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Seminar 1 PrintSeminar 1 PrintSeminar 1 PrintSeminar 1 PrintSeminar 1 PrintSeminar 1 PrintSeminar 1 PrintSeminar 1 PrintSeminar 1 PrintSeminar 1 PrintSeminar 1 PrintSeminar 1 PrintSeminar 1 PrintSeminar 1 PrintSeminar 1 PrintSeminar 1 PrintSeminar 1 PrintSeminar 1 PrintSeminar 1 PrintSeminar 1 Print...
Slide Content
Development Of Hard &
Soft Palate
Prepared By : Hafizali Lokhandwala
Guided By : Dr Ruchi Raj
Soft Palate
Prepared By : Hafizali Lokhandwala
Guided By : Dr Ruchi Raj
Contents
1.First Week of Gestational Development
2.Second Week of Development
3.Third Week of Development
4.Third to Eight Week : The Embryonic Period
5.Neural Crest Cells
6.Formation of Brachial Arches
7.Development of Palate
8.Ossification of Palate
9.Clinical Correlation (Cleft lip & palate)
10.Management of Cleft lip & palate
11.References
1.First Week of Gestational Development
2.Second Week of Development
3.Third Week of Development
4.Third to Eight Week : The Embryonic Period
5.Neural Crest Cells
6.Formation of Brachial Arches
7.Development of Palate
8.Ossification of Palate
9.Clinical Correlation (Cleft lip & palate)
10.Management of Cleft lip & palate
11.References
First Week of Gestational
Development
•Fertilization: It is the process by which male and female gametes fuse, it mostly
occurs in the ampullary region of the uterine tube.
•Cleavage: Once the zygote has reached the two-cell stage, it undergoes a series of
mitotic divisions, increasing the numbers of cells. These cells, which become smaller
with each cleavage division, are known as blastomeres. This process of multiple
divisions is known as cleavage.
Development
•Fertilization: It is the process by which male and female gametes fuse, it mostly
occurs in the ampullary region of the uterine tube.
•Cleavage: Once the zygote has reached the two-cell stage, it undergoes a series of
mitotic divisions, increasing the numbers of cells. These cells, which become smaller
with each cleavage division, are known as blastomeres. This process of multiple
divisions is known as cleavage.
First Week
Day 9 Day 12
Second Week
•Uteroplacental Circulation
•New population of cells derived from primary yolk sac cells, form a
loose connective tissue, i.e.Extra-embryonic mesoderm.
Second Week
•Uteroplacental Circulation
•New population of cells derived from primary yolk sac cells, form a
loose connective tissue, i.e.Extra-embryonic mesoderm.
Second Week
Third Week Of Development
•The most characteristic event occuringduring
third week of gestation is Gastrulation, the
process that establishes the three germ layers
in the embryo. These are :
1.Ectoderm
2.Mesoderm &
3.Endoderm
•The most characteristic event occuringduring
third week of gestation is Gastrulation, the
process that establishes the three germ layers
in the embryo. These are :
1.Ectoderm
2.Mesoderm &
3.Endoderm
Third to Eighth Week : The Embryonic
Period
•It is also known as the period of organogenesis.
•Three germ layers give rise to number of specific tissues and organs.
•At the beginning of the third week of development, the ectodermalgerm layer has
the shape of a disc that is broader in the cephalic than in the caudal region.
•Appearance of the notochord and the prechordalmesoderm induces the overlying
ectoderm to thickenand form the neural plate.
•Cells of the plate make up the neuroectoderm and their induction represents the
initial event in the process of neurulation.
Period
•It is also known as the period of organogenesis.
•Three germ layers give rise to number of specific tissues and organs.
•At the beginning of the third week of development, the ectodermalgerm layer has
the shape of a disc that is broader in the cephalic than in the caudal region.
•Appearance of the notochord and the prechordalmesoderm induces the overlying
ectoderm to thickenand form the neural plate.
•Cells of the plate make up the neuroectoderm and their induction represents the
initial event in the process of neurulation.
Neural Crest Cells
•As the neural folds elevate and fuse, cells at the lateral border or crest of the
neuroectodermbegin to dissociate from their neighbors.
•This cell population, the neural crest, will undergo an epithelial-to-mesenchymal
transitionas it leaves the neuroectodermby active migration and displacement to
enter the underlying mesoderm.
•These cells contribute to the craniofacial skeleton as well as neuronsfor cranial
ganglia, glialcells, melanocytes, and other cell types.
•Neural crest cells are so fundamentally important and contribute to so many
organs and tissues that they are sometimes referred to as the fourth germ layer.
•As the neural folds elevate and fuse, cells at the lateral border or crest of the
neuroectodermbegin to dissociate from their neighbors.
•This cell population, the neural crest, will undergo an epithelial-to-mesenchymal
transitionas it leaves the neuroectodermby active migration and displacement to
enter the underlying mesoderm.
•These cells contribute to the craniofacial skeleton as well as neuronsfor cranial
ganglia, glialcells, melanocytes, and other cell types.
•Neural crest cells are so fundamentally important and contribute to so many
organs and tissues that they are sometimes referred to as the fourth germ layer.
•As the germ layers undergo further diffrentiationand development, the embryo
undergoes folding, both cephalo–caudally and laterally.
•Due to the formation of head and tail folds, a part of yolk sac becomes enclosed within
the embryo. This enclosed tube lined by endoderm is called primitive gut and it gives
rise to the Gastrointestinal Tract.
•This tube can be divided into three regions :
1.Foregut
2.Midgut
3.Hindgut.
undergoes folding, both cephalo–caudally and laterally.
•Due to the formation of head and tail folds, a part of yolk sac becomes enclosed within
the embryo. This enclosed tube lined by endoderm is called primitive gut and it gives
rise to the Gastrointestinal Tract.
•This tube can be divided into three regions :
1.Foregut
2.Midgut
3.Hindgut.
•At its cephalic end, the foregut is temporarily bounded by an ectodermal–
endodermalmembrane called the OropharyengealMembrane.
•This membrane separatesthe stomodeum, the primitive oral cavity derived
from ectoderm, from the foregut, derived from endoderm.
•In the 4
th
week of development, this membrane ruptures, establishing an open
connection between oral cavity and the primitive gut.
endodermalmembrane called the OropharyengealMembrane.
•This membrane separatesthe stomodeum, the primitive oral cavity derived
from ectoderm, from the foregut, derived from endoderm.
•In the 4
th
week of development, this membrane ruptures, establishing an open
connection between oral cavity and the primitive gut.
Formation of Brachial Arches
•Around the same time, i.e. 4
th
week of IU life, a series of mesodermal thickenings
are seen in the wall of the cranial most part of the foregut. These are called as
brachialarchesor the pharyngeal arches.
•They are seen as six cylindrical thickenings that expand and pass beneath the floor
of the pharynx and approach their anatomic counterparts of the opposite side.
•The 5th arch is transient and disappears soon.
•The formation of arches results in progressive separation of the primitive
stomatodeumfrom the developing heart.
1
st
arch –Mandibular Arch
2
nd
arch –Hyoid Arch
Rest do not have any specific names.
•Ectodermal extension of the arch is known as Ectodermal Cleft.
•Endodermal extension of the arch is known as Endodermal Pouch.
•Around the same time, i.e. 4
th
week of IU life, a series of mesodermal thickenings
are seen in the wall of the cranial most part of the foregut. These are called as
brachialarchesor the pharyngeal arches.
•They are seen as six cylindrical thickenings that expand and pass beneath the floor
of the pharynx and approach their anatomic counterparts of the opposite side.
•The 5th arch is transient and disappears soon.
•The formation of arches results in progressive separation of the primitive
stomatodeumfrom the developing heart.
1
st
arch –Mandibular Arch
2
nd
arch –Hyoid Arch
Rest do not have any specific names.
•Ectodermal extension of the arch is known as Ectodermal Cleft.
•Endodermal extension of the arch is known as Endodermal Pouch.
Outer & the Cut Section
views to showcase
outside (ecto) and inside
(endo) of the arches.
views to showcase
outside (ecto) and inside
(endo) of the arches.
•The stomodeumis thus overlapped superiorly by the FrontoNasal Process.
•The mandibulararches of both sides form the lateral walls of ofthe stomodeum
•The mandibulararch gives off a bud from its dorsal end called the Maxillary
Process.
•The maxillary process grows ventro-medio-cranial to the main part of the
mandibulararch that is now called the mandibularprocess.
Fronto-Nasal Process
Stomodeum
Maxillary
process
Maxillary
process
MandibularProcess
Nasal
Placodes
•The mandibulararches of both sides form the lateral walls of ofthe stomodeum
•The mandibulararch gives off a bud from its dorsal end called the Maxillary
Process.
•The maxillary process grows ventro-medio-cranial to the main part of the
mandibulararch that is now called the mandibularprocess.
Fronto-Nasal Process
Stomodeum
Maxillary
process
Maxillary
process
MandibularProcess
Nasal
Placodes
•The ectoderm overlying the frontonasalprocess shows bilateral localized thickenings
above the stomodeum.
•These are called as Nasal Placodes.
•These soon sink in and form the Nasal Pits.
The formation of nasal pits divides the frontonasalprocess into two parts :
1.The Medial Nasal Process
2.The Lateral Nasal Process
•As the maxillary process undergoes growth, the frontonasal process becomes narrow
so that the two nasal pits come closer.
•The line of fusion of maxillary process and the lateral nasal process corresponds to
the nasolacrimalduct.
above the stomodeum.
•These are called as Nasal Placodes.
•These soon sink in and form the Nasal Pits.
The formation of nasal pits divides the frontonasalprocess into two parts :
1.The Medial Nasal Process
2.The Lateral Nasal Process
•As the maxillary process undergoes growth, the frontonasal process becomes narrow
so that the two nasal pits come closer.
•The line of fusion of maxillary process and the lateral nasal process corresponds to
the nasolacrimalduct.
•During the following 2 weeks, the maxillary prominences continue to increase in size.
•Simultaneously, they grow medially, compressing the medial nasal prominences
toward the midline. Subsequently, the cleft between the medial nasal prominence and
the maxillary prominence is lost, and the two fuse.
•Hence, the upper lip is formed by the two medial nasal prominences and the two
maxillary prominences.
•The lateral nasal prominences do not particípatein formation of the upper lip.
•The lower lip and jaw form from the mandibularprominences.
•Simultaneously, they grow medially, compressing the medial nasal prominences
toward the midline. Subsequently, the cleft between the medial nasal prominence and
the maxillary prominence is lost, and the two fuse.
•Hence, the upper lip is formed by the two medial nasal prominences and the two
maxillary prominences.
•The lateral nasal prominences do not particípatein formation of the upper lip.
•The lower lip and jaw form from the mandibularprominences.
Development of Palate
•Asaresultofmedialgrowthofthemaxillaryprominences,thetwomedialnasal
prominencesmergenotonlyatthesurfacebutalsoatadeeperlevel.
•Thestructureformedbythetwomergedprominencesistheintermaxillarysegment.
•Itiscomposedof
(1)Alabialcomponent,whichformsthephiltrumoftheupperlip;
(2)Anupperjawcomponent,whichcarriesthefourincisorteeth;and
(3)Apalatalcomponent,whichformsthetriangularprimarypalate.
•Theintermaxillarysegmentiscontinuouswiththerostralportionofthenasal
septum,whichisformedbythefrontalprominence.
•Asaresultofmedialgrowthofthemaxillaryprominences,thetwomedialnasal
prominencesmergenotonlyatthesurfacebutalsoatadeeperlevel.
•Thestructureformedbythetwomergedprominencesistheintermaxillarysegment.
•Itiscomposedof
(1)Alabialcomponent,whichformsthephiltrumoftheupperlip;
(2)Anupperjawcomponent,whichcarriesthefourincisorteeth;and
(3)Apalatalcomponent,whichformsthetriangularprimarypalate.
•Theintermaxillarysegmentiscontinuouswiththerostralportionofthenasal
septum,whichisformedbythefrontalprominence.
Development of Palate
•Although the primary palate is derived from the intermaxillarysegment , the main
part of the definitive palate is formed by two shelf-like outgrowths from the maxillary
prominences.
•Although the primary palate is derived from the intermaxillarysegment , the main
part of the definitive palate is formed by two shelf-like outgrowths from the maxillary
prominences.
Development of Palate
•These outgrowths, the palatine shelves, appear in the sixth week of development
and are directed obliquely downward on each side of the tongue.
•In the seventh week, however, the palatine shelves ascend to attain a horizontal
position above the tongue and fuse, forming the secondary palate.
•Anteriorly,the shelves fuse with the triangular primary palate, and the incisive
foramen is the midline landmark between the primary and secondary palates.
•At the same time as the palatine shelves fuse, the nasal septum grows down and
joins with the cephalic aspect of the newly formed palate
•These outgrowths, the palatine shelves, appear in the sixth week of development
and are directed obliquely downward on each side of the tongue.
•In the seventh week, however, the palatine shelves ascend to attain a horizontal
position above the tongue and fuse, forming the secondary palate.
•Anteriorly,the shelves fuse with the triangular primary palate, and the incisive
foramen is the midline landmark between the primary and secondary palates.
•At the same time as the palatine shelves fuse, the nasal septum grows down and
joins with the cephalic aspect of the newly formed palate
Ossification of Palate
•Ossification of the palate occurs from the 8
th
week of intra uterine life.
•This is an intra membranous type of ossification.
•The palate ossifies from a single centre derived from the maxilla.
•The most posterior part of the palate does not ossify. This forms the soft palate.
•The mid palatal suture ossifies by 12 –14 years.
•Ossification of the palate occurs from the 8
th
week of intra uterine life.
•This is an intra membranous type of ossification.
•The palate ossifies from a single centre derived from the maxilla.
•The most posterior part of the palate does not ossify. This forms the soft palate.
•The mid palatal suture ossifies by 12 –14 years.
Clinical Correlation
•Cleft lip and cleft palate are common defects that result in abnormal facial appearance
and difficulties with speech.
•Usually the aetiology is multifactorial, but failure of fusion of the developing processes
in various combinations lead to cleftingof lip, palate or both combined.
•Cleft lip and cleft palate are common defects that result in abnormal facial appearance
and difficulties with speech.
•Usually the aetiology is multifactorial, but failure of fusion of the developing processes
in various combinations lead to cleftingof lip, palate or both combined.
Bilateral Cleft Lip
Cleft Palate
Oblique Facial Cleft
Midline Cleft Lip
Cleft Palate
Oblique Facial Cleft
Midline Cleft Lip
Management of Cleft Lip & Palate
•The management of this congenital anomaly spans over years involving a
multidisciplinary approachby the surgeons, paediatricians, nurse, orthodontist, speech
therapist, prosthodontist and child counsellors.
•Role of a prosthodontistcomes in at a time where there is a need of fabrication of
certain prosthesis which aid in the overall management of the case.
•Impressions are usually made with a heavy body silicone using an icecreamstick in order
to fabricate appliances for obturatingthe defect.
•The management of this congenital anomaly spans over years involving a
multidisciplinary approachby the surgeons, paediatricians, nurse, orthodontist, speech
therapist, prosthodontist and child counsellors.
•Role of a prosthodontistcomes in at a time where there is a need of fabrication of
certain prosthesis which aid in the overall management of the case.
•Impressions are usually made with a heavy body silicone using an icecreamstick in order
to fabricate appliances for obturatingthe defect.
Stone model of the
cleft impression
Feeding obturator
in place
cleft impression
Feeding obturator
in place
Management of Cleft Lip & Palate
VelopharyngealImpairment –
Insufficient contact between the velum (soft palate) and the posterior and lateral
pharyngeal walls.
VelopharyngealInsufficeny–Deficiency
VelopharyngealIncompetence–Neuromuscular
VelopharyngealDysfunction --It’s an umbrella term that describes multiple disorders
that cause leakage of air into the nasal passages during speech production. Parts of a
child’s throat or the roof of their mouth is not working properly and allows air to escape
through the nose during speech. Children who are born with acleft palateare at the
most risk for VPD although it can occur in children without a cleft palate.
VelopharyngealImpairment –
Insufficient contact between the velum (soft palate) and the posterior and lateral
pharyngeal walls.
VelopharyngealInsufficeny–Deficiency
VelopharyngealIncompetence–Neuromuscular
VelopharyngealDysfunction --It’s an umbrella term that describes multiple disorders
that cause leakage of air into the nasal passages during speech production. Parts of a
child’s throat or the roof of their mouth is not working properly and allows air to escape
through the nose during speech. Children who are born with acleft palateare at the
most risk for VPD although it can occur in children without a cleft palate.
Management :
1. Speech therapy
2. Non surgical
•Speech aid prosthesis
•Obturators& Transitional appliance in growing patients
3. Surgical
•Palatoplasty
Speech Aid Prosthesis
1. Speech therapy
2. Non surgical
•Speech aid prosthesis
•Obturators& Transitional appliance in growing patients
3. Surgical
•Palatoplasty
Speech Aid Prosthesis
References
1.LangmanJ, Sadler TW. Langman’smedical embryology. Philadelphia. 1990;1990:7.
2.Si B. Orthodontics: The art and science.
3.ChandnaP, AdlakhaVK, Singh N. Feeding obturatorappliance for an infant with
cleft lip and palate. Journal of Indian Society of Pedodonticsand Preventive
Dentistry. 2011 Jan 1;29(1):71.
4.UphadhyayM, Jain D, Kumar S, UppalS. Speech aid prosthesis. Case Reports. 2013
Jul 16;2013:bcr2013010102.
5.Osmosis from Elsevier.
Thank You!
1.LangmanJ, Sadler TW. Langman’smedical embryology. Philadelphia. 1990;1990:7.
2.Si B. Orthodontics: The art and science.
3.ChandnaP, AdlakhaVK, Singh N. Feeding obturatorappliance for an infant with
cleft lip and palate. Journal of Indian Society of Pedodonticsand Preventive
Dentistry. 2011 Jan 1;29(1):71.
4.UphadhyayM, Jain D, Kumar S, UppalS. Speech aid prosthesis. Case Reports. 2013
Jul 16;2013:bcr2013010102.
5.Osmosis from Elsevier.
Thank You!
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