Embryology, growth and

development of the face and

jaws
Dr. Ramy Ishaq
BDS, MSc, PhD Orthodontics Cairo University
Morth RCSED UK
Prenatal Craniofacial Growth
and Development
Prenatal Craniofacial Growth and
Development
 Knowledge of the embryology of the facial
region

is vital as it provides the

orthodontist with

understanding of how
insight into how normal
congenital deformities occur
variations in facial structure
when normal facial
arise
development goes awry.
Lateral drawing of the disarticulated
craniofacial bones

Bones that ossify

Bones that ossify
by
by endochondral
intramembranous
ossification
ossification

green blue
 Prenatal Development

Prenatal development is divided into

3 stages

1- Ovum 2- Embryo 3- Fetus

(zero – 14 days) (14 days – 56 days) (8 weeks –birth)
Ovum (fertilization – 14 days)

The ovum stage may be

divided into 3 stages

Formation of Formation of
Fertilization
Morula Blastocyst
Ovum (fertilization – 14 days)
Fertilization
• Fertilization takes place when the sperm and ovum form the zygote
Formation of Morula
The zygote continue to multiply to form the Morula at day 3
The morula stage starts when the cell number reaches 16 cells
Formation of Blastocyst

the blastocyst is formed at the 4th or 5th day from conception

 Period of ovum
The centre of
Fertilization rapid mitosis → morula cavitates to
→zygote morula a 16 cell form a structure
called blastocyst.
Blastocyst structure
• Inner cell mass:
• Inside the blastocyst is the called the
embryoblast.
• It develops into the embryo.
• Trophoblastic layer:
• It is a single layer of cells surrounding the
BC.
• It forms the embryonic part of the placenta
• Blastocystic cavity (BC):
• A fluid filled space in the blastocyst.
• It is formed by cavitation of the morula in
the centre.
 By 2nd week of IUL
the blastocyst is implanted into the uterine
Embryo: (14 days – 56 days)

Divided into
3 stages

Presomite Somite Postsomite

14-20 days 21-31 days 4th-8th week.
Presomite period

Presomite period is the After implantation of the

the fetal membranes
period of formation of blastocyst, trophoblastic
provide
the fetal membranes layer differentiates into
• amnion • nutritional supply to • syncytiotrophoblast
• chorion the developing embryo layers
• the formation of • cytotrophoblast layers.
primary germ layers.
amnion and chorion

The 2 fetal • the amnion

membranes and the
are
chorion

make up • that surrounds

the
amniotic and protects
sac the fetus
Establishment of maternal blood circulation

Syncytiotrophoblast is
• a single multinucleated outer cell
• it erodes and invades the endometrium and its vessels to
establish maternal blood circulation to the developing
embryo.

The circulation is named

• uteroplacental circulation.
 The inner cell mass of the blastocyst
differentiates into a bilaminar disc
The 2 layers of the
disc are:
Hypoblast: formed of
squamous or cuboidal
cells

Epiblast: formed of
columnar cells
Primitive yolk sac

Blastocystic cavity, by now called

primitive yolk sac

It is bound partly by hypoblast and

partly by squamous cells.

Amniotic cavity develops between

epiblast and cytotrophoblast.
The three germ layers or embryonic layers

Embryonic layers

Ectoderm Mesoderm Endoderm

 The 3 germ layers are
derivatives of epiblast layer.
• Formation of Endoderm
• Cells of epiblast migrate and invaginate
beneath the epiblast itself and form the
endoderm.
• Formation of Ectoderm
• The outer layer or upper layer forms the
ectoderm
• Formation of Mesoderm
• The layer of mesoderm is formed by the
cells of epiblast invading between
ectoderm and endoderm throughout the
embryo except at the prochordal plate,
Ectoderm

From the
Ectoderm •Epithelial covering
the or skin.
following •Enamel of the teeth.
tissues are •Nervous system.
derived:
Mesoderm

From the • Skeletal system and muscles.

Mesoderm • Blood, lymph cells and
the vessels.
following • Kidneys.
tissues are • Dentine, cementum and
dental pulp.
derived:
Endoderm

From the
Endoderm, •Pharynx
the following •Stomach
tissues are
derived •Intestines
epithelial
lining of the : •Lungs
Neural crest cells (NCC)
• The Neural crest cells are a group of
cells derived from ectoderm .

• They are positioned on the top of the

neural fold.

• Once the neural tube is formed , the

cells form a group of cells resting on
the top of the neural tube
 Neural crest cells (NCC)
These cells
proliferate •Cartilage
and
differentiate •Bone
into the
various
•connective
components tissue of the face
of the face
Pharyngeal arches
Pharyngeal arches
Pharyngeal arches

The arches are

separated

Externally by
Internally by
pharyngeal
pouches.
grooves/clefts
 Each arch consists of
A central cartilage rod
• derived from cranial neural crest

A muscular component
• The muscle cells are formed from mesoderm
• the fascia and tendons from neural crest cells

A vascular component
• Which includes blood vessels

a nervous element
• which includes sensory and special motor fibers from a
cranial nerve
• They supply the mucosa and muscle of that arch
 Development of the Face

The major
this takes place in a
development of the
series of
facial region occurs

highly
between the4th
coordinated &
and 8th
pre‐programmed
embryonic weeks
events.
 Development of the Face
The face begins to develop at the 4th week IUL.
From the 1st brachial arch the
following processes begin to
develop:

Frontonasal Maxillary Mandibular

process Process processes
Development of the palate

The palate is formed from

• The palatine shelves which are
formed from the maxillary processes

The shelves fuse

• to each other and
• to the premaxilla region in a Y
shaped pattern
 nasal septum septal cartilage

Tongue

Meckel’s cartilage palatal shelves

 7th W IUL: 8th W IUL: 9th W IUL:

• The palatal • the palatine • The shelves

shelves begin shelves fuse with each
to develop on elevate rapidly other , the
either side of due to the primary palate
the tongue internal shelf and nasal
elevating force septum
Cleft palate
Failure of fusion results in a condition called
cleft palate
 Formation of the Upper Lip
Formed from the fusion
between the Globular
Process and the maxillary
process

Failure of fusion results in a

condition called cleft lip
Types of Cleft lip
The division
of the
craniofacial
skeleton into
anatomic
and
functional
regions.
Prenatal development of the cranial base

Anatomy of Cranial Base and

Calvaria
Prenatal Development of the
CB and Calvaria
Cranial Base Function and Anatomy

Function 5 Bones constitutes the CB

• support and protect the brain and • Occipital bone

spinal cord. • Sphenoid bone
• Articulates with the vertebral • Temporal bone
column, the mandible and the • Ethmoid bone
maxillary regions
• Frontal bone
• It acts as a buffer area between the
brain, face and pharyngeal region
as these areas grow at different
rates
Drawing
from above
of the skull
base
 The internal surface of the CB
midsagittal section of the CB
The internal surface • Anterior, middle and posterior
of the cranial base • They adre due to the depressions caused by the
is divided into lobes and intracranial contents.

The midsagittal • The Anterior cranial base being from Sella to

section is divided Nasion
into anterior and • The posterior cranial base being from Sella to
Basion.
posterior sections.
Skeletal structure of calvaria

mesenchyme for these

structures is derived from

paraxial
neural crest
mesoderm
(white)
(gray).
Prenatal Development of the CB and Calvaria
The development of the CB and calvaria goes
through 3 major phases:
The appearance of a
mesenchymal anlage

Chondrification

Ossification
The appearance of a mesenchymal anlage
• in the 4th embryonic week
Development of the
• The mesenchyme that surrounds the developing brain
skull starts forms a capsule.

This mesenchymal • neural crest

tissue is derived from • occipital sclerotomes.

The tissue condenses

• The basal portion will give rise to the CB
around the developing • The upper portion will give rise to the calvaria
brain
Origins of Mesenchyme

Anterior to
the pituitary •the neural
gland is crest
derived from

Posterior to
the pituitary •paraxial
gland is mesenchyme
derived from
This ectomeningeal mesenchyme will
eventually produce 3 areas
The neurocranium • which surrounds and protects the brain
or desmocranium • It is mainly ossified by intramembranous ossification

The • It is the future skull base

chondrocranium • ossified by endochondral ossification

• It which will develop into the facial skeleton

The
• It is ossified by both intramembranous and
viscerocranium endochondral ossification
Chondrification
 Chondrification
It begins to chondrify
Chondrification of the Chondrification of the
from 3 main pairs of
ectomeningeal capsule skull base
cartilaginous precursors:
• starts in the seventh • proceeds from • The Parachordal
embryonic week posterior to anterior. cartilage (posterior to
• cells within the the pituitary gland)
ectomeningeal capsule • The Hypophyseal
differentiate into cartilages (lateral to the
chondroblasts. pituitary gland) and
• The Prechordal
cartilages (anterior to
the pituitary gland)
Ossification

The ossification
• more than 110 ossification centres that appear
process is in the embryonic cartilaginous human skull.
complex

• initially produce 45 bones in the neonatal skull

These centres • after further postnatal fusion, only 22 bones are
recognized in the young adult.
Synchondroses
 In the cranial base
4 types of synchondroses are seen.
• Located between Presphenoid and Post‐sphenoid.
Intersphenoidal
• Fuses at +‐8th intra‐uterine month. (Ranly 1980)
Interethmoidal
• Located between Sphenoid and Ethmoid bone.
Sphenoethmoidal • Fuses at age 7 (this stops further growth from Sella to
Foramen Cecum)

• Located between Sphenoid and Occipital bone.

Sphenooccipital or • Active until 15 years of age .
basioccipital • Responsible for most post‐natal growth of midventral part
of Cranial Base length
Prenatal growth and development of the
calvaria

Embryonic
Fetal Phase
Phase

Formation of
mesenchymal Ossification Calcification
cells
 Formation of
mesenchymal cells by a • EMT is a process by which
process termed epithelial cells become
epithelial-mesenchymal mesenchymal cell
transformation (EMT)
Embryonic
Phase
All bones of the skull pass • development of the cranial
Formation of first through a bones begins with condensation
mesenchymal precondensation phase. of mesenchymal cells

cells
Within the first 4 weeks
• unsegmented paraxial
of IUL, the fetal head has mesoderm
mesenchyme originating
• cranial neural crest cells
from 2 sources
The viscerocranium is derived exclusively
from neural crest mesenchyme.
The neural crest • Frontal
provides the • Sphenoid
mesenchyme • squamous temporal bones
forming the • facial bone

Paraxial mesoderm • Parietal

play a direct role in • petrous temporal
skeletogenesis of • occipital bones
Fetal Phase
Ossification
• IM ossification (osteogenesis) starts by developing the ossification
centers in the outer layer of the ectomeninx to form individual bones.
Ossification centers first appear in areas corresponding to the future
eminences as early as 7th and 8th week post conception (PC) and
with bone formation spread centrifugally.
Calcification
• The next step is calcification which begins a few days after the deposit
of organic bone substance (or osteoid) by osteoblasts.
• With ongoing condensation of these centres, ossification proceeds to
form bones that are characterized bone spicules. These spicules
progressively radiate from primary ossification centres toward the
periphery.
Development of Sutures
• Sutures are formed during embryonic development at the sites of
approximation of the membranous bones of the cranial bones and as
a flexible fibrous tissue uniting the adjacent bones
Growth : remodeling and displacement
• A process of morphogenic sequencing begins during prenatal growth,
continues postnatally, and contributes to the basis for the differential
manner of growth.
Development and Growth of
the Naso‐Maxillary Complex
Anatomy of the Nasomaxillary Complex
 Developmentally, the skull is a composite
structure made up of
The • which surrounds and protects the
neurocranium brain

The • which forms the skeleton of the face.

viscerocranium
The Nasomaxillary complex is makes up a part
of the Viscerocranium.
 The viscerocranium is that part of the skull
that develops from the Pharyngeal arches

It includes the following 14 bones

Inferior
Lacrimal Nasal Palatine Zygomatic
nasal Mandible Maxilla (2) Vomer
bones (2) bones (2) bones (2) bones (2)
concha (2)
Inferior Nasal Conchae

• a curved bone that forms part of the lateral wall of

It is described as the nasal cavity.

Ossification • Endochondral.

• the maxilla and inferior nasal perpendicular plate of

Articulates with the conchae palatine, lacrimal, and ethmoid bones.
Inferior
Nasal
Conchae
 Lacrimal Bones

Ossifies by
• Intramembranous ossification.

Articulates with
• the frontal process of the
maxilla, orbital plate of the
ethmoid bone, the frontal
bone, and the inferior nasal
concha.
 Nasal Bones
Ossifies by
• Intramembranous ossification.

Forms
• the bridge the nose.

Articulates with
• the nasal bone of the opposite side,
the nasal portion of the frontal
bone, the frontal process of the
maxilla, and the perpendicular plate
of the ethmoid.
Palatine Bones

Ossifies by Forms part of It includes 3 parts

• Intramembranous • the nasal cavity • Perpendicular

ossification. • hard palate. plate
• Horizontal Plate
• Pyramidal Process
Perpendicular plate

On the superior A small orbital

Shape Forms Lateral wall
border is a notch process
• vertical • that articulates • helps form part • part of the wall • articulates with
rectangle with the of the orbit. of the the maxilla
sphenoid bone, pterygopalatine • to form the
forming the fossa palatine canal
sphenopalatine • the lateral wall
foramen of the nasal
cavity.
Horizontal Plate

Forms • the posterior portion of the hard palate.

Superior to the
• the nasal cavity
horizontal plate is
On the medial part,
• the posterior nasal spine
formed by both plates

On this plate there is • Greater palatine foramen

Pyramidal Process

• posteriorly and inferiorly

Extends • from the junction of the
perpendicular and horizontal plates

On this • The Lesser palatine foramina

process
Zygomatic
Bones
Ossifies by
• Intramembranous
ossification.
Forms
• majority of the skeleton of
the cheek
provides
• attachment of the masseter.
Zygomatic Bones

• Articulates with the frontal bone to help form

Frontal Process: the orbit

Temporal • Articulates with the zygomatic process of the

process: temporal bone to form the zygomatic arch.

Maxillary • Articulates with the zygomatic process of the

process: maxillary bone to help form the orbit.
Zygomatic Bones Process
Maxillary Bones

Ossifies by • Intramembranous ossification.

Forms • most of the skeleton of the face and the upper jaw.

• the opposite maxilla and the frontal, sphenoid, nasal, vomer, and
Articulates with ethmoid bones; inferior nasal concha; palatine, lacrimal, the and
zygomatic bones; and the septal and nasal cartilages.
Body

Gives rise to 4
The body is Contains
different regions:
• Major part of • maxillary • Orbit
maxilla paranasal sinus • Nasal cavity
• shaped like a • Infratemporal
pyramid. fossa
• Face
 Processes

Frontal • Extends superiorly to articulate with the nasal,

frontal, ethmoid, (maxillae) and lacrimal bones
• Forms the posterior boundary of the lacrimal
Process: fossa.

Zygomatic • Extends laterally to articulate with the maxillary

process of the zygomatic bone.
process:
 Processes

Palatine • Extends medially to form the majority of the hard

palate
• Articulates with the palatine process of the opposite
process: side and the horizontal plate of the palatine bone.

Alveolar • The part of the maxilla that supports all of the

maxillary teeth.
• Extends inferiorly from the maxilla. Alveolar bone is
process: resorbed when a tooth is lost.
Pre‐Natal Development
of the Nasomaxillary
Complex
 Overall Perspective
Where the Cells Come From
• The major development of the facial region occurs between
• the 4th & 8th embryonic weeks
• This process includes contributions from
• the head ectoderm
• the neural crest mesenchyme
• the head ectoderm
• will help form the face and oral cavity
• the neural crest mesenchyme
• contributes to the first branchial arch and its derivatives.
• This mesenchyme is derived from the neural crest and prechordal plate.
• It appears that the future frontonasal region has mesenchyme from 2 origins
of neural crest cells.
Neural Tube Formation “neurulation”
• neural plate formation
• The ectoderm above the
notochord is induced to form a
thickening called the neural plate
• Neural groove formation
• The midline of neural plate
deepens to form a groove with
elevated margins on either side,
the neural folds.
• Neural tube formation
• The folds grow towards each other
and fuse to form the neural tube
The NT forms the CNS
• The anterior end of the neural
tube forms the
• fore brain
• midbrain
• hind brain.
• The edges of the neural fold
on either side of neural groove
are called
• neural crests
• Cells that proliferate from the
neural crest
• undergo extensive migration
between all the three germ layers
and derivatives of neural crest cells
are seen in the craniofacial region
and the neck.
• Neural crest cells have their
origin in
• the ectoderm
• they also have mesodermal
properties.
Formation of
the face
Formation of the face:
• Pharyngeal arches not only contribute to
formation of the neck but also play an
important role in formation of the face.
• At the end of the 4th week, the centre of
the face is formed by the stomodeum,
surrounded by the first pair of
pharyngeal arches.
When the embryo is 42 days old,
5 mesenchymal prominences can be recognized:
• The mandibular prominences
• From the first pharyngeal arch and is caudal to the stomodeum
• the maxillary prominences
• From the dorsal portion of the first pharyngeal arch and lateral to the
stomodeum;
• the frontonasal prominence
• A slightly rounded elevation cranial to the stomodeum.
• Development of the face is later complemented by formation of the
nasal prominences.
• 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 the brain vesicles, constitutes the upper border of the
stomodeum.
• On both sides of the frontonasal prominence, local thickenings of the
surface ectoderm, the nasal (olfactory) placodes, originate under inductive
influence of the ventral portion of the forebrain.
• They are the precursors of the olfactory epithelium, responsible for the
sense of smell.
• During the following 2 weeks, the maxillary prominences continue to
increase in size.
• Simultaneously, they grow medially, compressing the medial nasal
prominences toward the midline.
• The two medial nasal processes grow towards each other and fuse at
the midline; from now on it is called globular process. The derivatives
of globular process are tip of the nose, columella, philtrum,
prolabium, primary palate (with 4 maxillary incisors).
Development of the
face. In the sixth
week, the nasal
placodes of the
frontonasal
prominence
invaginate to form
the nasal pits and
the lateral and
medial nasal
processes.
Frontal aspect of the face. A. 7‐week embryo.
Maxillary prominences have fused with the medial
nasal prominences. B. 10‐week embryo.
Table:
Structures
contributing
to
formation
of the face
Merging vs Fusion:

Most facial processes begin as two separate swellings

separated by a groove.

Merging
Fusion
Merging
• Merging s the process by which the groove between two facial
processes is eliminated
• The tissues in the groove “catch up” by proliferating more rapidly than
the surrounding tissues, causing the groove to become progressively
shallower until it smoothes out.
Merging is critical

Without it • a deep depression (a facial cleft) remains between what used to

be the facial processes.

• merging of the 2 mandibular processes (the former mandibular

Examples of arch) in the midline
• merging of the 2 medial nasal processes in the midline

merging are • merging of lateral nasal and maxillary processes

• the merging of mandibular and maxillary processes
Fusion
• Fusion is the process by which two facial processes, that were initially
separated by a space, grow together (Figure 15).
• An example of fusion is the formation of the secondary palate, where
two facial processes grow toward each other, touch each other and
then fuse in the midline.
• In fusion, unlike merging, the epithelium is broken down where the
two processes meet.
Schematic showing the difference between merging (left and
fusion (right)
Prenatal Growth and development of the
Mandible
 Viewed from a functional perspective, mandibular
development provides the basis for normal occlusal
relationships and the production of significant masticatory
force.

• Through increases in the size of the ramus, body, alveolar processes

and the eruption of teeth, the growth of the mandible occurs in
parallel with that of the nasomaxillary complex and dentition.
• This reciprocal growth is essential if proper occlusion is to be achieved
and an in‐depth understanding of this growth is necessary during
daily clinical practice.
 Anatomy Of The Mandible:
Each half of the mandible is characterized anatomically by

Condyle Ramus Corpus or body

• which articulates with • which extends roughly • which extends roughly

the temporal bone to vertically‐inferiorly horizontally anteriorly
make up the TMJ from the TMJ and to provide a base for
provides insertions for the mandibular dental
the muscles of arch and house the
mastication inferior alveolar
neurovascular bundle.
Supero‐later
al view of
the
Mandible
 Functional Units (Graber et al. 2011)

The anatomic structures of the mandible can also be

considered in terms of 5 overlapping functional units:
• The mandibular condyle
• The gonial region
• The coronoid process
• The alveolar process
• The body of the mandible
The mandibular condyle

• The mandibular condyle is closely

Articulation: related to the articular function of the
TMJ and movements of the mandible.

• The condylar cartilage also plays a

Growth: significant role in mandibular growth.
The gonial region

Function of •The gonial region of the

masseter & mandible is related to the
function of the masseter
medial and medial pterygoid
pterygoid muscles.
The coronoid process

Function •The coronoid process

of is primarily related to
temporalis the function of the
muscle temporalis muscle.
 Growth and form is influenced by
function

Variation in the the variation in the

growth and form of function of the
each of these muscles of
regions is caused by mastication.
The Alveolar Process

support •The alveolar process

of the mandible
for the functions to provide
dentition support to the teeth.
The Body Of The Mandible

support • The body of the mandible,

and provides support and
structural connection between
structural the various functional
connection components of the mandible.
 First step: • formation of mandibular processes and Meckel’s
Cartilage

Second step: • Formation of the mandibular division of the

trigeminal nerve

Third step: • Development by Intra‐membranous Ossification

Fourth step: • Development Of Secondary Cartilages

 First step:
formation of mandibular processes

The mandibular it is preceded by

processes of the first • the formation of Meckel's
branchial arch cartilage
• is the first step of formation
of the mandible
Role of Meckel's cartilage

Meckel's It is Meckel's Acts as a

cartilage accompanied by cartilage support for
• is the core • inferior • takes no direct • the
• It is the alveolar part in the mandibular
primary artery, vein, formation of nerve
cartilaginous and nerve. the corpus of • the membrane
skeleton of the the mandible, bone which
mandible will develop
later.
Fate of Meckel’s cartilage

completely
Meckel’s disappears by
cartilage approximately 24
weeks IUL

Its the dense

giving rise to the
remnant sphenomandibular
malleus and incus.
ligament and
form
Second step:
the mandibular division of the trigeminal nerve
The first structure to The prior presence
develop in the region of the nerve has
of the lower jaw is been postulated as

requisite for inducing

the mandibular
osteogenesis by the
division of the
production of
trigeminal nerve
neurotrophic factors.
Third step:
Development by Intra‐membranous Ossification
• condensation of mesenchyme occurs in the angle formed by
the division of the inferior alveolar nerve and its incisor and
By 6 weeks
gestation mental branches

• A centre of ossification appears lateral to Meckel’s cartilage.

• Intramembranous ossification of the body of the mandible
At 7 weeks starts as a mass of fibrous tissue lateral to the bifurcation of the
incisive and mental nerves
Diagram showing
the relationship of
Meckel's cartilage
to the mandibular
nerve and the site
where membrane
bone formation is
initiated.
Formation of the ramus

The ramus of the mandible

develops by
• a rapid spread of ossification
posteriorly into the
mesenchyme of the first arch,
• turning away from Meckel’s
cartilage.
Fourth step
Development Of Secondary Cartilages

By approximately 10 ‐12 weeks gestation,

secondary cartilages appear. These are

Symphysial Angular coronoid condylar

cartilages cartilages cartilages cartilages.
The condylar cartilage
• The most important cartilage in relation to the development and
growth of the mandible is the condylar cartilage.
At 12 weeks of IUL
• The condylar cartilage attains its fullest form
• The articulation between the condylar cartilage and the squamous
portion of the temporal bone becomes apparent as the
temporomandibular joint (TMJ).
• The of condylar cartilage is converted quickly to bone by
endochondral ossification
• At 20 weeks only a thin layer of cartilage remains in the condylar
head.
The coronoid cartilage
• The coronoid cartilage appears at about 4 months of development,
located at the anterior border and top of the coronoid process.
Coronoid cartilage is a transient growth cartilage and disappears long
before birth.
The symphysial cartilages
• The symphysial cartilages appear in the connective tissue between
the two ends of Meckel's cartilage, but independent of it. They are
obliterated within the first year after birth.