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Surgical embryology in relation to common cranio facial /certified fixed orthodontic courses by Indian dental academy


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  • (Figs. 3–3 and 3–4); the latter two are derivatives of the first pair of six pharyngeal arches.
  • Merging of what are initially incompletely separated prominences occurs asthe intervening grooves disappear as a result of migration into and/or proliferationof underlying mesenchyme in the groove. Fusion of the freely projectingmedial nasal prominences with the maxillary and lateral nasal prominences oneach side requires the disintegration of their contacting surface epithelia (thenasal fin), allowing the underlying mesenchymal cells to intermingle. Failure ofnormal disintegration of the nasal fin by cell death or mesenchymal transformationis a cause of cleft upper lip and anterior palate, as such failure preventsthe intermingling of maxillary and medial nasal mesenchyme.
  • The withdrawal of theembryo’s face from against the heart prominence by the uprighting of the headfacilitates jaw opening (Fig. 10–4). Mouth-opening reflexes have been implicatedin the withdrawal of the tongue from between the vertical shelves, andpressure differences between the nasal and oral regions due to tongue musclecontraction may account for palatal-shelf elevation.
  • Transcript

    • 1. Surgical embryology in relation to common craniofacial anomalies INDIAN DENTAL ACADEMY Leader in continuing dental education
    • 2. • • • • • • • Cleft lip/ cleft palate CRANIOSYNOSTOSIS SYNDROMES Treacher collins Syndrome Hemi facial microsmia Vascular malformation Hemangioma Down s syndrome
    • 3. BRANCHIAL ARCHES • Rod like thickening of mesoderm • 4 arches are well developed by 4th week of gestation • 5th and 6th arches are still rudimentary • Development takes place over weeks 4 to 7 • Contribute mostly to neck development but the first arch contributes to facial development
    • 4.
    • 5. Each arch contains: • A cartilagenous component • A muscular component • An aortic arch (artery) • A nerve
    • 6. First Branchial Arch • Divides early into 2 portions • Maxillary process dorsally (maxilla, zygoma, squamous ,temporal bone) • Mandibular process ventrally
    • 7. First Branchial Arch • Cartilage (Meckel’s Cartilage) • Dorsal end becomes the malleus and incus • Intermediate portion regresses, but the perichondrium • forms: • Anterior ligament of the malleus • Sphenomandibular ligament • Ventral portion forms the mandible
    • 8. • First Branchial Arch • Muscular component Muscles of mastication (temporalis, masseter, med & lateral pterygoids) Accessorymuscles of mastication (mylohyoid, ant belly ofdigastric) Tensor tympani Tensor veli palatini
    • 9. • Second Branchial Arch • Cartilage (Reichert’s Cartilage) • – Dorsal end becomes stapes (except footplate) and styloid • process • – Intermediate portion regresses and perichondrium forms • the stylohyoid ligament • – Ventral end forms the lesser cornu of the hyoid and the • upper half of the hyoid bone
    • 10. • Second Branchial Arch • Muscular Component • – Migrates over superficial face to form the muscles of facial • expression • – Stapedius muscle • – Stylohyoid muscle • – Posterior belly of digastric • Aortic Arch • – Hyoid artery • – Stapedial artery
    • 11. • Second Branchial Arch • Nerve-Facial Nerve (CN VII)
    • 12. DEVELOPMENT OF FACE • The face derives from five prominences that surround a central depression, stomodeum, which constitutes the future mouth. • The prominences are the single median frontonasal & paired maxillary and mandibular prominences • All of these prominences and arches arise from neural crest
    • 13. FNP MAN FG MAX ST
    • 14. • Union of the facial prominences occurs by either of two developmental events at different locations: • merging of the frontonasal, maxillary, and mandibular prominences or • fusion of the central maxillonasal components.
    • 15. ANOMALIES OF DEVELOPMENT • Defects of facial development are the result of a multiplicity of etiologic factors, some genetic, most unknown. The study of these anomalies constitutes TERATOLOGY. • Defective development is categorized into – malformations that are generally genetically determined, – deformations that are environmentally influenced, and – disruptions that are of metabolic, vascular, and/or teratogenic origin. • Malformation develop predominantly in the embryonic period and are not selfcorrecting • Deformations and Disruptions occur in the fetal period and may correct themselves.
    • 16. Cleft lip • Failure of the facial prominences to merge or fuse results in abnormal developmental clefts. • These clefts are due to the disruption of the many integrated processes of induction, cell migration, local growth, and mesenchymal merging
    • 17. • UPPER-When maxillary process do not fuse with Medial nasal process.(unilateral/Bilateral) • Unilateral cleft lip, more common on the leftside, is a relatively common congenital defect (1 in 800 births) that has a strong familial tendency, suggesting a genetic background
    • 18. • oblique facial cleft - persistence of the groove between the maxillary prominence and the lateral nasal prominence running from the medial canthus of the eye to the ala of the nose • Midline mandibular cleft Persistence of the furrow between the two mandibular prominences produces the rare
    • 19. • Median cleft lip (the true “hare lip”)is due to the incomplete merging of the two medial nasal prominences, therefore leading in most cases (with deep midline grooving of the nose) to various forms of bifid nose.
    • 20. • Macrostmia – Inadequate fusion of mandibular & maxillary process with each other . • If unilateral – Lateral facial cleft.
    • 21. • The three elements that make up the secondary definitive palate—the two lateral maxillary palatal shelves and the primary palate of the frontonasal prominence • Initially widely separated due to the vertical orientation of the lateral shelves on either side of the tongue . • During the 8th week post conception, a remarkable transformation in the position of the lateral shelves takes place. • They change from vertical to horizontal as a prelude to their fusion and to partitioning of the oronasal chamber
    • 22.
    • 23. • Successful fusion of the three embryonic components of the palate involves complicated synchronization of shelf movements with growth and withdrawal ofthe tongue and with growth of the mandible and head. • The mis-timing of any of these critical events, due to environmental agents or to genetic predisposition, • results in the failure of fusion, leading to clefts of the palate.
    • 24.
    • 25. CRANIOSYNOSTOSIS SYNDROMES • CRANIOSYNOSTOSIS -Pathological condition that results from premature fusion of one or more sutures in the cranial vault; Common syndromes: • Aperts • Crouzon
    • 26. Growth at sutures • Sutures allow growth perpendicular to them • Growth at suture lines related to brain growth Early closure causes growth parallel to suture
    • 27. • Fibroblast growth factor and fibroblast growth factor receptor (FGFR) regulate fetal osteogenic growth expressed in cranial sutures in early fetal life. • Mutations in FGFR2 →Apert’s syndrome and Crouzon’s disease • Mutation leads to increase in number of precursor cells that enter osteogenic pathway • Which leads to increased subperiosteal bone matrix formation & premature calvaria ossification during fetal development
    • 28. CROUZONS Clinical findings • • • • • Brachycephaly, significant hypertelorism, proptosis, maxillary hypoplasia, beaked nose Intracranial anomalies Hydrocephalus • Normal intellect • • Normal extremities
    • 29. APERT s
    • 30. Timing of surgery • Early operation(3-6 months) Rapid brain growth reshape bone • Better compliance of brain dura and scalp • Calvarium in an infant aged 3-9 months is much more malleable, easier to shape and providing a better outcome. • forehead advancement first • • facial advancement later, to avoid the risk of frontal • journal of pediatric neurosciences • REVIEW ARTICLE Year : 2009 | Volume : 4 | Issue : 2 | Page : 86-99 Pediatric craniofacial surgery for craniosynostosis: YN Anantheswar1, NK Venkataramana2
    • 31. Treacher collins Syndrome • Mandibulofacial dysostosis involves structures derived from the first and second pharyngeal arch • This syndrome is thought to result from retardation or failure of differentiation of maxillary mesoderm at & after 50 mm stage of embryo
    • 32.
    • 33. – Malar and supraorbital hypoplasia – Non-fused zygomatic arches – Cleft palate in 35% – Hypoplastic paranasal sinuses – Downward slanting palpebral fissures – Mandibular hypoplasia with increased angulation – Coloboma of lower eyelid with absent cilia – Malformed pinna – Normal intelligence
    • 34. HEMI FACIAL MICROSMIA • hemifacial microsomia was defined as a condition affecting primarily aural, oral, and mandibular development. • The disorder variesfrom mild to severe, and involvement is limited to one side in many cases, • Goldenhar syndrome is considered a variant of this complex, characterized additionally by vertebral anomalies and epibulbar dermoids
    • 35. HEMANGIOMA A type of birth mark , • The cause of hemangioma is currently unknown; however, several studies have suggested the importance of estrogen signaling in hemangioma proliferation. • maternal placenta embolizes to the fetal dermis during gestation resulting in hemangiomagenesis
    • 36. Thank you For more details please visit