PRENATAL GROWTH

AND DEVELOPMENT
 CONTENTS
• INTRODUCTION
• FORMATION AND FATE OF GERM LAYERS
• FORMATION OF TISSUES IN THE BODY
• THE PHARYNGEAL ARCHES
• DEVELOPMENT OF FACE, PALATE
• CONGENITAL ANOMALIES
• SOME GENERAL CONSIDERATIONS
• CONCLUSION
• REFERENCES
 Introduction
• Pre-natal & post-natal growth
• Pre-natal life- height increases by 5000
times •PERIOD OF OVUM

•PERIOD OF EMBRYO

•PERIOD OF FOETUS
Period of the ovum
-2 weeks from the time of fertilization.
-cleavage of ovum and attachment of ovum to intra-uterine wall.
Period of the embryo
-14th day to 56th day of IUL
-major portion of development of cranial and facial
region occurs

Period of the foetus

-56th day of IUL till birth.
-accelerated growth of cranio-facial structures; change
in proportion between various structures
Formation of germ layers

blastocyst
• 16th day
 Formation of tissues
• 3 germ layers give rise to epithelia and
mesenchyme.

Epithelia derived from ectoderm

Epithelium of
1. skin, hair follicles, sweat glands, sebaceous glands and
mammary glands
2. Cornea, conjunctiva, EAM, outer surface of tympanic
membrane
3. Some parts of oral cavity, lower part of anal canal, terminal
part of male urethra, parts of female external genitalia.
Epithelia derived from endoderm
Epithelium of
1. Entire gut except part of mouth and anal canal
2. Auditory tube and middle ear
3. Respiratory tract
4. Over part of UB, urethra and vagina
Epithelium derived from mesoderm
1. Tubules of kidney, ureter, trigone of urinary bladder
2. Uterine tubes, uterus, part of vagina
3. Testis and its duct system
4. Endothelium lining the heart, blood vessels and lymphatics
5. Mesothelium lining the pericardial, peritoneal and pleural
cavities and cavities of joints.
• Mesenchyme
Pharyngeal Arches (4th & 5th weeks of IUL)
• Rod-like thickenings of mesoderm present in the wall of the
foregut.
• Ventral ends of the arches meet in the midline in the floor of the
pharynx.
• In the interval between any two arches, endoderm is pushed
outwards to form a series of pouches (endodermal/pharyngeal
pouches)
• Opposite each pouch, the surface ectoderm dips inwards as an
ectodermal cleft.
 Development of face

• During the 4th week

Development of palate (7th -8th week)
 Mechanisms of palatal elevation
• Intrinsic shelf elevation due to hydration of extracellular matrix
components ( GAGs, hyaluronan)
• Alteration in vasculature & blood supply to the palatal shelves
• Rapid differential mitotic activity
• Muscular movements
• Withdrawal of embryonic face from against the heart
prominence results in slight jaw opening---withdrawal of
tongue from between the palatal shelves.
• Serotonin release from neural tissue
Pre-natal growth of mandible
Meckel’s cartilage
-derived from the 1st arch around 41st-45th day of IUL.
-extends from the cartilaginous otic capsule to the midline or
symphysis; provides a template for guiding the growth of
mandible.
-major portion disappears during growth; remaining part develops
into -Mental ossicles, incus & malleus, spine of sphenoid,
anterior ligament of malleus, sphenomandibular ligament.
• 1st structure to develop in primordium of the lower jaw is the mandibular
division of trigeminal nerve.

• A single ossification centre for each half of the mandible arises in the 6 th week of
IUL in the region of bifurcation of the inferior alveolar nerve into mental and
incisive branches.

• The ossification spreads below and around the inferior alveolar nerve and
upwards to form a trough for accomodating the developing tooth buds.

• Spread of intramembranous ossification dorsally & ventrally forms the body and
ramus of the mandible .
• Endochondral bone formation is seen in 3 areas of the
mandible:
1.Condylar process
2. Coronoid process
3. Mental region
Condylar process 5th week

4 months

middle of
foetal life till
adulthood
Coronoid process- secondary accessory cartilages – 10th-14th week
of IUL- in response to the developing temporalis muscles-
disappear before birth.

Mental region- 1 or 2 small cartilages on either side of symphysis-

ossify in the 7th month of IUL to form mental ossicles.
 Prenatal growth of maxilla
• Intramembranous ossification.

• Centre of ossification- close to the developing deciduous canine

tooth- appears during the 8th week of IUL.

• Ossification spreads throughout the developing maxilla into its

growing processes (palatine, zygomatic, frontal & alveolar).

• Maxillary sinus appears as an outpocketing of the mucosa of

middle meatus of nose at the 4th month of IUL. Later it enlarges
by resorption of nasal mucous membrane into the maxillary
bone.
 Congenital anomalies of face
1. Cleft lip
2. Oblique facial cleft

3. Macrostomia & microstomia

4. Mandibulofacial dysostosis or 1st arch

syndrome
5. Retrognathia

6. Hypertelorism

7. Lip pits and double lip

Cleft palate
Due to failure of elevation of palatal shelves (major clefts) or
failure of fusion of shelves (minor clefts) or lack of degeneration
of the midline epithelial seam or failure of mesenchymal
consolidation.
Development of tongue (4th month of IUL)
• Anomalies of tongue
1. Macroglossia, microglossia, aglossia

Downs syndrome, Beckwith-

Weidmann syndrome, Gargoylism
2. Bifid tongue

3. Ankyloglossia

4. Median rhomboid glossitis

5. Lingual thyroid nodule

6. Fissured tongue
(Melkersson-Rosenthal syndrome,
Down’s syndrome)
Development of salivary glands (6th -7th week)

• Develop as outgrowths of the buccal epithelium, which are first solid

and later canalised.
• Branch repeatedly to form the duct system, terminal parts of the duct
system develop into secretory acini.
• Develop at the junctional area between ectoderm of the stomodeum
and endoderm of the foregut.
• Outgrowth of the parotid gland arises in relation to the line along
which the maxillary and mandibular processes fuse to form the cheek
(considered to be ectodermal)
• Outgrowths for submandibular and sublingual glands arise in relation
to the linguo-gingival sulcus (considered to be endodermal in origin)
 Some general considerations
Control of foetal growth
IU growth of foetus is influenced by
1. Maternal factors- adequate availability of nutrition in maternal
blood & its transfer across placenta. Maternal hormones do
not cross placenta, but can influence the foetus indirectly by
controlling maternal metabolic processes.
2. Placental factors- placental hormones
3. Foetal factors- foetal growth is influenced by genetic factors,
hormones produced by foetal endocrine glands.
IUGR- when the growth of the foetus is less
than that seen in 90% of foetuses ( ie
< 90th percentile)
 Causes of congenital anomalies
• Factors that cause anomalies are called
teratogens.
• About 80% of congenital malformations
are produced by a combination of genetic
or chromosomal factors.
Teratogens include
1. Infections – TORCH complex
2. Malnutrition
3. Antigenic reactions
4. Drugs and chemicals- thalidomide, aminopterin,
diphenyl hydantoin, phenothiazines, lithium, diazepam,
alcohol
5. Hormones- synthetic oestrogens and progestins
6. Physical factors- radiation
Prenatal diagnosis
• Prenatal diagnosis is the process of ruling in or out fetal
anomalies or genetic disorders, to provide expecting
parents with information and the opportunity to modify
pregnancy management and/or postnatal care.
Indications for prenatal diagnosis
• Advanced maternal age
• Multiple pregnancy losses (≥3)
• Known or suspected family history of genetic disease or
multifactorial disorder
• Ethnicity at increased risk for genetic disease
• Teratogens
• Abnormal ultrasound findings
• Abnormal maternal serum screen results
Methods of prenatal diagnosis

1. Chorionic villus sampling

2. Amniocentesis
3. Percutaneous umbilical blood sampling
4. Pre-implantation genetic diagnosis and preconception testing-
Polar body testing and blastomere testing
5. Ultrasound is used from the second trimester to identify major
fetal structural anomalies and fetal anatomical markers.
6. Maternal serum screening- is used to identify women at
increased risk of having a child with trisomies 18 or 21 or an
open neural tube defect (NTD), while posing no risk to
pregnancy. AFP, HCG
7. FISH, Chromosome analysis, Karyotype analysis- is mainly used
to detect the presence or absence of microdeletions,
microduplications and aneuploidy.
8. DNA molecular analysis
9. Biochemical analysis

ENCYCLOPEDIA OF LIFE SCIENCES / & 2002 Macmillan Publishers Ltd, Nature Publishing Group / www.els.net
Conclusion
 References
1. Human Embryology- I.B.Singh
2. Textbook of Orthodontics- Samir.E. Bishara
3. Orthodontics The Art and Science- S.I.Bhalajhi
4. Oral Anatomy,Histology and Embryology-
B.K.B.Berkovitz
5. Shafer’s Textbook of Oral Pathology