If you remember last time we talked about the development of the oral region and we started talking about

branchial arches , we said these branchial arches are structures that appear in the lower part of the face and also the neck , starting from the the end of week three and they appear as arches , as we said they appear as arches so this is the head of the embryo and this is the lower jaw , we can see the first branchial arches , the second branchial arch and third branchial arch and so on

These are six arches , each arch is separate from the arch .below it by a groove For example these groove is called the branchial cleft , from inside if you look at theses groove from inside the embryo also you will see grooves but these grooves are called branchial pouches , so the groove is called pouch if it is from inside , it is called cleft if its from outside , the arch itself is called branchial arch and we have six

arches , it is not necessary to see all the arches at the same time but what you do actually you see , for example arch number one and two and three maybe but when you start see arch number four arch number one is disappear because arch number one will have added to the development of the lower part of the face arches arch number 4 arch number one arch Last time we said that each arch has skeletal elements , nervous elements , muscular elements and vascular elements and we said skeletal elements of face arch are meckels cartilage and so on , the nervous elements are trigeminal nerve for first , facial nerve for second , glossopharungeal for third and from four to six we have the vagus nerve and also if you remember , each muscle that is supplied by one of these nerves should also originate within the arch , for example if we have the muscle supply by trigeminal nerve like master muscle or temporalis muscle this means that these muscle develops within the first branchial arch because this is the nerve for . the first branchial arch

And we give an example about one of the muscle that develops in two arches which is the digastric muscle , the digastrics muscle located in the floor of the mouth , it has two bellies , the first belly is supplied by trigeminal , by this reason it develops in the first arch , the posterior belly is supplied by facial nerve , for this reason this belly is developed in the second branchial arch , and also we discussed the details of the muscular elements and the vascular elements and now we will come to the . pharyngeal pouches

this is how the arches look like from inside , we make a and we are looking at the arches from cut inside not from outside . for this reason these grooves here by this one and this one and this one are not called branchial cleft because these are located inside and called branchial pouches so branchial pouches important for the development of the tongue so the tongue is . develop from the branchial pouches The first part of the tongue starts to appear at age of thirty two days and it develops from different swelling , notice first that here we have the natural swellings and also we have what we called tuberculum impar in the middle , these three swelling they are related to which arch ?? arch number one , so this makes the anterior part part of the tounge , so these swelling , the two lateral swelling plus tuberculum impar which is the medial swelling they later on fused together , they swell and fuse together making the anterior two third of the tounge , now the swelling from the third arch , also we have a big swelling It's called Copula/Hypobranchial eminence this develops from arch # 3 as you see but it over grows the second arch it over laps the second arch arch 3

 arch 2

And what does this lead to ?this lead to the development of the posterior part of the tounge or the posterior third of the tounge

See here this is the tongue after development , we can see the first part of the tongue or the anterior two third of the tongue which is the body of the tongue , this develops from the first branchial arch and regarding the posterior . part of the tongue it develops from third branchial arch The root of the tongue which is the very much posterior part of the tongue which is just next to the epiglottis this develop from arch number 4 , so we have also swelling from the fourth arch which is particularly . these two swelling or this part as we see these are the extreme ( posterior of the tongue ( root of the tongue So on the exam if I said tongue develops from ?? we have to say arch one , arch three and arch four , these three gives the body of the tongue . arch one give the anterior two third of the tongue and arch 3 give the posterior third . of the tongue and arch 4 give the root of the tongue Do we have any contribution from the second arch ?yes the second arch only contribute to the taste buds so the taste buds of on the tongue they are derived from the .second arch For this reason because the anterior part of the tongue from arch # 1 , the sensation or the sensory innervation is from trigeminal nerve and the posterior third of the tongue is innervated by glossopharngeal nerve which is the nerve of third arch , and the root of the tongue is from the vagus

nerve , and the taste buds of the tongue are from the . facial nerve because it develops from arch # 2 Now what happens later on ?after fusion we still see some v-shape sulcus so when the anterior two third of the tongue fuse with the posterior third of the tongue , fusion leads to sulcus 001% fusion v-shape sulcus this is called sulcus terminalis , its the junction between the anterior part and posterior part of the tongue or if you like its the junction between the part of the tongue that develops from the first branchial arch and .the part developing from the third branchial arch what is located anterior the sulcus terminalis should be supplied by trigeminal nerve which is the cranial nerve of the first arch , and what is located posterior to it is . supplied by glossopharngeal nerve the very median part of the median end of sulcus terminalis we have what we call foramen caecum which is small depression , this foramen caecum is important because this is the origin for the development of thyroid . gland

this actually happen by a duct that drops down from this foramen cecum its called thyroglossal duct , why do we call it thyroglossal ?? because its now within the tongue so glossal , thyro from thyroid so thyroglossal, this drops down from foramen cecum and descend until it reach the .neck region where it swell and develop the thyroid gland this means thyroid gland develops from the area between the anterior two third and posterior third of the tongue , for this reason we may see thyroid tissue within the tongue , why ?? because this tissue is eminence Of the thyroid gland , we call it ectopic thyroid tissue , also this ectopic .thyroid tissue is functional we have group of papillae that are usually located anteriarly To sulcus terminalis , so these are located within the anterior two third of the tongue , but the origin of these papillae is from the posterior third , for this reason these taste buds that are present on the circumvallate papillae these are supplied by glossopharngeal nerve

although they are located anterior to sulcus terminalis ,, why ?? because during the development of the tongue these papillae migrate from the posterior third to the .anterior two third so they cross sulcus terminalis we have taste buds on vallate papillae , these taste buds are response for the sour taste . innervation for this papillae is glossopharungeal nerve sulcus papillae anterior two third of the tounge terminalis supplied by supplied by trigeminal glossopharungeal sulcus terminalis posterior third sulcus terminalis For this reason they take the embryological inervation with them . the tongue sensory the first nerve which is trigeminal nerve provides sensory innervations for the anterior two third of the tongue , sure except the region of the circumvallate papillae , the taste in the anterior two third of the tongue is from the facial nerve , the taste at the posterior part of the tongue is from glossopharngeal nerve this is also include the taste buds located at the vallate papillae , the extreme posterior of the tongue is from vagus nerve which is the cranial nerve # 10 that is responsible for the innervations of the 4th , 5th , 6th arches , so thats why the 4th arch nerve through the branch called superior laryngeal nerve , its supply both sensory and taste to the root of the tongue , if we have taste buds at the extreme posterior part of the tongue this is supplied by vagus nerve , the posterior third sensory and taste from

third branchial arch which is glossopharngeal nerve and regarding the motor supply , the muscles of the tongue they get very special innervations from another nerve , this nerve is called hypoglossal nerve which is cranial nerve # 12 hyogloosal nerve , the innervations of the .muscles of the tounge the intrinsic and extrinsic muscle Remember the myotoms , they are from the metotic somites , remember last lecture we said we have the head somites , we have the prootic somites will form the muscles of the eye and the myotom of metotic somites will form the muscles of the tongue , so thats why metotic somites carry with them the hypoglossal nerve supplied . muscle

: The development of the face

The face grows by number of process .we have the maxillary process , mandibular process and frontonasal . process , together these proceses they make the face Maxillary and mandibular process are paired process , . one process on the right and the another on the left Let us see this big process , FNP this is the frontonasal process , this process here and here are the maxillary process , and this long process here is the mandibular . process

Face develop around stomodeum ,stomodeum is the . primitive mouth

Can you see here this depression above the mandibular process ?this cavity is called stomodeum or the primitive . mouth of the embryo The primitive mouth of the embryo is separated from the beginning of gastrointestinal tract by the buccopharngeal membrane which came from prochordal plate , and we said before the age of 21 day this membrane is active so this means that the stomodeum is separated from the gastrointestinal tract . But at the age of 21 days this buccopharngeal or oropharungeal membrane is rupture Q: the mouth is communicated with GIT tract at the age of ( 1 _ 10 days ( F ( one month ( T _2

Each branchial arch is covered outside by ectoderm and inside by endoderm . for example arch 2 the outside covering is ectoderm and the covering inside is endoderm. the tongue in the first brachial arch from inside and outside is covered with ectoderm. *** question in the exam

The frontonasal process is not from the brachial arch** only the maxillary and mandible processes from first .brachial arch The frontonasal process " the area in pink " develops pits and its called nasal pits later it will become nostrils and at the sides of these pits we find some swellings 2 one medial called the medial nasal prominence and the lateral nasal prominence . notice how big the distance is between the pits at the beginning after that they start to migrate towards each other , around each nasal pit there is swelling , lateral nasal swelling and medial nasal swelling , the 2 medial nasal process of the 2 nostrils fuse together forming the intermaxillary segment which form the tip of the nose , the collamela of the nose (area

between the nostrils )and the median part of the upper lip. and we call it like that because it descends down and take place between the 2 maxillary processes , the lateral nasal process remain within the frontonasal process this gives the mid portion of the nose and the philtrum of upper lip inside it there is the area of bone that carries the maxillary palate ( contain the maxillary incisors central . ( aand lateral incisors The upper margin of the upper lip is like M but the lower** lip is one piece and why is that ? because the median part of the upper lip from the frontonassal process Regarding to the lateral nasal swelling it becomes the alae of the nose ( lateral to the nostril ) , the maxillary processes become the maxilla and the mandibular . processes fuse together forming the mandible : Nasolacrimal duct Its a canal that take the tears down to the nose and its form in the groove between the maxillary process and the .lateral nasal swelling

Between the maxillary process and lateral nasal swelling we have a groove this groove will deepen and create a canal called lacrimal canal or nasolacrimal duct ( joints the lacrimal bone with the nose ) when u start crying when u start releasing tears the first thing to feel is running nose now the extra tears that the duct can't coop with will go out and wet your skin . so what happens if something went wrong the maxillary process fails to fuse with the philtrum . of the upper lip we will have a condition called cleft lip We have to define two types of two part of the palate , primary palate and secondary palate , the anterior region of the palate that carries the central and lateral incisors is called the primary palate and the remain part is called the secondry palate , primary and secondry palate are formed

separately and finally they fuse together forming the whole . palate Secondry palate has two parts one on the left side and one on the other side , these are called the palatine processes , at first these processes are vertical , why are they vertically oriented not horizontal ? because we have a structure that occupies the space between them , this space is occupied by the tongue , with time , with the facial growth , the tongue becomes lower and drops in the space between the two palatine processes , which allows the processes to go horizontally and fuse with the primary palate , so now we have primary palate anteriorly and two palatine processes posteriorly , the three part fuse together and form the whole palate , thats why they start to adjust themselves ( they start to go horizontal instead of ( vertical In anatomy the palate is formed by two bones the maxilla and the palatine bones , here we talk about separate processes and not separate bones , that help in forming the palate , so , the tongue is in between , horizontal reorientation and then they start to reorient themselves , the tongue goes down , first they fuse with the nasal septum , because in the nasal cavity we have the nasal .septum so all of these fuse together The palate is completed by 60 days , the point of fusion is the point where the two sides meet with primary palate , . and then fusion goes in three directions

If we have a problem in fusion , this problem actually will be seen as failure of fusion , some people ( one case in every 700 birth ) are born with the cleft palate . why this happen ? It is because we have many reasons of fusion failure . most of the cases are because of genetic problems , so when the two palatine processes failed to develop , they form what we call cleft palate , what happens when the primary palate fails to fuse with one or both of the secondry palates ? it gives cleft lip , the primary palate which also called the premaxilla is formed by the palatine processes of the maxilla so when the intermaxillary projections are failed to fuse to each other the resultant will be cleft lip and failure of the primary and . secondary palate to each other

Sometimes when the patient is unlucky we will have a bilateral cleft . For example when the two palatine bones fail to fuse to each other and also fail to fuse with the primary palate ( premaxilla ) .These patients of cleft lip and palate require multiple surgical procedures which needed to be completed before the age of 12 , so the . management is going to be at early age

: Development of the maxilla

: Just to remember we have two type of bone formation Endochondral in which the preexisting cartilage -1 transform into bone Interamembranous no preexisting cartilage-2 The maxilla is formed by intramembranous ossification in which membranous mesenchymal .tissue become bone We have two ossification center in the maxillary : development which are Maxilla proper-1 ( Premaxilla ( primary palate-2 Ossification at the maxilla proper begin 40 days after fertilization and become hollowed out later to .form the maxillary sinus

The ossification of the maxillary proper begin below the infraorbital foramen from here the : process of the maxilla arise which are Frontal process which fuse with the -1 maxillary process of the frontal bone Palatine process -2 Alveolar process which carry the teeth -3 Zygomatic process -4 The most important thing mentioned above is the medial and lateral alveolar plate which forms the alveolar process which carries the teeth Development of the mandible

We will divide its development into two parts the body and the ramus The body is formed by intramembranous ossification , despite the fact we have cartilage in the region of the body of the mandible which called meckels cartilage but this cartilage have

nothing to do with development itself it only guide the development so it act as scaffold The ramus of the mandible is formed by endochondoralossification , we have two site of cartilage : condylar cartilage : it appears at the 11 week after fertilization and continues to provide growth for the mandible until 21 years and it provide growth for the mandible in height Coronoid cartilage : it only active prenatally because just before birth it gets replaced by bone The other thing that we need to understand is that when we have muscle attachment there will be growth of bone The angle of the mandible had two muscles of mastication : attached to which contribute to its growth Medial pterygoid-1 Masseter-2 The coronoid process has muscle attached to it which also contribute to its growth and called temporalis muscle Also in the mandible we have alveolar process which . carry the teeth

: Lecture 2
Development of the tooth and its supporting structures The stomodeum (primitive mouth ) the primitive mouth is lined by ectoderm and beneath the ectoderm we have the mesoderm (and we said that

mesoderm in this region the head region is not actually the real mesoderm it is ectomesenchymal tissue which means that it rises from neural crest cells ) the site where one tooth is going to develop we have condensation of ectomesenchymal tissue just under the ectoderm We start to see the condensation of the ectomesenchymal tissue and capillary network beneath oral epithelium at specific sites . Why at specific sites ? Because we have more than one tooth and each tooth should be developed at specific site so at the site where the tooth should be developed we have condensation of the ectomesenchyme Also we have capillary network at specific site then it leads to the formation of primary Epithelium band (PEB) when the oral epithelium thickens and invagenates into condensed ectomesenchyme . After that the PEB divides into two parts : one part goes buccully and also called vestibular lamina and the the other part goes lingually and also called dental lamina The dental lamina is the structure that will develop the tooth and the vestibular lamina will become the sulcus (space ) it goes buccully and labially to form the oral vestibule ( vestibular lamina with time the cells inside it become lost and well get a space this is the space between the teeth and the cheeks _ posteriorly _ or the teeth and the lips _ anteriorly _ )

and the remaining part which goes lingually is called the dental lamina So the vestibular lamina goes buccully to form the oral vestibule ( the space between the teeth and the ( cheeks or the teeth and the lips The dental lamina goes lingually to form the teeth . Thats why its called arch shaped because we r talking about all teeth together _arch shaped banded tissue going lingually and it is surrounded by a condensation . At the end of each one it will form a teeth but not at the same time .A series of swelling happens at the deep surface , the terminal end of the dental lamina .These swelling at the terminal end is called Enamel organ which is the swelling that happens in the first part of the tooth bud

This is a mandible this is the lower lip this is the area that is covered by oral epithelial as u see this is the primary epithelial band (PEB) starts here and divided .to vestibular lamina and lingual lamina Lingual is a band as u see at the edge of this mandible we have swelling each swelling is .responsible of one of the teeth Q: do u think that the band appear as one?? no each one will form a tooth but not at the same time as we said in dental anatomy for example mandible central incisor erupt before the maxillary central incisor We cant see all the tooth forming together* crown formation The dental lamina is responsible for formation of* primary tooth but also each primary tooth in addition to the dental lamina which forms primary tooth there

is another swelling responsible for forming the successor of that tooth ( successor tooth that come to replace the primary tooth Q: what is the tooth successes the mandibular ? deciduous central incisor Permanent mandible central incisor That means if we lost the formed structure no permanent tooth will be developed if the deciduous tooth is missing also the permanent tooth ( the successor ) will be missing why ?? because both the deciduous pre successor and the permanent successor they develop originally from the same germ layer But the opposite is not true if the primary is there but without swelling the permanent successor will not form if the primary is missed no permanent will develop *** What about non successor permanent teeth like ??? permanent first, second and third molar They will develop from this extension of the general lamina And here is the PEB (primary epithelium band ) divide the vestibular lamina from dental lamina where we find swellings that will form the teeth Tooth germ : is the early part of the tooth that formed it includes the enamel organ and the surrounding

ectomesenchymle tissue and we divide it into 3 : different stages bud stage _1 cap stage -2 bell stage 3

Here is the first stage of development we call it bud stage it looks like a bud we see the oral epithelium invaginating against condensed ectomasnchyme later on this epethiliuminvaginating will start to form a concavity so it looks like a cap so we call it a cap stage then this cavity will become a big cavity and that will gives the bell shape then at the end of bell stage we start to see the formation of dentine in Dentinogenesis and the after a short while we start

to see the formation of enamel which is Amelogenesis and finally the crown appear and crown completion after this the root start to develop and that will lead to the eruption of the tooth :D

Bud stage
It involves the formation of enamel organ which will form the outer surface of the crown which is the enamel Enamel organ : early structure of tooth that come .from ectoderm So the enamel organ is the one which determine the three dimensional shape of the crown REMEMBER that teeth can not develop at the same time .It s impossible to see the entire tooth developing at the same time In the bud stage the enamel organ look spherical or ovoid In the bud stage we cant differentiate the shape of the tooth it is poorly mrpho differentiated so the three dimensional shape of the crown is not recognized and poorly histo differentiated so we cant . recognize different type of cell Successive development of tooth germ involve complex interaction between epithelial and mesenchymal componenet In order to the development of the tooth there must be kind of interaction between the epithelium and ectomasynchyme or between ectoderm and ectomesnchyme so if we make tissue culture for the enamel organ there will be no tooth development

because there no mesenchymal tissue which is needed for process to continue and the opposite is true and it is similar to the development of nails The basement membrane which separate between the epithelium and the underlying mesenchymal tissue play an important role in order to facilitate this interaction Remember the epithelium is the enamel organ and . the epithelium is ectodermal origin

This is a tooth in the bud stage and here is the oral epithelium and underlying it we have the condensed ectomesenchymal tissue Cap stage We divide it into early cap stage and late cap stage Early cap stage The down surface of enamel organ invaginate to form a cap shaped structure

Cell is still poorly differentiated : not similar to each other but still we able to differentiate between two : populations of cell which are Inner ( central )_ related to the concavity _cell _1 which have no specific function and it rounded in appearance peripheral cell which further divided into _ 2 Internal enamel epithelium (IEE) External enamel epithelium ( EEE)

Late cap stage Here we have the development of cells called stellate reticulum which in the early cap stage were round cell with no specific function but here in this stage the .cell start to develop intercellular spaces the IEE cell become columnar in shape the EEE become cuboidal the ectomesenchymal tissue which surround the enamel organ is recognized here in 2 different region Dental papilla which is the future pulp and dentine-1 ( related to the cells in the central of the concavity) Dental follicle is very important in the formation of-2 the supporting structure of the tooth like cementum , alveolar bone and periodontal ligament So the whole structure is called enamel organ it has a concavity that looks like a cap so it is called cap stage of enamel organ at this stage we can identify different groups of cells the start of morpho

differentiation but it is still poorly histodifferentiated we can identify the border line or the peripheral cells and the core_the central part _ like the outer cells _ and the inside cells So there are : central portion and peripheral cells

The peripheral cells are divided into : External Enamel Epithelium EEE outside and Internal Enamel Epithelium IEE and the IEE are very important because they will finally differentiate to become the ameloblasts and secrete enamel ( those cells are in ( the cconcavity

Then we have the bell stage which is devided into early and late What happens in early bell stage ?? The concavity deepens starts to become deep until the tooth looks like a bell thats why it called the bell stage ??? So what happens during the early bell stage Defferential cell division a long IEE ( not at the* same way at different locations ) different rates of cell division at different sites that what gives different .shapes of the tooth What will happen if the rate of cell division rate is the ? same in all sites All our teeth will be spherical no incisors no canine no premolars and no molars *** important *** *Mapping out the occlusal pattern of the crown * Cessation of cell division ( stopping) For example if I have a cell division at a cusp or an incisal edge after awhile I dont want cell division to continue here because the tip of the tooth will swell Active cell division At fissure sites and margine* Dental lamina breaks down* losing connection with oral epithelium* Dental lamina between tooth germs is lost* Remnants of dental lamina may remain as epithelial rests of series that may be involved in the aetiology of cysts

We can identify here in early bell stage* : Histodifferentiation We can identify different groups of cells each with different function * EEE Cuboidal cells and they maintain the shape of the enamel organ and exchange substances between enamel and dental follicle enamel organ is avascular in order to maintain the** shape of the enamel *Cervical loop *Increased cell division *At junction EEE and IEE Stellate reticulum :are found in the center of enamel organ stellate because it is a star shape with many branchy processes and reticulum because it is a net work they have dendrites processes function in interacting nutrients SR are those white cells

function : *it protects the underlying tissue against physical disturbance and that maintain the tooth shape its hydrostatic pressure is in equilibrium with that of the dental papilla allowing the proliferation of IEE to determine crown morphogenesis What happens if the hydrostatic pressure inside here in dental papilla area increase over the hydro static ?? pressure of SR ( The tooth will look like spherical ( it will swell IEE : most important cells they are columner cells that become elonogated starting from the cusp tips and incisal edges Dental papilla : less differentiated than enamel organ

And now what happens In the late stage ( ( appositional stage Hard tissue formation ** dentine formation precedes ** enamel formation The first part of the tooth that start to calcify is ( the tip of the tooth ( incisal edge or cusp tip the last part of the crown that calcify is the most cervical part *Appearance of alingual downgrowth of EEE In adeciduous tooth germs Successor laminagives rise to tooth germs of permanent successorteeth

In permanent tooth germs :it is a transient* structure that disappears eventually Behind the second deciduous molars we should have first , second and third molars which are non successors dental lamina grows backwards to bud . off permanent molars successively very important Reciprocal interaction: Dentine and Enamel formation commences atCusp tips preameloblasts (mature IEE cells ) induce adjacentmesenchymal cells to become columnar and differentiate into odontobasts and secret predentine

and dentine, then dentine induces ameloblasts to .secrete enamel

: Done by Ala'a Al_ Selawi Mais Maloul Al _Selawi

It takes a little courage, and a little self-" control, If you want to reach the goal. It takes

a great deal of striving, and a firm and sternset chin. No matter what the battle, if you really want to win, there's no easy path to glory. There is no road to fame. Life, however we may view it, Is no simple game; But its prizes call for fighting For a rugged ".disposition that will not quit

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