Prenatal Growth and Development

P R E N ATA L
GROWTH AND
DEVELOPMENT
PA RT- 1
INDEX
INTRODUCTION
DEFINITION
PRE-NATAL GROWTH & DEVELOPMENT
PERIOD OF OVUM
PERIOD OF EMBRYO
PERIOD OF FOETUS
PHARYNGEAL ARCHES
PHARYNGEAL POUCHES
DEVELOPMENT OF SKULL
DEVELOPMENT OF FACE
DEVELOPMENT OF MAXILLA
DEVELOPMENT OF MANDIBLE
DEVELOPMENT OF TONGUE
DEVELOPMENT OF DENTITION
DEVELOPMENTAL ANOMALIES
CONCLUSION
REFERENCES
INTRODUCTION
• Every individual spends the first nine months (266 days

or 38 weeks to be exact) of its life within the uterus of its
mother.
• During this period it develops from a small one celled

structure to an organism having billions of cells.
• Numerous tissues and organs are formed and come to

function in perfect harmony.
INDERBIR SINGH , GP PAL . HUMAN EMBRYOLOGY , 8th EDITION MACMILLAN ,

2011. CHAPTER 1
• Embryology -It is the study of the formation and
development of embryo (or foetus) from the moment of
its inception up to the time when it is born as an infant.
• The most spectacular changes occur in the first 2 months,

the unborn baby acquires its main organs and just begins
to be recognizable as human.
• During these 2 months we call the developing individual

as embryo. From third month until birth it is called
foetus
Period of ovum
(1- 14th day)
Period of embryo
PRENATAL
(14- 56th day)
Growth and
development
Period of foetus
POST NATAL
(56- 270th day)
SRIDHAR PREMKUMAR. TEXTBOOK OF CRANIOFACIAL GROWTH, 1ST EDITION,

JAYPEE PUBLISHERS,2011. CHAPTER 3
Schematized synopsis of salient features of general embryology.
SPERBER, GEOFFREY F. CRANIOFACIAL EMBRYOLOGY, 3RD EDITION,

BUTTERWORTH- HEINEMANN Ltd, 1999,CHAPTER 2
PERIOD OF OVUM
T.W. SADLER. LANGMAN’S MEDICAL EMBRYOLOGY, 13TH EDITION,

WOLTERS KLUWER INDIA PVT. LTD. 2015, CHAPTER 2
FERTILIZATION
• Fertilization, the process by which male and female

gametes fuse -- occurs in the ampullary region of uterine
tube.
• This is the widest part of the tube and is located close to

ovary.
• Spermatozoa and the oocyte remain viable in the female

reproductive tract for approximately 24 hours.

2011. CHAPTER 4
• In humans, both the head and tail of the spermatozoan
enter the cytoplasm of the oocyte, but the plasma
membrane of the spermatozoa is left behind on the
oocyte surface
• the spermatozoan has entered the oocyte, the egg
responds in three different ways:
1. Cortical and zona reactions - As a result of the
release of cortical oocyte granules containing lysosomal
enzymes:-
Oocyte membrane becomes impenetrable to other
spermatozoa.
Zona pellucida alters its structure and composition
to prevent sperm binding.
2. Resumption of 2nd meiotic division - the oocyte finishes
its 2nd meiotic division immediately after entry of
spermatozoa.
3. Metabolic activation of egg - the activation factor is

probably carried by the spermatozoa.
The main results of fertilization are : -
• Restoration of diploid number of chromosomes
• Determination of sex of new individual.
• Initiation of cleavage
• It fosters genetic variation.
• Division of the fertilized ovum in to several cells for e.g.,

2 celled stage, 3 celled stage, 4 celled stage, 8 celled
stage, morula (16 celled stage)
FORMATION OF MORULA
A . 2 CELL STAGE
B. 3 CELL STAGE
C. 4 CELL STAGE
D. MORULA

2011. CHAPTER 4
MORULA
• As cleavage proceeds the ovum reaches 16 celled stage

• Looks like a mulberry and called as morula
• Still surrounded by Zona pellucida
• On CS, consist of Inner cell mass called as embryoblast
as it give rise to embryo proper.
• Outer rim of cells are called as trophoblast
• Cells of trophoblast helps to provide nutrition to the
embryo
FUNCTION OF ZONA PELLUCIDA
• Trophoblast has the property to stick to uterine epithelium
and its cells has capacity to “eat up” other cells.
• Zona pellucida helps in preventing implantation of

embryo in abnormal location
• Zona pellucida disappears as soon as the morula reaches

the uterine lumen
• Thus embryo gets implanted in lateral wall of uterus

2011. CHAPTER 4
FORMATION OF BLASTOCYST
• Some fluid passes into morula from uterine cavity-
partially separating the inner cell mass (embryoblast) and
outer cell mass (trophoblast)
• As the fluid quantity increases it acquires the shape of a

cyst
• Trophoblast cells become flattened and embryoblast cells

get attached to its one side
• Now it is called blastocyst and cavity is called blastocoele
• The site of attachment of inner cell mass is called

embryonic or animal pole and opposite site is the
abembryonic pole
2011. CHAPTER 4
FORMATION OF GERM LAYERS
o At a every early stage in development, the embryo proper

acquires the form of a 3 layered disc- embryonic disc.
o 3 layers: Endoderm, Ectoderm, Mesoderm.
o Some cells of inner cell mass differentiate into flattened
cells that come to line its free surface, these constitute
Endoderm
o Endoderm is the first of the three germ layers to be
formed
o Remaining cells of inner cell mass become columnar.
These cells form the second germ layer the ectoderm. The
embryo is now in the form of disc having 2 layers
2011. CHAPTER 4
-A space appears b/w the
ectoderm (below) &
trophoblast (above)
called amniotic cavity
which is filled by
amniotic fluid or liquor
amnii.
-Roof formed by
aminogenic cells
(trophoblast), floor- by
ectoderm
Primary yolk sac- cells

from endoderm-lining
cells (heusers
membrane)- a cavity line
by endodermal cells
from all sides.
Extra embryonic mesoderm/ primary
mesoderm- orginated from trophoblast-
btw trophoblast and endodermal cells
lining primary yolk sac- separate wall of
amniotic cavity from trophoblast
Extra embryonic coelom/chorionic

cavity- cavities in primary mesoderm-
join together to form a large cavity-
then primary mesoderm splits to 2- part
lining inside of trophoblast and outside
of amniotic cavity – parietal/
somatopleuric extra embryonic
mesoderm- lining outside yolk sac
visceral/ splanchnopleuric extra
embryonic mesoderm
HUMAN BLASTOCYST OF 12 DAYS
T.W. SADLER. LANGMAN’S MEDICAL EMBRYOLOGY, 13TH

EDITION, WOLTERS KLUWER INDIA PVT. LTD. 2015, CHAPTER 2
Connecting stalk- extra embryonic
coelom not extend to extra embryonic
membrane where amniotic cavity
attaches to trophoblast- in developing
embryo now its only attached in this un
split area.
Formation of Chorion and Amnion- 2

important membranes-
1. Parietal extra embryonic membrane +
trophoblast- Chorion
2. Aminogenic cells excluding
ectodermal floor- Amnion

2011. CHAPTER 4
Secondary yolk sac- with
appearance of extra embryonic
mesoderm and coelom- yolk sac
becomes smaller change in nature of
lining cells (flattened cuboidal)
-This stage embryoper proper-
circular disc 2 layers of cells-
upper layer ectoderm(columnar)
This stage, embryo proper- circular

disc 2 layers of cells- upper layer
ectoderm(columnar)- lower layer
(cubical cells)endoderm
Prochordal plate- 1 circular area
near the margin of disc-
endodermal cuboidal columnar
cells.
-Appearance determines the central
axis of the embryo
-Helps to distinguish future head
and tail ends
Primitive streak- after Prochordal

plate formation- Ectodermal cells
along central axis- near tail end-
proliferate – elevation into amniotic
cavity-1st rounded/ oval swelling- with
enlongation of embryonic disc- linear
structure- central axis of the disc.
-Intra embryonic mesoderm-
proliferation of cells sideways to
primitive streak-pushing between
ectoderm and endoderm- 3rd germ
layer
-Gastrulation- primitive streak +
intra embryonic membrane by that
Cloacal membrane- some intra

embryonic membrane from
primitive streak passes to
connecting stalk- area caudal to it
where ectoderm and endoderm
remain contact- region is similar to
Prochordal plate
GERM DISC AT THE END OF SECOND WEEK

GERM DISC AT THE 16 TH DAY

TIME TABLE OF EVENTS IN PERIOD
OF OVUM
• Fertilization to formation of bilaminar disc is called pre-

organogenesis period( 1 – 14 days).
AGE (IN DAYS) DEVELOPMENTAL EVENTS

2 Embryo in 2 cell stage
3 Morula formed
4 Blastocyst formed
8 Bilaminar disc is formed
14 Prochordal plate + primitive streak
16 Intraembryonic mesoderm/ disc 3
layered

2011. CHAPTER 4
PERIOD OF EMBRYO
INDERBIR SINGH , GP PAL . HUMAN EMBRYOLOGY , 8th EDITION

MACMILLAN , 2011. CHAPTER 5
FORMATION OF NOTOCHORD
• It’s a midline structure.
• Develops from cranial end of
primitive streak to caudal end
of Prochordal plate Passes
through various stages
• Primitive Knot/primitive
node/Henson’s node (A)
• Blastopore (B)
• Notochordal process/head
process (C)
• Does not give rise to vertebral column but lies in its future
position
• Most of it disappears but parts of it persist in the region of

each intervertebral disc as the nucleus pulposus
PROCESS OF FORMATION OF
NOTOCHORD
FORMATION OF NEURAL TUBE
• Give rise to brain and spinal cord.

• Formed from ectoderm over notochord
• Extends from prochordal plate to primitive knot
• Divisible into cranial enlarged part which forms brain and
caudal tubular part which forms spinal cord
• The process of formation is called neurulation

2011. CHAPTER 5
Sub-divisions of intra embryonic mesoderm
• Paraxial mesoderm
• Lateral plate mesoderm
• Intermediate mesoderm
FORMATION OF THE INTRA-
EMBRYONIC COELOM
• Forms by appearance of cavities in lateral plate mesoderm

• With the formation of intra-embryonic coelom lateral plate
mesoderm splits in to
1. Somatopleuric/parietal, intra embryonic
mesoderm (contact with ectoderm)
2. Splanchnopleuric/visceral intra embryonic
mesoderm (contact with endoderm)
• Intra embryonic coelom gives rise to pericardial, pleural &
peritoneal cavities
• Heart forms from splanchanopleuric mesoderm forming
floor of this part of the coelom
2011. CHAPTER 5
NEURAL CREST CELLS
• Forms from neuro ectoderm
• Migrate & differentiate extensively with in the developing

embryo
• Spinal & cranial sensory ganglia, Sympathetic neurons,

Schwann cells, pigment cells & meninges
• Most of the connective tissue of the head is formed
• Migration is essential for development of teeth & face
• All the tissues of teeth (except enamel) & its supporting

apparatus are derived directly from these cells
FOETAL PERIOD
• The period from the beginning of the ninth week to birth is

known as the fetal period.
• It is characterized by maturation of tissues and organs and

rapid growth of the body.
• The length of the fetus is usually indicated as Crown

Rump length (Sitting height) or Crown Heel length (CHL)
 measurement from vertex of the skull to the heel
(Standing length).

• Growth in length is particularly striking, during 3rd, 4th, 5th
months, while increasing weight is most striking during
last 2 months of gestation.
• During 3rd month face become more human looking
• Primary ossification centres are present in the long bones

and skull by 12th week.
• During 5th month, movements of fetus are clearly

recognized.
• During 6th month, skin of the fetus is reddish and has
wrinkled appearance due to lack of underlying connective
tissue.
• During last two months, the fetus obtains well rounded

contours as a result of deposition of subcutaneous fat.
• At the time of birth, weight of the fetus is 3000-3400gm.
• CRL about 36cm
• CHL about 50cm

A 7-month-old fetus. This fetus would be able to survive. It has well-
rounded contours as a result of deposition of subcutaneous fat. Note the
twisting of the umbilical cord.
PHARYNGEAL (BRANCHIAL)
ARCHES
• Separate primitive stomatodeum from the developing
heart.
• Formed by proliferating lateral plate mesoderm

sandwiched b/w ectoderm & endoderm bilaterally.
• Later reinforced by neural crest cells
• 6 cylindrical thickenings thus form, but 5th disappears as

soon as it is formed

• Separated externally by small clefts called branchial
grooves (Ectodermal clefts).
• On the inner aspect of pharyngeal wall are corresponding

small depressions called pharyngeal pouches.
• In aquatic vertebrates both branchial grooves &

pharyngeal pouches fuse to form gill slits.
FORMATION
A. Pharyngeal arches. Each arch contains a cartilaginous
component, a cranial nerve, an artery, and a muscular component
DERIVATIVES OF
PHARYNGEAL ARCHES

Arch Nerve of the Muscles of the arch
arch
First Maxillary and Mastication- Medial & lateral
(Mandib mandibular pterygoids, Masseter, Temporalis,
ular divisions Mylohyoid, ant belly of digastric,
arch) (Trigeminal) tensor tympani, tensor palati
V th nerve
Second Facial Muscles of face, Occipito-frontalis,
(Hyoid VII th nerve platysma, Stylohyoid, Posterior belly
arch) of digastric, Stapedius, Auricular
muscles
Third Glossopharyngeal, Stylopharyngeus
IX th nerve
Fourth Superior Muscles of Pharynx & larynx

Laryngeal
Sixth Recurrent Muscles of Pharynx & larynx
laryngeal
Trigeminal ganglion
Facial nerve
Ophthalmic
branch Vagus
nerve V nerve
Maxillary
branch
nerve V Mandibular branch
Glossopharyngeal
nerve V
nerve

DERIVATIVES OF ARCH
CARTILAGES
Arch Derivatives
Cartilage
1st arch Mallus, Incus, Anterior ligament for mallus,
(Meckel’s spenomandibular ligament & lays down the
cartilage) meshwork for formation of mandible & some part
of it may be included in mandible
2nd arch Stapes, Styloid process, stylohyoid ligament,
(Reichert’s smaller (lesser) cornu of hyoid bone, superior part
cartilage) of body of hyoid bone(S5)
3rd arch Greater cornu of hyoid bone, lower part of the
body of hyoid bone
4th & 6th arch Cartilages of larynx, controversial, may have
contribution from 5th arch
2011. CHAPTER 9
FATE OF GROOVES & POUCHES
• First groove & pouch form external auditory meatus,

tympanic membrane, tympanic antrum, mastoid antrum &
pharyngotympanic/ eustachian tube
• 2nd arch cleft grows much faster than the succeeding

arches & comes to over hang them. The space b/w the
overhanging 2nd arch & 3rd, 4th & 6th is called cervical
sinus

2011. CHAPTER 9
• Cavity of the cervical sinus is normally obliterated but part
of it may persist and give rise to swelling in the neck along
the anterior border of the sternocleidomastoid these are
called branchial cysts & most commonly they are located
below the angle of mandible
• If the cyst opens on to the surface it is called branchial

sinus
• Rarely cervical sinus may open in to the lumen of the

pharynx in the region of tonsil.
ENDODERMAL POUCHES
1ST POUCH:
• Its ventral part is obliterated by the formation of tongue
• Dorsal part along with the dorsal part of 2nd pouch form
tubotympanic recess, auditory (pharyngotympanic) tube,
middle ear cavity including tympanic antrum
2ND POUCH:
• Epithelium of ventral part gives palatine tonsil
• Dorsal part takes part in the formation of tubotympanic

recess

2011. CHAPTER 9
3RD POUCH:
• Inferior parathyroid glands
• Thymus
4TH POUCH:
• Superior parathyroid glands
• Contributes to thyroid gland
5TH POUCH:
• Forms ultimobranchial body in some species
• In humans believed to be incorporated in 4th pouch giving
rise to caudal pharyngeal complex, which gives rise to
superior parathyroid glands and parafollicular cells of
thyroid
Pharyngeal pouches as out pocketings of the foregut and the
primordium of the thyroid gland and aortic arches.

2011. CHAPTER 9
• Dual nerve supply to 1st arch, post-trematic
mandibular & pre-trematic chorda tympani (facial).
• Dual innervation reflected in ant 2/
3 of tongue
derived from ventral part of 1st arch.

2011. CHAPTER 9
SOMITOMERES
• Recent investigations suggest the mesenchyme giving

rise to the muscles of the pharyngeal arches is derived
from paraxial mesoderm of cranial occipital somites.
• Its organization is influenced by neural crest cells.
• Paraxial mesoderm forms 7 masses of mesenchyme

called somitomeres.

2011. CHAPTER 9
Somitomere 1 & 2 Muscles supplied by occlomotor nerve
Somitomere 3 Superior oblique muscle supplied by

trochlear nerve
Somitomere 4 Muscles of 1st pharyngeal arch supplied by
mandibular nerve
Somitomere 5 Lateral rectus muscle supplied by
abducent nerve
Somitomere 6 Muscles of 2nd pharyngeal arch supplied
by facial nerve
Somitomere 7 Stylopharyngeus (3rd arch) Supplied by
glossopharyngeal nerve
Occipital somites 1 & Laryngeal muscles (4th to 6th arches)
2 supplied by vagus nerve
Occipital somites 3 to Muscles of the tongue supplied by
5 hypoglossal nerve
MYOTOME
• In cervical, thoracic, lumbar & sacral regions one spinal

nerve innervate the myotome
• The no. of somites formed in these regions corresponds to

no. of spinal nerves
• In coccygeal region the number of somites exceed the

number of spinal nerves but many of them subsequently
degenerate.

2011. CHAPTER 7
• The first cervical somite is not the most cranial somite to
be formed , cranial to it there are Occipital somites & pre-
occipital somites (pre-optic)
• Pre- optic Somites are supplied by 3rd, 4th & 6th cranial
nerves
• Occipital somites (4 to 5)- muscles of tongue- supplied by

hypoglossal nerve.
DEVELOPMENT OF SKULL
• The skull develops from para-axial mesoderm forms,

tissue blocks called somitomers in head region and somites
from occipital region caudally.
• Somities differentiate into ventromedial called sclerotome

and a dorsolateral part gives dermatomyotome.
• Sclerotome gives rise to mesenchyme or embryonic

connective tissue.

Bones of the skull of a 3-month-old fetus showing
the spread of bone spicules from primary
ossification centers in the flat bones of the skull
• Development of skull can be divided into two parts.
• forms the
VISCEROCRANIUM skeleton of the
face
• forms protective
NEUROCRANIUM case around the
brain
• Approximately 110 ossification centres appear in

embryonic human skull gives rise to 45 separate
bones.
NEUROCRANIUM:
Divided into two portions.
• Membranous part - flat bones which surrounded the brain as a

vault.
• Cartilagenous part / chondrocranium- the bones of the base of

the skull
Membranous Neurocranium
• Roof and most of the sides develops from neural crest cells,
with only occipital region and posterior part of the otic
capsule arising from para-axial mesoderm.
.
WOLTERS KLUWER INDIA PVT. LTD. 2015, CHAPTER 8.
• Mesenchyme from neural crest cells and para-axial
mesoderm invests the brain and undergoes membranous
ossification
• Membranous bone are formed that are characterized by the

presence of needle like bone spicules.
• These spicules radiate to form primary ossification centres

towards the periphery.
• Further growth during fetal postnatal life, membranous

bones enlarge by apposition of new layers, on outer
surface and simultaneous osteoclastic resorption from the
inside.
CHONDROCRANIUM
• Chondrocranium initially consists of number of separate
cartilages.
• Pituitary in the sella turcianeural crest cells and from

prechondral chondrocranium.
• The base of the occipital bone parachondrial cartilage

and bodies of three occipital sclerotome.
• Hypophyseal cartilage + trabeculae carnii  body of the

sphenoid and ethmoid respectively.
• 3rd component, the periotic capsule petrous and mastoid

parts of temporal bone.
VISCEROCRANIUM (FACIAL
SKELETON)
• Formed from first two pharyngeal arches
• 1st arch gives rise to two portions
• Maxilla
Dorsal portion
• Zygomatic bone
Maxillary • Part of temporal
process bone.
Ventral portion
• Meckel’s cartilage
Mandibular
process

• Mesenchyme around the Meckel’s cartilage condenses and
ossifies by membranous ossification Mandible
• It disappears and except in sphenomandibular ligament.
Lateral view of the head and neck region of an older fetus,
showing derivatives of the arch cartilages participating in
formation of bones of the face.
FORMATION OF FACE
• At the end of the fourth week the facial prominences

consisting primarily of neural crest derived mesenchyme
and formed mainly by the first pair of arches appear.
• Maxillary prominences can be distinguished lateral to the

stomodeum.
• Mandibular prominences can be distinguished caudal to

this structure.

• The frontonasal prominence formed by proliferation of
mesenchyme ventral to brain vesicles constitute upper
border of the stomodeum.
• On both sides of frontonasal prominences local

thickenings of the surface ectoderm nasal or olfactory
placodes originate under inductive influence of the ventral
portion of the forebrain.
A B
C
T.W. SADLER. LANGMAN’S MEDICAL EMBRYOLOGY, 13TH EDITION, WOLTERS KLUWER
Frontonasal
prominence
Nasal
pit Eye Nasal pit
Maxillary
prominence Lateral nasal
prominence
Mandibular
prominence Nasolacrimal Medial nasal
groove prominence
Stomodeum
• The nose is formed from five facial prominences
2 medial nasal
Frontal prominences
prominence bridge merged crest and
tip
2 lateral nasal
prominences sides
(alae)

Lateral nasal
prominence
Medial nasal
prominence Eye
Maxillary
prominence
Nasolacrimal
Mandibular
groove
prominence Philtrum
A B
C
INTERMAXILLARY SEGMENT
• Medial growth of the maxillary prominences, the two

medial nasal prominences merge not only at the surface but
also at a deeper level.
• The structure formed by the two merged prominences is
the intermaxillary segment.
• It is composed of
(a) a labial component philtrum of the upper lip
(b) an upper jaw component which carries the four
incisor teeth
(c) a palatal component  triangular primary palate

• . The intermaxillary segment is continuous with the rostral
portion of the nasal septum, which is formed by the
frontal prominence
A. Intermaxillary segment and maxillary processes.

B. The intermaxillary segment giving rise to the philtrum of the upper
lip, the median part of the maxillary bone with its four incisor teeth, and
the triangular primary palate.
SECONDARY PALATE
• The primary palate is derived from the intermaxillary

segment
• Main part of the definitive palate is formed by two shelf
like outgrowths from the maxillary prominences.
• The palatine shelves, appear in the sixth week of
development and are directed obliquely downward on each
side of the tongue.
• In the seventh week the palatine shelves ascend to attain
a horizontal position above the tongue and fuse, forming
the secondary palate.
• Anteriorly the
shelves fuse with
the triangular
primary palate
• Incisive foramen
is the midline
landmark between
A B
the primary and
secondary palates.
• Palatine shelves
fuse the nasal
septum grows
down and joins
with the cephalic
aspect of the newly
formed palate C
FUSION:
• For the fusion of the shelves to occur elimination of the

epithelial covering is necessary.
• DNA synthesis ceases some 24-36 hrs before the epithelial

contact.
• Surface epithelial cells are sloughed off leading to the

exposure of basal epithelial cells

• These cells are carbohydrate rich that permits ready
adhesion & formation of junctions to achieve fusion of
process leading to formation of midline seam
• To achieve ectomesenchymal continuity this seam must be

removed this is achieved by growth of palatal shelves with
which it fails to keep pace with, it is reduced to islands,
later looses basal lamina & they transform into fibroblasts

STRUCTURES CONTRIBUTING
TO FORMATION OF FACE
• PROMINENCE Structures formed
Frontonasal Forehead, bridge of nose, medial and
(single) lateral nasal prominences.
Maxillary Cheeks, lateral portion of upper lip
Medial nasal Philtrum of upper lip,crest and tip of

nose
Lateral nasal Alae of nose
Mandibular Lower lip
DEVELOPMENT OF TONGUE
• Starts to develop at about 4 weeks IU
• Tuberculum impar in center & 2 lateral lingual swellings

unite to form mucous membrane of anterior 2/3 of tongue
• Mucosa on root (posterior 1/3) of the tongue is formed by

hypobranchial eminence (copula) which is derived from
3rd arch which overgrows second arch
• Mucosa on posterior most part of the tongue is derived

from 4th arch
• The muscles of the tongue arise from occipital myotomes

which have nerve supply from hypoglossal nerve (XII
cranial nerve)
T.W. SADLER. LANGMAN’S MEDICAL EMBRYOLOGY, 13 EDITION, WOLTERS KLUWER INDIA
TH
PVT. LTD. 2015, CHAPTER 15.

VISHRAM SINGH. TEXTBOOK OF CLINICAL EMBRYOLOGY,1ST EDITION,
ELSEVIER 2012. CHAPTER 11.
NERVE SUPPLY OF TONGUE
Sensory:
• Anterior 2/3 Chorda tympani (through lingual branch of
mandibular nerve)
• Posterior 1/3 glossopharyngeal nerve
• Posterior superior laryngeal (branch of vagus)
Motor:
• Hypoglossal nerve

ANOMALIES OF TONGUE
• Microglossia, macroglossia, aglossia

• Bifid tongue (non fusion of lingual swellings)
• Ankyloglossia/tongue tie, Ankyloglossia superior
• Median rhomboid glossitis (persistance of Tuberculum
impar in front of foramen caecum)
• Lingual thyroid (sub-mucosal, intra-muscular)
• Remnants of thyroglossal duct may form cysts at the base
of tongue
• Fissured/scrotal tongue
SHAFER, HINE,LEVY. TEXTBOOK OF ORAL PATHOLOGY, 7TH EDITION,ELSEVIER

2012. CHAPTER 1
Large fissured tongue. Bifidness of the tip of tongue.
Cleft tongue
Macroglossia
Congenital and Acquired

 Congenital- Haemangioma, lymphangioma, Down
syndrome, Beckwith- Weidman syndrome
 Acquired- Hypothyroidism, Cretinism,
Hypertrophy, Acromegaly
Congenital short lingual
frenum of the tongue with
microglossia
Median rhomboid glossitis.

Congenital short lingual
frenum of the tongue with
microglossia
The lingual thyroid is an anomalous condition in

which follicles of thyroid tissue are found in the
substance of the tongue, possibly arising from a
thyroid anlage that failed to ‘migrate’ to its
predestined position or from anlage remnants
that became detached and were left behind.
DEVELOPMENT OF MANDIBLE
• Develops from the mandibular process of 1st branchial
arch.
• The cartilage of the 1st arch (Meckle’s cartilage) forms

lower jaw in the primitive vertebrates.
• In human beings Meckle’s cartilage has close positional

relationship to the developing mandible but makes no
contribution to it.
• The mandibular nerve has close relationship to the

Meckel’s cartilage, beginning 2/3 of the way along the
length of cartilage At this point mandibular nerve divides
in to lingual and inferior alveolar branches

• These nerves run in medial & lateral to the meckel’s
cartilage
• Inferior alveolar nerve further divides into incisor &

mental branches
• On the lateral aspect of Meckel’s cartilage, during the 6th

week of the embryonic development a condensation of
mesenchyme occurs in the angle formed by the division of
inferior alveolar nerve & its incisor & mental branches.
Development of mandible. Site of initial
osteogenesis related to mandible
• At 7 weeks intramembranous ossification begins in its
condensation forming the 1st bone of the mandible
• Bone formation spreads anteriorly towards midline &

posteriorly towards the point where mandiular nerve
divides into lingual & inferior alveolar
• This spread of new bone formation occurs anteriorly along

the lateral aspect of the meckel’s cartilage forming a
trough that consists of lateral & medial plates that unite
beneath the incisor nerve
• The trough of bone extends anteriorly to meet adjoining
one, the 2 separate ossification centers remain separated at
the mandibular symphysis until shortly after birth.
• The trough is soon converted into a canal as bone forms

over the nerve, joining the lateral & medial plates.
• Backward extension of ossification along the lateral aspect

of the Meckel’s cartilage forms a gutter later converted
into a canal that contains the inferior alveolar nerve.
• The ramus of the mandible develops by a rapid spread of
ossification posteriorly into the mesenchyme of the of the
1st arch, turning away from Meckel’s cartilage.
• This point of divergence is marked by the lingula in the

adult mandible, the point at which the inferior alveolar
nerve enters the body of mandible.
• Thus by 10 weeks rudimentary mandible is formed almost

entirely by membranous ossification with little direct
involvement of Meckel’s cartilage.
FATE OF MECKEL’S CARTILAGE
• Posterior extremity forms malleus, incus &

sphenomandibular ligament.
• Most of the cartilage is absorbed except for some portion

in midline which may cause endochondrial ossification.

• Further growth of the mandible until birth is influenced by
the appearance of 3 secondary cartilages (condylar,
coronoid, symphyseal cartilages) & development of
muscular attachments
• Condylar cartilage appears at 12th week of development
• Coronoid process appears at about 4 months IU
• The symphyseal cartilages 2 in number appear in

connective tissue b/w the two ends of Meckel’s cartilage
but are entirely independent of it, they are obliterated with
in the 1st year of the birth.
Thus mandible is membrane bone developed in
relation to the nerve of the 1 st arch & almost
independent of Meckel's cartilage. the mandible
has neural, alveolar & muscular elements & its
growth is assisted by the development of
secondary cartilages
DEVELOPMENT OF
MAXILLA
• Maxilla develops from a center of ossification in
mesenchyme of maxillary process of 1st arch which is
associated closely with cartilage of nasal capsule.
• As in the mandible the center of ossification appears in

the angle b/w the divisions of the nerve (i.e., where the
anterior superior dental nerve is given off from the
inferior orbital nerve)
• From this center bone formation spreads posteriorly

below the orbit toward the developing zygoma &
anteriorly toward the future incisor region ossification
also spreads toward the frontal process
• As a result of this pattern of bone deposition a bony trough
forms for the infra orbital nerve
• From this trough a bony downward extension of bone
forms the lateral alveolar plate for the maxillary tooth
germs
• Ossification also spreads in to the palatine process to form
the hard palate
• The medial alveolar plate develops from the junction of
the palatal process & main body of the forming maxilla
• This plate together with its lateral counterpart forms a
trough of bone around the maxillary tooth germs, which
eventually become enclosed in bony crypts.
• A secondary cartilage also contributes to the development
of maxilla, zygomatic/malar cartilage
• At birth the frontal process of maxilla is well marked but

body consists little more than alveolar process containing
tooth germs & small zygomatic & palatal process
• Maxillary sinus develops around 16th week of IUL. At

birth the sinus is still rudimentary in the size of small pea

COMMON FEATURES OF JAW
DEVELOPMENT
• Both begin from a single center of ossification related to

the nerve & to a primary cartilage
• Both form a neural element related to the nerve
• Both develop an alveolar element related to the developing

teeth
• Both develop secondary cartilages to assist in their growth

DEVELOPMENT OF TMJ
The temporomandibular joint is a secondary development

in both evolutionary (phylogenetic) and embryological
(ontogenetic) history.
The joint between the malleus and incus that develops at
the dorsal end of Meckel’s cartilage is phylogenetically the
primary jaw joint and is homologous with the jaw Joint of
reptiles.
With both evolutionary and embryological development of
the middle-ear chamber, this primary Meckel’s joint loses
its association with the mandible, reflecting the adaption of
the bones of the primitive jaw joint to sound conduction.
HOW IS DEVELOPMENT OF TMJ
DIFFERENT?
Most synovial joints complete the development of their

initial cavity by the 7th week post conception, but the
temporomandibular joint does not start to appear until this
time.
In contrast to other synovial joints, fibrous cartilage (rather
than hyaline cartilage) forms on the articular facets of the
temporal mandibular fossa and mandibular condyle.
SPERBER, GEOFFREY F. CRANIOFACIAL EMBRYOLOGY, 3RD EDITION,

BUTTERWORTH- HEINEMANN Ltd, 1999,CHAPTER 9
•At 6th week of intrauterine life, articular disc is one of
the 1st components of joint to become recognizable.
• Disc is a vague layer of mesenchyme stretching across
the upper end of the mandibular ramus.
•At 7th week, the meckel’s

cartilage extends all the way
from the chin to
the base of the skull.
•TEMPORARY
ARTICULATION
10th week
BLASTEMATA STAGE
the otic capsule, a component the secondary

of the basicranium that forms condylar cartilage
the petrous temporal bone of the mandible
TEMPORAL CONDYLAR
BLASTEMATA BLASTEMATA
TEMPOROMANDIBULAR
JOINT
12th week
CAVITATION STAGE
• Two slit like joint cavities & an intervening disc appear
1st cleft appears immediately above condylar blastema becomes

inferior joint cavity. The condylar blastema then differentiates
into condylar cartilage
2nd cleft appears in relation to the temporal ossification that

becomes the superior joint cavity.
With the appearance of this cleft, the primitive articular disk
is formed
16th week
MATURATION STAGE
Malleus & Incus begin Transformation into middle ear bones &
dissappearance of primary joint starts
18th-20th week-Secondary joint becomes
functional & Meckel’s Cartilage loses its
function & disappears
At 26th week, all components of T.M.J. are

present except for the articular eminence.
At 31st week, Meckel’s cartilage has been

transformed to anterior ligament of
malleus and sphenomandibular ligament.
At 39th week, ossification of the bones in

this region has proceeded to the point
where the ligament gains its apparent
attachment to spine of sphenoid.
SALIVARY GLAND
DEVELOPMENT
• Parotid & submandublar appear in connective tissue
around 6th week
• Sublingual in 8th week
• Development of major & minor salivary glands is same as

any other gland in the body
• Organization is completed by 3rd month & differentiation

of terminally located acinar cells & canalization of ducts
by 6th prenatal month
ROBERT E. MOYERS.HAND BOOK OF ORTHODONTICS, 4TH
EDITION, YEAR BOOK PUBLICATION,1988. CHAPTER 3
• The acini of the mucous glands become functional during
the 6th month, where as serous glands become functional
by birth
FORMATION OF TOOTH GERMS
• Duration about 37th day of development
• Odontogenic epithelium also develops on the lateral aspect

of the medial nasal process  primary epithelial band.
• Primary epithelial band gives rise to

- Vestibular Lamina
- Dental Lamina
G S KUMAR. ORBAN’S ORAL HISTOLOGY AND EMBRYOLOGY, 12TH

EDITION, MOSBY PUBLICATIONS,2010. CHAPTER 8
• The earliest histologic indication of tooth development is
at day 11 of embryogenesis,
• Which is marked by a thickening of the epithelium where
tooth formation will occur on the oral surface of the first
branchial arch.
• The earliest mesenchymal markers for tooth formation are
the Lim- homeobox domain genes,Lhx-6 and Lhx-7.
• Both of these genes are expressed in the neural crest
ectomesenchymal of the oral half of the first branchial arch
as day 9.
• A prime candidate for the induction of Lhx genes is Fgf-8;
• The Pax-9 gene is one of the earliest mesenchymal genes

that defines the localization of the tooth germs.
• Pax-9 gene
- induced by fgf-8
- represssed by Bmp-2,Bmp-4
• Physiological processes in tooth
formation
- initiation
- proliferation
-histodifferentiation
- morphodifferentiation
- apposition
- calcification
FORMATION OF PERMANENT
DENTITION
• The formation of another tooth bud on the lingual aspect of

the deciduous tooth germ, which remains dormant for some
time
• Backward extension of dental lamina posteriorly gives off

epithelial outgrowths that, together with the associated
ectomesenchymal response, form the tooth germs of the
first, second and third molars
G S KUMAR. ORBAN’S ORAL HISTOLOGY AND EMBRYOLOGY, 12TH

EDITION, MOSBY PUBLICATIONS,2010. CHAPTER 8
• Primary Dentition
- Between 6th to 8th week of I.U.L
• Permanent Dentition
- Successional permanent teeth
between 20 week in utero and the 10th month
after birth
- Permanent Molar
between 20th week in utero and the fifth year of life
ANOMALIES
1.ANODONTIA:
• The complete absence of tooth or teeth is called anodontia.
In this condition one or two teeth may be absent.
2. SUPERNUMERARY TEETH (EXTRA TEETH):
• The extra tooth may be located posterior to normal teeth or
wedged between the normal teeth disrupting positions of
the teeth. The alignment of upper and lower teeth may be
improper (malocclusion). Sometimes the total number of
teeth may be even less.
3.NATAL TEETH (eruption of teeth before birth):
• Sometimes teeth are already erupted at the time of birth.
These are called natal teeth. Such teeth may cause injuries
to nipple during breast feeding.
4. FUSED TEETH:
• This condition occurs when a tooth bud divides or two
tooth buds partially fuse with each other.
5. IMPACTION OF TOOTH:
• In this condition there is a delay in the eruption of tooth. It
commonly involves last (third) molar tooth.
6. ANOMALIES OF ENAMEL FORMATION
(a) The defective enamel formation may cause pits or
fissures on the surface of the enamel of the tooth.
(b) The enamel may be soft and friable, if there is
hypocalcification. The enamel appears yellow or brown in
color (amelogenesis imperfecta). This condition is often
caused by vitamin D deficiency (rickets).
7. DENTINOGENESIS IMPERFECTA:
• It is an autosomal dominant genetic anomaly with a
genetic defect located in most cases on chromosome 4q. In
this, the teeth are brown or gray in color. Enamel wears
down easily; as a result the dentin is exposed on the
surface.
8. DISCOLORATION OF TEETH:
• If infants and children are given tetracyclines, it is
incorporated into the developing enamel causing yellow
discoloration of teeth (both deciduous and permanent).
9. DENTIGEROUS CYST:
• It is a cyst within mandible or maxilla and contains
unerupted permanent tooth.
DEVELOPMENTAL ANOMALIES
• Teratology is the study of developmental anomalies.

• Anomalies divided into
Malformation(abnormal development)
Deformation (mechanical constraints)
Disruption (frustrated development)

According to Proffit, development is divided into five
principle stages
1. Germ layer formation and initial organization of
craniofacial structures
2. Neural tube formation
3. Origin, migration, and interaction of neural crest cells
4. Formation of organ system especially the pharyngeal
arches and the primary and secondary palate.
5. Final differentiation of tissue (skeletal, muscular, and
neuron elements)
WILLAM. R. PROFFIT. CONTEMPORARY ORTHODONTICS, 6TH EDITION, ELSEVIER,Inc.

2019, CHAPTER 3
FETAL ALCOHOL SYNDROME
(FAS)
• This is due to the deficiency of midline tissue of the neural

plate very early in the embryonic development caused by
high exposure of ethanol by the mother.
• This is occurred in the 4th week of development.
• FAS does not kill the embryo but stunts its repair
potential.

2019, CHAPTER 5
NEURAL TUBE FORMATION
DEFECTS
Acephaly absence of head.

Anencephaly absence of brain.
Acrania absence of skull.
Acalvaria absence of roof of skull.
Holoprosencephaly is due to failure of normal
telencephalic cleavage of the fore brain into bilateral
cerebral hemisphere.

NEURAL CREST CELL
MIGRATION DEFECTS
This will cause the mesenchymal tissue deficiency in the
developmental process of cranio-facial structures.
i. Manibulofacial dysostosis (Treacher
collins syndrome)
ii. Hemifacial microsomia (Goldenhars
syndrome)
iii. Agnathia
iv. Micrognathia (Pierre robin syndrome)

v. Facial clefts (cleft lip)
vi. Drugs affecting neural crest cell migration
i.e, thalidomide and isotretinoin
vii. Ethmocephaly
A generalized lack of
mesenchymal tissue in the
lateral
B
part of the face is
A
the major cause of the
characteristic facial
appearance.
WILLAM. R. PROFFIT.
CONTEMPORARY ORTHODONTICS,
6TH EDITION, ELSEVIER,Inc. 2019,
C D CHAPTER 5
• In craniofacial microsomia,
both the external ear and the
mandibular ramus are deficient
or absent on the affected side.
• In this patient with a relatively

mild problem, note the use of the
hairstyle to conceal the ear and
short ramus on the affected side.

2019, CHAPTER 5
• Agnathia means absence of mandible.
• Pierre robin syndrome has main clinical
features of
- Micrognathia
- Macroglossia
- Cleft palate

FACIAL CLEFT :
• It is usually a result of deficiency of mesenchyme in the

facial region, caused by failure of the neural crest cell to
migrate.
• The drug like thalidomide and isotretinoin (vit-A

derivative) causes severe facial malformation due to
impairment of neural crest cell migration and formation.
A B C
E F.
D

ETHMOCEPHALY
This is resulting due to deficiency of anterior facial defect

having both brain tissue and nasal deficiency.
this is classified into two types
A. Ethmocephaly simplex
B. Ethmocephaly complex

Ethmocephaly complex with Ethmocephaly simplex
lack of development of showing a midline cleft lip
anterior brain, nasal and mid and nose
lip tissue
DEVELOPMENTAL CYST
Developmental cyst arise along the lines of facial and palatal

surface due to the epithelial residues merge in the
subjacent mesenchyme during merging.
a. Nasolabial cyst
b. Globulomaxillary cyst
c. Median mandibular cyst
d. Epstein pearl
e. Bohns nodules

NASOLABIAL CYST :
• It is formed in the junction of globular process, the lateral
nasal process and the maxillary process as a result of
proliferation of entrapped epithelial along the fusion line.
GLOBULOMAXILLARY CYST :
• This is formed within the bone at the junction of globular
portion of the median nasal process and the maxillary
process.
• This is found in between lateral incisor and canine of
maxillary arch.
Globulomaxillary cyst In between lateral
incisor and canine teeth of maxilla
MEDIAN PALATAL CYST :
Epithelial entrapment along the line of fusion of the
palatal process of maxilla.
EPSTEIN PEARL :
This is a alveolar cyst formed along the midline in the
median raphae of the palate.
BOHN’S NODULE :
This is developed from the palatal gland structure and
were scattered more widely in the junction of hard and soft
palate.
CLEFT PALATE
Cleft of palate may result from following developmental

reasons
1. Failure of the shelves and septum to contact because of
lack of growth and disturbance in the mechanism of
shelf elevation.
2. The epithelial covering does not break for fusion.
3. Rupture after fusion of shelves
4. Defective merging and consolidation of the
mesenchyme of the shelves.

2011. CHAPTER 11
Enviromental factors :
1. Infectious agents (Rubella or German
measels)
2. X-ray radiation
3. Drugs (cortisones)
4. Homones
5. Nutritional deficiency (vitamins
deficiency)
2011. CHAPTER 11
FINAL DIFFERENTIATION
DEFECTS
ACHONDROPLASIA :
• It has short stature with retruded maxilla because of
restriction of growth of base of skull.
Cause-
• Decrease endochondral Ossification, decrease cartilage
matrix formation.

2019, CHAPTER 5
Synostosis syndromes :
a. Crouzon syndrome
b. Apert’s syndrome
A. Crouzon’s syndrome :
This is a type of cranio-facial synostosis without
syndactyly.
1. Anteroposterior diameter is smaller than transverse
diameter
2. The fore head is high and wide.
3. Wide face with hypoplastic maxilla producing
Pseudoprognathic look.

2019, CHAPTER 5
Apert’s syndrome :
This is a cranio-facial synostosis

with syndactyly
Cervical sinus cyst or
branchial fistula
ROBERT E. MOYERS.HAND BOOK
-Occurs due to OF ORTHODONTICS, 4TH
the complete obliteration EDITION, YEAR BOOK
PUBLICATION,1988. CHAPTER 3
of Cervical sinus.
CONCLUSION
• The study of embryology imparts us the knowledge of

normal process of growth.
• It is with this knowledge that we can get a better
understanding of the deviations from the normal that
occurs during growth.
• “It has been said that if you want to treat the abnormality
you have to know what is normal”.
• Hence the knowledge of embryology essential for
orthodontist
REFERENCES
TEXTBOOKS:
T.W. SADLER. LANGMAN’S MEDICAL

EMBRYOLOGY, 13TH EDITION, WOLTERS KLUWER
INDIA PVT. LTD. 2015
INDERBIR SINGH , GP PAL . HUMAN
EMBRYOLOGY , 8th EDITION MACMILLAN , 2011
SPERBER, GEOFFREY F. CRANIOFACIAL
EMBRYOLOGY, 3RD EDITION, BUTTERWORTH-
HEINEMANN Ltd, 1999
VISHRAM SINGH. TEXTBOOK OF CLINICAL
EMBRYOLOGY,1ST EDITION, ELSEVIER 2012.
SRIDHAR PREMKUMAR. TEXTBOOK OF
CRANIOFACIAL GROWTH, 1ST EDITION, JAYPEE
PUBLISHERS,2011
ROBERT E. MOYERS.HAND BOOK OF
ORTHODONTICS, 4TH EDITION, YEAR BOOK
PUBLICATION,1988
WILLAM. R. PROFFIT. CONTEMPORARY
ORTHODONTICS, 6TH EDITION, ELSEVIER,Inc. 2019
G S KUMAR. ORBAN’S ORAL HISTOLOGY AND
EMBRYOLOGY, 12TH EDITION, MOSBY
PUBLICATIONS,2010.
SHAFER, HINE,LEVY. TEXTBOOK OF ORAL
PATHOLOGY, 7TH EDITION,ELSEVIER 2012.

Prenatal Growth and Development

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P R E N ATA L

• Every individual spends the first nine months (266 days

• During this period it develops from a small one celled

• Numerous tissues and organs are formed and come to

INDERBIR SINGH , GP PAL . HUMAN EMBRYOLOGY , 8th EDITION MACMILLAN ,

• The most spectacular changes occur in the first 2 months,

• During these 2 months we call the developing individual

SRIDHAR PREMKUMAR. TEXTBOOK OF CRANIOFACIAL GROWTH, 1ST EDITION,

SPERBER, GEOFFREY F. CRANIOFACIAL EMBRYOLOGY, 3RD EDITION,

T.W. SADLER. LANGMAN’S MEDICAL EMBRYOLOGY, 13TH EDITION,

• Fertilization, the process by which male and female

• This is the widest part of the tube and is located close to

• Spermatozoa and the oocyte remain viable in the female

INDERBIR SINGH , GP PAL . HUMAN EMBRYOLOGY , 8th EDITION MACMILLAN ,

3. Metabolic activation of egg - the activation factor is

• Restoration of diploid number of chromosomes

• Determination of sex of new individual.

• It fosters genetic variation.

• Division of the fertilized ovum in to several cells for e.g.,

INDERBIR SINGH , GP PAL . HUMAN EMBRYOLOGY , 8th EDITION MACMILLAN ,

• As cleavage proceeds the ovum reaches 16 celled stage

• Zona pellucida helps in preventing implantation of

• Zona pellucida disappears as soon as the morula reaches

• Thus embryo gets implanted in lateral wall of uterus

INDERBIR SINGH , GP PAL . HUMAN EMBRYOLOGY , 8th EDITION MACMILLAN ,

• As the fluid quantity increases it acquires the shape of a

• Trophoblast cells become flattened and embryoblast cells

• Now it is called blastocyst and cavity is called blastocoele

• The site of attachment of inner cell mass is called

o At a every early stage in development, the embryo proper

Primary yolk sac- cells

Extra embryonic coelom/chorionic

T.W. SADLER. LANGMAN’S MEDICAL EMBRYOLOGY, 13TH

Formation of Chorion and Amnion- 2

INDERBIR SINGH , GP PAL . HUMAN EMBRYOLOGY , 8th EDITION MACMILLAN ,

This stage, embryo proper- circular

Primitive streak- after Prochordal

Cloacal membrane- some intra

T.W. SADLER. LANGMAN’S MEDICAL EMBRYOLOGY, 13TH EDITION,

T.W. SADLER. LANGMAN’S MEDICAL EMBRYOLOGY, 13TH

• Fertilization to formation of bilaminar disc is called pre-

AGE (IN DAYS) DEVELOPMENTAL EVENTS

INDERBIR SINGH , GP PAL . HUMAN EMBRYOLOGY , 8th EDITION MACMILLAN ,

INDERBIR SINGH , GP PAL . HUMAN EMBRYOLOGY , 8th EDITION

• Most of it disappears but parts of it persist in the region of

• Give rise to brain and spinal cord.

INDERBIR SINGH , GP PAL . HUMAN EMBRYOLOGY , 8th EDITION MACMILLAN ,

• Forms by appearance of cavities in lateral plate mesoderm

• Migrate & differentiate extensively with in the developing

• Spinal & cranial sensory ganglia, Sympathetic neurons,

• Most of the connective tissue of the head is formed

• Migration is essential for development of teeth & face

• All the tissues of teeth (except enamel) & its supporting

• The period from the beginning of the ninth week to birth is

• It is characterized by maturation of tissues and organs and

• The length of the fetus is usually indicated as Crown

T.W. SADLER. LANGMAN’S MEDICAL EMBRYOLOGY, 13TH EDITION,

• During 3rd month face become more human looking

• Primary ossification centres are present in the long bones