Embryology of Maxilla, Palate, Maxillary sinus & Lips and their Defects

Embryology of Maxilla, Palate,
Maxillary sinus, Upper &
Lower lip and their Defects
Presentation by:
Dr. Vanshree Sorathia
MDS Prosthodontist
Total no. of slides: 94

CONTENTS
2
1. Introduction
2. Embryology:
a. General
b. Maxilla
c. Palate
d. Maxillary sinus
e. Upper and lower lip
3. Defects
4. Conclusion
5. References

5
Orban’s . Oral histology and embryology . 13th edition, Elsevier 2011.

6
Orban’s . Oral histology and embryology . 13th edition, Elsevier 2011.

8
Prenatal growth
Tencate’s. Oral histology. 5th edition, Mosby 1998.
Orban’s. Oral histology and embryology. 13th edition, Elsevier 2011.
Inderbir Singh. Human embryology. 8th edition, Macmillan India limited 2007.

9
Postnatal growth:
Downward and forward

PALATE
10
2
Primary palate: 6th wk – 9th wk
Secondary palate: 7th wk – 3rd mth

11

12
Primary palate
Secondary
palate
Ossification of palate: 8th week of IUL
SI Bhalajhi. Orthodontics – The art and science. 5th edition, Arya Publication 2014.

13
Histology of palate:
Boucher’s – Prosthodont Treatment for Edentulous Patient, 9th edition, C.V. Mosby 1982.

15
4th week of gestation to 7th week

16
Histology of Lips:

19
Development of sinuses:
Gestational month
when development
starts
Present in clinically
significant size
Fully developed
Maxillary 2 Birth 12 years
Ethmoidal 3 3 years 12 years
Frontal 4 3 years 18-20 years
Sphenoidal 3 8 years 12-15 years

Development of Maxillary Sinus:
20
Carl E Misch- Contemporary implant dentistry, 3rd edition, Elsevier 2008.

3 Growth Spurts:
21
Tubular in birth
Pyramid in adulthood
185,244 users
Ovoid in childhood
Birth – 2.5 years
7.5 – 10 years
12 – 14 years

Anatomy of maxillary sinus:
22
Width 25-35
mm
Heigth 36-
45 mm
Length 38-
45mm
Volume 10-
20 cc
Capacity
15mm

23
In adults: sinus floor – 1.25cm
from nasal floor
Children & Edentulous patients:
lies at same level
Pneumatization

Histology of maxillary sinus:
24
 Paler and bluish hue
 Mucoperiosteum
 0.3-0.8mm
Schneiderian membrane

Innervations of maxillary sinus:
25

26

Diagnostic evaluation
27
History
▰ Detailed medical and
dental history
Clinical evaluation
5 tests
▰ Mirror test
▰ Water test
▰ Cotton test
▰ Probing
Radiographic examination
▰ Water’s projection
▰ Panoramic
▰ Periapical
▰ CT
▰ MRI
▰ Ultrasound

Misch 1987 - Classification of maxillary sinus
based on residual bone height
28

Lateral window approach
29
Tarun Kumar AB, Anand U. Maxillary sinus augmentation. J Int Clin Dent Res Organ
2015;7:81-93.

Crestal approach
30
Tarun Kumar AB, Anand U. Maxillary sinus augmentation. J Int Clin Dent Res Organ
2015;7:81-93.

Summary
31
Structure Time (in week of
IUL)
Derived from
Maxilla 6th Maxillary process
Palate 6th – 9th Primary palate - Frontonasal & Maxillary
process
Secondary palate - Palatine process
Lips 4th – 7th Upper lip - Frontonasal process and
maxillary process
Lower lip - Mandibular process
Maxillary sinus 16th Nasal epithelium invades maxillary
mesenchyme

33
Defects
Acquired
Congenital
Congenital defects: Existing at, and usually before, birth; referring to conditions that are
present at birth, irrespective of their causation.
Glossary of prosthodontic terms- 9.

Congenital defects
Maxilla
1. Agnathia
2. Micrognathia
3. Macrognathia
4. Facial hyperplasia
5. Facial hemiatrophy
6. Treacher collin
syndrome
7. Cleidocranial dysplasia
8. Crouzon’s syndrome
9. Apert’s syndrome
10. Achondroplasia 34
Palate
1. Epstein pearl &
Bohns nodules
2. Nasoplalatine duct
cyst
3. Median palatal cyst
4. Globulomaxillary
cyst
5. Nasoalveolar cyst
Maxillary sinus
1. Agenesis
2. Aplasia
3. Hypoplasia
4. Hyperplasia
5. Supernumerary
sinus
Lips
1. Microstomia
2. Macrostomia
3. Cleft lip & palate
4. Congenital lip &
commissural pits
and fissures
5. Van der Woude
syndrome
6. Double lip

1. Agnathia
Synonyms: Octocephaly,
Holoprocencephaly agnathia.
Etiology: Missing either 1 maxillary
process or premaxillary process.
Clinical manifestation: Hypoplasia or
absence of jaw.
Prosthetic consideration:
35
Shafer’s. Textbook of oral pathology. 7th edition, Elsevier 2014.

2. Micrognathia
Etiology: Deficiency of premaxilla.
Clinical manifestation: Retracted middle 3RD face.
Prosthetic consideration: Special impression
technique, customized teeth set.
Syndrome: Silver Russell syndrome.
36

Micrognathia - Case
37
Department of Prosthodontics, Pacific dental college & hospital.

38
Silver Russell syndrome (SRS)
Kim K, Noh K, Paek J, Kwon KR, Pae A. Prosthetic management of a growing patient with Russell-
Silver syndrome: a clinical report. J Adv Prosthodont 2015;7:406-10.

3. Macrognathia
Etiology: Unknown or heriditary pattern.
Clinical manifestation: Abnormally large size jaw.
Associated conditions: Paget’s disease, acromegaly,
Leontiasis Osea.
Prosthetic consideration: Ostectomy, repeated
fabrication of CD.
39

4. Facial hemihypertrophy
Synonyms: Hyperplasia, Partial/Unilateral gigantism,
Hemimacrostomia.
Etiology: Unknown, vascular or lymphatic or
chromosomal abnormality.
Prosthetic consideration: Only cosmetic correction.
40

41
Bhuta BA, Yadav A, Desai RS, Bansal SP, Chemburkar VV and Dev PV. Clinical and Imaging
Findings of True Hemifacial Hyperplasia. Case Reports in Dentistry 2013.

42
Bhuta BA, Yadav A, Desai RS, Bansal SP, Chemburkar VV and Dev PV. Clinical and Imaging
Findings of True Hemifacial Hyperplasia. Case Reports in Dentistry 2013.

Syndrome:
▰ Beckwith Widemann syndrome
▰ Neurofibromatosis
▰ Klippel Tranaumy-Weber syndrome
▰ Maffucci syndrome
▰ Multiple exostosis syndrome
▰ Olleiv syndrome
▰ Proteus syndrome
43

5. Facial hemiatrophy
Synonyms: Parry Romberg Syndrome,
Progressive facial hemiatrophy.
Etiology: Cerebral disturbances.
44
Deshingkar SA, Barpande SR, Bhavthankar JD, Humbe JG. Progressive hemifacial atrophy (Parry-
Romberg Syndrome). Contemp Clin Dent 2012;3:S78-81.

▰ Clinical manifestation:
45

▰ Prosthetic consideration:
46
Shetty S, Mohammad F, Shetty R, Shenoy K. Prosthetic rehabilitation of an orbital defect for a
patient with hemifacial atrophy. J Indian Prosthodont Soc 2016;16:91-5.
Case report 1 – Orbital prosthesis

47
Shetty S, Mohammad F, Shetty R, Shenoy K. Prosthetic rehabilitation of an orbital defect
for a patient with hemifacial atrophy. J Indian Prosthodont Soc 2016;16:91-5.

48
Case report 2 –
Titanium plate designed by stereolithography design
Vergara F, Caro J, Mora E. Individual replacement prosthesis: contemporaneous treatment
of parry-Romberg syndrome. A case report. J Dent Maxillofacial Res. (2018);1(2):85‒88.

6. Treachers Collins Franceschetti syndrome
Synonyms: Mandibulofacial dysostosis.
Etiology: Failure of differentiation of
maxillary mesoderm. Syndrome of 1st &
2nd brachial arches.
49

50
Antimongoloid face
Hypoplasia of malar bone
Malformation of ear
Macrostomia
Malocclusion
Para nasal sinus - underdeveloped
Cleft palate
Clinical manifestation: “Bird like” face

Case report 1 – Interim obturator
51
Bhandari S, Aras M, Bakshi S. Interim obturator in an infant with Treacher Collins syndrome:
Review and chairside modification in impression making. Contemp Clin Dent 2011;2:342-6.

52
Madhan R and Sanjna N. Prosthetic management of Treacher Collins syndrome. Ind J Dent
Res 2006;17.
Case report 2 – Auricular prosthesis

7. Cleidocranial dysostosis
Synonyms: Marie & Sainton’s disease,
Scheuthauer - Marie Sainton’s disease,
Mutational dysostosis.
Etiology: Congenital disorder of bone
formation.
53

▰ Clinical manifestation:
54
High narrow arched palate
Cleft palate
Retention of deciduous teeth
Roots – short & thinner
Crpt formation
Lacrimal & zygomatic bone
underdeveloped
Underdeveloped maxilla

Case report 1: Interim Prosthetic Phase of
Multidisciplinary Management
55
Berg et al. Interim Prosthetic Phase of Multidisciplinary Management of Cleidocranial
Dysplasia: “The Bronx Approach”. J Prosthodont 2011;20:S20-S25.

56
Petropoulos et al. Treatment of a Patient with Cleidocranial Dysplasia Using a Single-Stage
Implant Protocol. J Prosthodont 2011;20:S26-31
Case report 2: Implant prosthesis

8. Crouzon’s syndrome
Synonyms: Craniofacial dysostosis.
Etiology: Mutation of FGFR2.
Clinical manifestation:
57

Case report 1 – CPD and fixed restoration
58
Bhardwaj P and Aras M: Combined denture prosthetic treatment of patients with Crouzen
syndrome. J Indian Prosthodont Soc 2008;8:173-176.

Case report 2 – Telescopic overdenture
59
Kurt H, Gencel B, Kader AC. Prosthetic rehabilitation of a Crouzon patient: A case report.
Contemp Clin Dent 2010;1:196-200.

60
Kurt H, Gencel B, Kader AC. Prosthetic rehabilitation of a Crouzon patient: A case report.

9. Apert syndrome
Synonyms: Acrocephalosyndactyly
Etiology: FGFR2
61

62
Madapathi S et al. Prosthetic Rehabilitation of a Patient with Apert Syndrome: A Case
Report. IOSR-JDMS 2019;18:59-61.
Case report 1 – Telescopic overdenture

10. Achondroplasia
Synonyms: Chondrodystrophia fetalis.
Etiology: FGFR3 mutation.
Short stature
Long trunk
Trident hands
Midface hypoplasia
63

11. Epstein’s pearls and Bohn’s nodules
Synonyms: Palatal & alveolar cyst of new born.
Etiology: Epithelial remnants.
Clinical manifestation: Asymptomatic
Prosthetic consideration: Not applicable
64

12. Nasopalatine canal cyst
Synonyms: Incisive canal cyst , cyst of incisive papilla.
Etiology: Unknown or Trauma
Clinical manifestation: Translucent or bluish coloured dome
shaped swelling.
Midline of maxilla.
Radiographic feature: Heart shaped.
65

66
Takeshita K, Funaki K, Jimbo R, Takahashi T. Nasopalatine duct cyst developed in association
with dental implant treatment: A case report and histopathological observation. J Oral
Maxillofac Pathol 2013;17:319.
Case report 1 – Cyst after implant placement

67
Sukegawa S, Kanno T, Kawai H, Takebe Y, Shibata A, Takahashi Y, Furuki Y. Nasopalatine
duct cyst associated with dental implant treatment: A case report. Oral and Maxillofacial
Surgery Cases 2015;1: 38–41.
Case report 2 – NP Cyst after implant placement

13. Median palatal cyst
Etiology: Epithelium entrapment.
Clinical manifestation: Swelling
Prosthetic consideration: Surgical removal and
curettage.
Radiographic feature: Well circumscribed R/L.
68

14. Globulomaxillary cyst
Clinical manifestation: swelling between junction
of premaxilla and maxilla process.
Radiographic feature: Inverted pear shaped.
69

15. Nasoalveolar cyst
Synonyms: Nasolabial cyst, Klestadt’s cyst.
Clinical manifestation: Swelling.
70

16. Agenesis
Etiology: No epithelial growth.
Clinical manifestation: -
Prosthetic consideration: -
71

17. Aplasia and hypoplasia
Etiology: Localized GF deficiency
Clinical manifestation: Not seen /
hypoplastic maxilla
72

18. Supernumerary maxillary sinus
Etiology: Outpocketing of nasal mucosa.
Clinical manifestation: 2 completely seperated
sinus.
73

19. Microstomia
Etiology: Undue fusion of maxillary to mandibular
process.
Clinical manifestation: Less mouth opening
74

75
Case report 1 – Sectional tray
Gauri M, Ramandeep D. Prosthodontic Management of a Completely Edentulous Patient
with Microstomia: A Case Report. J Indian Prosthodont Soc 2013;13:338-342.

76
Gauri M, Ramandeep D. Prosthodontic Management of a Completely Edentulous Patient
with Microstomia: A Case Report. J Indian Prosthodont Soc 2013;13:338-342.

20. Macrostomia
Etiology: Failure of fusion of maxillary and
mandibular process.
Clinical manifestation: Increased mouth
opening.
77

21. Cleft lip and cleft palate
Etiology: Failure of fusion of nasal
process to maxillary process.
78

Classification:
79
Veau classification: Karnahan & Stark symbolic classification:

Prosthetic appliance for cleft palate
80
A. Prosthesis in infancy
period:
i. Feeding obturator,
ii. Premaxilla positioning
appliances,
iii. Palatal lift prosthesis,
iv. Speech aid or speech bulb
prosthesis (3rd and 4th
given in adult patient
also).
C. Prosthesis for tooth
replacement:
(i) Removable prosthesis
(ii) Complete dentures
prosthesis
(iii)Fixed prosthesis
(iv)Implant prosthesis
B. Obturator:
▰ Palatal obturator with
solid or hollow bulbs
meatus.

Obturator:
1. Surgical obturator
a) Immediate
b) Delayed
2. Interim obturator
3. Definitive obturator
81

Nasoalveolar moulding applaince
82

22. Congenital lip and commissural
pits and fissures
Etiology: Fixation of tissue at base of notch.
Clinical manifestation: Unilateral or bilateral
depression of pit.
83

23. Double lip
Etiology:
Excessive areolar tissue & non- inflammatory
labial mucous gland hyperplaisa.
Clinical manifestation: Monkey lip.
84

Acquired defects
Maxillary defects
Armany’s classification
85
Aramany MA. Basic principles of obturator design for partially edentulous
patients. Part I: classification. J Prosthet Dent 1978;40:554-7.

References
1. The Glossary of Prosthodontic Terms, 9th edition. J. Prosthet Dent. May
2017; 117(5S):e1-e105.
2. Tencate’s. Oral histology. 5th edition, Mosby 1998.
3. Orban’s. Oral histology and embryology. 13th edition, Elsevier 2011.
4. Inderbir Singh. Human embryology. 8th edition, Macmillan India limited
2007.
5. SI Bhalajhi. Orthodontics – The art and science. 5th edition, Arya Publication
2014.
6. Shafer’s. Textbook of oral pathology. 7th edition, Elsevier 2014.
7. Boucher’s – Prosthodont Treatment for Edentulous Patient, 9th edition, C.V.
Mosby 1982. 87

References
8. Kim K, Noh K, Paek J, Kwon KR, Pae A. Prosthetic management of a
growing patient with Russell-Silver syndrome: a clinical report. J Adv
Prosthodont 2015;7:406-10.
9. Shanmugasundaram K, VedamVKV, Ganapathy S, Sathish S and Satti P.
Congenital Hemifacial Hyperplasia: Clinical Presentation and Literature
Review. Case Reports in Dentistry 2016.
10. Bhuta BA, Yadav A, Desai RS, Bansal SP, Chemburkar VV and Dev PV.
Clinical and Imaging Findings of True Hemifacial Hyperplasia. Case
Reports in Dentistry 2013.
11. Esan T, Olusile A. Hemifacial Atrophy: A Case Report And Review Of
Literature. he Internet Journal of Dental Science. 2003;1. 88

References
12. Deshingkar SA, Barpande SR, Bhavthankar JD, Humbe JG. Progressive
hemifacial atrophy (Parry-Romberg Syndrome). Contemp Clin Dent
2012;3:S78-81.
13. Shetty S, Mohammad F, Shetty R, Shenoy K. Prosthetic rehabilitation of an
orbital defect for a patient with hemifacial atrophy. J Indian Prosthodont Soc
2016;16:91-5.
14. Vergara F, Caro J, Mora E. Individual replacement prosthesis:
contemporaneous treatment of parry-Romberg syndrome. A case report. J
Dent Maxillofacial Res. (2018);1(2):85‒88.
15. Soğukpınar A, Almaz ME. Dental Treatment of a Patient with Treacher Collins
Syndrome Under General Anaesthesia: A Case Report. Cumhuriyet Dent J
2019;22:1:136-139. 89

References
16.Bhandari S, Aras M, Bakshi S. Interim obturator in an infant with Treacher
Collins syndrome: Review and chairside modification in impression making.
17.Duque C. Treacher Collins syndrome and implications in the oral cavity. Clin
Res Trials 2019;5.
18.Madhan R and Sanjna N. Prosthetic management of Treacher Collins
syndrome. Ind J Dent Res 2006;17.
19.Berg et al. Interim Prosthetic Phase of Multidisciplinary Management of
Cleidocranial Dysplasia: “The Bronx Approach”. J Prosthodont 2011;20:S20-
S25.
90

References
20. Lee et al. Manifestation and treatment in a cleidocranial dysplasia patient
with a RUNX2 (T420I) mutation. Maxillofacial Plastic and Reconstructive
Surgery 2015;37:41.
21. Petropoulos et al. Treatment of a Patient with Cleidocranial Dysplasia
Using a Single-Stage Implant Protocol. J Prosthodont 2011;20:S26-31.
22. Noh et al. Prosthetic Rehabilitation of a Cleidocranial Dysplasia Patient
with Vertical Maxillofacial Deficiency: A Clinical Report. J Prosthodont
2014;23:S64-70.
23. Bhardwaj P and Aras M: Combined denture prosthetic treatment of
patients with Crouzen syndrome. J Indian Prosthodont Soc 2008;8:173-
176. 91

References
24. Kurt H, Gencel B, Kader AC. Prosthetic rehabilitation of a Crouzon
patient: A case report. Contemp Clin Dent 2010;1:196-200.
25. Madapathi S et al. Prosthetic Rehabilitation of a Patient with Apert
Syndrome: A Case Report. IOSR-JDMS 2019;18:59-61.
26. Takeshita K, Funaki K, Jimbo R, Takahashi T. Nasopalatine duct cyst
developed in association with dental implant treatment: A case report
and histopathological observation. J Oral Maxillofac Pathol
2013;17:319.
27. Sukegawa S, Kanno T, Kawai H, Takebe Y, Shibata A, Takahashi Y,
Furuki Y. Nasopalatine duct cyst associated with dental implant
treatment: A case report. Oral and Maxillofacial Surgery Cases 2015;1:
38–41. 92

References
28. Gauri M, Ramandeep D. Prosthodontic Management of a Completely
Edentulous Patient with Microstomia: A Case Report. J Indian
Prosthodont Soc 2013;13:338-342.
29. Prithviraj DR, Ramaswamy S, Romesh S. Prosthetic rehabilitation of
patients with microstomia. Indian J Dent Res 2009;20:483-6.
30. Tarun Kumar AB, Anand U. Maxillary sinus augmentation. J Int Clin Dent
Res Organ 2015;7:81-93.
31. Carl E Misch- Contemporary implant dentistry, 3rd edition, Elsevier 2008.
32. Aramany MA. Basic principles of obturator design for partially edentulous
patients. Part I: classification. J Prosthet Dent 1978;40:554-7.
93

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