The face develops from five swellings called facial primordia that form around the primitive mouth. These include the frontonasal process, paired maxillary processes, and paired mandibular processes. Each process contributes to specific structures of the face. For example, the frontonasal process forms parts of the nose and upper lip, while the maxillary processes form parts of the upper lip, cheek, and nose. Malformations can occur if the merging or fusion of these processes during development is incomplete, leading to cleft lip and cleft palate.

1. DEVELOPMENT OF FACE AND
COGENITAL ANOMALIES
Dr. Mario Edgar Fernández.

2. DEVELOPMENT OF FACE
The face develops from five swellings/processes that form around
primitive mouth (stomodeum). These processes are:
● Single frontonasal process.
● Paired maxillary processes.
● Paired mandibular processes
● Frontonasal process forms forehead, external nose, nasal
cavity, nasal septum, and philtrum of the upper lip
● Maxillary processes form lateral parts of the upper lip and
upper parts of the cheek
● Mandibular processes form chin, lower lip, and lower parts
of the cheek.

3. DEVELOPMENT OF FACE
At the end of the fourth
week, five swellings
(facial primordia)
appear around the
primitive mouth
(stomodeum). The five
facial primordia
consist mainly of
mesenchyme (derived
from neural crest cells)
covered by an ectoderm.

4. DEVELOPMENT OF FACE
The frontonasal
process is formed by
the proliferation of
mesenchyme lying
ventral to forebrain
vesicle and forms middle
part of the upper border
of the stomodeum.

5. DEVELOPMENT OF FACE
The paired maxillary
processes of first arch
form the lateral parts of
the upper border of the
stomodeum.
The paired maxillary
processes of first arch
form the lateral parts of
the upper border of the
stomodeum.

6. DEVELOPMENT OF FACE
On each side of the median plane in the
ventrolateral part of frontonasal process,
the surface ectoderm thickens to form an
ectodermal elevation—the olfactory
placode. The olfactory placodes
invaginate into the underlying
mesoderm to form olfactory pits or
nasal pits. The pits are continuous
with the stomodeum below. The
mesenchyme around margins of nasal
pits proliferates to form horseshoe
shaped elevations. Medial half of
horseshoe-shaped elevation is called
medial nasal process and lateral half
is called lateral nasal process. The
medial nasal processes extend more
towards the stomodeum and form two
globular processes that are separated by
a small triangular notch.

7. Development of Various Parts
of the Face
1. The olfactory pits grow deeper to form nasal cavities.
2. The median nasal process thins out gradually to form primitive
nasal septum.
3. The globular processes of medial nasal processes fuse to form
philtrum of the upper lip.
4. The two maxillary processes grow medially below developing eyes
and fuse with the lateral nasal process to form the lateral part of the
upper lip and upper part of the cheek.
5. The two mandibular processes form the lower lip and lower part
of the cheek.
6. The surface opening of stomodeum forms the oral fissure.
Lateral angles of the oral fissure are formed by fusion of maxillary
and mandibular processes.

8. DERIVATION OF THE VARIOUS
PARTS OF THE FACE

9. DEVELOPMENT OF LIPS
The mesodermal basis of
lateral parts of the upper lip
is derived from the mesenchyme
of the maxillary processes, and
skin over these parts is derived
from ectoderm covering these
processes. The mesodermal
basis of the median part of the
upper lip (philtrum) is derived
from the mesenchyme of the
frontonasal process. The
ectoderm overlying the
maxillary processes overgrows
the mesoderm of the philtrum
to form skin over it

10. According to the recent clinical and embryological
evidences, the upper lip is entirely formed from the
maxillary processes. The lower parts of medial nasal
processes become deeply positioned and get covered
by medial extensions of maxillary processes to form
the philtrum. Hence sensory innervation of upper lip
is derived from maxillary nerves.

11. Embryological basis of the sensory
innervations of the
face.

12. Embryological basis of innervation of
structures in
the region of head and face
 The structures derived from frontonasal process are
supplied by ophthalmic nerve (V1).
 The structures derived from maxillary processes are
supplied by maxillary nerve (V2).
 The structures derived from mandibular processes are
supplied by the mandibular nerve.

13. Correlation of nerve supply of various
components of face and their source of
development

14. The line of fusion of
maxillary and lateral
nasal processes presents
a groove called
nasolacrimal groove.
This groove is lined by
surface ectoderm.
DEVELOPMENT OF
NASOLACRIMAL SAC AND DUCT

15. DEVELOPMENT OF
NASOLACRIMAL SAC AND DUCT
The ectoderm in floor of
this groove proliferates
to form a solid epithelial
cord (ectodermal
cord). Later on this
epithelial cord is
detached from the
surface ectoderm and
gets canalized to form
nasolacrimal duct.

16. DEVELOPMENT OF
NASOLACRIMAL SAC AND DUCT
Upper end of nasolacrimal duct
widens to form the lacrimal
sac. The nasolacrimal duct
becomes completely patent
only after birth. The
nasolacrimal duct
communicates secondarily with
the nasal cavity at its caudal end
and with the conjunctival sac at
its cephalic end. In adults the
nasolacrimal duct runs from
medial angle of the eye to
inferior meatus of the nasal
cavity.

17. Development of External Nose
The external nose develops from
five facial processes, frontonasal
process, two medial nasal
processes,and two lateral nasal
processes as follows:
 The frontonasal process
forms the bridge of the nose.
 Two fused medial nasal
processes form dorsum and
tip of the nose.
 Two lateral nasal processes
form sides and alae of the
nose.

18. FACIAL MALFORMATIONS
Various types of cleft lip and cleft
palate may be encountered
clinically. Complete clefts indicate
the maximum degree of clefting of
any particular type. Incomplete
clefts are found when some merging
or fusion has taken place during
development. Clefts may be
unilateral or bilateral.
The important thing to remember
clinically is: each site where
merging or fusion occurs during
development of face is a
potential site for a facial cleft.