Embryology Arches What are the structures that give origin to the ventral and lateral regions of the

head and neck? - Pharyngeal arches - Pharyngeal grooves - Pharyngeal pouches - Pharyngeal membranes What are pharyngeal arches formed by? - Somitomeric mesoderm - Neural crest cells What does the mesoderm differentiate into when forming the pharyngeal arches? - Muscles - Arteries (aortic arches) What do the neurocrest cells produce from forming the pharyngeal arches? - Connective tissues - Bone By week 4, how many pairs of pharyngeal arches exist? - 4 pairs of pharyngeal arches What evaginates into the endoderm lining the foregut? - Pharyngeal pouches What invaginates into the ectoderm located between each pharyngeal arch? - Pharyngeal grooves Pharyngeal membranes are structures consisting of what located between each pharyngeal arch? - Ectoderm - Mesoderm - Neural crest - Endoderm Whats the first pharyngeal arch called? - Mandibular arch What does the mandibular arch separate into? - Maxillary prominence - Mandibular prominence What does the maxillary prominence form? - Maxilla

- Zygomatic bone - Vomer What does the mandibular prominence form? - Mandible - Squamous temporal bone What is the second pharyngeal arch called? - Hyoid arch The Hyoid arch (second pharyngeal arch) contributes with the third and fourth arches, to the formation of what? - Hyoid bone Whats the primordial mouth called? - Stomodeum The stomodeum (primordial mouth) appears as a slight depression of the surface ectoderm. It is separated from the cavity of the primordial pharynx by what? - Oropharyngeal membrane What is the dorsal end of the first pharyngeal arch cartilage called? - Meckel cartilage What is Meckel cartilage related to? - Meckel cartilage is related to the developing ear What cartilages do the Meckel cartilage form? - Malleus - Incus The middle part of the Meckel cartilage, regresses but its perichondrium forms what? - Anterior ligament of malleus - Sphenomandibular ligament Whats the other name for the second pharyngeal arch cartilage? - Reichert cartilage What does the second pharyngeal arch cartilage (Reichert cartilage) give rise to? - Stapes of the middle ear - Styloid process of the temporal bone - Stylohyoid ligament - Lesser cornu of the hyoid bone Third pharyngeal arch cartilage ossifies to form what? - The greater cornu - Inferior part of the hyoid bone

What nerve supplies the facial skin in the embryo? - CN V (5) - Trigeminal nerve What branches of the trigeminal nerve supply innervation to the first arch? - Maxillary - Mandibular Whats the principal sensory nerve of the head and neck? - Trigeminal nerve What parts of the head and neck does the trigeminal nerve innervate? - Face - Teeth - Muscous membranes of the nasal cavities - Palate - Mouth - Tongue What nerve supplies the second arch?- Facial nerve (CN 7) What nerve supplies the third arch? - Glossopharyngeal nerve (CN 9) What nerve supplies the fourth and sixth arch? - Vagus nerve (CN 10) Chart What innervates the first arch (mandibular)? - Trigeminal nerve (CN 5) What innervates the second arch (hyoid)? - Facial nerve (CN 7) What innervates the third arch? - Glossopharyngeal (CN IX) What innervates the fourth and sixth arch? - Superior laryngeal branch of vagus (CN X) - Recurrent laryngeal branch of vagus (CN X)

What muscles are formed by the first arch (mandibular)? - Muscles of mastication - Mylohyroid and anterior belly of digastric - Tensor tympani - Tensor veli palatini What muscles are formed by the second arch (hyoid)? - Muscles of facial expression - Stapedius - Stylohyoid - Posterior belly of digastric What muscles are formed by the third arch? - Stylopharyngeus What muscles are formed by the fourth and sixth arch? - Cricothyroid - Levator veli palatini - Constrictors of pharynx - Intrinsic muscles of larynx - Striated muscles of esophagus What skeletal structures does the first arch form? - Malleus - Incus What skeletal structures does the second arch form? - Stapes - Styloid process - Lesser coru of hyoid bone - Upper part of body of hyoid bone What skeletal structures does the third arch form? - Greater coru of hyoid bone - Lower part of body of hyoid bone What skeletal structures are formed by the fourth arch? - Thyroid cartilage - Cricoid cartilage - Arytenoid cartilage - Corniculate cartilage - Cuneiform cartilage

What ligament is formed from first arch? - Anterior ligament of malleus - Sphenomandibular ligament What ligament is formed from the second arch? - Stylohyoid ligament Pouches What does the first pharyngeal pouch expand into? - A long tubotympanic recess The distal part of the tubotympanic recess will go in contact with the first pharyngeal groove and will give origin to what? - Tympanic membrane The cavity of the tubotympanic recress becomes what? - Tympanic cavity - Mastoid antrum - Tubotympanic tube Histogenesis of the Thymus The thymus develops from what type of cells and derived from what? - Epithelial cells - Derived from the endoderm of the third pouch When does the thymus gland complete its growth? Before or after birth? - Its growth is not complete at birth The fourth pharyngeal pouch degenerates when? - When the pouch has a connection with the pharynx, it degenerates At week 6, each dorsal part of the fourth pharyngeal pouch forms into what? - Superior parathyroid gland Epithelium from which pouches will proliferate and form small nodules, in which mesenchyme grows forming a capillary network? - Third and fourth pouches Whats the first endocrine gland to develop in the embryo? - Thyroid gland When does the thyroid gland begin to develop in the embryo? - Begins to form 24 days after fertilization

What does the thyroid gland form from? - From endoderm of the pharynx Whats the connection called between the tongue and thyroid called? - Thyroglossal duct A part of thyroglossal duct persists as the what? - Foramen cecum A remnant of the thyroglossal duct cyst persists and forms in the tongue or in the anterior part of the neck, usually under what? - Usually under the hyoid bone If a thyroglossal cyst is located at the base of the tongue, what is it called? - Lingual cyst An abnormal canal that opens internally into the tonsillar sinus and externally in the side of the neck. What is this called? - Branchial fistula Where is the branchial fistula usually found? - Anterior border of the sternocleidomastoid muscle Remnants of the second pharyngeal groove may persist and form a cyst. Usually lie free in the neck just inferior to the angle of the mandible. The cyst enlarge due to accumulation of fluid and cellular debris. They are painless. What is this cyst called? - Branchial cysts Pharyngeal cartilages fail to disappear, may appear under the skin in the side of the neck. What is this called? - Branchial Vestiges Anomalies of the eyes, ears, mandible, and palate, due to insufficient migration of neural crest cells into the first arch, what is this syndrome called? - First arch syndrome What fails to migrate to the first arch and causes the embryo to have First Arch Syndrome? - Neural crest cells fail to migrate Neural crest cells fail to migrate to where and causes the patient to have First Arch Syndrome? - First arch What are the 2 types of First Arch Syndrome? - Treacher Collins Syndrome - Pierre Robin Syndrome

What are the characteristics of Treacher Collins Syndrome? - Mandibulofacial dysostosis (defective ossification of fetal cartilages) - Autosomal dominant gene - Malar hypoplasia - Downslanting palpebral fissures - Defects of the lower eyelids - Deformed external ears What are the characteristics of Pierre Robin Syndrome - Hypoplasia of the mandible (micrognathia) - Bilateral cleft palate - Defects of the ear and eye What is this syndrome when a patient comes into the clinic with mandibulofacial dysostosis, malar hypoplasia, downslanting palpebral fissures, defects of the lower eyelids, deformed external ears? - Treacher Collins Syndrome If a patient comes in with hypoplasia of the mandible (micrognathia). Bilateral cleft palate, defects of the eyes and ears, what syndrome do they have? - Pierre Robin Syndrome What is the syndrome called when the pharyngeal pouches 3 and 4 fail to differentiate into the thymus and parathyroid glands? - DiGorge Syndrome How does DiGorge Syndrome occur? - Pharyngeal pouches 3 and 4 fail to differentiate into the thymus and parathyroid glands. In DiGorge Syndrome, the cardiovascular anomalies are due to what? - Due to abnormal neural crest cell migration If a patient comes in with facial anomalies that resemble first arch syndrome (Treacher Collins Syndrome and Pierre Robin Syndrome), cardiovascular anomalies, immunodeficiency due to absence of thymus gland, and hypocalcemia due to absence of parathyroid gland, what condition/syndrome do they have? - DiGorge Syndrome A 2 year old boy comes into the clinic, he has chronic infections since birth. You observe the boy and he had a fish mouth deformity, low set ears, nasal cleft, and his history was significant thyroid hypoplasia, congenital hypoparathyroidism, andcardiac abnormalities first week after birth, what is the likely diagnosis? - DiGorge Syndrome

Ectopic location of the inferior parathyroid gland is frequent, they may be found near where? - Carotid artery - Thorax Whats the most common type of ectopic thyroid gland? - Lingual thyroid tissue is the most common presentation What are some reasons why infants have congenital hypothyroidism? - Severe lack of dietary iodine - Thyroid agenesis - Mutations involving the biosynthesis of thyroid hormone - Impairs skeletal growth and mental retardation What are some characteristics of congenital hypothyroidism? - Dry, rough skin - Wide-set eyes - Periorbital puffiness - Flat, broad nose - Large protuberant tongue In early stages of development, the tongue has 2 portions: - Oral part (anterior two-thirds of the tongue) - Pharyngeal part The oral and pharyngeal part are separated by what? - Terminal sulcus (a V-shaped depression) The oral part forms from what? - The oral part forms from the median tongue bud - Two distal tongue buds develop in the floor of the pharynx associated with first pharyngeal arch The distal tongue buds overgrow median tongue bud and fuse with the midline, forming what? - Median sulcus What are different parts of the tongue and what are their characteristics? - Filiform papillae (no taste buds) - Fungiform papillae (taste buds) - Foliate papillae ( taste buds) - Circumvallate papillae (taste buds) General sensation from the mucosa is carried by what? - The lingual branch of the trigeminal nerve (CN V)

Taste sensation from the mucosa is carried by - Facial nerve (CN VII) What nerve innervates the tongue muscles as they develop? - Hypoglossal nerve (CN XII) The pharyngeal part of the tongue forms from what? - Copula - Hypopharyngeal eminence Copula and hypopharyngeal eminence develop at the floor of the pharynx and is associated with which pharyngeal arches? - 2, 3, and 4 Congenital Anomalies of the Tongue What are some tongue characteristics of patients with Down Syndrome? - Fissuring of the tongue - Macroglossia - Microglossia - Hypertrophy of the lingual papillae What may produce discomfort of dysphagia (difficulty in swallowing?) - Congenital lingual cysts Fistulas are due to persistence of what? - Thyroglossal duct What is it called when someone has a short frenulum and it extends to the tip of the tongue, interfering its protrusion and making breast feeding difficulty? - Ankyloglossia Incomplete fusion of the lateral lingual swellings resulting in a deep midline groove, what is this called? - Bifid or cleft tongue (Glossoschisis) Development of the Face At week 4 of development, facial primordia appears around what? - Stomodeum What are the 5 facial primordial? - 1 frontonasal prominence - 2 maxillary prominences - 2 mandibular prominences

Bilateral ectodermal thickenings of the face is called: - Nasal placodes Nasal placodes develop on the ventrolateral aspects of what? - Frontonasal prominence Nasal placodes invaginate into the mesoderm to form what? - Nasal pits Nasal pits produce a ridge that forms what? - Medial nasal prominence - Lateral nasal prominence Nasolacrimal groove forms between what? - Maxillary prominence - Lateral nasal prominence The prominence of the nasolacrimal groove form what? - Nasolacrimal duct - Lacrimal sac The intermaxillary segment forms what? - Philtrum of the lip - Four incisor teeth - Primary palate Secondary palate forms from outgrowths of the maxillary prominences called what? - Palatine shelves The palatine shelves project downward on either side of the tongue but later attain horizontal position and fuse along the _______________ ______________ to form the secondary palate. - Palatine raphe The primary and secondary palates fuse at the ___________________ __________________ to form the definitive palate. - Incisive foramen The posterior part of the secondary palate, eventually forms what? - Soft palate and uvula The nasal septum develops from what? - Medial nasal prominences (fuses with the definitive palate) What is the most common craniofacial anomaly? - Cleft lip/clieft palate

What is it called when palatine shelves fail to fuse with the primary palate? - Anterior cleft anomalies What is it called when the palatine shelves fail to fuse with each other and with the nasal septum? - Posterior cleft palate Combination of both cleft lip and palate is called? - Anteroposterior cleft palate What is the most common congenital malformation of the head and neck? - Unilateral clept lip Unilateral cleft lip results from what? - Failure of the maxillary prominence to fuse with the medial nasal prominence - Failure of the underlying mesoderm and neural crest to expand resulting in persistent labial groove. Bilateral cleft lip, failure of the mesenchymal masses in both maxillary prominences to meet and unite with the merged what? - Medial nasal prominences Bilateral cleft lips affect what? (Closes the mouth and purses the lip) - Orbicularis oris muscle Complete cleft palate extends through what? - Soft palate - Incisive fossa When are you able to use sonogram to view the fetal face? - Beginning of second trimester