Craniofacial growth and development
This chapter describes, in general terms, the prenatal development and postnatal growth of the craniofacial skeleton, and the occlusal development of the primary and permanent dentitions. Understanding of embryological development is essential for the dental practitioner who may frequently face patients with common craniofacial anomalies such as cleft lip and/or palate. For routine care, an understanding of their development and aetiology will bring insight to their likely presenting signs and symptoms. This section will include a brief summary of the development of the face, including the neural crest and pharyngeal arches. It is not the intention of this summary to be in any way a complete or thorough description but simply to describe some of the key cells/interactions and structures. Neural crest cells are derived from the neural fold, and are highly migratory and specialized cells capable of predetermined differentiation. The differentiation occurs after their migration and is essential for the normal development of face and teeth. By week 4 the primitive mouth or stomatodeum is bordered laterally and from the developing heart inferiorly by the pharyngeal or branchial arches. These are six bilateral cylindrical thickenings (although the fifth and sixth are small) which form in the pharyngeal wall and into which the neural crest cells migrate. They are separated externally by the branchial grooves and internally by the pharyngeal pouches. The first groove and pouches are involved in the formation of the auditory apparatus and the Eustachian tube. Each arch has a derived cartilage rod, muscular, nervous, and vascular component. The first two arches and their associated components are central to the development of the facial structures. This period is also characterized by the development of the organs for hearing, sight, and smell, namely the otic, optic, and nasal placodes. By the end of week 4, thickenings start to develop in the frontal process. The medial and lateral frontonasal processes develop from these, together with the nasal placodes. The maxillary process develops from the first pharyngeal arch and grows forward to meet the medial and nasal processes, from which it is separated by distinct grooves at week 7.