Embryology of the Face, Lips and Palate

ENT Residents Academic Half-Day May 9th 2003 Resident Coordinator: Francis Ling

Development of the Face and Lips

4th week GA
By the end of the fourth week, all five swellings have appeared. The maxillary swellings can be distinguished lateral, and the mandibular swellings caudal to the stomodeum The frontonasal process is blue in these illustrations.

5th week GA (early)

The paired maxillary swellings enlarge and grow ventrally and medially. A pair of ectodermal thickenings called the nasal placodes appear on the frontonasal process and begin to enlarge.

5th week GA (late)

The ectoderm at the centre of each nasal placode invaginates to form an oral nasal pit, dividing the raised rim of a placode into a lateral nasal process and a medial nasal process

6th week GA
Each medial nasal process begins to migrate towards the other and they fuse. The mandibular swellings have now fused to create the primordial lower lip. The nasal pits deepen and fuse to form a single, enlarged, ectodermal nasal sac.

7th week GA
Lateral and inferior expansion of each fused medial nasal process forms the intermaxillary process. The tips of the maxillary swellings grow to meet this process and fuse with it. The intermaxillary process gives rise to the bridge and septum of the nose, and the philtrum on the upper lip.

10th week GA
Ectoderm and mesoderm of frontal process and each medial nasal process proliferate, forming a midline nasal septum. This divides the nasal cavity into two nasal passages which open into the pharynx, behind the secondary palate, through the definitive choana.

10th week GA
The philtrum is now formed, and the lateral portions of the maxillary and mandibular swellings fuse to create the cheeks and reduce the mouth to its final width.

Development of the Palate

7th week GA
The floor of the nasal cavity at this stage is a posterior extension of the intermaxillary process known as the primary palate. The medial walls of the maxillary swellings begin to produce a pair of thin medial extensions, ' palatine shelves' , which grow inferiorly on either side of the tongue.

8th week GA
The tongue moves downward and the palatine shelves rapidly rotate upwards towards the midline, growing horizontally.

9th week GA
The palatine shelves begin to fuse ventrodorsally with each other, the primary palate and the inferior nasal septum.

10th week GA
The ventral secondary palate becomes the bony hard palate through mesenchymal condensations (endochondral ossification). The dorsal secondary palate becomes the soft palate through myogenic mesenchymal condensation.

Cleft Lip Abnormal Facial Development

Underdevelopment of mesenchyme of the maxillary swelling, resulting in inadequate contact with the medial nasal process and intermaxillary process. The length and depth of the resulting cleft can vary considerably.

Cleft Lip
Pathogenetic factors such as inadequate migration or proliferation of neural crest ectomesenchyme, or excessive cell death during maxillary swelling or nasal placode development may account for a cleft lip.

Cleft Lip
Etiology is multifactorial, however drugs such as phenytoin and vitamin A and its analogs may induce the condition

Cleft Palate
Caused by inadequate palatine shelf growth, incorrect shelf elevation, an excessively wide head, failure of shelves to fuse or rupture after fusion.

Cleft Palate
It may result from a wide range of congenital insults and genetic errors. Etiology is again multifactorial, with the same teratogens as for cleft lip, although an x-linked cleft palate syndrome has been described.