6th wk

1st pharyngeal groove – external auditory canal

1st pharyngeal pouch – middle ear eustacian tube
2nd pharyngeal pouch – palatine tonsils
3rd pharyngeal pouch – interior parathyroids and thymus
4th pharyngeal pouch – sup. parathyroids
5th pharyngeal pouch – ultimobranchial body

CARTILAGENEOUS SKELETAL DEVELOPMENT

1st arch
– Meckel’s Cartilage
– Malleus, Incus
2nd arch
– Stapes
– Styloid
– Lessern horns of hyoid arch
3rd arch – greater horn of hyoid arch
4th and 5th arch
– Thyroid cartilage
– Laryngeal cartilage

Insights:
– From the initial development each pharyngeal arch has a specific cranial
nerve associated with it
– The nerves and the musculature of each arch emerge together and follow
defined pathways to their functional
– A professional must understand the variability that can occur in facial form

FACIAL DEVELOPMENT
- the human face develops from the 4th to 7th embryonic wk and the palate
closes during the 8th week
 frontal process
 Mandibular arch

4th embryonic week

- critical period wherein environmental factors can affect facial development
5 embryonic week
th

- the frontal process becomes the frontonassal process because of the brain
- the frontal prominence ↓ and the face broadens
6th embryonic week
- the lateral parts of the expands broadening the face (caused by the lateral
growth of the brain)
- the maxillary process and the eyes come to the fron of the face
- the nasal pits
7th embry
- the face has a more human appearance
- the eyes approach the front of the face
- the nose represents less of the face
- the upper lip has fused producing a medially located philtrum
- the nose and eyes are still at the same horizontal plane
- the ear develops
- the ridge around the eyes will firm the eyelids
- the danger of the cleft lip has passed
Palatal development from the 7th-9th week
- palate develops from an anterior wedge-shaped medial part (primary palate)
and 2 lateral palatine process
- lateral palatine processes developed from the maxilliary tissues laterally and
grown towards the midline
- as the ps grows medially they contact the tongue
INSIGHTS:
- cleft lip and palate are among the most common congenital malformation
- the incidence in Asians is about 3 to 1000 birth
ETIOLOGY FACTORS:
1. Heredity (40% in cleft lip, 20% in cleft palate)
2. Environmental factor
- Nutritional deficiency during pregnancy
- Psychological, emotional or traumatic stress during pregnancy
- Defective vascular supply
- Mechanical obstruction due to enlarged tongue
- Steriod therapy during pregnancy
- Infections
- Alcohol, drug and toxins
CLASSIFICATION
1. Unilateral incomplete
2. Unilateral complete
3. Bilateral complete
4. Incomplete

TONGUE DEVELOPMENT
PARTS OF TONGUE
1. Body – 1st pharyngeal arch
2. Base – 2nd and 3rd pharyngeal arch

3 Mechanism of BONE GROWTH

- continually occurring
1. Cortical Drift
2. Displacement
3. Remodelling

1. Cortical Drift
 - produces generalized enlargement and relocation as a result of
simultaneous deposition and resorption of bone tx in the different
bones of the skull movement towards depository surface
1. Scalloping – resorption
2. More deposition – larger bone
3. More resorption – smaller bone
4. Side of tension – there will be deposition
5. Side of pressure – resorption??
DISPLACEMENT
- movement of the whole bone as a unit result of push o rpull by diff.
bones and their soft tissues away from one another as they all
continue to enlarge; always takes place in the opposite side
TYPES:
a. PRIMARY DISPLACEMENT
- bone displacement in conjunction with bone’s own growth
- (example: growth of the maxilla ath the tuberosity region results in
pushing of the maxilla against the cranial base resulting to
displacement of the maxilla)
b. SECONDARY DISPLACEMENT
- bone displacement in conjunction with growth of nearby adjacent and not
immediate bones of soft tissues
- (example: maxilla, zygoma, ant. cranial base, forehead shift anteriorly due to
growth of middle cranial fossa and sphenoid bone)

PRIMARY DISPLACEMENT AND BONE GROWTH

- the entire mandible is displaced downward and forward
- away from its articular joints, by the growh of its surrounding tissues
- the translator movement stimulates the enlargement and remodeling
of the condyles and rami which takes place parallel to displacement
- the bone growth processes are directed upward and backward by an
amt that equals the displacement of mandible
*andyic moves upward and backward = remember opposite!
* growth is faster in the early postnatal period than
*maxilla and mandible moves in the same manner (backward and forward)
* in secondary, there will be growth of adjacent structure that will cause
displacement.
3. Remodeling
- process of reshaping or resizing as a result of progressive continuous relocation
- selective deposition and resorption of the whole bone to change regional shape in
order to conform to progressively new positions and change the dimensions and
proportions of each regional part.

CHANGES PRODUCED BY REMODELING

- changes in size
- change in shape
- change in proportion
 - change in relationship of the bone with adjacent structures
* sinus – downward and forward movement of bone in baby
 resorption of max  superior surface
 deposition of mand.  inferior surface
 for the sinus

OSTEOGENESIS
2 TYPES OF BONE FORMATION
- bone opposition gen. occurs in osteogenic area under tension, not pressure

1. INTRAMEMBRANOUS OSSIFICATION
- bone formed at periosteal and sutural. Maxilla and body of mandible
2 TYPES OF BONE
1. Bundle bone
- develops directly in uncalcified or fibrous connective tissue; in adults , is
usually formed during rapid bone remodeling, is often a preliminary type
of ossification is reinforced by lamellar bone)
2. Lamellar bone
- only takes placed in mineralized matrix (example: calcified
cartilage or bundle bone spiculae)
*osteoblasts appear in mineralized matrix, that forms in osteon/Haversian
canal.

INTRAMEMBRANEOUS OSSIFICATION
- subject to continual deposition and resorption which can be
influenced by environmental factors like orthodontic treatment
- more modifiable in context of dentofacial orthopedics, orthodontics
2. ENDOCHONDRAL OSSIFICATION
- has cartilagenous precursor
- found in bone associated with immovable joints and some parts of the
cranial base which involve relatively high levels of compression and
the condyle of the mandible
- less modifiable(compared intramembranous)in context of dentofacial
orthopedics
* Reversal line – represents the interface between, endosteally and periosteally
produced bone layers

INDIVIDUAL COMPONENT
1. Cranial Base
2. Speno Occipital base??? (Spheno-occipital base???)

GROWTH OF FACIAL COMPONENTS

1. Cranial VAULT
- intramembranous bone formation occurring primarily at periosteum
tried contact areas, suture
- remodeling occurs inner and outer surfaces of bone
 2. Cranial base
- endochondral bone formation
- synchondrosis play a role in early growth
*spheno –occipital synchondrosis – considered principal growth cartilage
of cranial base and only one remaining active during childhood growth
period.
3. MAXILLA (NASOMAXILLARY COMPLEX)
- intramembranous bone formation
- growth occurs through balanced apposition and resoprtion
(remodeling, cortical drift, displacement)
- appositional growth predominates up and back against cranial base
4. MANDIBLE
- endochondral  condyle
- intramembranous  body of the mandible
- condyle fibrocartilage grows by apposition
(Similar to epiphyseal growth plates of long-bone)
- appositional growth predominates along the post. border??? Of ramus
with remodeling resoprtion along ant. border???
HIGHLY ACTIVE GROWTH
- cranial
- alveolar process
- condylar area
HIGHLY GROWTH CENTER
Spheno occipital synchondrosis
- depth of face
- very active during growth process

FACIAL GROWTH PATTERN

- “somatic growth pattern”
- female reach skeletal maturity earlyier than males by about 2 years of
an average
*Female growth spurt
- starts at approx. 10.5-11y/o
- peaks in 14-18 mo. (about 12-13 y/o)
- completes by about (13.5-14y/o)
*Male growth spurt
- starts at approx. 12.5-13.5 y/o
- peaks in 18-24 mo (about 14-16 y/o)
-completes by about 17-18 y/o

SIGNIFICANCE
- to know the time frame of what procedure to be done
- Example: if you know that the patient is an 18 y/o boy, you know that
you need to proceed with surgical procedure
- In female, if with menstruation growth spurt is already starting
o Not that successful tissue because short time for the treatment
 o Better if before menstruation to have the treatment
MESOPHALIC??? (Normal)
2 TYPES OF FACIAL FORMS
1. HYPERDIVERGENT/DOLICHOCEPHALIC
- anterior vertical field growth greater than posterior condylar growth
with clockwise rotation expressed as steep(inclination) mandibular
plane with open bite tendency

- anterior facial height = nose – chin

- posterior facial height = condyle – angle of mandible
2. HYPODIVERGENT/BRACHYFACIAL
- posterior face height proportionately greater than anterior face height
with counter clockwise rotation expressed as flat mandibular plane
and deep bite
- facial for m and growth pattern are maintained through the growth
years.
SIGNIFICANCE:
- to know the strength of its musculature

DIMENSIONAL FACIAL GROWTH

1. FACIAL HEIGHT (nasion-menton; condyle-angle)
70% complete by age 3
90% complete prior to adolescent growth spurt
2. FACIAL WIDTH: shows least amount of change
- Upper face width(bizygomatic width)
Increases throughout childhood and adolescence;
- Greater rate observed is between 2-6 years
- lower face width (bigonial width)
80% complete by the time first molar erupt
3. FACIAL DEPTH(Anteroposterior)-“sagittal dimension”
- longest growing facial dimension
- maybe divided into upper, middle and lower facial dimension with
areas growing, at different times and rates (differential growth)
- greater mandibular increments allow profile to change from convex in
childhood to straighter in adult profile
*Lower 1/3 is the last to express its full growth potential