with the bones own enlargement vectors orientedposteriorly

and superiorly bone displaced anteriorly and inferiorly

2 displacement - movement of bone and soft tissues

not directly related to its enlargement. Temporal lobe of cerebrum


Middle cranial fossa Displace nasomaxillary complex downwards and

forwards

Primary movement-displacement or remodelling?

Displacement is presently believed by many

researchers to be the primary change with rate and direction of bone growth representing a secondary (transformative) response common signals that separately but simultaneously activate both to operate in unison

It is also believed that both may be responding to

Rotation 2 types Remodelling rotation Displacement rotation.

Nasomaxillary complex- displacement rotation in

either a clock or counter clock wise direction depending on growth activities of basicranium and sutural system.
Palate- remodeling rotation occurs in a counter

direction.

POSTNATAL GROWTH OF MANDIBLE


Of all the facial bones mandible

undergoes the largest amount of growth postnatally.

THE SYMPHYSIS
By the 1st year the

symphyseal cartilage is replaced by bone.

THE RAMUS
The principle growth

vectors are in posterior & superior direction

FUNCTIONS OF REMODELING OF RAMUS


To accommodate & provide an attachment base for the

increasing mass of masticatory muscles. To accommodate the enlarged breadth of the pharyngeal space. To accommodate the vertical lengthening of the nasomaxillary part of the growing face. To facilitate the lengthening of the corpus which in turn accommodate the erupting molars.

RAMUS UPRIGHTING
Greater amounts of bone

deposition takes inferiorly than superiorly on the posterior border of ramus. Correspondingly greater amounts of resorption on ant. Border takes places inferiorly than superiorly resulting in a REMODELLING ROTATION

CORONOID PROCESS

MANDIBULAR CONDYLE

CHIN
In infancy chin is under developed.
As age advances the growth of chin becomes significant

Males are seen to have prominent chin compared to females.


The prominence is accentuated by bone resorption in

the alveolar region below it, creating a concavity

THE ALVEOLAR PROCESS


It develops in response to the presence of tooth buds .
Its formation is controlled by dental eruption & it resorbs where teeth are exfoliated / extracted.

When corpus growth is over, vertical alveolar growth persists as the occlusal surfaces wear & the occlusal height is maintained
Adaptive remodelling of alveolar process makes orthodontc tooth movement possible.

ANOMALIES OF FACE
Congenital defects: Teratogens Infection German Measles Cleft Palate X-Irradiation Cleft Palate Drugs Tetracycline Discoloration of teeth Nutrition Vitamin deficiency- Tested Hormones Cortisone- Cleft Palate in Mice

CLEFT LIP AND PALATE


Unilateral, bilateral cleft lip Oblique facial cleft and cleft lip Median cleft lip and nasal defect

Median mandibular cleft


Unilateral microstomia

CLEFT PALATE
More in females than males
Tongue obstruction Small palatal shelves

Failure of epithelial breakdown


Failure of mesodermal penetration Post fusion rupture Cleft palate and Cleft lip

Cleft palate-

Cleft lip and palate

BIFID UVULA
Mildest form of cleft palate

TREACHER COLLIN SYNDROME


Anti mongoloid slope
Hypoplasia of maxilla and zygoma

Malocclusion
Cleft palate

DOWNS SYNDROME
Trisomic chromosome
Typical mongoloid

appearance Mid face is hypoplastic Cleft lip and cleft palate are seen

ASCHERS SYNDROME
Sagging eyelids
Nontoxic thyroid enlargement

Double lip is seen

PATAUS SYNDROME
Cleft lip
Cleft palate Micrognathia

GORLINS SYNDROME
Odontogenic keratocyst in mandible Multiple basal cell neavi
Cleft lip and/or cleft

palate is seen Bifid ribs are seen

TONGUE TIE
Ankyloglossia
Interferes with speech

Difficult to cleanse the food away


Lingually placed

centrals

ELLIS-VAN CREVELED SYNDROME


Chondro ectodermal dysplasia
Dwarfism

Incisiors are missing


Hypoplastic teeth Multiple freanae are

present

PIERRE ROBINSON SYNDROME(BIRD FACE)


Severe micrognathia
Cleft palate Periodic dyspnoea

Congenital cardiac annomalies


Mentally handicap

glossoptosis

CONCLUSION

Facial growth is a process requiring intimate morphogenic interrelationships among all of its component growing, changing and functioning soft and hard tissue parts. No part is developmentally independent and self contained.