ILLUSTRATED el Embryology, Histology, avo Anatomy SECOND MARY BATH-BALOGH PD UnICn MARGARET J. FEHRENBACH SSDental Embryology, Histology, ano Anatomy Perpustakaan FKGUI{To access your Student Learning Resources, visit: http://evolve.elsevier.com/Bath-Baloghiillustrated/ eee eee rn Embryology, Histology, and Anatomy, 2" edition offers the following = + Supplemental Considerations ‘The Supplemental Considerations provide the students with additional areas of study, expanding upon the material found in the book, * Discussion Questions Biscussion Questions are provided for each chapter in the text. They can be used to Stimulate classroom discussion and for group oF sel study and review. * Ghent Gpstes will be posted periodically to help keep students informed of Ontent Updates will be posted periodically to help keep students informed of new and exciting developments in the feld as Well as address additional concepts and information that may not be covered in the text, = Weblinks A vatiety of weblinks are provided so students can pursue further study.ILLUSTRATED Dental Embryology, Histology, ano Anatomy SECOND EDITION MARY BATH-BALOGH,, BA, BS, MS acuity, Department Coordinator Department of Biological Sciences Perce College, Lakewood, Washington MARGARET J. FEHRENBACH, RDH, MS (Oral Biologist and Dental Hygienist, ‘Adjunct Faculty Postion, Marqustta University, Milwaukee, Wisconsin ‘Educational Constant and Private Practice, Seat, Washington mustates by PAT THOMAS, cI CCertfiad Medical llustrator, AM (ak Park, linoisFLSEVIER SAUNDERS. [RLUSTRATED DENTAL EMBRYOLOGY HISTOLOGY, ANDANATORS Gryyest 2 aver, Agha eon, No pt of hi pston may be nepedndo trareit n any em o¢ {fey mars dena mecnat ung photcpying coving or ony nema ene aera ste at ems i wring os to pa eee may ec ly Ehren dhe gh apart Finda TA USA pore th 3189 96a (1) 21529308 ema Responses You ay i ole Jur gut ane ihe rer ef in/near yang Cn apparent ‘ce ater te Publ ee the Antes ee ny. pony for an os ot ur nor Ste nyoeee rey nga ny le elk {Sd Keedg ipo darn 8 Get etc aod apr the mes Tere Previous clon pyri 1997 Ison 0.2996 Exeter: Penny Rudolph ee feller feta Lastlgis the pie owner 9 8 7 6 5 4 ‘Woking coger vo grow in developing counsiesOVERVIEW “This textbook provides an extensive background for the dental professionals in the are of eral biology, a well ae grades of dental professional programs that teed to take competency examinations or update their background knowledge inthis area eis divided into four units: Introduction to Dental Structures, Dental Embryology, Dental Histology, and Dental Anatomy. ‘The textbook was organized into units to accommo- late difering curicalum. FEATURES: Each of the four units of this textbook consists of ‘several chapters, with each chapter building on the preceding ones. Each chapter begins with an outline, ‘bjectives, and key terms (with a pronunciation guide ‘when needed). The chapters contain both microscopic fra clinical photographs as well 35 useful tables. ‘Within each chapter are discussions of clinical and developmental considerations, which allow for an increaved integttion of the material into everyday practice for the dental profesional. Within each (Pen Perpustakaan FKGUL Preface chapter, thene may be ferences to other chapters so that the reader con review or investigate interrelated subjects, The centent ofthis eltion incorporates adie tional input fen students and educators. "The textbook concludes with a bibliography, com- plete glossary of terms (with pronunciation guide fen needed), and appendices that contin # review Of anatomical nomenclatare, unis of measurement, tooth measurement, and developmental information. "A separate workbook is avallable for student use. ‘The workbook features activites such as structure identiication exercises, glossary exercises, tooth dravving exercises, and casestudies. An Evolve site is Sls available 6 both the student and instructor, f turing discussion questions, supplemental considera- tons and content updates. Instructors canals obtain an instractor’s manual #0 accompany the text, featur ing estan nd transparency masters “This textbook is coordinated with the Masteed Anwtony. of Tie Hout and. Neck by Margaret I Fehrenboch and Susan W. Herring, al as such can be considered companion textbook to complete the ‘ursculum in oral biology Margaret J FebrenbachUNIT INTRODUCTION TO DENTAL. STRUCTURES 1. Face and Neck Regions, 3 Reglons ofthe Face 4 Regions of the Neck, 7 2 Oral Cavity and Pharynx, 13 Divisions ofthe Oral Cavity, 14 Divisions ofthe Pharyns, 22 UNIT IL DENTAL EMBRYOLOGY 3. Overview of Prenatal Development, 25 Prenatal Development, 26 Preimplantation Period of Prenatal Development 27 Embryonic Period of Prenatal Development 29 Fetal Period of Prenatal Development, 36 4 Development of the Face and Neck, 33 Development ofthe Face, 40 Development ofthe Neck, 46 Table of Contents 5. Development of Orofacial Structures, 51 ‘Orofacal Development, 5t Palatal Development, 52 [Nasal Caity and Septuzn Development, 54 Tongue Bevelopment, 56 6 Tooth Development and Eruption, 61 “Tooth Development, 62 Root Development 73 Persanent Tooth Eruption, St UNIT DENTAL HISTOLOGY 7 Overview of the Cell, »5 The Cel, 96, Cal Division, 101 Extracelslar Materials, 102 Interelelar Junctions, 102 8 Basic Tissues, 105 Basic Tissue, 106 Ppitheil Tissue, 105 agement Membrane, 111 Connective Hssue, 11 Speciolizad Connective Tse, 114 ‘Muscle Tiss, 123 Nerve Tisue, 12410 1" 12 13 4 Table of Contents Oral Mucosa, 127 (Oral Mucosa, 128, Regional Diferenes in Oral Mucosa, 134 ‘Tongue, 141 Pigmentation ofthe Oral Mucosa, 146 ‘Tumover Time, Repair, and Aging ofthe Oral Mucosa, 147 Gingival and Dentogingival Junctional Tissues, 151 Gingival Tissues, 151 Dentoginglval functional Tissues, 154 Head and Neck Structures, 161 Head and Neck Structures, 162 Glands, 162 Lymphaties, 171 Nasal Cavity, 176 Paranasal Sinuses, 176 Enamel, 179 Enamel, 179 Appostion of Enamel Matrix, 180 “Matuation of Enamel Matrix, 183 Components of Mature Enamel, 185 Further Microscopie Features of Mature Enamel, 186 Dentin and Pulp, 191 Dentin-Pulp Compl, 192 Dentin, 192 Pulp, 200 Growth Factors and Dentin-Pulp Complex, 205 Periodontium: Cementum, Alveolar Bone, Periodontal Ligament, 207 Pevodontim, 208 Components ofthe Priodontm, 208 unit iv DENTAL ANATOMY 15 Overview of the Dentitions, 235, ‘The Denttions, 26 Denton Periods, 235 Dental Anatomy Terminology, 299 Considerations For Tooth Study, 245 16 Permanent Anterior Teeth, 257 Permanent Anterior Teeth, 248, Permanent incisors, 250 Permanent Canines, 263 17 Permanent Posterior Teeth, 273 Permanent Posterior Tet, 274 Permanent Promolars, 276 Permanent Moars, 291 18 Primary Dentition, 213 Primary Teeth 313 19. Temporomandibular Joint, 325 Temperomandibalar Joint, 225 Bones ofthe Joint, 326 Joine Capsule 327 Dis ofthe Join, 327 Jaw Moverents ofthe Joint, 328 Disorders ofthe Joint, 332 20 Occlusion, 335, Occlusion, 336 Normal Occlusion, 336 Centric Occlusion, 336 Maloccusion, 344“Table of Contents jenn nnn nn SRR Speen Ls ck Coase BIBLIOGRAPHY, 355 APPENDIX Cc, TOOTH MEASUREMENTS, 379 GLOSSARY, 357 APPENDIX D, TOOTH DEVELOPMENT, 383 APPENDIX A, ANATOMICAL POSITION, 373, INDEX, 385 APPENDIX B, UNITS OF MEASURE, 317INTRODUCTION TO DENTAL STRUCTURES CHAPTER 1 Face and Neck Regionscuarren 1 Face and Neck Regions This chapter discusses the following topics: 1+ Regions of the face = Oral gion 1 Frontal, orbital, and nasal regions 1+ Mental epion 1 Infaorbtal and zygomatic regions Regions of the neck 15 Beal region ‘After studying this chapter, the reader should be able to: 4. Define and pronounce the key terms in this chapter. 12 Locate and identify the regions and associated surface Iandirarks ofthe face land neck on a diageam ancl on a patient. 13, Integrate the knowledge of surface anatomy ofthe face and neck into the ‘nical practice of patient examination and the understanding ofthe evelopmental aspects of these regions. mem Key Terms ‘i (pra ae fy Manabi an Regine ofthe face, neck ge of the mance Mandar symphysis sim fs) Stemocedomastkd muscle ‘uecal region ka Masser marl (esa eters ke aomasso) ‘Soro note, process Mental eon ron ‘bing! eleary glen en) are ray pra nares ‘ub ova Coneyle om, areata ney submandibular ssoary gland ote araicjoue hgh, Nal ny gin, spt (eohmansb-you andi ‘cep “Temporomandus jt for-poh- ‘teal noc Nese, apex, rot romana youl) ‘Frontal eon (runt Ona region “ryt cartogs, and thy) ‘Goin Proportions rst “uber ofthe upper ip oo-Der Foi bone) ‘rita ei obi ‘ern border sane for mt-yon). cree ct gion -tar-orbita Parhyrt! lands Garohthy-old Vertialgimenson of he co (eigarite ear famcnoss pat avey ira coreot)Zypemate eh region yore.) yn re) na rm) {moh nae Gn) Remus ayn4___ UNF 1 Introduction to Dental Structures Dental professionals must be thoroughly familiar with the surface anatomy ofthe face and neck as discussed in this inteoduction to Unit I. The soperficil eatares fof the face and neck provide esential landmarks for many ofthe deeper anatomical structures. Dental pro- fessionals may need to review these underlying strc- tures in a head and neck anatomy textbook before continuing further inthe study of orofacial embryo} (and histology as well as dental anatomy, Examination of thse accesible features By visuai- zation and palpation can give information aout the bealth of deeper Sssues. Any changes or deviations from normal noted in thew sutface features must be recorded by the examining dental profesional Some ‘degre of variation in surface features can be consid ‘ered within a normal range. However, a change in 3 surface feature in a given person may signal a conde tion of clinical sgnieance, Thus it isnot the varatons among individuals that should be noted but the changes in a particular individual Some ofthese surface changes inthe features ofthe {face and neck may be doe to underlying developmen: tal disturbances. Knowledge ofthe surface festires of the face and neck also helps dental professionals #0 ‘understand the developmental pater of these Ussucs Unit 1 in this textbook describes the development of the face and neck and any developmental distit- brancs. Other surface changes may be due to underly ing. histological reasons. Un Ill describes the histology’of the face and neck that gives them many of their characteristic surface features, "The study of the face and neck begins with the div sion ofthe surface ito regions Within each region are lar rdges of thsue radiating from the papilla and raphe "The loser posterior portion ofthe palate is called the soft palate sce Figure 212). mide muscolat structure theuvulaof the palate, hangs down from the posterior margin of the soft palate. The. plerygo- mandibular fold extends fom the junction of hard and ottpaltes down fo the mandible just behinal the most, Gistalmandibulie tooth, an stretches when the mouth is opened wider This fold covers a deeper fibrous Structure and separates the cheek from the that. Masta necy Preygornsour ad Peoria pie20__ UNIT 1 Introduction to Dental Structures Inga pps Pose tte ona FIGURE 2-13 The normal variaon ofthe pst tons {aroun nets onthe mine ef thar pale ‘Suess temale Medan ipa suas fag FIGURE 2-14 Dera vow of he tongue, wh sandra toed. From Fornbch My Fring SA insiatedAnatany ofthe Maa ord ec, ed & WE Sauna, Usui 2007) TEE cries concerns wn he Pate ‘A noma! variten noted on the mide of he had pala f te palatal tora gure 219, smart the mnie {on Those ae dovlopmantl gout froma bone wh Sheet ely Tmt cre se ‘owing nd sommptomai, ard may bo caer ‘agra. Tay nett ey hen center i onscire, Patons may rand tbe esau Ts ‘arson mst be not onthe pa chart TONGUE ‘The tongue a prominent feature of the oral cavity proper (Figure 2-1 see Chapters and 11 for mone Information). The posterior third 6 the pharyngeal portion ofthe ongue or base ofthe tongue. The base Df the tong attaches tothe flor ofthe mouth, The bbe of the tangue doesnot le within the oral cavity proper but within the oral part ofthe throat (discs later in this chapter. The anterior two thirds ofthe tongue, termed the body ofthe tongue ies within the ‘oral cavity proper. The tip of the tongae i the apex of the tongue.Folate ryote Baty Base FIGURE 2-18 Later view of th ong, vith its orton and ers nee From ‘FeSertac hi Haring SN Husrated Ariomy of te Noad and Nock, 2d 3 WS Sans, sr taue" 207 Certain surfaces of the tongue have small elevated structures of specialized mucosa called Kingual papi Iae, some of which ane associated with taste buds, “Taste buds are the specialized organs of taste. ‘The top, or dorsal surface of the tongue, has a midline depression, the median lingual sulews, coree- ponding tothe positon ofa midline rou structure ‘deeper in the tongue and fusion tssue area. The dorsal ‘srfae ofthe tongue also has many’ lingual papillae. ‘he slender threadike, whitish lingual papillae ae the fliform lingual pape, which give the dorsal surface its velvety texture. The reddish, smaller, ‘mashroom-shaped dots on the dorsal surface are Called fangiform lingval papillae. Farther posteriorly fon the dorsal surface ofthe tongue and more difficult to see clinically isan inverted Vshaped groove, the lus terminalis, The sulcus terminalis separates the base fom the body ofthe tongue, demarcatng a line ‘of fusion of issue in the tongue's development. Where the sulcus terminalis points backward toward the throat isa small, pthke depresion called the foramen cecum. The 10 to 14 lage mushsoom- shaped lingual papillae, the cireamvallate Tingual ‘papillae, lineup along the anterior side ofthe slcus {erminais onthe body Even farther posterony onthe dorsal surtace ofthe base of the tongue Is a ieegular ‘ass of tswe, the lingual tonsil ciscussed fart in Chapeer 1). “The side or Lateral surface of the tongue is noted forte vertical ridge of lings! ppl, eller flint lingual papillae (Figure 215) “The underside or ventral surface of the tongue, is noted for its visible lage blood vessels, the deep lingual veins, which pass close to the surface (Figure 2-16) Lateral to each deep lingual vein isthe plica fimbriata with fringelke projections. FIGURE 2-16 Vora aurtaca othe tong, wth 8 ‘Enararte note em Fanereach 9, Heng SA steted Arar oe Fea ard Neck ca’ WS Seunoers, St bow, 2007) FLOOR OF THE MOUTH “The floor of the mouth is located in the eral cavity proper inferior to the ventral surface of the tongue (Figure 217) The Hngualfrenum isa midline fold of tissue between the ventral surface ofthe tongue and fhe flooe ofthe mouth "A ridge of Hstue on each side of the floor of the south, the sablingual fold, joins in a V-shaped22__UNIT Introduction to Dental Structures ty aise om Nssophs roars Figen Layraepane ay Esophagus FIGURE 2-10 widsgital acon of ho head it the {sks of e ary ated. om Faeroe Wl Hong ‘Siciveetey Antony ofthe Nest and Neck od? WE Sster Pisco, 2002) configuration extending from the liga frum to the base of the tongue. The ia folds contain ‘openings of the sublingual duct from the sublingual salivary gland (soe Chapters 1 and 11 for more information on salivary glande). The small papilla, or Linu ‘nn Sting acai ote. Grom Faranbach Need Wo Sunde us sublingual earuncle, atthe anterior end of exch sub old cantains epenings ofthe submandibular sand. sublingual ducts (or Whavton’s duct and Bartholin’s duct, respectively) from beth the sub- ‘mandibular salivary gland and sblingval salivary sland, DIVISIONS OF THE PHARYNX ‘The oral cavity proper provides the enteance into the throat, oF pharyine: The pharynx is a mseulae tube that serves both the sspiatory and digestive systems, Teas three divisions: the nasopharynx, the orophar ym, and the lryngopharynx Figure 2-18) “The divisin ofthe pharynx tha is superior tothe level of the sat plate isthe nasopharyna, which i continuous with the nasal cavity The division that is between the sft palate and the opening ofthe lary is the oropharymy, whichis the ora portion of the pharynx. The fauces, discussed ‘earlier, marks the boundary between the oropharynx and the oral eavity proper Only postions oF the nasopharym and ‘oropharynx are visible on an intraoral examination (see Figure 2-1), The laryngopharyns is more inferior, clase 19 the laryngeal opening, and thus isnot visible ‘om an intraoral examination.DENTAL EMBRYOLOGY CHAPTER 3 Overview of Prenatal Development CHAPTER 4 Development of the Face and Neck CHAPTER 5 Development of Orofacial Structures CHAPTER 6 Tooth Development and Eruptioncuarrten 3 Overview of Prenatal Development — This chapter discusses the following topics: 1 Pronatal development = Third week 1 Preimplantation period = Fourth week 1 Embryoni period = Foal perod «= Second week 19 this chapter, the reader should be able to: and pronounce the key terms in this chapter. 2. Discuss the periods of prenatal development, especially the major events that ‘occur during the early Weeks. 2, Integrate background on prenatal development into the development ofthe face, neck, and orl structures and developmental disturbanees related to thee structures — Key Terms riocentesi an-naeo- Embryo emo Hypoblat ayer pos) ‘roo, Embryediat ayer Impantation rst ‘xml cavity (ar-nee- ot) Terre Inti rst) ‘aminarembyene oe mbyoiogy arvtre-taivee) Karyotype tare--oh te) ‘olan Embryone cl yer (on-oe-on, Maturation ravi Batra syrmety olin, period of ponatal Nous (yah Blastocystis evelopment Maven eang-ina (Cat oe a endoderm ln oese) Nseaserm mar chs) {Cephason eak) Entast yeep) Mga mia ene rou ystare Fereation fuonzaych) Msi roe) ‘Gave hve Fetal anal snare Morproaterenttion jo ‘Goacal membrane (o--ka) ‘Fetal pariod of prenatal devlopnont"foeavar shay sh) ‘Congenal matomations ‘tae Morphogonese (neo tei There! timaltormay shes) Fea ote) Morphoogytrorf-aht ‘oxoaierentiton Foret eau) Neural creat cele oor, as, (etecivaiterershesy-shun) — Fasonfszon ‘oor, pts tbe Dien arenshe-ay she) Grow appectionlapot= own syncome Cohan) arta Estosom ok te-dem) literatan Estodamal yeaa lcloedrm ingot ine) ‘depiyzee) Histoetteentatin ctple pregnancy (top Inostoe-terarshe-y hun)LUNIT 1 Dental Embryology Prmplataton patio of prenatal Somes o-ris) (tahoe) ‘ovelopment pei pon teenie) Spar ‘laminar embryonic dso Prenatal developmen renaya) Spina bia p-aa itsh ah) yom Primitive streak ‘Syphie sptochete ele ‘ophoblast ayr foto in) Primordum py-more-e-un) peo-tec Yaleane Prolferatonfe-terayshny_‘Tertagens er ahsoyene 2ygot (ergo) ‘Rubee vis foobet ah PRENATAL DEVELOPMENT In humans, prenatal development begins a the start of pregnancy an continaes unt the birt ofthe child Embryology is the stay of prenatal development and Is introduced in this beginning of Uni Prenatal Periods of Prenatal Development PREIMPLANTATION PERIOD ‘Tine spon Frat week ‘acyeine senna development consists of three distinct periods: the preimplantation period, the embryonic period sn the fetal period (Table 3-1). The preimplantation petiod snd the embryonic period make up the Rrst trimester fof the prognancy, and the fetal period comprises the last two trimesters "EMBRYONIC PERIOD ‘Second wook 1 FETAL PERIOD yh week “Thi te ninth month Src ss Sct rset got to bastayat Descipin of prod Fasten and molentatin Basocyt osc endo Enaxyo to tie Inducten, pra, rent, "morphogens satratonOverview of Prenatal Development CHAPTER 3__27 Developmental Dekurbancee Burma az Prenatal Devslopment “mse devlpmértalproblrscan include congenital ith defects, ch re coop rion at ty, Met hoo coz rg Boh ‘oN sngon poo ana to rec peau ad. iui ranor tbe poorrey tected a. ats show tt sn maorrators osc wih an SESSA Seti oes doe rot ede ice ara, whch ve common, Duh 2 aon Vise Joa of abenes ore, ‘ Mfaornatione can be duo to genetic factors uch a compact abnoraiies or enero! ages 0 eres enonmrt! agents or fac’ can nego ‘ite nd asabon ar we cle terete (Sie hema orexoducire ae shoud wo ESL alti te otter et moze mort Sbarro pect he oven hon Geena Sent he fe neck, aoa cay ange erin ee nt ae pat room esa sas of tn sft pale est naereath an ct cess part o deal rian decovwed hen exerPig a ptt 8 Unc ed omtle oa spocte ie ne “silent th nda. Tus or Gihe davcopment fs ics tant for dental profssionalsto understand jor events of prenatal development to under the development of the structures Known Teratogens Involved in Congenital Malformations ‘rage anal race, phony sod a, ‘retest, aminoplat, ceytbes, ‘term, alone. eotetron fetnoe 0, anrogere, progesterone Chemicals _Matyinrouy, pveNornats phan Infections utes vine, epee sree vs, human manossicney vs, eye merebe Radiation igh ve foi type" “a apc rn a tT ‘tem ea ‘or an organ dusing prenatal development. This infor- ‘ation also helps in the appreciation of any develop ‘mental problems that may occur in these stricta. “The fist peciod, the preimplantation period of pre- natal development, or period of the unattached con optus, takes place during the first woek At the Denning ofthe first week, a woman’s ovum Is pene- trated by an mite with a man’s sperm during fer tilzation (Figure 31). This union of the ovum and sperm subsequenty forms a fertilized egg, oF zygote. {pe sho fries tne ovum and unites th tt rm he ago, tre ara aig te at west of rena Grelopmen The evan ore mesic term a soe hw vlUNIT Wt Dental Embryology a = yay 2? a2 ge ort a, Beane ater an © det roe TaN a *" TK KN AR XK BK OB OAM aa a8 ae oe RQURE 3.2 Expl of aha kayotpe, Proopapic ensyac os pans cvrvonones which {lone By rer aangoment ote para tn ay Doing fertilization, the final stages of meiosis ‘ceur the ovam. The result ofthis process is the joining ofthe ovum’ chromosomes with these of the sperm, This joining of chromosomes from both bio- Togical parents forms new individual with “shed ‘chromosomes. To allow this formation of anew indi- Vidal the sperm and ovum when joined have the proper number of chromosomes (diploid number of 4), Both these cells, sperm and ovum, carcied the full complement of chromosomes, fertilization would result n'a 2ygote with two tines the proper number, resulting in Severe congenital malformations and pre natal death “Thisstuationofexcesschromosomesisavoided with reiosn, because during their development in the gonad, this process enables the ovtim and speem 10 Fedluceby onehalf the narmal number of chromosomes (Wo a haploid number of 23), Thus the zygote has received halfitschromesomes from the female and half from the male, with the resultant genetic material a sefletion of both biological parents, The photographic analyss of person's chromosomes is dane by orderly arrangement ofthe pars ina karyotype (Figure 32) ‘Aer fertilization, the zygote” then undergoes mitosis or individual call division or cleavage. After initial cleavage the solid bal of cllsb know as. a ‘moral, Because ofthe ongoing process of mitosis and Secretion af fluid by the cells within the morula, the zygote becomes a. esicle known as a blastocyst, oF bastul (Figure 33), The vest ofthe fst week is char- acieriael By further mitotic cleavage, in which the blastocyst spits into smaller and more numerous cells ast undergoes successive el divisions by mitosis. Ei TE AAT, Vacate Goma) cate 0-60 ous) cae (0 Pas 12-1 de aatooyt Ce RIQURE 3-3 A zygote undaing mote okeiage ofa a bseonyt. Aer ong, ‘ Dstooyt baectos Faria Ihe endomeOverview of Prenatal Development CHAPTER 3 + Goat estonia ‘Toph er FIGURE 3-4 Aasacyst cons of a vophblat yer nd an ambryatae yer Mitosis takes place during growth or repair and is ferent fom meiosis, which akes place during repro- ution (mitosis is discussed farther with el structure in Chapter 7). Mitosis that occurs during cel division {s the selfdupication of the cheomosomes of the parent cell and their equal distribution to daughter ells Ths the ests hat the daughter cells have the Same chromosome number and hereditary potential as the parent cells. As it grows by cleavage, the blastocyst travels from the site where fertilization tok place to the uterus By the end of the frst week, the blastocyst stops traveling and undergoes implantation and this ‘becomes embedded in the prepared endometrium, the Jnnermost lining of the uterus. The fel implantation sites the back wall of the Body of the uterus toward the mother's spine, After 7 days of cleavage, the blas- toeyst consists of «layer of peripheral cls, the tro- jphoblast layer, and 2 small inner mass of embryonic cells, or embryoblast layer (Figure 3-1). The tro- ‘phoblast layer gives rise to important prenatal sipport tissues. Theembeyeblas layer gives rs tothe embryo uring the next prenatal period, & FIGURE 3-5 Parson with Down sya, o iomy 21, ieee romero nn eet ‘Earn fated dean hav vero rl feral ‘adelon ron Stat BL ans Gav HW Ais of Poa ‘Prseal Dogme e481 Lous 2002, ost) 1 any datrbarese acu in meine czngfietin, Ilr congenits matioratns resi em the chromosomal Serna. Down syndrome or samy 21.29 srs ttromasome ruber 21s preset ater maote ison [Fur 33) A cuit the syne ha tt ond {eco hh wie set oye it ages noon epcartnie ‘ols otgueeyel oaues = turowed lovers {engus: pars of he ng papas, acer ‘lcs. An ced hed can have vars el fetal ‘Caron wth Oown ensere may have increases eves of prosortal ene an fever end sb raped {auth presatng charges orl gene care The "Zoned pata an poo ue of one soe oat open mouth positon and prtson ote ‘oma tod tongue. Throat speech is of, ‘So pariaon may ocr oui th ves onion ‘ated ectopic pegraey, this te and sometimes ‘eran forup te weal of prognancy ters bang ‘Se, The cotsetoe ta eer causes it say ‘te actor aay proert rrapo of ‘hing ype oe rs, sucha cared ore bes din tpave tari daeare. Econ progres an tre, eausg en lhe enbyo ad estonng etteot te pert woman Bagnesed icky, eb Pregrenote cans featospramecclogeaty shout Ege recing dng fe mae and ese te Stet hhe econe pegancy