GROWTH AND

DEVELOPMENT OF FACE
















INTRODUCTION



The period from the 3rd to 8th week of the development is
known as the EMBRYONIC PERIOD.

Each of the three germ layers gives rise to different
tissues and organs.


The period from the beginning of the 3rd month to the birth
is known as the FETAL PERIOD.

The main characteristic of the fetus in this period is
the rapid growth of the body and the maturation of the
tissues.

Ectoderm

The ectoderm which contributes to the formation of the face are well
around the stomodeum by the 4th week of embryonic life. The oral
plate of the embryo is located at a level just in front of the palatine
tonsil. It is evident that the ectodermal structures bounding the
stomodeum participate not only in the formation of the face, but also
in the formation of the nasal and oral cavities.
Craniofacial Derivatives


Mesenchyme of head
region is derived from:

Paraxial mesoderm
(somites &
somitomeres)
Lateral plate
mesoderm
Neural crest cells
Ectodermal placodes


Paraxial Mesoderm

Sclerotome (ventromedial part)-forms vertebral column, floor of brain case,
occipital skull bones
Dermatome (lateral part)-forms dermis & connective tissue of head,
meninges caudal to forebrain
Myotome (intermediate part)-voluntary muscles of craniofacial region,
muscles of trunk & limbs.

Lateral plate mesoderm
Lies lateral to paraxial mesoderm
Two layers:
1) Somatic or Parietal - lines peritoneal,
pleural, pericardial cavities
2) Splanchnic or Visceral - forms thin serous
membrane around lungs, heart &
abdominal organs
In head region forms laryngeal cartilages
(arytenoid & cricothyroid)
& connective tissues of larynx
Neural Crest Cells

Cranial neural crest
( forebrain,midbrain and
hindbrain region) enters
pharyngeal arch
mesenchyme

Forms connective tissues
cells (chondroblasts,
osteoblasts, fibroblasts)

Forms bones of midfacial
skeleton and skull

Forms hyoid cartilage

Forms pharyngeal arch
skeletal structures

Plus cartilage, bone, dentin,
tendon, dermis, meninges,
cranial nerve peripheral
neurons and glia


Ectodermal Placodes
The Pharyngeal Arches
Appear at 4-5 weeks as series
of 5 distinct bilateral
mesodermal thickenings in the
wall of the cranial most part of
the foregut.

There are five arches:
1(mandibular arch), 2(hyoid
arch), 3 ,4 & 6;the fifth arch
regresses rapidly.

Face derived mainly from arch
1 & 2.

Neck derived from arch 3 & 4.

Arch 4 & 6 fuse

View and section through an embryo depicting the
pharyngeal arches, pouches and clefts


1 First pharyngeal arch (mandibular arch)
2 Second pharyngeal arch (hyoid arch)
3 Third pharyngeal arch
4 Fourth pharyngeal arch
5 Pharyngeal pouches (endodermal evaginations)
6 Pharyngeal cleft (ectodermal grooves)
Pharyngeal Arch Components
Each arch consists of a core of mesenchyme covered
externally by ectoderm & internally by endoderm.
These arches are separated from each other externally
by pharyngeal clefts & internally by pharyngeal pouches.
Each arch contains Artery, Cartilage, Nerve, Muscular
component.

ARCH NERVE MUSCLES SKELETAL ELEMENTS
1
(mandibular)
Mandibular division
of Trigeminal (V),

Chorda Tympani
branch of
facial nerve
(VII)
Muscles of mastication:
(Temporalis, Masseter
Medial pterygoid, lateral
pterygoid)
Mylohyoid,
Ant. Belly of digastric,
Tensor Tympani,
Tensor veli palatini.

Meckel's cartilage: Incus,
Malleus,
Mandibular Template
Sphenomandibular ligament,
Maxilla, Zygomatic Bone,
Palatine Bone,
Part of Temporal Bone

2
(hyoid)
Facial (VII)
Stapedius, Stylohyoid,
Posterior belly of digastric,
Muscles of face
Auricular Muscles,
Occipito-frontalis,
Platysma
Reicherts cartilage
Stapes,
Styloid process,
Lesser cornu of hyoid,
Upper part of body of
hyoid bone,
3 Glossopharyngeal (IX) Stylopharyngeus
Greater cornu of hyoid,
Lower part of body of Hyoid
bone
4 and 6
Superior laryngeal and
Recurrent laryngeal
branch of Vagus (X)
Cricothyroid,
Constrictors of pharynx
Levator veli palatini,
Intrinsic muscles of
larynx

Thyroid cartilage,
Cricoid, Arytenoid,
Corniculate and Cuneform
cartilages of larynx
PHARYNGEAL ARCH DERIVATIVES
Structures arising from cartilaginous
component of pharyngeal arches
POUCH Overall Structure Specific Structures
1 Tubotympanic recess
Tympanic membrane,
Tympanic cavity, Mastoid
antrum, Auditory tube
2 Intratonsillar cleft
Crypts of palatine tonsil,
lymphatic nodules of palatine
tonsil
3
Inferior parathyroid gland,
Thymus gland
4
Superior parathyroid gland,
Ultimobranchial body
5
Becomes part of 4th pouch,
Ultimobrachial body
Parafollicular or C cells of
thyroid gland,
Structures Derived From
Pharyngeal Pouches
Clinical Anomalies Associated With
Pharyngeal Arches
1) Agnathia:
- fatal autosomal
recessive anomaly
- complete or partial
absence of jaw

Clinical anomalies associated with
pharyngeal arches
2) Treacher Collins
syndrome
(mandibulofacial
dysostosis)
- dominant autosomal
anomaly
- hereditary pattern
- malar hypoplasia
- mandibular hypoplasia
- antimongoloid palpebral
fissures
- malformed external
ears







Clinical Anomalies Associated With
Pharyngeal Arches
3) Robin Sequence
(Pierre Robin
syndrome)

- affects the first arch
structures, particularly
mandible(micrognathia)

- cleft palate

- glossoptosis
( posteriorly placed tongue)


Clinical Anomalies Associated With
Pharyngeal Arches
4) Goldenhar Syndrome
(oculoauriculovertebral
spectrum)

- craniofacial
abnormalities

- ear (anotia, microtia)
eye (tumors & dermoids)
and vertebral defects
( fused vertebrae, spina bifida)

- maxillary, temporal
and zygomatic bones affected



Clinical anomalies associated with
pharyngeal arches
5) Ectopic thymus and parathyroid tissue:
Glandular tissue remnants along path of migration

6) Brachial cysts and fistulas:
- cervical sinus cavity fails to get obliterated,and persists to give rise to
swellings along the anterior border of the sternocleidomastoid.
- Most often these cysts are located just below the angle of the jaw.

Appearance of facial prominences

The face develops at the
end of 4th WEEK i.u. from 5
prominences that surround a
central depression-
stomodaeum

Facial prominences consist
primarily of neural crest
derived mesenchyme.


Mesoderm covering the
developing forebrain forms a
downward projection-
FRONTONASAL PROCESS,
overlapping the upper part of
the stomodaeum.


Paired MAXILLARY &
MANDIBULAR processes
arise from the 1
st
arch.

1. Stomodeum
2. Frontonasal swelling
3. Cardiac bulge
4. Nasal placode
5. Pharyngeal arches (2nd and 3rd)
6. Mandibular swelling
7. Maxillary swelling
Face at week 5

Ectoderm overlying
Frontonasal
prominence shows
bilateral localized
thickenings-
NASAL(OLFACTORY)
PLACODES. There
formation is induced
by underlying
forebrain.

The placodes
invaginate to form
NASAL PITS which are
continuous with
stomatodaeum below

Edges of each pit are
raised.Medial edge is
called the MEDIAL
NASAL PROMINENCE
and the lateral edge is
called the LATERAL
NASAL PROMINENCE





1. Stomodeum
2. Eye
3. Maxillary swelling
4. Mandibular swelling
5. Nasal pit
6. Frontal swelling
7. Lateral nasal swelling
8. Medial nasal swelling
Face at 7 week
- maxillary
prominence
increase in
size
- maxillary
prominence
grow to
midline
- medial nasal
prominence
grow to
midline

1. Stomodeum
2. Eye
3. Maxillary swelling
4. Mandibular swelling
5. Nasal pit
6. Frontal swelling
7. Lateral nasal swelling
8. Medial nasal swelling
9. Nasolacrimal groove
Formation of upper lip
The lateral part of upper lip is formed by maxillary process
The median part of the lip PHILTRUM is formed by
midline merging of frontonasal process.
The lateral nasal prominence do not take part in formation
of the upper lip
Formation of lower lip
Mandibular prominences of the two sides
grow towards each other and fuse in the
midline.
Form the lower margin of the
stomatodaeum.
Give rise to lower lip & lower jaw.
Formation of Cheek & Maxilla
After formation of the upper & lower
lips, the stomatodaeum laterally is
bounded by the maxillary prominence
above and mandibular prominence
below.

These Maxillary & Mandibular
prominences undergo progressive
fusion to form the cheeks.

The lateral merging of these
prominences creates the commissures
of the mouth.

The maxillae arise from the maxillary
prominences.

Formation of Nose
Formed from 5 facial prominences:
frontonasal ,medial nasal (2), lateral
nasal (2)
Fusion of medial nasal prominence
& maxillary prominence cuts off the
nasal pits from the stomatodaeum ,
giving rise to external nares
Maxillary prominences grow
considerably & frontonasal
prominence becomes narrow so the
two external nares come closer.
Deeper part of the frontonasal
prominence gives rise to the nasal
septum. Mesoderm thickens to form
the prominence of the nose
The medial nasal prominences
merge to form the crest and tip of
nose
Lateral nasal prominence form the
alae of the nose.
Nose becomes prominent ; the
external nares come to open
downwards instead of forwards.




The Nasolacrimal Duct
Maxillary & Lateral Nasal
prominences are seperated by
NASOLACRIMAL GROOVE. A
strip of ectoderm gets burried
along this furrow and later
gives rise to NASOLCRIMAL
DUCT.

This duct runs from the medial
corner of the eye to the inferior
meatus of nasal cavity.

Upper end of the duct forms
the lacrimal sac.

Intermaxillary segment
Merging of the two medial
nasal prominences

It is composed of :

* Labial component
philtrum of upper lip
* Upper jaw component
4 insisor teeth
* Palatal component
primary palate (which
arises from frontal
prominence)

Continuous with nasal
septum (which arises
from frontal prominence)

Primitive palate
Derived from intermaxillary segment.
Plays role in formation of secondary palate.
Forms the premaxilla which carries the incisor
teeth.

Development of secondary palate
During 6
th
week i.u., 2 palatal processes appear
as shelf like outgrowths of the maxillary
prominences.
They are directed obliquely downwards on
either side of tongue.


Each palatine process fuses with posterior margin
of the primitive palate.
By 7
th
week i.u. palatine shelves attain a horizontal
position above the tongue and fuse in the midline
Fusion begins anteriorly and proceeds posteriorly
Medial edges fuse with lower edge of nasal septum,
separating the nasal cavities from each other and
the mouth.
Later mesoderm in
the palate undergoes
intramembranous
ossification to form
hard palate.

Ossification does not
extend into posterior
most region, which
remains as soft
palate.

Formation of external ear

6 auricular hillocks become apparent
around 6
th
week. Three form from the
first arch and three form from the
second arch

Each of the auricular hillocks forms a
distinctive portion of the definitive
external ear. For example, hillock #1
forms the tragus and hillock #6 forms
the antiragus, as well as part of the
helix. The lobule of the ear is not
derived from the hillocks.

The developing external ears are
initially more caudal than the lower
jaw. Growth of the lower jaw places the
external ear in a relatively higher and
more vertical orientation by 4
th
month
i.u.
Formation Of Eye & Eyelids
Optic vesicles
develop as
outgrowths on either
side of the forebrain.
Optic vesicles grow to
contact surface
ectoderm.
Lens placode develop
in the region overlying
optic vesicles.

Optic vesicles invaginate to form
double layered optic cup , and
lens placode invaginate to form
lens vesicle.

Lens vesicles give rise to lens of
eye.

Outer layer of optic cup forms
the pigmented layer of the
retina, while the inner layer
differentiates into light sensitive
nervous layer (rods, cones,
bipolar neurons ,ganglion cells
and other neurons)

The optic stalk is converted into
the optic nerve.

The mesoderm surrounding the
optic cups and the lenses forms-
Sclera, Choroid, Ciliary body,
Iris. Cornea is derived from the
same mesodermal layer that
forms the sclera.

Formation Of Eye & Eyelids
Begin to develop around 1
st
month of pregnancy.

By the end of the 2nd month, the transparent eyelids are flawless.

By the 5th month, the eyelids are completely shut, and covered with a
protective oily substance.
The eyelids develop from ectodermal folds above and below the cornea.
As the folds enlarge, their margins fuse together and cut off a space
called the conjunctival sac. The lids remain close till 7th month i.u.

The extrinsic muscles of the eye are derived from the prechordal
somitomeres.
Post Natal Changes In Face
At birth, the lower third and the middle third of
the face are underdeveloped due to absence of
teeth.

Forehead is high and bulging.

Face of new born is round and flat.

Eyes dominate and appears to be widely
separated due to absence of root of nose.

After onset of Puberty,
- Forehead flattens and widens
- Lips thicken
- Face acquires an oval shape
These occur due to growth of jaws.

Convex facial profile straightens out, due
to more anterior position of jaws.
Growth of Face in Different
Planes
Postnatally , growth of face is completed
in following sequence:

1.Transverse plane i.e. Width
2.Sagittal plane i.e. Depth
3.Vertical plane i.e. Height
DEVELOPMENT ANOMALIES OF THE FACE
Facial abnormalities number as the most frequent congenital
anomalies (1:1000 newborns) and are often encountered in
combined forms

Occur during the period of organogenesis( 3 to 8 weeks) as a
result of faliure of fusion of various facial prominences.

Environmental factors as well as genetic factors play a role

Teratogens
- Infectious agents: Rubella virus, Cytomegalovirus, HSV,
Varicella virus,HIV,Toxoplasmosis, Syphillis
- Ionising Radiation ,X-rays
- Drugs: Thalidomide,Phenytoin,Valproic acid,Trimethadione,
Lithium,Warfarin, ACE inhibitors, Cocaine
- Maternal Alcohol abuse
- Maternal folic acid deficiency
- Chemical agents: Industrial solvents, Organic mercury,Lead,
- Vitamin A excess


Problems encountered in children
with craniofacial clefts include:

- Breathing and airway problems
- Feeding and dental problems
- Visual and eyelid problems
- Psychosocial problems
- Neurological problems
TYPES OF FACIAL ANOMALIES
Cleft lip
Cleft palate
Oblique facial cleft
Microstomia & macrostomia
Coloboma
Cyclops, synopthalmia and anopthalmia
External ear defects preauricular
appendages & pits
Proboscis , Bifid nose
Cleft Lip
When one or both maxillary prominences fail to
fuse with medial nasal prominence.
May be unilateral or bilateral.
Cleft line starts at lateral part of lip, continues
through the philtrum up to alveolus
Cleft of primary palate - Cleft anterior to incisive
foramen.
Cleft lip & palate - When cleft continues posterior
to the incisive foramen in the midline.
Median cleft lip Very rare condition.
Types Of Cleft Lip
Cleft Palate
Failure of fusion of maxillary and nasal
prominences
May be unilateral or bilateral
Cleft of primary palate
Cleft of secondary palate - varies from
bifid uvula to cleft up to incisive foramen

Types of cleft palate
Cleft Lip And Palate
Oblique Facial Cleft
Non fusion of
maxillary and
lateral nasal
prominences.
Cleft runs from
medial angle of
the eye to the
mouth.
Nasolacrimal duct
is usually exposed
to the surface.

Macrostomia And Microstomia
Macrostomia:
Inadequate fusion
of maxillary and
mandibular
prominences
Microstomia :
excessive fusion of
maxillary and
mandibular
prominences.
Coloboma
Failure of closure of
choroid fissure during
7
th
week
Mostly iris is involved,
may extend to ciliary
body, retina, choroid,
and the optic nerve.
Coloboma of eyelid-
part of eyelid may be
missing.
Cyclopia: two eyes
fuse completely to form
a single midline
structure.

Synopthalmia : partial
fusion of eyes

Anopthalmia :
absence of eyes.
Hypertelorism
Widely separated
eyes due to their
undermigration from
initial lateral position
towards midline.

Poor visual ability.

Uncoordinated eye
movements.
Preauricular Appendages And Pits
Preauricular
appendages are skin tags
seen in front of the auricle
which arise due to
accessory hillocks

Preauricular pits are
shallow depressions
anterior to the ear and
indicate abnormal
development of the
auricular hillocks.
Proboscis
Nose formed as a cylindrical projection jutting
out from just below the forehead.
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