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EMBROYOLOGY IN DENTISTRY
This is a lecture on embroyology in dentistry.
EMBRYOLOGY

CONTENTS:

1. Branchial Arches

2. Branchial Apparatus

3. Salivary Gland Embryology

4. Thyroid

5. Thyro glossal Duct and Sinuses

6. Tongue Development

Branchial Arches

Structures which develop in head & neck similar in origin and structure to the gills of fish.
 Branchia means Gill in Greek; In fish, similar structures form Gills

Branchial Arch = Pharyngeal Arch 

Five pairs of mesodermal pharyngeal arches characterize the embryonic head and neck and
is visible between 4-5 week of gestation

The arches are separated by an outer layer of ectoderm that invaginates to form the
pharyngeal clefts and an inner layer of endoderm which forms the pharyngeal pouches on the
lateral pharyngeal wall.

The pluripotential mesoderm of each pharyngeal arch from a cartilaginous cone, skeletal
muscles and an artery.

One nerve derived from the developing hindbrain grows in to a given arch to innervate its
musculature

   Branchial Apparatus
     Branchial apparatus � 4 elements

Branchial arches: Covered by ectoderm EXTERNALLY, mesenchyme � CORE 

and endoderm INTERNALLY.   
Each arch has own cartilage, nerve, muscle and artery.  Each nerve innervate
structures derived from its associated arch

        Branchial Groove (Pharyngeal Cleft) - Ectodermal cleft between adjacent arches

Branchial Pouch � Form on the endodermal side between branchial arches and
  pharyngeal grooves(or clefts) form the lateral ectodermal surface of neck region to
  separate the arches.

 
        Branchial Membrane � Site of contact of Groove (ectoderm) 
 Pouch (endoderm)

   STRUCTURES DERIVED FROM BRANCHIAL ARCHES AND POUCHES

   Skeletal      Ligaments      Muscles Pouch

Arch /
Nerve

   First 1) Ant. 1) Muscles of 1)Auditory     tube 

1) Malleus
(V) ligament of Mastication 2)Tympanic    Cavity
2) Incus
malleus 2)Tensor tympani
3) Tensor Palati
 2)Sphenoma 4) Mylohyoid
n-    dibular     5)Ant. belly of      
ligament digastric

1)
Second  Stylohyoid 1)Muscle of facial Lining (crypts) of palatine
(VII) Stapes ligament expression tonsils
2)Stapedius
2)
3)Stylohyoid
Styloid 4)Post. belly of
process digastric
3) Hyoid
bone-lesser
horn, upper
half of body

Third Hyoid bone- ------------------ Stylopharyngeus 1) Interior parathyroid gland

(IX) lesser horn, -- 2) C-cells of Thyroid
lower half of
body

Fourth Cartilages of ------------------ 1) All muscle of

(X) Larynx -- Larynx
2)All muscles of
Pharynyx
3) All muscle of
Soft Palate (exc.
Tensor Palatini)

Sixth ----------------- ------------------ 1)Sternocleidoma

(XI) -- stoid 
2)Trapezius
Note: First Branchial Groove (Cleft) becomes External Auditory Meatus

 First Arch � forms face, has maxillary & mandibular process

- Surrounds stomodeum (primitive mouth)

Stomodeum formed by Ectoderm; forms Oral Cavity & Nasal Cavity

Contacts Endoderm at Orpharyngeal Membrane

Pharynx � rostral foregut � formed by Endoderm

 
(Special Visceral Efferents) � Motor to muscles of face, ear, pharynx and neck that are
derived from branchial arches
ARCH NERVE INNERVATES

FIRST ARCH  V (Trigeminal)

� Muscles of
mastication
           Mylohyoid
                  Tensor
tympani
                   Tensor palatini
                   Anterior belly
of                                  
digastric

SECOND VII (Facial) � Muscles of

ARCH facial              expression
� Stylohyoid
� Posterior
belly of              digastric
� Stapedius

 
THIRD ARCH IX �
(Glossopharygeal) stylopharyngeus

FOURTH X (Vagus) � All muscles

ARCH of the pharynx( except
stylopharyngeus)
� Muscles of
larynx
� All muscles
of palate(except tensor
palatini)

�
CAUDAL XI (Accessory)
SIXTH Sternocleidomastoid
� Trapezius

FLEXION: angle narrowed between two surfaces

 EXTENSION: angle enlarged between two surfaces

ABDUCTON: to draw away the median plane

ADDUCTION: to draw towards the median plane

                
SALIVARY GLANDS EMBRYOLOGY

 
     Derive from oral mucosa

Arise in weeks 5-6 of embryonic life.

Parotid gland primordial arises in week 5-6 from ECTODERM

Submandibular  gland primordial arises in week 6 from ENDODERM

Sublingual gland primordia in week 7-8 from ENDODERM

Primordia develops from primitive oral cavity (stomodeum) as buds,

which proliferates as cords, form terminal bulbs, develops clefts and further
proliferate as branches from original cords, then this process is repeated.

Lumens form epithelial in cords and progress to terminal bulbs, cells differentiate into
various ducts and acini.

Connective tissue diminishes with maturation as do myoepithelial cells

Parotid buds may penetrate intra-parotid lymph nodes; rare with submandibular 
or sublingual structures.
 

DEVELOPMENT OF THE THYROID

 
The thyroid gland is the first endocrine gland to develop in embryo

It begins to form about 24 days after fertilization

It develops from a median endodermal thickening in the floor of a primordial 

pharynx
 Thickening soon forms a small outpouching called thyroid primordium

As the embryo and tongue grow, the developing thyroid gland descends in the neck,
  passing ventral to the developing hyoid bone and laryngeal cartilages
        

For a short time the thyroid gland is connected to the tongue by a narrow tube,
the thyroglossal duct
 

At first the thyroid primordium is hollow but it soon becomes solid and divides into right
and left lobes

The two lobes are connected by the isthmus of the thyroid gland

Isthmus lies anterior to the developing second and third tracheal rings

By seventh week it assumes the definitive shape and has reached its final site 
in the neck 

  The thyroglossal duct has normally degenerated by seventh week

The proximal opening of the thyroglossal duct persists as a small pit in the
tongue,the foramen cecum

A pyramidal lobe extends upward from the isthmus in about 50% of people
 The pyramidal lobe may be attached to the hyoid bone by fibrous tissue or smooth muscle
the levator of thyroid gland

The pyramidal lobe and the associated smooth muscle represent a persistent part of the
distal end of the thyroglossal duct

        

Thyroglossal Duct Cysts & Sinuses

 

Cyst may form anywhere along the course followed by the thyroglossal duct during descent
of the primordial thyroid gland from the tongue

Normally the thyroglossal duct atrophies and disappear 

A remanant of it may persist and form a cyst in the tongue or in the anterior part of 
the neck

 It usually lies just inferior to the hyoid bone

 Most thyroglossal duct cysts are observed by the age of 5 years

The swelling produced usually develops as a painless, progressively enlarging,

   moveable mass

The cyst may contain some thyroid tissue

Following infection of a cyst, a perforation of the skin occurs forming a thyroglossal duct
sinus

It usually opens in the median plane of the neck, anterior to the laryngeal cartilages

  
Development of Tongue

 
A median triangular elevation appears in the floor of the primordium pharynx near the end
of 4th week, just rostral to the foramen cecum

This swelling or median tongue bud is the first indication of tongue development

Soon two oval distal tongue buds develop on each side of the median tongue bud

The three lingual buds result from the proliferation of mesenchyme in ventromedial parts of
the first pair of pharyngeal arches
 The distal tongue buds rapidly increase in size, merge with each other, and overgrow the
median tongue bud

The merged distal tongue buds form the anterior two-thirds (oral part) of the tongue

Fusion of the distal tongue buds is indicated by a middle groove, the median sulcus of the
tongue and internally by the fibrous lingual septum

Median tongue bud forms no recognizable part of the adult tongue

      
FORMATION OF POSTERIOR THIRD OF TONGUE

 
   It is indicated by two elevations that develop caudal to the foramen cecum

Copula: Forms by fusion of the ventromedial part of the second pair of pharyngeal arches

The hypopharyngeal eminence: Develops caudal to the copula from mesenchyme in the
ventromedial parts of the third and fourth pairs of arches

 As the tongue develops the copula is gradually overgrown by the hypo

pharyngeal eminence and disappear 

As a result, the pharyngeal part of the tongue develops from the rostral part of the hypo
pharyngeal eminence
 The line of fusion of the anterior and posterior parts of the tongue is roughly indicated by
a V-shaped groove called terminal sulcus

Pharyngeal mesenchyme forms the connective tissue and vasculature of the tongue

    Most of the tongue muscles are derived from myoblasts that migrate from the occipital
myotomes

The hypoglossal nerve (CN Ⅻ) accompanies the myoblast during their migration and
innervates the tongue muscles as they develop

The entire tongue is within the mouth at birth, its posterior third descends into the
oropharynx by 4 years of age  

              
Papillae and Taste Buds

 
    Lingual papillae appear towards the end of the eighth week

The vallate and foliate papillae appear first, close to the terminal branches of
theglossopharyngeal nerve (CN Ⅸ)

The fungiform papillae appear later near termination of chorda tympani branch of the facial
nerve
 The most common lingual papillae, known as filiform papillae because of their threadlike
shape, develop during early fetal period (10-11 weeks)

They contain afferent nerve endings sensitive to touch

Taste buds develop during 11-13 weeks

Most taste buds form on the dorsal surface of the tongue

Fetal responses in the face can be induced by bitter tasting substances at 26-28weeks,
indicating that the reflex pathways between taste buds and facial muscles  are established by this
age

   

INTRAMEMBRANOUS OSSIFICATION

 
Intramembranous ossification mainly occurs during formation of the flat bone of the

skull but also the mandible, maxilla and clavicles, the bone is formed from connection

tissue such as  mesenchymal tissue rather than from cartilage. The steps in intra
 membranous ossification are:
 
 

- Development of classification Center

- Calcification

- Formation of trabeculae

- Development of periosteum

 
ENDOCHONDRIAL OSSIFICATION

 
     Endochondral ossification, occurs in long bones and most of the rest of the bones in
   the body, it involves an initial hyaline cartilage that continues to grow. The steps inendochondral
ossification are:
    
 - Development of cartilage model.

- Growth of cartilage model.

- Development of the primary ossification center

- Development of the secondary ossification  center

- Formation of articular cartilage and epiphyseal plate.

 
Endochondral ossification begins with points in the cartilage called �primary ossification 
centers�

They mostly appear during fetal development, though a few short bones begin their
  primary ossification after birth.

They are responsible for the formation of the diaphysis of long bones, short bones and
  certain part of irregular bones.
 Secondary ossification occurs after birth and forms the epiphysis of long bones and
  extremities of irregular and flat bones.

             
INTRAMEMRANOUS OSSIFICATION

       -      Parietal

     -    Maxilla

     -     Frontal

     -     Nasal Bone

               -       Vomer

               -     Lacrimal

    
MIXED IS (TOMS)

     - Temporal

       - Occipital

               -        Mandible

  -      Sphenoid

 
ENDOCHONDRIAL OSSIFICATION

                -          Hyoid
               -        Inferior nasal 

              -          Ethmoid bone

Development of the face

 
 
The face and its related tissues begin to form during the fourth week of prenatal
development, within the embryonic period.

During this time, the rapidly growing brain of the embryo bulges over the oropharyngeal
membrane and developing heart.

The area of the future face is now squeezed between the developing brain and heart.

All the embryonic layers are involved in the facial development. This development includes
the formation of the primitive mouth, mandibular arch, maxillary process, frontonasal process and
nose.

Facial development depends on the five facial processes or prominences that form during
the fourth week and surround the embryo�s primitive mouth: the single frontonasal process and
the paired  maxillary and mandibular processes.

These facial processes are then the centers of growth for the face.

If the adult face is divided into thirds � upper, middle and lower portions � these portions
roughly correspond to the centres of facial growth.

The upper portion of the face is derived from the frontonasal process, the middle from the
maxillary processes and the lower from the mandibular processes.

This facial development that starts in the fourth week will be completed later in the 12th
week, within the fetal period.
 The development of the related oral structures is occuring at the same time.

Most of the facial tissues develop by infusion of swellings or tissues on the same surface of
the embryo.

A cleft or groove is initially located between the adjacent swellings as they are  created by
growth, morphogenesis and differentiation.

During this type of fusion, these grooves are usually eliminated by underlying mesenchymal
tissues migrating into the groove, making the embryonic surface smooth.

This migration takes place because adjacent mesenchyme grows and merges beneath the
external ectoderm.

A slight groove or line is sometimes left on the facial surface, showing where the fusion of
the swellings took place.

An exception to this type of facial fusion is what occurs during palatal development.

Palatal fusion allows the fusion of swellings from different surfaces.

The overall growth of the face is in an inferior and anterior direction in relationship to the
cranial base.

The growth of the upper face is initially the most rapid, in keeping its association with the
developing brain.

The forehead then ceases to grow much after age 12.

In contrast, the middle and lower portions of the face grow more slowly over a prolonged
period of time and finally cease to grow late in puberty.
 The eruption of the permanent third molars at around 17 to 21 years of age marks 
the end of the major growth of the lower two thirds of the face.

The underlying facial bones developing also at this time depending on centers of bone
formation by intramembranous ossification

          
Development of The Maxilla 

 
It includes development of:

1. Maxilla proper

2. Premaxilla

3. Accessory cartilages.

 
MAXILLA PROPER

It develops in the mesenchyme of the maxillary process of the mandibular arch as

intramembranous ossification.
 It has one center of ossification which appears in a band of fibrocellular tissue 

immediately lateral to and slightly below the infra orbital where it gives off its anterior

superior dental branch. 

The ossification center lies above that part of the dental lamina from which develop

the enamel organ of the canine.

The ossified tissue appears as a thin strip of bone. It spreads in different 

directions as: 

Backward: Below the orbit toward the developing zygomatic bone.

Forward: Toward the future incisor region

Upward: To form the frontal process of the maxilla.

 

PREMAXILLA

Two centers of ossification for the premaxilla:

A. The palato-facial center: Appear at the end of 6 WIU. It starts close to the external surface
of the nasal capsule, in front of the anterior superior dental nerve and above the germ of
the lateral deciduous incisor. From this center bone formation spreads: 

1. Above the teeth germ of the incisors.

2. Then downward behind them.

To form the inner wall of their alveoli & palatal part of the pre-maxilla.
  B. The prevomerine center ( paraseptal center ):

It begins at about 8-9 WIU along the outer alveolar wall. It is situated beneath the

  anterior part of the vomer bone and it forms that part of the bone lies mesial to

  the nasal paraseptal cartilage. At 8 WIU union occurs between the maxilla

and premaxilla

  
ACCESORY CARTILAGE

Unlike the mandible the development and growth are little affected by the appearance of
secondary cartilages:

1. Accessory cartilagenous center appears in the region of the future zygomatic or molar
process and this undergoes rapid ossification & adds considerable thickness to the bulk of this part.

2. Also small areas of secondary cartilagenous center appears along the growing margin of
the alveolar plate.

3. In the middle line of the developing hard palate between the two palatine processes.

  
GROWTH OF THE MAXILLA

- Sutural growth

- Alveolar process development

 - Subperiosteal bone formation

- Enlargement of maxillary sinus

- Bone resorption and bone deposition

  
Changes Produced in the Maxilla by Age

 
At birth:

- The transverse and antero-posterior diameters of the bone are each greaterthan the
vertical. 

- The frontal process is well-marked and the body of the bone consists of little
  more than the alveolar process. 

- The teeth sockets reaching almost to the floor of the orbit. 

- The maxillary sinus presents the appearance of a furrow on the lateral wall of
the nose 
 
In the adult:

In the adult the vertical diameter is the greatest

 
In old age:

In old age the bone reverts in some measure to the infantile condition as: 

- Its height is diminished. 

- After the loss of the teeth the alveolar process is absorbed, and the lower part of the
bone contracted and reduced in thickness.
  

 
DEVELOPMENT OF THE MANDIBLE

 
The Mandible is the largest and strongest bone of the face, serves for the reception 
of the lower teeth. It consists of a curved, horizontal portion, the body, and two
perpendicular portions, the rami, which unite with the ends of the body nearly at right angles.

 
For better description development of the mandible will be divided into:
 - Body of the mandible.

- The rami

- The alveolar process

 

THE BODY OF THE MANDIBLE

 

 
The mandible is ossified in the fibrous membrane covering the outer surfaces of Meckel's
cartilages. These cartilages form the cartilaginous bar of the mandibular arch and are two in
number, a right and a left.

Meckel�s cartilage has a close, relationship to the mandibular nerve, at the junction
between proximal and middle thirds, where the mandibular nerve divides into the lingual and
inferior dental nerve. 

The lingual nerve passes forward, on the medial side of the cartilage, while the inferior
dental nerve lies lateral to its upper margins & runs forward parallel to it and terminates by
dividing into the mental and incisive branches.

From the proximal end of each cartilage the Malleus and Incus, two of the bones of the
middle ear, are developed;

Between the lingula and the canine tooth the cartilage disappears, while the portion of it
below and behind the incisor teeth becomes ossified and incorporated with this part of the
mandible. 

The mandible first appears as a band of dense fibrocellular tissue which lies on the lateral
side of the inferior dental and incisive nerves. 

Ossification takes place in the membrane covering the outer surface of Meckel's cartilage
and each half of the bone is formed from a single center which appears, in the region of the
bifurcation of the mental and incisive branches, about the sixth week of fetal life
  

II. THE RAMI OF THE MANDIBLE 

          The ramus of the mandible develops by a rapid spread of ossification backwards into the
mesenchyme of the first branchial arch diverging away from Meckel�s cartilage.
 
This point of divergence is marked by the mandibular foramen. Somewhat later, accessory
nuclei of cartilage make their appearance: 

A wedge-shaped nucleus in the condylar process and extending downward through the
ramus.  

A small strip along the anterior border of the coronoid process.      

 

A. The condylar cartilage:  Carrot shaped cartilage appears in the region of the
  condyle and occupies most of the developing ramus. 

It is rapidly converted to bone by endochondral ossification (14th. WIU) it gives

rise to: 

- Condyle head and neck of the mandible. 

 - The posterior half of the ramus to the level of inferior dental foramen 

  
B. The coronoid cartilage: 

It is relatively transient growth cartilage center (4th - 6th. MIU). It gives rise: 

- Coronoid process. 

- The anterior half of the ramus to the level of inferior dental foramen 

      These accessory nuclei possess no separate ossification centers, but are invaded 

by the surrounding membrane bone and undergo absorption. 

III. The alveolar process 

      It starts when the deciduous tooth germs reach the early bell stage. The bone of the
mandible begins to grow on each side of the tooth germ. 
By this growth the tooth germs come to be in a trough or groove of bone, which also
includes the alveolar nerves and blood vessels. 

 
 GROWTH OF THE MANDIBLE 

     This process occurs with: 

1. Growth by secondary Cartilage. 

2. Growth with the alveolar process 
3. Subperiosteal bone apposition and bone resorption
     

Age changes in the mandible 

 At birth 

The body of the bone is a mere shell 

The mandibular canal is of large size, and runs near the lower border of the bone; the
mental foramen opens beneath the socket of the first deciduous molar tooth. 

The angle is obtuse (175�), and the condylar portion is nearly in line with the body. 

The coronoid process is of comparatively large size, and projects above the level of the
condyle. 

Childhood 

The two segments of the bone become joined at the symphysis, 

The body becomes elongated in its whole length

The depth of the body increases owing to increased growth of the alveolar part,

The mandibular canal, after the second dentition, is situated just above the level of the
mylohyoid line; and the mental foramen occupies the position usual to it in the adult.

The angle becomes less obtuse, owing to the separation of the jaws by the teeth; about the
fourth year it is 140�. 

  
 Adulthood 

The alveolar and subdental portions of the body are usually of equal depth.

The mental foramen opens midway between the upper and lower borders of the bone, and
the mandibular canal runs nearly parallel with the mylohyoid line.

The ramus is almost vertical in direction, the angle measuring from 110� to 120�. 

Old age 

The bone becomes greatly reduced in size, for with the loss of the teeth the
alveolar process is absorbed,

The mandibular canal, with the mental foramen opening from it, is close to the alveolar
border.

The ramus is oblique in direction, the angle measures about 140�, and the neck of the
condyle is more or less bent backward. 

          
Development of the primary palate

(median palatine process, premaxilla)

Appears earlier than Secondary palate at 6WIU. It is a triangular bone anterior to the
 incisive papilla that supports the 4 maxillary incisors

Primary Palate

Develops from the deep tissues of the intermaxillary segment during the deepening of the
nasal pit to form the nasal sac. Tissues beneath the nasal sac enlarge & grow inferiorly to form the
primary palate.

It acquires the triangular shape due to the continuous growth of the maxillary process in a
medial direction.

During the deepening of the nasal sac & the formation of the primary palate, the ectoderm
at the depth of the nasal sac proliferates to form a thickened ectodermal plate, the nasal fin, which
then thins down to a thin double thickened membrane called the � oro-nasal membrane� ( 2
layers of ectoderm from stomodeum & nasal sac)

The rupture of the oronasal membrane detaches the Primary palate from the nasal cavity.

Primary palate & central parts of upper lip are one unit at first, then by 8WIU become
separated by the vestibular lamina

Development of the secondary palate

The secondary palate forms the palate posterior to the incisive fossa that comprises
both the hard & the soft palate

The inferior medial edges of the maxillary process forms the palatine processes
(shelves) at 6WIU.

The tongue is narrow & high filling all the oro-nasal cavity, so the palatine shelves
growmedially & downwards (vertically) on either sides of the tongue
    

Palatal shelf elevation

The fusion of the palatine shelves occurs first just posterior to the primary palate. 
From this point the fusion of the palatine shelves with
  premaxilla proceeds anteriorly and fusion between palatine shelves proceeds
  posteriorly

  
  Fusion also between Palatine shelves & the nasal septum( formed from the interior 
parts of the premaxilla) except posteriorly, where the soft palate  & uvula remain
unattached

     

 Hard & soft Palate Formation

The palate then becomes invaded in its anterior 2/3 by bone (from premaxillary &
maxillary palatal centers) to form the hard palate.

The posterior part becomes invaded by muscles to form the soft palate

The incisive suture demarcate the union between 1ry & 2ry palate, while palatine
raphe demarcate union between 2 palatine shelves.

The incisive suture demarcate the union between 1ry & 2ry palate ( young skulls)

While palatine raphe demarcate union between 2 palatine shelves.

                  

Developmental anomalies

      Cleft Palate

Less common than cleft lip

Due to:

- lack of growth, or failure of fusion between medial & lateral palatine process  & nasal
septum.

- Interruption of the growth after initial fusion ( at any point)

- Interference with palatal shelves elevation

1. Cleft primary palate

Clefts anterior to incisive Foramen. Results from failure of lateral palatine processes to meet
& fuse with primary palate associated with missing or malformed teeth.

2. Clefts secondary palate

Cleft posterior to incisive foramen. As fusion of secondary palate begins at incisive papilla &
proceeds posteriorly. The degree of cleft may vary. From simplest form of bifid uvula to a
complete cleft involving both hard & soft palate.

3. Cleft both primary & secondary palate

 Complete palatal cleft. Results from failure of growth or lack of fusion of 3 palatine processes
with each other and with the nasal septum.

     
CLINICAL CORRELATES

 
Abnormal development of disappearance of various part of the first pharyngeal arch
  result in a variety of malformations.

 
a. TREACHER COLLIN SYNDROME

Also called Mandibulofacial dysostosis

It is a rare autosomal dominant congenital disorder

Characterized by craniofacial deformities

 
Micrognathia (small mandible)

Abnormal auricles (conductive hearing loss)

Underdeveloped zygoma

Drooping part of the lateral lower eye lids

  2) PIERRE ROBIN SYNDROME

 
Congenital condition of facial abnormalities in humans

The main features are:

 
Cleft palate

Micrognathia

Glossoptosis  (downward displacement or retraction of the tongue

Defects of the eye and ear.

  3) SPINA BIFIDA

 
Is a developmental congenital condition caused by incomplete closing of the embryonic
neural tube.

It is also called neural tube defect or myelodysplasia.

Patients may present with a spectrum of impairments but the primary functional deficits
are:
 
Lower limb paralysis and sensory loss 

Bladder and bowel dysfunction

Congestive  dysfunction

 
The lumbar and sacral areas are the most common sites for spine bifida.
 
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