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*Development of Orofacial region /lab (1) 21/2/2011

- Folding of the embryo:

At early stage of embryogenesis, the embryo start to be folded and the folding takes place in
two dimensions; (length and width of the embryo). As u can see in the pictures below which
indicate the folding of the embryo along the long axis, because of the fast growing of the
brain it becomes the head of everything. At the beginning the most cephalic thing is the liver
followed by the heart followed by the mouth region then the brain but because of its fast
growing the sequence is different now, the brain becomes the most cephalic part followed by
the oropharyngeal membrane which represents the mouth region, then the heart and finally
the liver. Notice that also because of the fast growing of the brain there'll be a cavity in front
of the Oropharyngeal membrane at the external surface this is called "Stomodeum" the
primitive mouth. At the beginning our heart is just below the mouth then it started to migrate
downwards, as u can see in the 2nd picture the heart is now located peripherally to the mouth.

-Branchial arches :-

They develop at the age of 21 days when the buccopharyngeal

membrane ruptures. After that there will be a continuation between
The stomodeum (primitive mouth) and the foregut which is the
first part of the GI tract and they are series of arches that appears in
the neck region and in the upper and lower jaw of the embryo, as u
see in this picture this is a coronal section from the head & neck
region of the embryo which shows the branchial arches, it's
important to remember that this arches are 5-6 in number but they
don't appear all at once because later on the first arch will form a
different structures. Between two arches three are a cleft outside
and a pouch

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Inside so the first cleft located between the first and the second arch, the second one between
the second and third and so on …

Some of the pouches or clefts may further develop for

example, The first pouch gets deepen giving one canal
and a cavity, this canal as u can see in this picture on the
right is called the auditory tube this tube establish a
connection between the tympanic cavity and the
nasopharynx .the first cleft also deepens giving the
external auditory meatus ( ‫ )القناة السمعية‬,between the
tympanic cavity and the external auditory meatus there
is a thick membrane which becomes the tympanic
membrane (‫)طبلة الذن‬.The deepening in the second
pouch is related to the palatine tonsil, the third pouch
has two regions the upper one becomes the inferior
parathyroid and the lower one becomes the thymus.
Notice that the second is cleft is open-to region so there
is no second cleft.

Each arch will have a nerve (in yellow) and a blood

vessel (in red) and a skeletal component which starts as
a cartilage. and each arch is a pair of two arches.

As u can see this picture represent the brachial arches,

these are the clefts but we won't see the pouches because
they are inside .notice that the first cleft stated to deepen
giving the external auditory meatus.

Above the first brachial arch there's a cavity which is the

stomodeum,before the age of 21 days if u look through this
cavity u will see a membrane u won't able to see the GI tract this membrane is called the
buccopharyngeal membrane within 21 days it ruptures and then there'll be a continuation
between the first GI tract part and the mouth. The arches are on either side of the pharyngeal
foregut.

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 In the picture above represent the embryo in the early embryogenesis, notice the spherical
globules that represent the somites it looks like something chewed (‫ )ُمضغة‬.

In lower vertebrates like fish they don't have a buccopharyngeal membrane instead of that
they have bars which makes the gills (‫)خياشيم‬.

Each arch consists of 3 layers: the outer one is the ectoderm, the inner one is the endoderm
and in the middle is the mesoderm except the first arch which has an ectoderm outside and
inside as a continuation because the inside surface of the first arch is the mouth. Arches are
separated further into:

1- External, ectoderm-lined pharyngeal clefts

2- Internal, endoderm-lined pharyngeal pouches.

First stages of a recognizable face at the end of the third week.

as u can see in this picture >> (2) represent the arches (3) represents
the head (the developing brain), (6) represents the trail.

Over weeks, the arches grow differentially and obliterate plates

/grooves to give rise to the face and each arch gives rise to a
cranial nerve, muscles and cartilage/bone.

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*Each branchial arch has:

1-Skeletal elements
2-Nervous elements
3-Muscular elements
4-Vascular elements

(1) Skeletal Elements :

In the first arch there're 2 cartilages one is more important than the other which is called
"meckel's cartilage" and the less important is called "Pterygoquadrate bar cartilage".

this pictures represent the head of very early embryo just like the end of the 4th week ,as u can
see their are bars which are Meckel's cartilage ,this cartilage is divided into 3 parts: the
anterior part, the middle part and the dorsal end . the anterior part is related to the mandible
but it doesn't form the body of it, the body of mandible is formed by a process called
intramembranous ossification without the involvement of the cartilage. Although the cartilage
isn't important in the actual anterior growth of the mandible bone, it’s important to guide the
growth of it and finally it disappears.

"It acts as a scaffold for the body of the mandible to form at its lateral aspect."

The middle part of Meckel's cartilage disappears but the coverings of this part remain which
are: Anterior malleolar ligament and the Sphenomandibular ligament.

The dorsal end becomes ossified and become the malleus (‫)المطرقة‬.

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The Pterygoquadrate bar cartilage which is posterior to Meckel's cartilage ossified and
become the Incus (‫ )السندان‬which is the second ear ossicle .

-Malleus and Incus form within the first branchial arch. (True)
-Malleus and Incus form Meckel's cartilage. (False)
-The anterior part of Meckel's cartilage ossifies to become the body of the mandible. (False)

This picture represent the part of the skull that form in cartilage, there’s the nasal capsule
which will finally lead to the formation of the ethmoid bone there's also the base of the skull
and Meckel's cartilage these are formed by endochondral ossification "this means we should
have some cartilage"( cartilage : the areas in green ) ,but the areas in pink are formed by
intramembranous ossification. Notice that the cranial bones that cover the brain are formed by
intramembranous ossification.

The skeletal element of the second arch is Reichert’s cartilage when the dorsal end ossifies it
becomes the Stapes (‫ )الركاب‬the third ear ossicle, the remainder becomes the Styloid process
and stylohyoid ligament and also the Hyoid bone except the greater horn which is formed the
third cartilage. From fourth to sixth arches they give the Thyroid, cricoid & arytenoid
cartilages (cartilages of the larynx) .

(2) Nervous Elements :

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the first arch has the trigeminal nerve as the main nerve, this nerve is cranial nerve #5,we
should know that the cranial nerves are 12. the 1st one is the olfactory nerve . 2nd one is the
optic nerve, the 3rd one Oculomotor ,4th one Trochlear,5th Trigeminal,6th Abducens,7th Facial, 8th
Vestibulocochlear,9th Glossopharyngeal,10th Vagus,11th Spinal Accessory and finally the 12th is
the Hypoglossal.

"I am not sure if we should memorize this but the doctor mentioned them and said we'll take
them later."  ( c.t : the doctor mentioned them as a previous info so don’t worry about them)

The second arch is innervated by the facial nerve and the third arch by the glossopharyngeal
nerve.

Each arch also has :

(3) Muscular elements

for the first arch all the muscles that are supplied by the by trigeminal nerve are actually
developing within the first branchial arch, these muscles include:
• muscles of mastication ( masseter, temporalis , medial and lateral pteryoid
muscles)
• Anterior belly of digastric
• Myloyoid muscle
• Tensor tympani (one of the anterior muscles that is related to the tympanic
cavity)
• Tensor veli palatine (one of the muscles of the soft palate)

In the second arch there're the muscles that innervate by facial nerve which are :
• Muscles of facial expression
• Posterior belly of digastric

Third arch has the muscles that are innervated by the glossopharyngeal nerve and there's only
one muscle which is the stylopharyngeus muscle

** there is a mistake in the slide #13:the Pharyngeal muscle and the

Muscles of the soft palate except tensor veli palatine is innervated by the
vagus nerve (the cranial nerve for 4th -6th arches) not by the
glossopharyngeal nerve.

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(4) Vascular Element:

Each arch has a right and left aortic arch vessels that leave from the heart and they ascends
dorsally to the face, brain & posterior region of the body, Third arch vessel becomes
prominent to take over the facial region of the first two and become common carotid artery.
The forth arch vessel become the dorsal aorta.

Blood supply for neck & face:

• Before week seven by the internal carotid

• After week seven by the external carotid

Pharyngeal pouches :

They also develop giving the tongue which develops from the inside of the branchial arches
"from the Pharyngeal pouches"

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This sketch above represent the development of the tongue, the tongue develops at the age of
32 days from a number of swelling ; there're swellings from the 1st arch that represent the 2/3
of the tongue which are: "Lateral lingual swellings and Tuberculum impar. " there's also
small contribution from the 2nd arch but the posterior 1/3 of the tongue is from the 3rd
branchial arch which is " Copula/Hypobranchial eminence" that Overgrows the 2nd arch
because it grows faster than it.there're also swelling from the 4th arch which represent the
extreme part of the tongue and it also forms the epiglottis.

The taste buds which are on the anterior part of the tongue originate from the 2nd branchial
arch which has a small contribution as we mentioned before and they are innervated by the
facial nerve.

Between the anterior 2/3 of the tongue and posterior 1/3 of it there's a v-shaped sulcus which
called "sulcus terminalis", it represent the fact that the tongue forms from different arches, at
the midline part of this groove there's a depression called foramen cecum that represents the
beginning of the growth of the thyroid gland ,in some regions we may have a thyroid tissue
within the body of the tongue because sometimes a small part of the thyroid gland remains in
the body of the tongue it's called topic lingual thyroid tissue, so the duct that is lead to the
formation of the thyroid gland is called thyroglossal duct .
*Innervation of the tongue: (Refer to slide #17)

Because of the multiple sources of tongue formation, it is innervated by more than one nerve
for example the anterior 2/3 of the tongue is innervated by the trigeminal nerve because it's
formed by the 1st branchial arch, the posterior part is innervated by the glossopharngeal nerve
which is the cranial nerve of the 3rd arch, the taste buds are from the facial nerve and the very
posterior part if it is innervated by the vagus nerve and so on.

The muscles of the tongue come from a different region which is the myotomes of the somites
that are the most cephalic ones which means it isn't from the arches at all. And it is supplied
by the hypoglossal nerve.

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*Development of the face:

the growing brain develops process,like the one that appears in

the picture here which is the FNP "frontonasal process" above
the mouth and below it there's the 1st branchial arch notice
here that the branchial arch is divided into 2 arches:
the maxillary process and the mandibular process these 2
processes with the frontonasal process form the face.

• Face forms around stomodeum

• Buccopharyngeal membrane ruptures @ 21 days
• Mesodermal processes
• Nasolacrimal duct

**Reffer to slide #20 to see the picture….

The frontonasal process" the area in pink" develops pits and it's called nasal pits later it will
become nostrils. notice how big the distance is between the pits at the beginning after that they
start to migrate towards each other,around each nasal pit there're swellings:lateral nasal
swelling and medial nasal swelling,the 2 medial nasal processes of the 2 nostrils fuse together
forming the Intermaxillary sigment and we call it like that because it descends down and take
place between the 2 maxillary processes, the lateral nasal process remain within the
frontonasal process this gives the mid portion of the nose and the Philtrum of upper lip
inside it there's the area of bone that carries the maxillary palate.

Maxillary cental and lateral incisors form from a segment that is related to the first branchial
arch. (False)

So all the maxillary teeth are from the maxillary process except the upper incisors.

Regarding to the lateral nasal swelling it becomes the Alae of the nose (lateral to the
nostril),the maxillary processes become the maxilla and the mandibular processes fuse
together forming the mandible.

Nasolacrimal duct:

It's a canal that take the tears down to the nose and it's form in the groove between the
maxillary process and the lateral nasal swelling.
Best of luck all

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 
Done by:Lamees Nimri

Special thanks to our colleague Lamees

Nimri for her perfect effort on writing
this lecture . Good luck everyone
* Correction team *

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