COLLEGE OF DENTAL SCIENCES

DEPARTMENT OF ORTHODONTICS AND

SEMINAR
ON

PRENATAL GROWTH
AND DEVELOPMENT

Submitted by:

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 Dr. VINNY BHASIN

Staff in charge Professor and HOD

I SHALL BE DISCUSSING THE PRENATAL GROWTH AND

DEVELOPMENT UNDER THE FOLLOWING HEADINGS.

 INTRODUCTION

 FERTILIZATION

 EMBRYONIC DEVELOPMENT

 CLEAVAGE

 IMPLANTATION

 POST IMPLANTATION DEVELOPMENT

 GASTRULATION

 GROWTH OF GERM DISC

 EMBRYONIC PERIOD

 DERIVATIVES OF GERM LAYER

 FETAL PERIOD

 DEVELOPMENT OF SKULL

 PHARYNGEAL ARCHES

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 DEVELOPMENT OF FACE

 DEVELOPMENT OF MAXILLA

 DEVELOPMENT OF MANDIBLE

 DEVELOPMENT OF TONGUE

 DEVELOPMENT OF TOOTH

 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 hormony.

Embryology - It is the study of the formation and development of

embryo (or fetus) 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 fetus.

FERTILIZATION :

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 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.

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.

As soon as 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 spermatozoan.

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 The spermatozoan, meanwhile moves forward until it lies in close

proximity to the female pronucleus. Its nucleus becomes swollen and

forms the male pronucleus while the tale is detached and degenerates.

During the gorwth of male and female pronuclei (both haploid), each

pronucleus must replicate its DNA. Immediatley after DNA synthesis,

chromosomes become organised on the spindle in preparation for a

normal mitotic division. The 23 maternal and 23 paternal (double)

chromosomes split longitudinally at the centromere and sistes

chromatids move to opposite pole; thus providing each cell of the zygote

with the normal diploid number of chromosomes and DNA. While sister

chromatids move to opposite poles, a deep furrow appears on the surface

of the cell, gradually dividing the cytoplasm into 2 parts.

The main results of fertilization are : -

1) Restoration of diploid number of chromosomes

2) Determination of sex of new individual.

3) Initiation of cleavage

4) It fosters genetic variation.

EMBRYONIC DEVELOPMENT :

Fertilized, activated eggs containing both male and female

pronuclei, are termed zygote.

The embryonic development can be divided into -

 Pre implantation - This is before the zygote has established a

firm connection with the mother.

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  Post implantation - This is the subsequent development.

The development can also be divided into -

a) Primary embryogenesis - a stage when cell populations are formed

and massive cell migrations occur.

b) Organogenesis - a stage when development of organs and systems

occur.

c) Fetus - when mammalian embryos reach a certian size, growth rather

than morphogenesis occurs. This occurs at 56-57 postovulatory days

in humans.

The term conceptus defines the embryo (or fetus) plus its

associated extraembryonic (or fetal) membranes.

CLEAVAGE :

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 Cleavage is the process by which the first mitotic divisions of the

zygote produce the founder cells of the embryo. It restores the

nuclear/cytoplasmic ratio of cells, little growth occurs during this time.

The first cells formed by cleavage are called blastomeres and till the 8 cell

stage they form a loosely arranged clump. However, following the 3 rd

cleavage i.e. at the 8 cell stage, the blastomeres undergo compaction,

where the cells maximise their contact with one another. The outer cells

form tight junctions where as inner cells form gap junctions. The fourth

cleavage division produces a 16 cell morula which has as outer layer of

cells, termed trophoblast destined to form extraembryonic structures;

especially the placenta and an inner cell mass which will give rise to the

embryo.

BLASTOCYST FORMATION :

About the time, the morula enters the uterine cavity, fluid begins

to penetrate through the zona pellucida into the intercellular spaces of

inner cell mass. Gradually, the intercellular spaces become confluent

and finally, a single cavity the blastocoele is formed. At this time, the

embryo is known as a blastocyst. Cells of the inner cell mass now

referred to as embryoblast are located at one pole. While those of the

outer cell mass, or trophoblast, flatten and form the epithelial wall of the

blastocyst. The zona pellucida has now disappeared allowing

implantation to begin.

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 In the human, trophoblastic cells over the embryoblast pole begin

to penetrate between the epithelial cells of the uterine mucosa at about

6th day. Penetration and subsequent erosion of epithelial cells of the

mucosa result from proteolytic enzymes produced by the trophoblast.

Hence by the end of first week of development, the human zygote has

passed through the morula and blastocyst stages and has begun

implantation in the uterine mucosa.

BILAMINAR GERM DISC :

Eighth day of development :

At the 8th day of development, the blastocyst is partially embedded

in the endometrial stroma. In the area over the embryoblast, trophoblast

has differentiated into 2 layers.

a) An inner layer of mononucleated cells, the cytotrophoblast.

b) An outer multinucleated zone without distinct cell boundaries, the

syncytotrophoblast. Mitotic figures are found in the cytotrophoblast

but never in the syncytotrophoblast. Thus, cells in the

cytotrophoblast divide and then migrate into the syncytiotrophoblast,

where they fuse and lose their individual cell membranes.

Cells of the inner cell mass or embryoblast also differentiate into 2

layers.

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a) A layer of small, cuboidal cells adjacent to the blastocyst cavity,

known as the hypoblast layer.

b) A layer of high columnar cells adjacent to the amniotic cavity, the

epiblast layer. Cells of each germ layer form a flat disc and together

are known as bilaminar germ disc. At the same time, a small cavity

appears within the epiblast. This cavity enlarges to form the amniotic

cavity. Those epiblast cells adjacent to the cytotrophoblast are called

amnioblast and together with rest of the epiblast, line the amniotic

cavity. The endometrial stroma adjacent to the implantation site is

edematous and highly vascular.

NINTH DAY OF DEVELOPMENT :

The blastocyst is more deeply embedded in the endometrium and

the penetration defect in the surface epithelium is closed by a fibrin

coagulum. The trophoblast shows considerable progress in development,

particularly at the embryonic pole where vacuoles appear in the

syncytium. When these vacuoles fuse, they form large lacunae and this

phase of torhoblast development is therefore known as lacunar stage.

At the abembyonic pole, mean while, flattened cells, probably

originating from the hypoblast, form a thin membrane, known as

exocoelomic (Heuser’s membrane), that lines the inner surface of

cytotrophoblast. This membrane together with the hypoblast, forms the

lining of the exocoelomic cavity (primitive yolk sac).

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ELEVENTH TO TWELTH DAY OF DEVELOPMENT :

By The 11th to 12th day of development, the blastocyst is completely

embedded in the endometrial stroma and the surface epithelium almost

entirely covers the original defect in the uterine wall. The blastocyst now

produces a slight protrusion into the lumen of the uterus.

The trophoblast is characterised by lacunar spaces in the

syncytium that forms an intercommunicating network. This is

particularly evident at the embryonic pole; at the abembyonic pole,

however the trophoblast still consists mainly of cytotrophoblastic cells.

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 Concurrently, cells of the syncytiotrophoblast penetrate deep into

the stroma and erode the endothelial lining of maternal capillaries.

These capillaries are congested and dilated and are known as sinusoids.

The syncytial lacunae then become continuous with the sinusoids and

maternal blood enters the lacunae system. As the trophoblast continues

to erode more and more sinusoids, maternal blood begins to flow through

the trophoblastic system; thus establishing the uteroplacental

circulation. In the meantime, a new population of cells appear between

the inner surface of the cytotrophoblast and the outer surface of

exocoelomic cavity. These cells are derived from yolk sac cells and form

a fine, loose connective tissue, the extraembryonic mesoderm (chorionic

cavity). This space surrounds the primitive yolk sac and amniotic cavity

except where the germ disc is connected to the trophoblast by the

connecting stalk. The extra embryonic mesoderm lining the

cytotrophoblast and amnion is called the extraembryonic somatopleuric

mesoderm, that covering the yolk sac is called extra embryonic

splanchnopleuric mesoderm.

THIRTEENTH DAY OF DEVELOPMENT :

By the thirteenth day of development, the surface defect in the

endometrium has usually healed. Occasionally however, bleeding may

occur at the implantation site as a result of increased blood flow into the

lacunar spaces. Since this bleeding occurs near the 28 th day of

menstrual cycle, it may be confused with normal menstrual bleeding.

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 The trophoblast is characterised by appearance of villous

structures. Cells of the cytotrophoblast proliferate locally and penetrate

into the syncytotrophoblast; thus forming cellular columns surrounded

by syncytium. Cellular columns with the syncytial covering become

known as primary villi.

In the meantime, the hypoblast produces additional cells that

migrate along the inside of the exocoelomic membrane. These cells

proliferate and gradually form a new cavity within the exocoelomic cavity.

This new cavity is known as the secondary or definitive yolk sac. This

yolk sac is much smaller than the original exocoelomic cavity or primitive

yolk sac. During its formation large portions of exocoelomic cavity are

pinched off. These portions are represented by exocoelomic cysts, which

are often found in the extraembryonic coelom or chorionic cavity.

Meanwhile, the extraembryonic coelom expands and forms a large

cavity known as chorionic cavity. The extraembryonic mesoderm lining

the inside of the cytotrophoblast is then known as the chorionic plate.

The only place where extraembryonic mesoderm traverses the chorionic

cavity is in the connecting stalk. With development of blood vessels, the

stalk will become the umbilical cord.

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 By the end of 2nd week, the germ disc is represented by two

apposed cell discs; the epiblast, which forms the floor of the continuously

expanding amniotic cavity and the hypoblast which forms roof of

secondary yolk sac. In its cephalic region the hypoblastic disc shows a

slight thickening known as the prechordal plate. This is an area of

columnar cells that are firmly attached to the overlying epiblastic disc.

TRILAMINAR GERM DISC :

Gastrulation :

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 The most characteristic event occuring during the 3 rd week is

gastrulation, the process that establishes all three germ layers in the

embryo. Gastrulation begins with formation of primitive streak on the

surface of the epiblast. Initially, the streak is vaguely defined, but in a 5-

16 day embryo, it is clearly visible as a narrow groove with slightly

bulging regions on either side. The cephalic end of the streak, known as

the primitive node, consists of a slightly elevated area surrounding the

small primitive pit. In a transverse section through the region of the

primitive groove, it is seen that the cells are flask shaped and that a new

cell layer develops between the epiblast and hypoblast. Cells of the

epiblast migrate in the direction of primitive streak to form mesoderm

and intraembryonic endoderm. On arrival in the region of the streak,

they become flask shaped, detach from the hypoblast, thereby creating

the embryonic endoderm, while some cells come to lie between the

epiblast and newly created endoderm to form mesoderm. Cells

remaining in the epiblast then form ectoderm; thus the epiblast through

the process of gastrulation, is the source of all germ layers in the

embryo.

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 As more and more cells move in between the epiblast and

hypoblast layers, they begin to spread in lateral and cephalic directions.

Gradually, they migrate beyond the margin of the disc and establish

contact with extraembryonic mesoderm covering the yolk sac and

amnion. In the cephalic direction, they pass on each side of the

prechordal plate to meet each other in front of this area, where they form

the cardiogenic or heart forming plate.

FORMATION OF THE NOTOCHORD :

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 Prenotochordal cells invaginating the primitive pit move forward in

a cephalic direction until they reach the prechordal plate. These

prenotochordal cells become intercalated in the hypoblast such that, for

a short time the midline of the embryo consists of two cell layers that

form the notochordal plate. As the hypoblast is replaced by endodermal

cells moving in at the streak, cells of the notochordal plate proliferate

and detach from the endoderm. They then form a solid chord of cells,

the definitive notochord, that underlies the neural tube and serves as the

basis for axial skeleton. Since elongation of the notochord is a dynamic

process, the cranial end forms first and caudal regions are added as the

primitive streak assumes a more caudal position. The notochord and

prenotochordal cells extend cranially to the prechordal plate (future

buccopharyngeal membrane) and caudally to the primitive pit. At the

point where the pit forms an indentation in the epiblast, a small canal,

the neurenteric canal, temporarily connects the amniotic and yolk sac

cavities.

The cloacal membrane is formed at the caudal end of embryonic

disc. This membrane is similar in structure to prechordal plate and

consists of tightly adherent ectoderm and endoderm cells with no

intervening mesoderm. When the cloacal membrane appears, the

posterior wall of the yolk sac forms a small diverticulum that extends

into the connecting stalk. This diverticulum, the allantoenteric

diverticulum or allantois , appears at about the 16 th day of development.

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GROWTH OF GERM DISC :

The embryonic disc, initially flat and almost round, gradually

becomes elongated with a broad cephalic and a narrow caudal end.

Expansion of the embryonic disc occurs mainly in the cephalic region,

the region of primitive streak remains more or less the same size.

Growth and elongation of the cephalic part of the disc are caused

by a continuous migration of cells from the primitive streak region in a

cephalic direction. Invagination of surface cells in the primitive streak

and their subsequent migration in forward and lateral direction

continues until the end of 4th week. At that stage, the primitive streak

shows regressive change, rapidly diminishing in size and soon diappears.

That the primitive streak at the caudal end of the disc continues to

supply new cells until the end of 4th week has an important bearing on

development of the embryo. In the cephalic part, germ layers begin their

specific differentiation by the middle of 3rd week, whereas in the caudal

part differentiation begins by the end of 4th week. Thus, gastrulation or

formation of germ layers continues in caudal segments while cranial

structures are differentiating and the embryo develops cephalocaudally.

EMBRYONIC PERIOD :

Third to eighth weeks or period of organogenesis.

DERIVATIVES OF THE ECTODERMAL GERM LAYER :

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 At the beginning of 3rd week of development the ectodermal germ

layer has the shape of a flat disc that is broader in the cephalic than the

caudal region. With appearnace of the notochord and under its inductive

influence ectoderm overlying the notochord thickens to form neural

plate. Cells of the plate make up the neuroectoderm and their induction

represents the initial event in the process of neurulation.

Once induction has occured, the elongated slipper shaped neural

plate gradually expands towards the primitive streak. By the end of 3 rd

week, the lateral edges of the neural plate becomes more elevated to form

neural folds, while the depressed midregion forms a groove, the neural

groove. Gradually, the neural folds approach each other in the midline,

where they fuse. This fusion begins in the region of the future neck (4 th

somite) and proceeds in the cephalic and caudal directions. As a result,

the neural tube is formed. Until fusion is complete the cephalic and

caudal ends of the neural tube communicate with amniotic cavity by way

of cranial and caudal neuropores, respectively. Closure of cranial

neuropore occurs approximatley at day 25 whereas the posterior

neuroproe closes at day 27. Neurulation is then complete and the CNS is

represented by a closed, tubular structure with a narrow caudal portion,

the spinal cord, and a much broader cephalic portion characterised by a

number of dilatations, the brain vesicles.

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 As the neural folds elevate and fuse, cells at the lateral border or

crest of the neuroectoderm begin to dissociate from their neighbours.

This cell population is known as neural crest and it will undergo an

epithelial to mesenchymal transition as it leaves the neuroectoderm by

active migration and displacement to enter the underlying mesoderm

(Mesoderm refers to cells derived from the epiblast and extraembryonic

tissues. Mesenchyme refers to loosely arranged embryonic connective

tissue regardless of origin). Crest cells, then give rise to a heterogenous

array of tissues, including spinal (sensory) and autonomic ganglia, parts

of the ganglia of cranial nerves V, VII, IX and X; Schwann cells and

meninges (pia and arachnoid); melanocytes; medulla of adrenal gland;

bones and connective tissues of craniofacial structure; cells of

conotruncal cushions of heart.

By the time, the neural tube is closed, two bilateral ectodermal

thickenings, the otic placodes and the lens placodes, become visible in

cephalic region of the embryo. During further development, the otic

placodes invaginate and form otic vesicles, which will develop into

structures needed for hearing and maintainence of equilibrium. At

approximately the same time lens placodes appear. These placodes also

invaginate and during the 5th week form the lenses of the eyes.

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 So, the ectodermal germ layer gives rise to those organs and

structures that maintain contact with the outside world :

a) The central nervous system

b) The peripheral nervous system

c) Sensory epithelium of ear, nose and eye.

d) Epidermis, including the hair and nails.

e) Subcutaneous glands

f) Mammary glands

g) Pituitary gland

h) Enamel of teeth.

DERIVATIVES OF MESODERMAL GERM LAYER :

Initially, cells of the mesodermal germ layer form a thin sheet of

loose woven tissue on each side of the midline. By about the 17 th day,

however, cells close to the midline proliferate and form a thickened plate

of tissue known as paraxial mesoderm. More laterally, the mesoderm

layer remains thin and is known as the lateral plate. With the

appearance and coalescence of intercellular cavities in the lateral plate,

this tissue is divided into 2 layers.

a) A layer continuous with mesoderm covering the amnion, known as

the somatic or parietal mesoderm layer.

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b) A layer continuous with mesoderm covering the yolk sac, known as

the splanchnic or visceral mesoderm layer.

Together, these layers line a newly formed cavity, the

intraembryonic coelomic cavity, which on each side of the embryo, is

continuous with the extraembryonic coelom. Tissue connecting paraxial

and lateral plate mesoderm is known as intermediate mesoderm.

By the beginning of the 3rd week, paraxial mesoderm becomes

organised into segments. These segments, known as somitomeres, first

appear in the cephalic region of the embryo, and their formation

proceeds in a cephalocaudal direction. Each somitomere consists of

mesodermal cells arranged in concentric whorls around the centre of the

unit. In the head region, such structures, in association with

segmentation of neural plate, form into nueromeres and contribute the

majority of head mesenchyme. From the occipital region caudally,

somitomeres become further organised into somites. The first pair of

somites arise in the cervical region of the embryo at approximately the

20th day of development. From here, new somites appear in the

craniocaudal sequence, at a rate of approximately 3 pairs/day, until at

the end of 5th week, 42-44 pairs are present. There are 4 occipital, 7

cervical, 12 thoracic, 5 lumbar, 5 sacral and 8-10 coccygeal pairs. The

first occipital and the last 5-7 coccygeal somites later disappears, while

the remaining somites form the axial skeleton. During this period of

development, age of the embryo is expressed in number of somties.

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 NUMBER OF SOMITES CORRELATED TO

APPROXIMATE AGE IN DAYS

Approximate age (days) No.of somites

20 1-4

21 4-7

22 7-10

23 10-13

24 13-17

25 17-20

26 20-23

27 23-26

28 26-29

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30 34-35

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DIFFERENTIATION OF SOMITE :

By the beginning of 4th week, cells forming the ventral and medial

walls of the somite lose their compact orgnaisation, become

polymorphous and shift their position to surround the notochord. These

cells, collectively known as the sclerotome, form a loosely woven tissue

known as mesenchyme. They will surround the spinal chord protochord

to form the vertebral column.

The remaining dorsal somite wall, now referred to as

dermomyotome gives rise to a new layer of cells characterised by pale

nuclei and darkly stained nucleoli. These cells consistitute the myotome

and each myotome provides musculature for its own segment.

After cells of the dermomyotome have formed the myotome, they

loose their epithelial characteristics and spread out under the overlying

ectoderm. Here they form dermis and subcutaneous tissues of the skin.

Hence, each somite forms its own sclerotome (the cartilage and form

component), its own myotome providing the segmental muscle

component and its own dermatome, the segmental skin component.

Each myotome and dermatome also has its own segmental nerve

component.

INTERMEDIATE MESODERM :

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 This tissue, which temporarily connects paraxial mesoderm with

the lateral plate, differentiates in a manner entirely different from that of

somites. In cervical and upper thoracic regions, it forms segmentally

arranged cell clusters (future nephrotomes), whereas more caudally it

forms an unsegmented mass of tissue known as nephrogenic cord. From

this partly unsegmented intermediate mesoderm develop excretory units

of the urinary system and the gonads.

PARIETAL AND VISCERAL MESODERM LAYERS :

The parietal and visceral mesoderm layer line the intra embryonic

coelom. Parietal mesoderm, together with overlying ectoderm, will form

the lateral and ventral body wall. Visceral mesoderm and embryonic

ectoderm will form the wall of the gut. Cells facing the coelomic cavity

will form thin membranes, the mesothelial or serous membranes, which

will line the peritoneal, pleural and pericardial cavities.

DERIVATIVES OF ENDODERMAL GERM LAYER :

The gastrointestinal tract is the main organ system derived from

the endodermal germ layer its formation is greately dependent on

cephalocaudal and lateral folding of the embryo. Cephalocaudal folding

is caused mainly by the rapid, longitudinal growth of the central nervous

system, whereas transverse or lateral folding is produced by formation of

rapidly growing somites.

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 As a result of cephalocaudal folding, a continuously larger portion

of the endoderm lined cavity is incorporated into the body of the embryo

proper. In the anterior part, the endoderm forms the foregut, in the tail

region, it forms hindgut. The part between foregut and hind gut is

called the midgut. Temporarily, the midgut communicates with the yolk

sac by way of a broad stalk, the omphalomesentric or vitelline duct. This

duct is wide initially, but with further growth of the embryo it becomes

narrow and much longer.

At its cephalic end, the foregut is temporarily bounded by

prechordal plate, an ectodermal-endodermal membrane that is now

called the buccopharyngeal membrane. At the end of 3 rd week, the

buccopharyngeal membrane ruptures, thus establishing an open

connection between the amniotic cavity and primitive gut. The hindgut

also terminates temporarily at an ectodermal - endodermal membrane

known as cloacal membrane.

EXTERNAL APPEARANCE DURING THE SECOND MONTH :

At the end of 4th week, when the embryo has approximately 28

somites, the main external features are the somites and pharyngeal

arches. The age of the embryo is, therefore, usually expressed in

somites. Since counting the number of somites becomes difficult during

the 2nd month of development, the age of embryo is then indicated as

crown rump length (CRL) and expressed in millimeters.

CROWN RUMP LENGTH CORRELATED TO

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 APPROXIMATE AGE IN WEEKS

CRL (mm) Approximate age (weeks)

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 CRL is the measurement from the vertex of the skull to the

midpoint between the apices of the buttocks. Owing to considerable

variation in the degree of flexure from one embryo to another, the

measurements gives in the table are only approximate indications of the

real age and the embryo. During the 2 nd month, the external appearance

of the embryo is changed greately by the enormous size of the head and

formation of limbs, face, ears, nose and eyes. By the beginning of the 5 th

week, forelimbs and hindlimbs appear as paddle shaped buds. With

further growth, the terminal portion of the bud flattens and becomes

separated from the proximal, more cylindrically shaped segment by a

circular constriction. Soon, four radial grooves separating five slightly

thicker areas appear on the distal portion of the buds, foreshadowing

formation of digits.

FETAL PERIOD : (3rd month to birth )

Development of fetus :

The period from the beginning of the third month to the end of

intrauterine life is known as fetal period. It is characterised by

maturation of tissues and organs and rapid growth of the body. Few

malformations arise during this period, although deformatons caused by

mechanical forces, such as intrauterine compression may occur. Also,

insults to central nevus system, may result in postnatal behavioural

disturbances and lowered intelligence.

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 The length of the fetus is usually indicated as Crown Rump Length

(CRL - sitting height) or as the Crown Heel Length (CHL), the

measurement from the vertex of the skull to the heel (standing height).

These measurements, expressed in centimeters are then correlated with

age of the fetus expressed in weeks or months. Growth in length is

particularly striking, during the 3rd, 4th and 5th months, while increase in

weight is most striking during the last 2 months of gestation. In general,

the length of pregnancy is considered to be 280 days or 40 weeks after

the onset of last normal menstrual period (LNMP) or, more accurately,

266 days or 38 weeks after fetilization.

MONTHLY CHANGES :

Once of the most striking changes taking place during fetal life is

the relative slowdown in growth of the head compared with rest of the

body. At the beginning of 3rd month, the head constitutes approximately

one - half CRL. By the beginning of the 5th month, the size of the head is

about one third CHL and at birth, it is approximately one fourth CHL.

Hence with time, growth of the body accelerates, but that of head slows

down.

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 During the 3rd month, the face become more human looking. The

eyes initially directed laterally, become located on the vertical aspect of

the face and the ears come to lie close to their definitive position at the

side of the head. Primary osification centres are present in the long

bones and skull by 12th week. Also by the 12th week, external genitalia

develop to such a degree that the sex of the fetus can be determined by

external examination. At the end of 3 rd month, reflex activity can be

evoked in aborted fetuses indicating muscular activity.

During the 4th and 5th months, the fetus lengthens rapidly and at

the end of the first half of intra uterine life its CRL is approximately

15cm ie. about half the total length of the newborn.

During the 5th month, movements of the fetus are usually clearly

recognised by mother.

During the second half of i.u. life, weight increases considerably,

particularly during the last 2½ months, when 50% of the full term

weight (approximately 3200 gm) is added.

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 During the 6th month, skin of the fetus is reddish and has a

wrinkled appearance because of lack of underlying connective tissue and

fetus born during the 6 th month or first half of 7 th month has great

difficulty surviving. Although several organ system are able to function,

the respiratory system and central nervous system have not

differentiated sufficiently and coordination between the two systems is

not yet well established. During the last 2 months, the fetus obtains

well rounded contours as a result of deposition of subcutaneous fat.

At the end of 9th month, the skull has the largest circumference of

all parts of the body, as important fact with regard its passage through

the birth canal. At the time of birth, the weight of normal fetus is 3000-

3400 gm; its CRL about 36 cm and its CHL about 50 cm. Sexual

characteristics are pronounced and testes should be in scrotum.

TIME OF BIRTH :

The date of birth is most accurately indicated as 266 days or 38

weeks after fertilization. The oocyte is usually fertilized within 12 hours

after ovulation, and coitus must have occured within 24 hours preceding

fertilization.

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 The obstetrician calculates the date of birth as 280 days or 40

weeks from the first day of the last normal menstrual period (LNMP). In

women with regular 28 day menstrual periods, the method is rather

accurate but when cycles are irregular, substantial miscalculation can be

made. It must be remembered that the time between ovulation and

succeding menstrual bleeding is constant (14 day ± 1 day), but the time

between ovulation and the preceeding menses is highly variable.

In general, most fetuses are born within 10-14 days of the

calculated delivery date. If they are born much earlier, they are

categorized as premature, if born later, they are considered postmature.

SKELETAL SYSTEM :

The skeletal system develops from paraxial and lateral plate

(somatic layer) mesoderm and from neural crest. Paraxial mesoderm

forms a segmented series of tissue blocks on each side of the neural

tube, known as somatomeres in the head region and somites from the

occipital region caudally. Somites differentiate into a ventromedial part,

the sclerotome, and a dorsolateral part, the dermomyotome. At the end

of the 4th week, sclerotome cells become polymorphous and form a

loosely woven tissue known as mesenchyme or embryonic connective

tissue. It is characteristic for mesenchymal cells to migrate and to

differentiate in many different ways. They may become fibroblasts,

chondroblasts or osteoblasts (bone forming cells).

31
 The bone forming capacity of mesenchyme is not restricted to cells

of the sclerotome but occurs also in the somatic mesoderm layer of the

body wall, which contributes mesoderm cells formation of the pelvic and

shoulder girdles and long bones of the limbs. It has also been shown

that neural crest cells in the head region differentiate into mesenchyme

and participate in formation of bones of the face and skull. Occipital

somites and somitomenes also contribute to formation of the cranial

vault and base of the skull. In some bones such as flat bones of the

skull, mesenchyme differentiation directly into bone, a process known

as membraneous ossification. In most bones however, mesenchymal

cells first give rise to hyaline cartilage models, which in turn become

ossified by endochondral ossification.

SKULL :

The skull can be divided into 2 parts :-

The neurocranium is most conveniently divided into 2 portions.

 The membraneous part consisting of flat bones which surround the

brain as a vault.

 The cartilaginous part, or chondrocranium, which form bones of the

base of the skull.

32
a) Membraneous Neurocranium :

The roof and most of the sides of the skull develop from neural rest

cells, with only the occipital region and posterior parts of otic capsule

arising from paraxial mesoderm. Mesenchyme from these two sources

invests the brain and undergoes membraneous ossification. As a result,

a number of flat membranous bones are formed that are characterised

by the presence of needle like bone spicules. These spicules

progressively radiate from primary ossification centres towards the

periphery. With further growth during fetal and post natal life,

membraneous bones enlarge by apposition of new layers on the outer

surface and by simultaneous osteoclastic resorption from the inside.

b) Cartilaginous neurocranium or chondrocranium :

The cartilaginous neurocranium or chondrocranium of the skull

consists initially of a number of separate cartilages. Those that lie

infront of the rostral limit of notochord, which ends at the level of

pituitary gland in the centre of sella turcica, are derived from neural

crest cells and form prechondral chondrocranium. Those that lie

posterior to this limit arise from paraxial mesoderm and form the

chondral chondrocranium when these cartilaginous processes fuse and

ossify by endochondral ossification, the base of the skull is formed.

33
 The base of occipial bone is formed by parachodnal cartilage and

bodies of three occipital sclerotomes. Rostral to the occipital baseplate

are the hypophyseal cartilages and trabeculae cranii. These cartilages

soon fuse to form the body of the sphenoid and ethmoid, respectively. In

this manner, an elongated median plate of cartilage extending from the

nasal region to the arteriors border of foramen magnum is formed.

A number of other mesenchymal condensations arise on either

side of the median plate. The most rostral, the ala orbitalis, forms the

lesser wing of sphenoid bone caudally, it is followed by the ala

temporalis, which gives rise to greater wing of the sphenoid. A third

component, the periotic capsule, gives rise to the petrous and mastoid

parts of temporal bone. These components later fuse with the median

plate and with each other, except for openings through which cranial

nerves leave the skull.

2) Viscerocranium :

34
 The viscerocranium consists of bones of the face and is formed

mainly from the first two pharyngeal arches. The first arch gives rise to a

dorsal portion, the maxillary process, which extends forward beneath the

region of the eye and gives rise to the maxilla, the zygomatic bone and

part of temporal bone. The ventral portion is known as mandibular

process and contains Meckel's cartilage. Mesenchyme around Meckel's

cartilage disappears except in the sphenomandibular ligament. The

dorsal tip of the mandibular process, along with that of the 2nd

pharyngeal arch, later gives rise to incus, malleus and the stapes.

Ossification of the three ossicles begins in the 4th month thus making

these the first bones to become fully ossified. Mesenchyme for formation

of the bones of the face is derived from neural crest cells, including the

nasal and lacrimal bones.

At first the face is small in comparison with neurocranium. This

appearance is caused by ;

 Virtual absence of paranasal air sinuses and

 The small size of the bones, particularly the jaws with the apperance

of teeth and development of air sinuses, the face obtains its human

characteristics.

HEAD AND NECK :

35
 Mesenchyme for formation of the head region is derived from

paraxial and lateral plate mesoderm, neural crest and thickened regions

of ectoderm known as ectodermal placodes. Paraxial mesoderm (somites

and somitomeres) forms the floor of the brain case and a small portion of

the occipital region, all voluntary muscles of the craniofacial region, the

dermis and connective tissues in the dorsal region of the head and the

meninges caudal to parasencephalon. Lateral plate mesoderm forms the

laryngeal cartilages (arytnoid and cricoid) and connective tissue in this

region. Neural crest cells originate in the neuroectoderm of forebrain,

midbrain and hindbrain regions and migrate ventrally into the

pharyngeal arches and rostrally around the forebrain and optic cup into

the facial region. In these locations, they form midfacial and pharyngeal

arch skeletal structures and all other tissues in these regions including

cartilage, bone, dentin, tendon, dermis, pia and arachnoid, sensory

neurons and glandular stroma. Cells from ectodermal placodes, together

with neural crest, from neurons of the 5 th, 7th, 9th and 10th cranial

sensory ganglia.

36
 The most typical feature in development of the head and neck is

formed by the pharyngeal or branchial arches. These arches appear in

the 4th and 5th weeks of development and contribute to the

characteristic external appearance of the embryo. Initially they consists

of bars of mesenchymal tissue separated by deep clefts known as

pharyngeal or banchial clefts. Simultaneously, with development of the

arches and clefts, a number of outpocketings, the pharyngeal pouches,

appear along the lateral walls of pharyngeal gut, the most cranial parts of

foregut. The pouches penetrate the surrounding mesenchyme but do

not establish an open communication with the external clefts. Hence

although development of pharyngeal arches, clefts and pouches

resembles formation of gills in fishes and amphibia; in the human

embryo, real gills are never formed. Therefore the term pharyngeal

(arches, clefts and pouches) has been adopted for human embryo.

Pharyngeal Arches :

37
 Each pharyngeal arch consists of a core of mesenchymal tissue

covered on the outside by surface ectoderm and on the inside by

epithelium of endodermal origin. In addition to mesenchyme derived

from paraxial and lateral plate mesoderm, the case of each arch receives

substantial numbers of neural crest cells, which migrate into the arches

to contribute to skeletal components of the face. The original mesoderm

of the arches gives rise to the musculature of the face and neck. Thus,

each pharyngeal arch is characterised by its own muscular components.

The muscular components of each arch carry their own nerve and

wherever the muscle cells migrate, they carry their cranial nerve

component with them. In addition, each arch has its own arterial

component.

First Pharyngeal Arch :

38
 The 1st pharyngeal arch consists of a dorsal portion, known as

maxillary process, which extends forward beneath the region of the eye

and a ventral portion, the mandibular process, which contains Meckel's

cartilage. During further development Meckel's cartilage diappears

except for 2 small portions at its dorsal end that persist and form the

incus and malleus. Mesenchyma of the maxillary process gives rise to

the premaxilla, maxilla, zygomatic bone and part of the temporal bone,

through membranous ossification. The mandible is also formed by

membranous ossification of mesenchymal tissue surrounding meckel's

cartilage. In addition first arch contributes to formation of the bones of

the middle ear.

Musculature of the 1st pharyngeal arch includes the muscles of

mastication (temporal, masseter and pterygoids), anterior belly of the

digastric, mylohyoid, tensor tympani and tensor palatini. The nerve

supply to the muscles of the 1st arch is provided by the mandibualr

branch of trigeminal nerve. Since mesenchyme from the 1st arch also

contributes to the dermis of the face, sensory supply to the skin of the

face is provided by ophthalmic, maxillary and mandibular branches of

the trigeminal nerve.

39
Second Pharyngeal Arch : The cartilage of the 2nd or hyoid arch

(Reicherts cartilage) gives rise to the stapes, styloid process of the

temporal bone, stylohyoid ligament and ventrally, the lesser horn and

upper part of the body of the hyoid bone. Muscles of the hyoid arch are

the stapedius, stylohyoid, posterior belly of the digastric, auricular and

muscles of facial expression. The facial nerve, the nerve of 2nd arch,

supplies all these muscles.

Third Pharyngeal Arch :

The cartilage of the 3rd pharyngeal arch produces the lower part of

the body and greater horn of the hyoid bone. The musculature is limited

to stylopharyngeous muscles. These muscles are innervated by the

glassopharyngeal nerve, the nerve of the 3rd arch.

Fourth and Sixth Pharyngeal Arches :

Cartilagenous components of the 4th and 6th pharyngeal arches

fuse to form the thyroid, cricoid, arytenoid, corniculate and cuneiform

cartilages of the larynx.

Muscles of the 4th arch (cricothyroid, levator palatini and

constrictors of pharynx) are innervated by the superior laryngeal branch

of the vagus, the nerve of the 4th arch. Intrinsic muscles of the larynx,

however, are supplied by the recurrent laryngeal branch of the vagus, the

nerve of the 6th arch.

PHARYNGEAL POUCHES :

40
 The human embryo has five pairs of pharyngeal pouches. The last

one is atypical and often considered as part of the 4th. The epithelial

endodermal lining of the pouches gives rise to a number of important

organs.

First Pharyngeal Pouch : The first pharyngeal pouch forms a stalk

like diverticulum, the tubotympanic recess, that comes in contact with

the epithelial lining of the 1st pharyngeal cleft; the future external

auditory meatus. The distal portion of the diverticulum widens into a

sac like structure, the primitive tympanic or middle ear cavity, whereas

the proximal part remains narrow, forming the auditory (eustachian)

tube. The lining of the tympanic cavity later aids in formation of the

tympanic membrane or eardrum.

Second Pharyngeal Pouch :

The epithelial lining of the 2nd pharyngeal pouch proliferates and

forms buds that penetrate into the surrounding mesenchyme. The buds

are secondarily invaded by mesodermal tissue, thus forming the

primordium of the palatine tonsil. During the 3rd and 5th months, the

tonsil is infiltrated by lymphatic tissue. Part of the pouch remains and is

found in the adult as the tonsillar fossa.

Third Pharyngeal Pouch :

41
 The 3rd and 4th pouches are characterized at their distal extremity

by a dorsal and ventral wing. In the 5th week, epithelium of the dorsal

wing of the 3rd pouch differentiates into the inferior parathyroid gland

while the ventral wing forms the thymus. Both gland primodia lose their

connection with the pharyngeal wall and the thymus then migrates in a

caudal and a medial direction, pulling the inferior parathyroid with it.

Although main portion of the thymus moves rapidly to its final position

in the thorax (where it fuses with its counterpart from the opposite side),

its tail portion sometimes persists either embedded in the thyroid gland

or as isolated thymic nests.

The parathyroid tissue of the 3rd pouch finally comes to rest on

the dorsal surface of the thyroid gland and forms the inferior parathyroid

gland.

Fourth Pharyngeal Pouch :

Epithelium of the dorsal wing of this pouch forms the superior

parathyroid gland. When the parathyroid gland loses contact with the

wall of the pharynx, it attaches itself to the caudally migrating thyroid

and finally, is located on the dorsal surface of this gland as the superior

parathyroid gland.

Fifth Pharyngeal Pouch :

42
 The 5th pharyngeal pouch is the last of the pharyngeal pouches to

develop and is usually considered to be a part of the 4th pouch. It gives

rise to the ultimobranchial body which is later incorporated into the

thyroid gland. Cells of the ultimobranchial body gives rise to the

parafollicular cells of the thyroid gland and secrete calcitonin.

Pharyngeal Clefts :

The 5 week embryo is characterised by the presence of four

pharyngeal clefts of which only one contributes to the definitive structure

of the embryo. The dorsal part of the 1st cleft penetrates the underlying

mesenchyme and gives rise to the external auditory meatus. The

epithelial lining at the bottom of the meatus participates in formation of

ear drum.

Active proliferation of mesenchymal tissue in the 2nd arch causes

it to over lap the 3rd and 4th arches. Finally its merges with the

epicardial ridge in the lower part of the neck and 2nd, 3rd and 4th

clefts loose contact with the outside. Temporarily the clefts form a cavity

lined with ectodermal epithelium, the cervical sinus, but with further

development this sinus diappears.

Development of Face :

43
 At the end of 4th week, facial prominences consisting primarily of

neural crest derived mesenchyme and formed mainly by the first pair of

pharyngeal arches appear. Maxillary prominences can be distinguished

lateral to the stomodeum, and mandibular prominences can be

distinguished caudal to this structure. The frontonasal prominence,

formed by proliferation of mesenchyme ventral to brain vescicles,

constitutes the upper border of stomodeum. On both sides of

frontonasal prominence, local thickenings of the surface ectoderm, the

nasal placodes, originate under inductive influences of the ventral

portion of the forebrain.

During the 5th week, the nasal placodes invaginate to form nasal

pits. In so doing, they create a ridge of tissue that surrounds each pit

and forms nasal prominences. Those prominences on the outer edge of

the pits are the lateral nasal prominences, those on the inner edge are

the medial nasal prominencs.

During the following 2 weeks, the maxillary prominences continue

to incresae in size. Simultaneously, they grow in a medial direction

thereby compressing the medial nasal prominences. Subsequently, the

cleft between the two is lost, and the two fuse. Hence, the upper lip is

formed by the two medial nasal prominences and the two maxillary

prominences. The lateral nasal prominences do not participate in

formation of the upper lip. The lower lip and jaw are formed from the

mandibular prominences that merge across the midline.

44
 Initially, the maxillary and lateral nasal prominences are separated

by a deep furrow, the nasolacrimal groove. Ectoderm in the floor of this

groove forms a solid epithelial chord that detaches from the overlying

ectoderm. After canalization, the cord forms the nasolacrimal duct, its

upper end widens to form the lacrimal sac. Following detachment of the

cord, the maxillary and lateral nasal prominences merge with each other.

The nasolacrimal duct thus runs from the medial corner of the eye to the

inferior meatus of the nasal cavity. The maxillary prominences then

enlarge to form the cheeks and maxillae.

The nose is formed from five facial prominences; the frontal

prominences gives rise to the bridge; the merged medial nasal

prominences provide the crest and tip; and the lateral nasal prominences

from the side (alae).

Intermaxillary Segment :

As a result of medial growth of the maxillary prominances, 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

known as the intermaxillary segment. It is composed of ;

 A labial segment, which forms the philtrum of the upper lip.

 An upper jaw component, which carries the four incisor teeth.

 A palatal component, which forms the triangular primary palate.

45
 Cranially, the intermaxillary segment is continuous with the rostral

portion of nasal septum, which is formed by frontal prominence.

Development of Mandible :

The mandible initially develops intramembranously but its

subsequent growth is related to the appearance of secondary cartilages

(the condylar cartilage being most important). The developing mandible

is preceded by the appearance of a rod of cartilage belonging to the first

branchial arch. This is known as Meckel's cartilage and it first appears

at about the sixth week of intrauterine life. Meckel's cartilage extends

from the cartilaginous otic capsule in the region of the developing ear to

a midline symphysis. However, it merely provides a framework around

which the bone of the mandible forms.

46
 The mandible first appears as a band of dense fibrous tissue on

the anterolateral aspect of Meckel's cartilage. During the seventh week

of iu. life, a centre of ossification appears in this fibrous tissue at a site

close to the future mental foramen. From this centre, bone formation

spreads rapidly backwards, forwards and upwards, around the inferior

alveolar nerve and its terminal branches (the incisive and mental nerves).

Further spread of the developing bone in a forward and backward

direction produces a plate of bone on the lateral side of Meckel's

cartilage that corresponds to the future body of the mandible and which

extends towards midline where it comes to lie in close relationship with

the bone forming on the opposite side. However, the two plates of bone

remain separated by fibrous tissue to form the mandibular symphysis.

At a later stage in the development of the body of the mandible,

continued bone formation markedly increases the size of the mandible,

with development of the alveolar process occuring to surround the

developing tooth germs. At an even later stage, Meckel's cartilage

resorbs. The neurovascular bundle that initially was located with the

developing tooth germs now becomes contained within its own bony

canal and there is considerable development of the alveolar process.

47
 Although Meckel's cartilage contributes no significant tissues to

the developing mandible, nodular remnants of cartilage may be seen in

the region of the mandibular symphysis until birth and, in its most

dorsal part, Meckel's cartilage ossifies to form ear ossicles. (malleus and

incus). Behind the body of the mandible, the perichondrium of Meckel's

cartilage persists as the sphenomandibular and sphenomalleolar

ligaments. The sphenomandibular ligament ossifies at its sites of

attachment to form the lingula of the mandible and spine of sphenoid

bone.

As the developing tooth germs reach the bell stages, developing

bone becomes closely related to it to form the alveolus. The size of the

alveolus is dependent upon the size of the growing tooth germ. The

developing teeth come to lie in a trough of bone. Later the teeth become

separated from each other by development of interdental septa.

48
 The ramus of mandible is first mapped out as a condensation of

fibro-cellular tissue that although continuous with the developing body

of the mandible, is positioned some way laterally from Meckel's cartilage.

Further development of the ramus is associated with a backward spread

of ossification from the body and by the appearance of secondary

cartilages. Between the tenth and fourteenth weeks in utero, three

secondary cartilages develop within the growing mandible. The largest

and most important of these is the condylar cartilage, which, as its name

suggests, appears beneath the fibrous articular layer of future condyle.

Less important, transitory, secondary cartilages are seen associated with

the coronoid process and in the region of mandibular symphysis.

The temporomandibular joint develops from mesenchyme lying

between the developing mandibular condyle below and the temporal

bone above, which develop intramembranously. During the twelth week

of iu. life, 2 clefts appear in the mesenchyme, producing the upper and

lower joint cavities. The remaining intervening mesenchyme

surrounding the developing joint becomes the intra articular disc. The

joint capsule develops from a condensation of mesenchyme surrounding

the developing joint.

DEVELOPMENT OF PALATE :

49
 The palate develops from three parts one medial and two lateral

palatine processes. The medial palatine process is also called primary

palate since it appears before the secondary palate at the beginning of

sixth week.

At the end of the sixth week, the lateral palatine processes which

form the secondary palate develop from the medial edges of the maxillary

processes that bound the stomodeum. The lateral palatine processes

grow medially first, then grow downward and vertically on either side of

the tongue. At this stage of development, the tongue is narrow and tall,

almost completely filling the oronasal cavity and reaches the nasal

septum.

At about 8½ weeks of i.u. life, the lateral palatine shelves slide or

roll over the body of the tongue. The process of elevation occurs when

the shelves have developed sufficient strength to slide over the tongue.

Palatal shelf elevation begins in the posterior region and depresses the

tongue downward and forward, which releases the anterior part of

shelves.

After the shelves are in a horizontal position the closure occurs in

midline just posterior to median palatine process and the fusion

continues both anteriorly and posteriorly. Fusion of the lateral palatine

processes also occurs with the nasal septum except posteriorly where the

soft palate and uvula remain unattached.

50
DEVELOPMENT OF TONGUE :

This appears as a small median elevation named the median

tongue bud (tuberculum impar) in the floor of the pharynx before the

pharyngeal arches meet ventrally; it subsequently becomes incorporated

in the anterior part of tongue.

A little later two oval distal tongue buds (lingual swellings) appear

on the inner aspect of the mandibular prominences. They meet each

other in front and caudally they converge on the median tongue bud with

which they fuse. A sulcus forms along the ventral and lateral margins of

this elevation and deepens, internal to the future alveolar process of the

mandible, to form the linguogingival groove, while the elevation

constitutes the anterior or buccal part of the tongue.

51
 Caudal to the median tongue bud, a second median elevation, the

hypobranchial eminence (Copula of His), forms in the floor of the

pharynx, and the ventral ends of the fourth, the third and later, the

second pharyngeal arches converge into it. A transverse groove separates

its caudal part to form the epiglottis, while ventrally it approaches the

presulcal tongue rudiment, spreading in the form of a V and forming the

posterior or pharyngeal part of the tongue. In the process the third arch

elements grow over and bury the elements of the second arch excluding

it from the tongue. As a result, the mucous membrane of the pharyngeal

part of the tongue receives its sensory supply from the glossopharyngeal,

the nerve of the 3rd arch. In the adult, the union of anterior and

posterior parts of the tongue approximately corresponds to the angulated

suclus terminalis, its apex at the foramen caecum, a blind depression

produced at the time of fusion of the constituent parts of the tongue, but

also marking the site of ingrowth of the median rudiment of the thyroid

gland.

At first the tongue consists of a mass of mesenchyme covered on

its surface by ectoderm and endoderm. During the second month,

occipital myotomes migrate from lateral aspects of the myelencephalon

and invade the tongue to form its musculature. They pass ventrally

round the pharynx to reach its floor accompanied by their nerve (the

hypoglossal).

The nerve supply of tongue is as follows –

52
1) The lingual nerve derived from post trematic nerve of first arch (i.e.

the mandibular nerve) is sensory to anterior 2/3rd of tongue. The

chorda tympani, often held to be pretrematic nerve to first arch is

special sensory to anterior 2/3rd of tongue.

2) The posterior 1/3rd of tongue is supplied by glossopharyngeal

nerve.

3) The posterior most part of tongue i.e. the root of tongue near the

epiglottis, by the vagus.

DEVELOPMENT OF TOOTH :

By the 6th week of development, the basal layer of the epithelial

lining of the oral cavity forms a C-shaped structure, the dental lamina,

along the length of upper and lower jaws. This lamina subsequently

gives rise to a number of dental buds, 10 in each jaw, which form the

primordia of the ectodermal components of the teeth. Soon, the deep

surface of the buds invaginates the underlying mesenchyme, resulting in

the cap stage of tooth development. Such a cap consists of an outer

layer, the outer dental epithelium, an inner layer, the inner dental

epithelium and central core of loosely woven tissue, the stellate

reticulum. The mesenchyme, which is of neural crest origin, located in

the indentation, forms the dental papilla.

53
 As the dental cap grows, the indentation deepens the tooth takes

on the appearance of a bell (bell stage). Mesenchyme cells of the papilla

adjacent to the inner dental layer then differentiate into odontoblasts

which later produce dentin. The remaining cells of the dental papilla

form the pulp of the tooth.

In the mean time, epithelial cells of the outer dental epithelium

differentiate into ameloblasts (enamel formers). These cells produce long

enamel prisms that are deposited over the dentin. The contact layer

between the enamel and dentin layers is known as enamel dentin

junction.

Enamel is first laid down at the apex of the tooth and from here

spreads towards the neck. Formation of root of the tooth begins when

the dental epithelial layers penetrate into underlying mesenchyme and

form the epithelial root sheath. Cells of the dental papilla lay down a

layer of dentin continuous with that of the crown. As more and more

dentin is deposited, the pulp chamber narrows and finally forms a canal

containing blood vessels and nerves of the tooth.

54
 Mesenchymal cells located on the outside of the tooth and in

contact with dentin of the root differentiate into cementoblasts. These

cells produce a thin layer of specialized bone, the cementum. Outside

the cement layer, mesenchyme gives rise to periodontal ligament which

holds the tooth firmly in position and simultaneously functions as a

shock absorber.

Buds for permanent teeth are located on the lingual aspects of the

milk teeth and are formed during the 3rd month of development.

CONCLUSION :

The study of embryology imparts us the knowledge of the normal

processes of growth. It is with this knowledge that we can get a better

understanding of the deviations from normal that occur during growth.

It has been correctly said that, if you want to treat the abnormality,

you have to know what is normal. Hence the knowledge of

embryology is essential not only for an orthodontist but for every health

professional who undertakes active part in patient management.

55
REFERENCES :

 Gray's Anatomy

 Langman's Embryology.

 Orban's Oral Histology & Embryology.

 Colour Atlas of Human Oral Histology – KITAMURA, MASATOYO,

JOHN A. HESS.

 Text book of Orthodontics – BISHARA.

 Essentials of Oral Histology and Embryology – JAMES K. AVERY.

 Oral Anatomy, Histology and Embryology – BERKOVITZ, HOLLAND,

MOXHAM.

 Oral Development and Histology – JAMES K. AVERY.

 Oral Histology – A.R. TENCATE.

 Essentials of Facial Growth – ENLOW AND HANS.

 Orthodontics, Principles and Practice – T.M. GRABER.

 Contemporary Orthodontics – WILLIAM R. PROFFIT.

 Handbook of Orthodontics – ROBERT E. MOYERS.

 Functional Human Anatomy – JAMES E. CROUCH.

 Cunningham's text book of Anatomy.

 Human Embryology – INDERBIR SINGH.

 Craniofacial Embryology – G.H. SPERBER.