Embryologi Week II

Pembentukan Wajah (Arcus) Urogenital

*Labiopalatoskisis & Labiopalato *Horshoe

*Fistula Preauricular Respi

Cardio *Surfaktan
*Tetralogi Fallot Digesti

*PDA *Retro Intraperitoneal

*ASD *Hernia
*VSD *Omfalocele

Neuro *Hirsprung
*Spina Bifida
Pembentukan Wajah
• The external human face develops between the 4th and 6th week of
embryonic development
Completed by the 6th week.
• Between the 6th and 8th week, the palate begins to develop.
Completed by the 12thweek.
• Two important tissue structures involved in development of the nose
and face: the pharyngeal arches and neural crest cells.
• In the developing embryo, there are 6 pharyngeal arches. They arise
in the 4th week of development as outpocketings of mesoderm on
both sides of the pharynx.
pharyngeal arches
Pharyngeal Clefts
• There are initially 4 pharyngeal clefts. However, only the 1st cleft gives
rise to a permanent structure in the adult; the external auditory
meatus.
• The 2nd, 3rd and 4th clefts only form temporary cervical sinuses –
which are then obliterated by the rapidly proliferating 2nd pharyngeal
arch.
Pharyngeal Arches
• here are six pharyngeal arches – however, the 5th regresses soon after
forming.
• Each arch is innervated by an arch-associated cranial nerve, and has
a muscular component, a skeletal and cartilaginous supporting
element. as well as a vascular component.
• In the adult, each pharyngeal arch is associated with specific
structures within the head and neck.
Cranial Nerve
• The cranial nerves are a set of 12 paired nerves that arise directly
from the brain. The first two nerves (olfactory and optic) arise from
the cerebrum, whereas the remaining ten emerge from the brain
stem.
 Origin of the Cranial Nerves
• There are twelve cranial nerves in total. The olfactory nerve (CN I) and optic nerve (CN
II) originate from the cerebrum.
• Cranial nerves III – XII arise from the brain stem (Figure 1). They can arise from a specific
part of the brain stem (midbrain, pons or medulla), or from a junction between two
parts:
• Midbrain – the trochlear nerve (IV) comes from the posterior side of the midbrain. It
has the longest intracranial length of all the cranial nerves.
• Midbrain-pontine junction – oculomotor (III).
• Pons – trigeminal (V).
• Pontine-medulla junction – abducens, facial, vestibulocochlear (VI-VIII).
• Medulla Oblongata – posterior to the olive: glossopharyngeal, vagus, accessory (IX-XI).
Anterior to the olive: hypoglossal (XII).
• The cranial nerves are numbered by their location on the brain stem (superior to
inferior, then medial to lateral) and the order of their exit from the cranium (anterior to
posterior).
First Arch
• The first pharyngeal arch is comprised of two parts:
• Maxillary prominence (dorsal portion) – becomes the future maxilla, zygomatic
bone and part of the temporal bone.
• Is associated with the maxillary cartilage, which gives rise to the incus.
• Mandibular prominence (ventral portion) – becomes the future mandible.
• Is associated with Meckel’s cartilage, which gives rise to the malleus and the
sphenomandibular ligament.
• The artery of the first pharyngeal arch becomes the terminal portion of
the maxillary artery, which is a branch of the external carotid.
• Its associated nerve is the trigeminal nerve (CN V). The first arch gives rise to the
muscles of mastication, and also the mylohyoid, the anterior belly of digastric,
tensor veli palatani and tensor tympani – all of which are innervated by the
branches of the trigeminal nerve.
• Its sensory field is that of the trigeminal nerve too, namely the skin of the face,
the lining of the mouth and nose, and general sensation to the anterior 2/3 of
the tongue.
Second Arch
• There are two arteries associated with the second pharyngeal arch:
• Stapedial artery – connects the embryonic precusors of the internal carotid,
internal maxillary and middle meningeal arteries. It regresses before birth.
• Hyoid artery – gives rise to the corticotympanic artery in the adult.
• Reichart’s cartilage is the name given to the cartilage component of the second
arch. It is the precursor to the stapes, the styloid process, the stylohyoid ligament
and the upper body and lesser horn of the hyoid bone.
• The nerve associated with the second pharyngeal arch is the facial nerve (CN VII).
It innervates all the muscular derivatives of the 2nd arch – the muscles of facial
expression, stapedius, stylohyoid, platysma and the posterior belly of digastric.
• The sensory field of the second arch is that of the facial nerve, namely taste
sensation to the anterior 2/3rds of the tongue (via the chorda tympani).
Third Arch
• The artery of the third pharyngeal arch becomes the common carotid
artery and the proximal portion of the internal carotid artery.
• Its cartilaginous component is less complex than the first two arches,
and gives rise to only the lower body and greater horn of the hyoid.
• Its associated cranial nerve is the glossopharyngeal nerve (CN IX).
• The third arch gives rise to stylopharyngeus, and its sensory function
is to provide taste and general sensation to the posterior 1/3rd of the
tongue.
Fourth Arch
• The vascular derivatives of the fourth pharyngeal arch differ between the
left and right:
• Right – proximal portion of the subclavian artery
• Left – aortic arch
• The fourth arch gives rise to laryngeal cartilages – namely the thyroid,
corniculate and cuneiform cartilages.
• The associated nerve is the superior laryngeal branch of the vagus nerve
(CN X), which innervates the muscular derivatives of the fourth arch; the
constrictors of the pharynx, levator palatini and cricothyroid.
• Innervation to the root of the tongue is provided by the superior laryngeal
branch.
Sixth Arch
• The vascular derivatives of the sixth pharyngeal arch differ between the left
and right:
• Right – proximal portion of the pulmonary arteries
• Left – ductus arteriosus
• The associated nerve is the recurrent laryngeal branch of the vagus nerve
(CN X). It innervates the intrinsic muscles of the larynx (with the exception
of cricothyroid), which are derived from the sixth arch.
• The sensory field of the recurrent laryngeal branch is widespread. It
includes taste sensation from the epiglottis and pharynx, general sensation
in the pharynx, larynx, oesophagus, tympanic membrane, external auditory
meatus and part of the external ear. It also provides the efferent limb of
the gag reflex, and parasympathetic innervation to viscera.
Pharyngealarch derivatives

Source : Lustwithlife.com
Pharyngealarch derivatives

Source : dr. N Satyanarayana, AIMST University, Malaysia

Pharyngeal Pouches
• The pharyngeal pouches separate the pharyngeal arches on the inner
(endodermal) surface. There are five pairs of pouches, with only four
giving rise to adult structures.
• Below is a table summarising the derivatives of the branchial
pouches:
Arch Derivatives
st
1 Eustachian tube and middle ear cavity
nd
2 Lining of the palatine tonsils
rd
3 •Dorsal – Inferior parathyroid glands
•Ventral – Thymus
th
4 •Dorsal – Superior parathyroid glands
•Ventral – Ultimobranchial body (C cells)
Neural Crest Cell
• Neural crest cells are a specialized cell lineage which originate from
neuroectoderm. As the neural tube forms, cells from the lateral
border of the neuroectoderm are displaced into mesoderm, and from
there they migrate throughout the body to form various structures.
Of relevance to the head and neck, these cells enter the pharyngeal
arches to help contribute to their derivatives.
Development of the Face
• During week 3 of embryonic development, an oropharyngeal
membrane initially appears at the site of the future face. It is comprised of
ectoderm and endoderm – externally and internally, respectively.
• During the 4th week, the oropharyngeal membrane begins to break down
in order to become the future oral cavity, and sits at the beginning of the
digestive tract.
• The structures of the external face are derived from two sources:
• Frontonasal prominence – formed by the proliferation of mesenchymal
neural crest cells ventral to the forebrain.
• Mandibular and maxillary prominences – parts of the 1st pharyngeal arch.
• A space lies between the maxillary prominences, covered by
the oropharyngeal membrane; this is known as the stomatodeum, the precursor to
the mouth and pituitary gland.
• Nasal development is instigated by the appearance of raised bumps
called nasal placodeson both sides of the frontonasal prominence.
These then invaginate to form nasal pits, with medial and lateral nasal
prominences on either side.
• As the maxillary prominences expand medially, the nasal prominences
are ‘pushed’ closer to the midline. The maxillary prominences then
fuse with the nasal prominences – and soon after fuse in the midline
to form a continuous central structure.
Prominence Derivatives
Frontonasal Forehead, bridge of nose, medial
and lateral nasal prominences

Medial nasal Philtrum, primary palate, upper 4

incisors and associated jaw

Lateral nasal Sides of the nose

Maxillary (1st pharyngeal arch) Cheeks, lateral upper lip,
secondary palate, lateral upper jaw

Mandibular (1st pharyngeal arch) Lower lip and jaw

Development of the Palate
• Initially, the nasal cavity is continuous with the oral cavity. A series of steps
lead to their separation, and the establishment of the palate.
• As the nose forms, the fusion of the medial nasal prominence with its
contralateral counterpart creates the intermaxillary segment – which
forms the primary palate (becomes the anterior 1/3 of the definitive
palate). The intermaxillary segment also contributes to the labial
component of the philtrum and the upper four incisors.
• The maxillary prominences expand medially to give rise to the palatal
shelves. These continue to advance medially, fusing superior to the tongue.
Simultaneously, the developing mandible expands to increase the size of
the oral cavity; this allows the tongue to drop out of the way of the
growing palatal shelves. The palatal shelves then fuse with each other in
the horizontal plane, and the nasal septum in the vertical plane, forming
the secondary palate.
Cardiovascular System
Cardiovascular system
• The cardiovascular system is one of the first body systems to appear
within the embryo. It is active by the beginning of the end of the third
week or fourth week – when the placenta is unable to meet the
requirements of the growing embryo.
Primitive Heart Tube
• The development of the heart begins with the formation of
the primitive heart tube following the folding of the embryo during
the end of the third week.
• Firstly, lateral folding creates the heart tube by bringing together two
precursor regions, then cephalocaudal folding positions the heart
tube in the future thorax. Initially, the heart tube is suspended within
the pericardial cavity by a membrane; this subsequently degenerates
to allow for further growth.
 Coronal View
Sagital view

Source : http://11e.devbio.com/wt1802.html Source : Frederick Melton

Sagital view
From superior to inferior, the primitive heart tube is comprised of six
regions:
• Aortic roots (Arterial poles)
• Truncus arteriosus
• Bulbus cordis
• Ventricle
• Atrium
• Sinus venosus (Venous poles)
• The heart tube continues to elongate, and begins looping at around
day 23 of development. The bulbus cordis moves ventrally,
caudally, and to the right (forward, down and right), and the
caudal portion – the primitive ventricle – moves dorsally, cranially and
to the left (backwards, up and left).
Source : tinycards.duolingo.com
Source : Joachim Behar
Atria
• At the fourth week, the sinus venosus is responsible for the inflow of blood
to the primitive heart, and empties into the primitive atrium. It receives
venous blood from the right and left sinus horns.
• Over time, the venous return shifts to the right side of the heart, causing
the left sinus horn to recede and form the coronary sinus (responsible for
the drainage of venous blood from the heart itself). The enlarged right
sinus horn is absorbed by the growing right atrium and eventually forms
part of the inferior vena cava in the adult.
• In the left atrium, a similar process occurs with the pulmonary veins. The
four pulmonary veins are incorporated into the left atrium, forming the
smooth inflow portion of the left atrium and the oblique pericardial sinus.
The derivatives of the aortic arches in the adult
are as follows:
st
1 arch Contributes to the maxillary, hyoid and stapedial arteries.
nd
2 arch Contributes to the maxillary, hyoid and stapedial arteries.
rd
3 arch Forms the common carotid artery and part of the proximal internal
carotid artery.
th
4 arch Right arch forms the right subclavian artery
Left arch forms part of the arch of the aorta
th
5 arch Either never forms, or forms incompletely and regresses
th
6 arch Right arch forms the right pulmonary artery
Left arch forms the left pulmonary artery and the ductus arteriosus.
• Each of the arches has a corresponding nerve during development.
The most important of these is the recurrent laryngeal nerve (a
branch from CN X) – which is associated with the 6th arch:
• Right recurrent laryngeal nerve – initially hooks around the right
6th aortic arch. However, when the distal part of the right 6th arch
disappears, it moves up to hook around the right subclavian artery
(4th arch).
• Left recurrent laryngeal nerve – hooks around the left 6th aortic arch.
The distal part of the left 6th aortic arch persists as the ductus
arteriosum, and so the nerve remains in this position.
• The long course of the left recurrent laryngeal nerve is clinically
relevant, as it is susceptible to pathology in the chest (e.g.
compression by an aortic aneurysm).
Septation of the Heart
• Septation of the heart into right and left channels occurs first,
when endocardial cushions developing in the atrioventricular
region expand to divide the heart.
Atrioventricular septation

Source : https://hduod.weebly.com
Atrial Septation
• The septation of the primitive atrium involves the formation of
two septa and three ‘holes’.
• Firstly, the septum primum forms and extends down towards the
fused endocardial cushions to split the atrium into two. The ostium
primum is a hole present before the septum primum completes
fusion with endocardial cushions. Before the ostium primum is closed
a second hole, the ostium secundum, appears within the septum
primum.
• Following this a second septum, the septum secundum, grows with a
hole known as the foramen ovale present. The presence of both
the ostium secundum and foramen ovale allows a right to left
shunt to be present in the developing heart.
• The timing of this process is carefully controlled. At all times, at least
one hole is present in the septa to allow communication between the
left and right atria. This allows blood to be shunted to the left side of
the heart, bypassing the non-functional lungs.
 1. 2.

Source : https://hduod.weebly.com
 3.

Source : https://hduod.weebly.com
Source : UNSW Embryology
Ventricular
• The interventricular septum of the ventricles has two components;
one muscular and one membranous.
• The muscular portion forms much of the septum and grows up from
the floor of the ventricles towards the fused endocardial
cushions, but a small gap, the primary interventricular
foramen, remains.
• This gap is filled by the membranous portion of the
interventricular septum, which is comprised of connective tissue
derived from endocardial cushions.
Source : www.studyblue.com
Source
Source :: https://step1.medbullets.com
https://step1.medbullets.com
Outflow Tract
• Endocardial cushions also appear within the truncus arteriosus which
grow towards each other.
• As they grow towards each other they twist around each other and
form a spiral septum, dividing the outflow tract into left and right
sides.
Source : https://hduod.weebly.com
Source : https://hduod.weebly.com
Source : https://hduod.weebly.com
Circulatory Shunts
• In the fetal circulation, vascular shunts are required to bypass the
liver and non-functioning lungs.
• The lungs are bypassed by two separate shunts, firstly the foramen
ovale between the two atria, which is responsible for bypassing the
majority of the circulation. Any blood that does not pass through
the foramen ovale enters the pulmonary trunk, which is linked to the
distal arch of aorta by the ductus arteriosus. These two separate
shunts allow the circulation to bypass the lungs.
• The oxygenated blood entering the fetus also needs to bypass
the primitive liver, this ensures that enough oxygen reaches the
developing brain. This is achieved by passage through the ductus
venosus, which is estimated to shunt around 30% of umbilical
blood directly to the inferior vena cava.
At birth, these shunts need to close to allow the
normal adult circulation to be established:
• Foramen ovale – intake of air leads causes pulmonary resistance to
fall. The pressure within the left atrium is now higher than the right.
As blood cannot flow through the foramen ovale left to right, this
effectively closes the shunt. It fuses shut in most individuals by the
age of 1 year.
• Ductus arteriosus – muscular wall contracts to close after birth (a
process mediated by bradykinin).
The circulatory shunts are summarised in the
table below:
Fetal shunt Adult remnant
Foramen ovale Fossa ovalis
Ductus arteriosus Ligamentum arteriosum
Ductus venosus Ligamentum venosum
Umbilical vein Ligamentum teres (hepatis)
Respiratory System
Respiratory
• The function of the respiratory system can be divided into two parts:
the conducting portion and the respiratory portion. The conducting
portion conveys, moistens, and warms the air from outside the body
as it makes its way to the lungs. The exchange of gas occurs at the
respiratory portion.
• Structurally, the respiratory system is divided into the upper and
lower respiratory tracts/systems. The upper respiratory
system consists of the nasal cavity, oral cavity, pharynx and their
associated structures.
• The lower respiratory system consists of the trachea, bronchi,
bronchioles and alveoli. It develops relatively late in the embryo –
which can cause problems when babies are born prematurely.
Initial Development
• The respiratory system is derived from the primitive gut tube – the
precursor to the gastrointestinal tract. The gut tube is an endodermal
structure which forms when the embryo undergoes lateral folding
during the early embryonic period.
• At approximately week 4 of development, an outpocketing appears in
the proximal part of the primitive gut tube (the foregut) – this is
known as the respiratory diverticulum.
• itially, the respiratory diverticulum is continuous with the foregut; but
this is not functionally suitable. The formation of a longitudinal ridge
known as the tracheoesophageal septum rectifies this to make the
two structures compatible with life.
• The diverticulum bifurcates into two buds, which become the left and
right primary bronchi. The primary bronchi then proliferate to give
rise to secondary and tertiary bronchi.
Source :
http://www.ultratwistersgym.com/Resources/Respiratory
/Respiratory.html
Source : accesspediatrics.mhmedical.com
Source : https://courses.lumenlearning.com
Embryonic Stage : Week 4 – Week 8
• The embryonic phase of lung development begins with the formation
of a groove in the ventral lower pharynx, the sulcus laryngotrachealis
• After a couple of days - from the lower part - a bud forms, the true
lung primordium
• In the further subdivision into the two main bronchi the smaller bud
on the left is directed more laterally than the somewhat larger one on
the right that - parallel to the esophagus - is directed more caudally
Source : UNSW Embryology
Pseudoglandular Stage: Weeks 8-16
• Each bronchopulmonary segment will become a specific portion of
the lung, carrying its own tertiary bronchus and branches of the
bronchial and pulmonary arteries. During weeks 8-16, the ducts
develop within bronchopulmonary segments. Bronchiolar buds
branch off from the tertiary bronchi, and begin to proliferate.
• At this stage, as there are no alveoli, there is no gas exchange – and
so the lungs are unable to oxygenate blood. However, the lungs are a
metabolically active, developing tissue, which means they are able to
remove large amounts of oxygen from the blood
• In order to stop the lungs from starving the body of oxygen,
the ductus arteriosus shunts blood from the pulmonary artery
directly to the aortic arch. This closes at birth in the vast majority of
people.
• During this stage, the lungs resemble the development of tubule-
acinous glands – hence the name.
Source : Embriology.ch
Canalicular Stage: Weeks 16-26
• Throughout the canalicular stage, the respiratory bronchioles
develop, budding off from the terminal bronchioles formed within the
pseudoglandular stage.
• Despite this, there is still no gas exchange membrane, and so the
lungs are not yet functional. Therefore, the prognosis for vast
majority of babies born during this stage is not high.
Source : Embriology.ch
Saccular Stage: Week 26 – Week 36
• From week 26 onwards, the alveoli develop. Within these alveoli there are
two types of cell:
• Type I pnuemocytes – basic simple squamous epithelial cells, which
comprise 90% of the alveolus.
• Type II pnuemocytes – simple cuboidal cells which comprise the remaining
10%, and are responsible for the production of surfactant.
• Surfactant is amphipathic, meaning it is able to bind to both hydrophobic
and hydrophilic molecules simultaneously. In this case, surfactant binds to
water and air within the alveoli. This has the effect of reducing the surface
tension. As a result of the reduced surface tension, the alveoli are able to
expand to greater volumes at a given pressure.
• Simply put, surfactant allows us to expand our lungs with minimal effort.
Source : Embriology.ch
Alveolar Stage Week 36 onwards
• Depending on the author, the alveolar phase begins at varying times.
Probably in the last few weeks of the pregnancy, new sacculi and,
from them, the first alveoli form.
• Thus, at birth, ca. 1/3 of the roughly 300 million alveoli should be fully
developed. The alveoli, though, are only present in their beginning
forms. Between them lies the parenchyma, composed of a double
layer of capillaries, that forms the primary septa between the
alveolar sacculi.
Source : Embriology.ch
Source
:http://basenat.u707.jussieu.fr/site_respirare/index.php?
option=com_content&view=article&id=59&Itemid=30&la
ng=en&showall=1
 Source :
http://www.ultratwistersgym.com/Resources/Respiratory
/Respiratory.html

Source : Embriology.ch
Nervous System
Nervous
• Following fertilisation, the nervous system begins to form in the
3rd week of development. It continues after birth and for many years
into the future.
• Structurally, the nervous system is divided into two parts:
• Central nervous system – consists of the brain and the spinal cord.
• Peripheral nervous system – consists of cranial and spinal nerves,
ganglia, plexuses, and sensory receptors.
Early Stages
• At the end of week two, a structure called the primitive
streak appears as a groove in the epiblast layer of the bilaminar disk.
• Cells within the epiblast migrate downward through the primitive
streak, giving rise to three layers from the initial two. These three
germinal layers form the trilaminar embryonic disk:
• Endoderm – innermost layer
• Mesoderm – middle layer
• Ectoderm – outermost layer
• The nervous system is derived from the ectoderm, which is the
outermost layer of the embryonic disc. For more details, check out
our article on early embryonic development.
Neurulation
• In the third week of development, the notochord appears in the
mesoderm. The notochord secretes growth factors which stimulate
the differentiation of the overlying ectoderm into neuroectoderm –
forming a thickened structure known as the neural plate.
• The lateral edges of the neural plate then rise to form neural folds.
The neural folds move towards each other and meet in the midline,
fusing to form the neural tube (precusor to the brain and spinal cord).
• During fusion of the neural folds, some cells within the folds migrate
to form a distinct cell population – known as the neural crest. They
give rise to a diverse cell lineage –
including melanocytes, craniofacial cartilage and bone, smooth
muscle, peripheral and enteric neurons and glia
• The formation of neural tube is known as neurulation, and is
achieved by the end of the fourth week of development.
Brain and Cerebellum
• In the fifth week of development, swellings appear at the cranial end
of the neural tube. Three primitive vesicles appear first, and
subsequently these develop into five secondary vesicles.
• These vesicles will give rise to all the structures of the brain and
cerebellum, as well as the ventricular system shown in the table
below:
Primary Vesicles Secondary Vesicles Neural Derivatives Cavity Derivatives

Prosencephalon Telencephalon Cerebral hemispheres Lateral ventricle

and globus pallidus

Diencephalon Thalamus, Third Ventricle

hypothalamus, and
epithalamus
Mesencephalon Mesencephalon Midbrain Cerebral aqueduct
Rhombencephalon Metencephalon Pons and cerebellum Upper part of
th
4 ventricle
Myeloencephalon Medulla Lower part of
th
4 ventricle/central
canal
• Meanwhile, neuroderm cells begin to differentiate into neurones and
glial cells. Neurones migrate throughout the brain, and once they
have reached their final destination they develop axons and
dendrites, forming synapses.
Spinal Cord
• Whilst the cranial end of the neural tube forms the brain and
cerebellum, the caudal end develops to form the spinal cord.
• Cells on the dorsal side form the alar plate, which subsequently
becomes the dorsal horn(posterior). Cells at the ventral end form the
basal plate, which then becomes the ventral horn (anterior).
After Birth
• Development of the central nervous system continues for many years
after birth. Synapses form and new connections appear, increasing in
number throughout childhood and into adulthood.
• Only synapses and pathways that are used survive into adulthood; the
process of synaptic pruning allows unused synapses to be eliminated.
Myotome
• An adult myotome is defined as ‘a group of muscles innervated by a
single spinal nerve root‘. They are clinically useful as they can
determine if damage has occurred to the spinal cord, and at which
level the damage has occurred.
Origin of Myotomes
• Skeletal muscle development can be traced to the appearance
of somites. By day 20 the trilaminar disc has formed and
the mesoderm has differentiated into different areas. The area
directly adjacent to the neural tube is known as the paraxial
mesoderm.
• From day 20 onwards the paraxial mesoderm begins to differentiate
further into segments known as somites. 44 pairs of somites are
formed, however some of these regress until 31 pairs remain,
corresponding to 31 pairs of spinal nerves in the adult.
• Somites are composed of a dorsal and ventral portion. The ventral
portion forms the sclerotome, the precursor of the ribs and vertebral
column. The dorsal portion consists of the dermomyotomes. As the
embryo continues to develop the myotome proliferates and
eventually develops into muscle.
Distribution of Myotomes
• Most muscles in the upper and lower limbs receive innervation from
more than one spinal nerve root. They are therefore comprised of
multiple myotomes. For example, the biceps brachii muscle performs
flexion at the elbow. It is innervated by the musculocutaneous nerve,
which is derived from C5, C6 and C7 nerve roots. All three of these
spinal nerve roots can be said to be associated with elbow flexion.
The list below details which movement is most
strongly associated with each myotome:
• C5 – Elbow flexion • L3 – Knee extension
• C6 – Wrist extension • L4 – Ankle dorsiflexion
• C7 – Elbow extension • L5 – Great toe extension
• C8 – Finger flexion

• T1 – Finger abduction • S1 – Ankle plantarflexion

• L2 – Hip flexion
Dermatomes
• A dermatome is defined as ‘a strip of skin that is innervated by a
single spinal nerve‘. They are of great diagnostic importance, as they
allow the clinician to determine whether there is damage to the
spinal cord, and to estimate the extent of a spinal injury if there is one
present.
Origins of Dermatomes
• We can trace back the origins of dermatomes to the 3rd week of
embryogenesis. At around day 20, the tri-laminar disc has been
established and the middle layer (mesoderm) has differentiated into
its different types. The portion that is directly adjacent to the neural
tube is called paraxial mesoderm.
• From day 20 onwards the paraxial mesoderm differentiates into
segments called somites. 44 pairs of somites are formed, but 13 of
these break down leaving 31 somites. This corresponds to the 31 sets
of spinal nerves in the body.
• The somites themselves are comprised of a ventral and a dorsal
portion. The ventral portion consists of sclerotome, the precursor to
the ribs and vertebral column.
• The dorsal portion consists of dermomyotome. Over time,
the myotome proliferates and the dermatome disperses to
form dermis. As the limbs grow, the dermis associated with the
precursor of the limbs is stretched and moved down the limb,
creating the segmental innervation that is associated with the Keegan
and Garrett dermatome map of 1948.
Dermatome Maps
• There are two main maps that are accepted by the medical
profession. The first is the Keegan and Garret map of 1948. This
depicts dermatomes in a way that correlates with the segmental
progression of limb development. The second is the Foerster map of
1933 which depicts the medial part of the upper limb as being
innervated by T1-T3 which follows the distribution of pain from
angina or an MI. This is the most commonly used map, and features
in the ASIA scale of assessing spinal injury.
• Both maps depict progression of limb growth around an axial line.
Across this line there is no overlap between dermatomes, but often
those adjacent each other have a slight overlap.
Urinary System
Urinary
• The main functions of the urinary system include:
• Removal of metabolic waste products such as uric acid, urea and
creatinine.
• Maintain electrolyte, water and pH balance.
• Regulation of blood pressure, blood volume and erythropoiesis, and
vitamin D production.
• Development of the urinary system is closely related to the
development of the reproductive system; particularly during the
earlier stages – where they develop from the same origin. However,
the urinary system develops ahead of the reproductive system.
• The urinary system consists of the kidneys, ureters, bladder and
urethra. A region ofintermediate mesoderm, known as the urogenital
ridge, gives rise to these structures.
Development of the Kidneys
• In the embryo, the kidneys develop from three overlapping sequential
systems; the pronephros, the mesonephros, and the metanephros.
They are all derived from the urogenital ridge.
Pronephros
• The pronephros appears in the 4th week of development.
• Its development begins in the cervical region of the embryo.
Segmented divisions of intermediate mesoderm form tubules, known
as nephrotomes. In total, 6-10 pairs of nephrotomes are formed.
• These tubules join into the pronephric duct, which is a duct that
extends from the cervical region to the cloaca (distal end) of the
embryo. This early system is non-functional and regresses completely
by the end of week 4.
Mesonephros
• The mesonephros develops caudally (inferiorly) to the pronephros.
First, the presence of the pronephric duct induces
nearby intermediate mesoderm in the thoracolumbar region to
form mesonephric tubules.
• These tubules receive a tuft of capillaries from the dorsal aorta –
allowing for the filtration of blood – and they drain into
the mesonephric duct (a continuation of the pronephric duct). They
act as a primitive excretory system in the embryo, with most tubules
regressing by the end of the 2nd month.
• Additionally, the mesonephric duct sprouts the ureteric bud caudally,
which induces the development of the definitive kidney.
Metanephros
• The metanephros forms the definitive kidney. It appears in the 5th
week of development and becomes functional around the 12th week.
• The ureteric bud from the mesonephric duct makes contact with a
caudal region of intermediate mesoderm – the metanephric
blastema
Collectively, these blastema form the metanephric
system, which has two components:
• Collecting system – derived from the ureteric bud.It dilates to create
the ureter, renal pelvis, major and minor calyces and collecting
tubules – terminating at the distal convoluted tubule.
• If the uretic bud splits too early, two ureters, or two renal pelvices
connecting to one ureter may result.
• Excretory system – derived from the metanephric blastema.Each
collecting tubule from the collecting system is covered by a
metanephric tissue cap which gives rise to the excretory tubules.
• These excretory tubules (along with the developing glomeruli) form
the kidney’s functional units – the nephron.
• The proximal end of the excretory tubule forms the Bowman’s
capsule around a glomerulus, while the distal end elongates to form
the proximal convoluted tubule, loop of Henle and distal convoluted
tubule
• The definitive kidney initially develops in the pelvic region before
ascending into the abdomen. In the pelvis, the kidney receives its
blood supply from a pelvic branch of the abdominal aorta and as it
ascends, new arteries from the abdominal aorta supply the kidney.
The pelvic vessels usually regress, but can persist as accessory renal
arteries.
Development of the Bladder and Urethra
• The bladder and urethra of the urinary system are ultimately derived
from the cloaca – a hindgut structure that is a common chamber for
gastrointestinal and urinary waste.
• In the 4th-7th weeks of development, the cloaca is divided into two
parts by the uro-rectal septum:
• Urogenital sinus (anterior) – divided into three parts:The upper part
of the urogenital sinus forms the bladder.
• The pelvic part forms the entire urethra and some of the reproductive
tract in females, and the prostatic and membranous urethra in males.
• The phallic/caudal part forms part of the female reproductive tract,
and the spongy urethra in males.
• Anal canal (posterior)
• The urinary bladder is initially drained by the allantois. However, this
is obliterated during fetal development and becomes a fibrous cord –
the urachus. A remnant of the urachus can be found in adults; the
median umbilical ligament, which connects the apex of the bladder to
the umbilicus.
• As the bladder develops from the urogenital sinus, it absorbs the
caudal parts of the mesonephric ducts (also known as the Wolffian
ducts), becoming the trigone of the bladder. The ureters, which have
formed as outgrowths of the mesonephric ducts, enter the bladder at
the base of the trigone. The final structure varies between sexes:
 Male Female

Bladder •As the kidneys ascend into the •As the kidneys ascend
abdomen, the ureteric openings into the abdomen, the
move cranially. ureteric openings move
•The mesonephric ducts cranially.
(Wolffian ducts) move caudally •The mesonephric
and closer together, entering ducts degenerate due
the prostatic urethra to become to a lack of testicular
the ejaculatory ducts. androgens.
Urethra •The pre-prostatic, prostatic and •Urethra is formed
membranous urethra is formed from the pelvic part of
from the pelvic part of the the urogenital sinus
urogenital sinus.
•The spongy urethra is formed
from the phallic part of the
urogenital sinus.
Gastrointestinal System
GastroIntestinal
• Sebagai akibat pelipatan mudigah ke sefalokaudal dan lateral,
sebagian rongga yolk sac yang dilapisi endoderm masuk ke mudigah
untuk membentuk usus primitif. Dua bagian rongga yang dilapisi
endoderm lainnya, yolk sac dan alantois, tetap berada di luar
mudigah
• Di bagian sefalik dan kaudal mudigah, usus primitif membentuk
tabung buntu, usus depan dan usus belakang. Bagian tengah, usus
tengah, tetap terhubung dengan yolk sac untuk sementara melalui
duktus vitelinus, atau yolk stalk
• Usus depan muncul cekungan yang terdiri dari ektodem →
stomodeum → rongga mulut
• membrana orofaring : membran yang memisahkan usus depan dari
stomoideum → akan pecah di minggu ke-4

• Usus belakang muncul cekungan yang terdiri dari ektoderm →

porktodeum → anus
• Membran kloaka : membran yang memisahkan usus belakang dari
proktodeum → akan pecah di minggu ke-7
Foregut → faring, esofagus, lambung dan sebagian duodenum

Midgut → sebagian duodenum, jejunum, ileum dan sebagian usus

besar (sekum, appendix, kolon asendens dan sebagian kolon
transversum)

Hindgut → usus besar sisanya

Daftar Pustaka
• Langman Embryologi
• http://teachmeanatomy.info/the-basics/embryology