Pre-Natal and Post-Natal Development of Maxilla Part 4 / Orthodontic Courses by Indian Dental Academy

Pre-natal and Post-
natal Development of
Maxilla
Continued..
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PALATOGENESIS
End of 5
TH
week IUL
12
TH
week IUL End of 6
th

Week IUL
Beginning of 9
th

week
CRI TI CAL PERI OD
The entire palate develops from two primorida
The primary palate, and

The secondary palate

Week 6:
A cut between the maxillary and
the mandibular prominences and
tipping the top of the head back
allows visualization of the
developing palate.
The secondary palatal shelves
are considered to be part of the
maxillary prominences.
Week 6:
The medial nasal
prominences
merge in the
midline to smooth
the median furrow.

This fusion
produces a wedge-
shaped mass of
mesenchymal
tissue known as
the intermaxillary
segment.
Week 6:

After the oronasal
membrane ruptures,
The intermaxillary
segment will form the
anterior part of the
palate, the primary
palate (circled).

This section is cut like
the last one (b/w
maxillary & mandibular
prominences)
1.
2.
3.
4.
5.
6.
A higher magnification view of the
circled area illustrates the oronasal
membrane that is beginning to break
down.

Week 7:
A parasagittal cut illustrates that the
oronasal membrane breaks down to
allow continuity between the nasal pit
and the common oral and nasal
cavities.
Secondary Palatal
Shelves
Week 8:

A frontal cut
illustrates that the
tongue is initially
interposed
between the
secondary palatal
shelves.
The two lateral maxillary palatal
shelves and the primary palate of
the frontonasal prominenceare
initially widely separated due to the
vertical orientation of the lateral
shelves on either side of the
tongue.
Elevation of head and lower jaw
Mechanism of palatal shelf elevation
*Intrinsic Force within the shelf (accumulation and hydration of hyaluronic
acid)
*Accumulation of Glycosaminoglycans
*EGF(epidermal growth factor) andTGF (transforming growth factor h3)
stimulate production of Hyluronan
*Increase in vascularity
*Contraction of elastic fibres or muscle fibres.
*Unequal division in the palatal and the oral epithelium
*Neurotransmitters like Serotonin
*Increase in MMP-3
*Upregulation of Vimentin expression
*Master controlling gene is FSP-1
(gene encoding a fibroblast-specific protein) ,
ssh
Pressure differences between the nasal and oral
regions due to tongue muscle contractions may
account for the palatal shelf elevation. This
occurs at about 8
th
and 9
th
week p.c.. It is
possible that the nerve supply to tongue is
sufficiently developed to provide
neuromuscular guidance to the intricate
activity of palatal elevation followed by
closure.
Shelf elevation and fusion begin a few days
earlier in male than in female embryos, possibly
accounting for sex differences in the incidence of
cleft palate.

During palate closure, the mandible becomes
more prognathic and the vertical dimension of
the stomodeal chamber increases, but
maxillary width remains stable, allowing shelf
contact to occur.
Also, forward growth of Meckels cartilage
relocates the tongue more anteriorly,
concomitant with upper-facial
elevation.
The transition from vertical to horizontal is completed within hours
Week 9:
The palatal shelves
become positioned
above the tongue to
allow for fusion in the
midline.
Week 9: Fusion begins
The secondary palatal shelves change their
contours towards a midpoint from which they
fuse anteriorly and posteriorly.
At this point, the nasal septum grows
downwardly from the fused medial nasal
processes.
Medial Edge Epithelium. (M.E.E.)
During the initial stage of the fusion process, MEE cells form a midline
epithelial seam (MES) separating mesenchymes of the two apposing
shelves.

For the complete fusion of the palate, the MEE
acts as a barrier:

Epithelium cells of MEE transforms into
connective tissue cells.

Epithelium undergoes necrosis. (not supported
as microscopic structure Doesnt show any
necrotic cells)

Epithelial cells migrate towards oral and nasal
cells.

Release of MMP (Matrix metalloproteinase)
causes disintegration of the cells and allows
the connective tissue to mix up.

Balance between the MMP and TIMMP
(Tissue inhibiting MMP)

The loss of epithelial continuity in the area
of the shelf contact was originally
described as a classic example of apoptosis
(programmed cell death).

Two other mechanisms may also play a role
in palatal shelf fusion.

Migration of the basal cells into the
mesenchyme and differentiation of these cells
into mesenchymal cells.

Cells near the periphery appear to migrate to the
nearest epithelial surface, and then differentiate
into either oral or nasal epithelium
Since the differentiation patterns of MEE cells
in the cultured single palatal shelf is similar to
that observed during palatal fusion (Mori et al.
, 1994; Martnez-lvarez et al. , 2000), it is
clear that terminal differentiation of MEE cells
is not necessarily dependent on palatal shelf
contact and midline seam formation in vitro

Int. J. Dev. Biol. 48: 307-317 (2004)
TOSHIYA TAKIGAWA and KOHEI SHIOTA
Week 10
Fusion of the palatal shelves with each other
and with the nasal septum separates the nasal
cavities from the oval cavity.
Fusion of the three palatal components initially
produces a flat unarched roof to the mouth.

Ossification
Ossification of the palate proceeds during the 8th
week post conception from the spread of bone into
the mesenchyme of the fused lateral palatal shelves
and from trabeculae appearing in the primary palate
as premaxillary centers, all derived from the single
primary ossification centers of the maxillae.
Posteriorly, the hard palate is ossified by
trabeculae spreading from the single primary
ossification centers of each of the palatine
bones.

Most posterior part - no ossification - soft palate

Week 10
The four maxillary incisors develop within the
primary palate.
Fusion completes at week 12.
Note: tongue has
been removed.
MID PALATAL SUTURE

Appears at 10 wk IU
Growth ceases b/w 1 - 2 yrs
But no synostosis till adulthood
RME can be done
Obliteration starts in adolesence but
complete fusion occurs by 30 yrs.

Palatal Vault

Eruption of teeth Deepening of palatal vault
Musculature of palate
Tensor veli palatini 40 days 1
st
arch
Palatopharangeous 45 days
Levator veli palatini 8
th
week 2
nd
arch
Palatoglossus 9
th
week
Uvular muscle 11
th
week 2
nd
arch

MAXILLARY SINUS
First to develop at 10th week IU.

Develop from middle meatus by
primary pneumatization in ecto-ethmoidal cartilage

Secondary pneumatization in ossifying maxilla starts
at 5th
month IU.

Post natal growth of
maxilla
Growth of maxilla occurs by two
processes:

Extensive appositional and resorptional
surface remodelling

Displacement

apposition resorption
MOSS
Transformation
Translation
SUTURES
Displacement
Surface remodeling
CRANIAL BASE MAXILLA
Enlow and Hans have described this by
applying the principle of Area Relocation.
(i.e. Specific local areas come to occupy new
actual positions in succession, as the entire
bone enlarges, involving both processes,
translation and transposition)
Two methods have been used for precise
assessment of remodelling process:
Cross sectional study using histologic sections of
dried skulls

Longitudinal studies using implant markers and
cephalometric radiographs.
Mechanism of growth
Surface apposition and resorption
Sutural growth
Nasal septal growth
Spheno-occipital synchondrosis
Alveolar process

Maxilla develops postnatally entirely by
intramembranous ossification.

During the different eras, different eras,
different theories have been propounded to put
forth the concepts (e.g.: Sutural theory or
Scotts septal cartilage theory etc.).
However none of these theories could answer
all the questions and hence it is best to explain
the growth of the different parts of maxilla
based on a composite explanation.
Growth of maxilla can be viewed in
three aspects:
Growth in height

Growth in transverse direction.

Growth in the antero-posterior direction.
Height
In the coronal section, the palate is V shaped.
Applying the Enlows V principle:

Deposition on the oral side.

Resorption on the nasal side. This increases the height of the
nasal cavity.
Primary Pneumatization
Ethmoid air cells from the middle and superior
meatus and sphenoethmoid recess invade the
ectethmoid nasal capsule (primary
pneumatization), from the 4th month post
conception.

Secondary Pneumatization
Secondary pneumatization occurs between birth
and 2 years as groups of 3 to 15 air cells grow
irregularly to form the ethmoid labyrinth

Vimentin
Vimentin is a member of the intermediate
filament family of proteins. Intermediate
filaments are an important structural feature of
eukaryotic cells. They, along with microtubules
and actin microfilaments, make up the
cytoskeleton
matrix metalloproteinase-3
Human fibroblast stromelysin (also called transin or matrix
metalloproteinase-3) is a proteoglycanase closely related to collagenase
(MMP1) with a wide range of substrate specificities. It is a secreted
metalloprotease produced predominantly by connective tissue cells.
Together with other metalloproteases, it can synergistically degrade the
major components of the extracellular matrix (Sellers and Murphy, 1981).
Stromelysin is capable of degrading proteoglycan, fibronectin, laminin, and
type IV collagen, but not interstitial type I collagen.

Primary displacement

Secondary displacement

Reversal line
Directions of growth sequentially undergo
reversals

A reversal line showing the crossover between
resorptive and depository growth fields seen in
microscope

Factors affecting reversal shape of bone
muscle attachments rotations growth fields


Sutural
Nasal septum
Surface apposition and resorption on periosteal
and endosteal surfaces
Alveolar process
Spheno occipital synchondrosis
Surface apposition
Sutural growth
Nasal septum growth
Spheno occipital synchondrosis
In contrast to cranial base maxilla is dominated by
intra membranous ossification
Endochondral bone growth seen at the ethmoid
bone and nasal septum

Surface apposition
Growth according to various
theories
Sutural Theory (Weinman &Sicher)

Cartilagenous Theory ( Scott)

Functional Matrix Theory (Moss)
Sutural Theory
Bone growth in various maxillary sutures

Causes pushing apart of bone

Resultant thrust on whole maxilla in
forward and downward direction

Shortcomings of sutural theory
Not pressure related - Tension adapted tissue.

No innate growth potential.

Crouzons syndrome
Cartilagenous Theory


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