PRE-NATAL GROWTH & DEVELOPMENT.

Dr. M. Sadegh Birjandi

Contents

Introduction Definition Pre-natal Growth & Developmnt Period of Ovum Period of Embryo Period of Fetus Pharyngeal arches Pharyngeal pouches

Development Development Development maxilla Development mandible Development tongue Conclusion References

of skull of face of of of

INTRODUCTION
Every individuals spends first nine months 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.

DEFINITION
Growth Growth may be defined as the normal changes in the amount of living substance. (MOYERS) Development Development refers to all naturally occuring unidirectional changes in the life of an individual from its existance as a single cell to its elaboration as a multifunctional unit terminating in death (MOYERS)
Development = growth + differentiation + translocation

DIFFERENTIATION Change from general cells or tissue to a more specialized kinds during development TRANSLOCATION Is change in position EMBRYOLOGY It is the study of the formation and development of embryo (fetus) from the moment of its inception up to the time when it is born as an infant.

Growth & development of an individual can be divided in to

Pre-natal

Post-natal

Period of Ovum 1-14th day

Period of embryo 14th 56th day

Period of Fetus 56th 270th day

Pre-Natal Growth & Development

It is a dynamic phase in the human development. During this phase Height increases by almost 5000 times as compared to only 3 fold increase during post-natal period. Weight increases by 6.5 billion fold from Ovum to Birth & Post-natally there is only 20 fold increase from birth to adulthood.

PERIOD OF OVUM Weeks)

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FERTILIZATION Fertilization is the process by which male and female gamates fuse occurs in the ampullary region of uterine tube. As soon as the spermatozoan has entered into the oocyte, the egg responds in three different ways.
Cortical and zona reactions: As a result of release of cortical occyte granules containing lysosomal enzymes.
Oocyte membrane becomes impermeable to other spermatozoa Zono pellucida alters its structure and composition to prevent sperm binding

Resumption of second meotic division Metabolic activation of egg.

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 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

Morula
Embryo by process of cleavage reaches 16 celled stage Looks like a mulberry thats why called so Zonapellucida still presents Contains outer rim of cells called trophoblast Inner cell mass called embryoblast

Function of Zonapellucida
Trophoblast has the property to stick to any epithelium and eat up the cells Zonapellucida helps in preventing implantation of embryo in abnormal location Zonapellucida disappears as soon as the morula reaches the uterine lumen Thus embryo gets implanted in lateral wall of uterus

Formation of Blastocyst
Some fluid passes into morula from uterine wall seperating the inner cell mass (embryoblast) and outer cell mass (trophoblast) As the fluid quantity increases it acquires the shape of cyst Trophoblast cells become flattened and embryoblast cells get attached to 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 abembryonic pole

Formation of germ layers

Some cells of inner cell mass differentiate into flattened cells that come to line its free surface, these constitute Endoderm Endoderm is the first of the three germ layers to be formed 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

A space appears b/w the ectoderm (below) & trophoblast (above) called amniotic cavity which is filled by amniotic fluid or liquor amni Primary yolk sac Extra embryonic mesoderm (primary mesoderm) Extra embryonic coelom (Chorinic cavity) Parietal/Somatopluric extra emryonic mesoderm (Chorionic plate) Visceral/splanchnopleuric extra-emryonic mesoderm Connecting stalk

HUMAN BLASTOCYST OF 12 DAYS

Formation of chorion & Amnion Secondary yolk sac Prochordal plate: Divides embryo into right & left Primitive streak Intraembryonic mesoderm (Gastrulation) Cloacal membrane Alternative view of formation of germ layers

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 is called pre-organogenesis period( 14 days) 2 days after fertilization the embryo is cell stage. 3 days after fertilization the embryo become morula On the 4th day, the blastocyst formed. By the 8th day, the bilaminar disc been established. disc 1 in 2 has has has

Around the 14th day, the prochordal plate and primitive streak are seen. On the 16th day, we see the formation of the intra-embryonic mesoderm, i.e., the embryonic disc is now 3 layered.

Period of Embryo

Formation of notochord
Its a midline structure Develops from cranial end of primitive streak to caudal end of prochordal plate Primitive Knot/primitive node/Hensons node Blastopore Notochordal process/head process 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 intervertibral disc as the nucleus pulposus

Process of formation of notochord

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Neural tube
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

Sub-divisions mesoderm

of

intra

embryonic

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

The Neural crest

Forms from neuro ectoderm Migrate & differentiate extensively within 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 Treacher collins syndrome

FETAL PERIOD

It is characterized by maturation of tissues and organs and rapid growth of the body. The length of the featus usually indicated as crown Rump length (Sitting height) or crown Heal 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 looking face become more human

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 featus obtains well rounded contours as a result of deposition of subcutaneous fat.
At the time of birth, weight of the featus is 30003400gm. CRL about 36cm

CHL about 50cm

Pharyngeal (Branchial) Arches

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

Nerves & muscles of the arches

Arch
First (Mandibul ar arch) Second (Hyoid arch) Third

Nerve of the arch

Mandibular (Trigeminal) V th nerve Facial VII th nerve

Muscles of the arch

Medial & lateral pterygoids, Masseter, Temporalis, Mylohyoid, ant belly of digastric,tensor tympani, tensor palati Muscles of face, Occipito-frontalis, platysma, Stylohyoid, Posterior belly of digastric, Stapedius, Aurticular muscels

Glossopharyngeal Stylopharyngeus , IX th nerve Superior Larngeal Muscles of Pharynx & larynx Recurrent Muscles of Pharynx & larynx

Fourth Sixth

Derivatives of arch cartilages

Arch Cartilage
1st arch (Meckels cartilage) 2nd arch (Reicherts cartilage) 3rd arch 4th & 6th arch

Derivatives
Mallus, Incus, Anterior ligament for mallus, sphenomandibular ligament & lays down the meshwork for formation of mandible & some part of it may be included in mandible Stapes, Styloid process, stylohyoid ligament, smaller (lesser) cornu of hyoid bone, superior part of body of hyoid bone Greater cornu of hyoid bone, lower part of the body of hyoid bone Cartilages of larynx, controversial, may have contribution from 5th arch

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 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 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

DEVELOPMENT OF SKULL
Neurocranium which forms protective case around the brain Viscerocranium forms the skeleton of the face Approximately 110 ossification centres appear in embryonic human skull gives rise to 45 separate bones.

Neurocranium: Divided into two portions. Membranous part consisting of flat bones which surrounded the brain as a vault Cartilagenous part / chondrocranium which form 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. Mesenchyme from neural crest cells and para-axial mesoderm invests the brain and undergoes membraneous ossification.

Membraneous 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, membraneous bones enlarge by apposition of new layers, on outer surface and simultaenous osteoclastic resorption from the inside.

Chondrocranium

Chondrocranium initially consists of number of separate cartilages. Pituitary in the sella turcia derived from neural crest cells and from prechondral chondrocranium. The base of the occipital bone is formed by parachondrial cartilage and bodies of three occipital sclerotome. Hypophyseal cartilage and trabeculae carnii fuse to form the body of the sphenoid and ehtmoid respectively. 3rd component, the periotic capsule gives rise to the petrous and mastoid parts of temporal bone.

Viscerocranium (Facial skeleton)

Formed from first two pharyngeal arches 1st arch gives rise to two portions Dorsal Ventral Dorsal portion: Maxillary process which gives rise to maxilla, the zygomatic bone and part of temporal bone.
Ventral portion: Mandibular process and contains Meckles cartilage.

Mesenchyma around the Meckles cartilage disappears except in sphenomandibular ligament.

Formation of face

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 vescicles constitute upper border of the stomodeum.

STRUCTURES CONTRIBUTING TO FORMATION OF FACE

PROMINENCE

Structures formed

Frontonasal

Maxillary Medial nasal Lateral nasal Mandibular

Forehead,bridge of nose,medial and lateral nasal prominence. Cheeks,lateral portion of upper lip Philtrum of upper lip,crest and tip of nose Alae of nose Lower lip

Formation of palate
Primary palate (pre maxilla) develops from frontonasal & median nasal process Common oronasal cavity is bounded by primary palate & occupied mainly by developing tongue Palate proper develops from primary & secondary components

Secondary palate: Formation starts b/w 7 & 8 weeks & completes by 3rd month
Only after its formation there distinction b/w oral & nasal cavities is

3 outgrowths appear in oral cavity, the nasal septum grows downward in the midline from frontonasal process & 2 palatine shelves from each side, extend from maxillary process towards midline

The shelves are 1st directed downward on each side of the tongue After 7 weeks of development the tongue is withdrawn from b/w the shelves, which now elevate & fuse with each other above the tongue & with the primary palate

The nasal septum & 2 shelves converge & fuse along the midline

The closure of the secondary palate involves an intrinsic force in palatine shelves the nature of which has not been determined yet. The high concentration of glycosaminoglycans which attract water & make the shelves turgid has been suggested as has the presence of contractile fibroblasts in palatine shelves, another factor in the closure of secondary palate is the displacement of tongue from b/w the palatine shelves by the growth pattern of the head

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

Development of tongue
Starts to develop at about 4 weeks IU Tuberculum impar in center & 2 lateral lingual swellings are derive in the floor of the pirimitive pharynx from proliferation of first branchial arch mesenchyme 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 which is derived from 3rd arch which overgrows second arch Mucosa on posterior most part of the tongue (epiglottis) is derived from 4th arch The muscles of the tongue arise from occipital myotomes which have nerve supply from hypoglossal nerve (XII cranial nerve)

Sensory: Anterior 2/3 Chorda tympani (through lingual branch of mandibular nerve)( nerve of the first arch) Posterior 1/3 glossopharyngeal nerve (from nerve of the 3rd arch). Posterior superior laryngeal (branch of vagus) Motor: Hypoglossal nerve

Nerve Supply of tongue

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 (faulty migration of normal thyroid gland (sub-mucosal, intra-muscular) Remnants of thyroglossal duct may form cysts at the base of tongue Fissured/scrotal tongue

Development of mandible
Develops from the mandibular process of 1st branchial arch The cartilage of the 1st arch (Meckles cartilage) forms lower jaw in the primitive vertebrates In human beings Meckles cartilage has close positional relationship to the developing mandible but makes no contribution to it The mandibular nerve has close relationship to the Meckels 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 meckels cartilage Inferior alveolar nerve further divides into incisive & mental branches On the lateral aspect of Meckels 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 incisive & mental branches.

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 meckels 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 Meckels 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 1st arch, turning away from Meckels 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 Meckels cartilage

Fate of Meckels 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 appearnce of 3 secondary cartilages (condylar, coronoid, symphyseal cartilages) & development of muscular attachments
Condylar cartilage appears at 12th week of development Coronoid process months IU appears at about 4

The symphyseal cartilages 2 in number appear in connective tissue b/w the two ends of Meckels cartilage but are entirely independent of it, they are obliterated within the 1st year of the birth.

Thus mandible is membrane bone developed in relation to the nerve of the 1st arch & almost independent of Meckels cartilage. The madible has neural, articular, 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 and body consists of 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
Before the condylar cartilage forms, a broad band of undifferentiated mesenchyme exists b/w the developing ramus of the mandible and developing squamous tympanic bone. With formation of condylar cartilage, this band is reduced rapidly in width & converted into a dense strip of mesenchyme The mesenchyme adjacent to this strip breaks down to form the joint cavity & the strip becomes the articular disc of the joint

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 The acini of the mucous glands become functional during the 6th month, where as serous glands become functional by birth

Conclusion

References

Cranio Facial Embryology G.H. Sperber Essentials of Facial Growth Enlow and Hans Human Embryology Indrabir Singh Langmans Embryology Grays Anatomy Oral Histology A.R. Tencate Handbook of Orthodontic Robert Moyers Orthodontics Principles and Practice T.M. Graber Contemporary Orthodontics Willium R. Proffit. Orthodontics principles and practice - Basavaraj

YOU

THANK

BY: M. S. BIRJANDI