Vascular Pattern in Embryos with Clefts of Primary and Secondary Palate

48 Pages·1973·3.101 MB·English

by  Dr. Edith Frederiks (auth.), Dr. Edith Frederiks (eds.)

Ergebnisse der Anatomie und Entwicklungsgeschichte
Advances in Anatomy, Embryology and Cell Biology
Revues d'anatomie et de morphologie experimentale
46·6
Editors
A. Brodal,Oslo . W.Hild,Galveston' R.Ortmann,Koln
T.H. Schiebler, Wurzburg . G. Tondury, Zurich. E. Wolff, Paris
Edith Frederiks
Vascular Pattern in Embryos
with Clefts of
Primary and Secondary Palate
With35Figures
Springer-Verlag Berlin Heidelberg NewYork 1973
Dr. E.Frederiks
Lectorin PlasticSurgery
at the University of Leiden
Heelkundige Kliniek
AcademischZiekenhuis
Leiden, The Netherlands
ISBN-13: 978-3-540-06128-1 c-ISBN-13: 978-3-642-65535-7
DOI: 10.1007/978-3-642-65535-7
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Contents
Introduction . . . . . . . . . . . . . . . . . . 7
Formationand GrowthofVesselsand VascularPatterns. 7
TheVascularPatternanditsChangesDuringDevelopmentofthePrimaryandSecondary
PalateinNormal Embryosof8-50mm. . . . . . . . . . . . . . . . . . . . 10
Description of the Facial Region ofsixEmbryoswithClefts in Primary and Secondary
PalateandoftheVascularPatternTherein,FollowedbyaComparisonwithPatterns
in Normal Embryosof the Same Stage 19
1. ZiirichEmbryo 13mm.. . . . . 19
2. HeidelbergEmbryo Scha22mm. 22
3. NewYork Embryo 36mm. 25
4. NewYork Embryo46mm. 31
5. NewYork Embryo48mm. 34
6. Ziirich Embryo 64mm.. . 39
The Changesin VascularPatternDuringDevelopmentof CleftPrimaryand Secondary
Palatein Embryosof 13-64mm. 44
Discussion 45
Summary 48
References 49
SubjectIndex 50
Introduction
Mostembryologists willsay afterThoma, that bloodvesselsfollow the pattern
set by organs and have no influence on organs in themselves. If this be true in
normal development, what would we find in abnormality? If there be a certain
vascular pattern in the developing face, will this pattern be essentially different
in cases of clefts of primary and secondary palate? Or is Thomas statement also
true here, and are the differences due to following the abnormalformation ofthe
nasal and maxillary parts of the face? Could it be so that the unknown agents
responsiblefor abnormaldevelopmentactina timeofchangeinvascularpattern,
take their chance just when there is a depletion in vascular supply? Or to the
contrary, is there a specific vascular pattern which would allow causal haemato
genic agents to reach the areas where we find abnormal development?
To answerthese questionswewillhaveto comparevascularpatternsinnormal
embryos and those with clefts, in stages as near as possible those in which the
formation of the clefts takes place, which means for the primary palate the
9-12mm. stage, for the secondary palate about the 35mm. stage (Streeters
Groups XV-XVII and XXI).
Our research concerns normal embryos of 8, 11.5, 12, 15, 17, 18, 25, 29, 30,
34, 35, 40 and 50mm. of the laboratory for Anatomy and Embryology of the
University of Leiden, The Netherlands and embryos with clefts of primary and
secondary palate of 13.5and 64mm. of the Institute for Anatomy and Embryo
logy of the University of Zurich, Switzerland; of 22mm. of the Institute for
Anatomy and Embryology of the University of Heidelberg, Germany and of 36,
46 and 48mm. of Dr. R. B. Stark, NewYork (studied at the Carnegie Institute
for Embryology, JohnHopkins University, Baltimore).
Formation and Growth ofVessels and Vascular Patterns
In studying such young embryos as the 8-12mm. stage, we find the vascular
system in a very interesting phase of development: there is on the one hand a
central system of vessels growing from the heart with the main vessels cranial
ward dividing in branches ventrally toward the facial region, on the other hand
we find in regions where these branches have not yet penetrated a peripheral
formation ofsmallvessels: mesenchymalcellsdifferentiatedintoangioblastsgrow
together in nets and strings andform minute vessels byliquefaction and vacuoli
sation of their central cytoplasma.
Sabin (1923) said hereof: "itseems difficult to accepttheideathat thelumen
ofa vessel maydevelop withinthe cytoplasmaofa singlecell, butthe processhas
now been so frequently observed that there is no escape from thefact".
In much the same way a branch of a vessel grows by celldivision at its end
and in places sideways where the wall of a vesselforms"buds", compact strings
of cells in which again a lumen is formed as described above. Between the
peripherallyformed vessels and those growing out of the central vascular system
8 E.Frederiks:
a.carotisff--:=--, ~,----"I,v.capitisprim.
....,....-+-If-v.pharoventr.
a.olfactoria........+----"U""""'''"'', M"'---'t.-+--\\-v.max.prim.
a.pharoventr.-.-;::=--i::=----JL.LJI 8mm.
3.stapediaff--~-=::...,
"1j1l~tT-rrV. pharoventr.
a.olfactoria---'.-\--,-;!!JY M"'----'IIH-+v.max.prim.
11,5mm.
'---_-'L-"'---"
max-mand.branches~..,.-..::lIi:--1~~ r.·~ldIl+--#-v: phar.~en.tr.
a.stap.
a.olfac.---'n----i.F 1W'-----'lI+-It-v.max.prim.
'--_....u......J-LJ12mm.
a.stap.--,<,-"-....,,,...-'1'J!lIIt.. k"(TlOI~+-H-v.linguo·facialis
3.oil. ~"+--:J»""~' I'Y-'----...~ft-v.max.prim.
'--_.....................15mm.
Fig. 1and2. The arterial and venous patterns simplified and modified after Padget. From:
British Journal of Surgery 25, 207-223 (1972)
anastomoses develop due to a stimulation which may be either centrifugal only
or possibly centripetal also.
The question arises: when this vascular tree has formed, does it grow out
but in essence stay as it is, or does it change its pattern~ Padget (1948-1957)
established the facts of a certain basic vascular pattern for the ventral part of
the head, which does change in various periods.
At the 10-12mm. stage she found a ventral pharyngeal artery, formed from
the ventral parts of the first and second aortic arches going to the processus
hyoideus and mandibularis, and the carotid artery with its stem at the third
aortic arch supplying all the more cranial parts of the face by its branches: the
hyoid artery to the mandibular region dorsally, the ophthalmic artery to the eye
region and the olfactory artery to the nasal fossa.
In the 12-14mm. stage there is a change from branchial to postbranchial
period according to Congdon (1922): out of the hyoid artery the stapedial artery
VascularPatterninEmbryoswithCleftsofPrimaryand SecondaryPalate 9
supra-orbital
brancha.stap.++-~f-.
a.hyaloidea*-~+.~
a.stapedia-\:~=,,-'"\o.---J,.;;IJ.l\ "'-f'I~"'-+-t+-v.linguofacialis
a.olfactoria--=="c::riY' ---J....-?=--"!.-t--H-V.max.prim.
a.pharoventr.----z=::::...~l1L._L.JJ17mm.
plexusduralis
,-----"-.:--medius
sinussigmoidalis
plexusduralis
anastomosisa. post.
stap.-a. II,..·~~-l-++v.capitis
max.into-'r-'~-T""-~~~
a.olf.---"'<2~, "'~;'-,ll--Hrt-v.linguofacialis
~~-""I--I'-If-v.max.prim.
plexusduralis
r+---T-medius
a.max.into-tt------:;:;iHh '---!::Lr'--'l't-sinussigmoidalis
snpra-orbital \\--1t~~"';;;;;;J ....-1+-plexusduralispost.
brancha.stap. \ '-:::)~~~~ttU~
v.max.prim.
- v.facialis
a.oil. -==::::::~I!;~
a.max.ext. - L.----'......L..J..--lJ25mm.
Fig.2. From: British Journal of Surgery 20, 207-223 (1972)
is formed which now runs cranially in the hyoid arch and to the earprimordium
dorsally, caudally it anastomoses with the distal part of the ventral pharyngeal
artery, supplying the dorsal part of the mandibular region; the proximal part of
the ventral pharyngeal artery now forms the arteria carotis externa.
Whilst the cranio-frontal part of the facial region stays supplied by the
olfactoryartery, inthe 14-18mm. periodthe cranio-dorsalpartislookedafter by
the stapedialartery, the caudo-ventralpart by the external maxillary artery,the
caudo-dorsal part by the internal maxillary artery, which anastomosis with the
stapedial artery.
Inthe 18-24mm. periodthe olfactoryartery losesitsownstemin theinternal
carotidartery, onlya small branchstayingassupplytothe laminacribrosa,andis
anastomosedwiththe ophthalmicartery; thestapedialarteriesstemdwindlesand
itsbranchesaretakenoverbytheinternalmaxillaryartery;theexternalmaxillary
artery extends ventral and cranialward. The venous pattern is simpler: a vena
maxillaris primitiva cranially, a vena pharyngea ventralis caudally drain this
wholearea. In the 14-18mm. stagethey anastomoseina venalinguo-facialisand
at the 24mm. stage the cranial part of the face is drained by the linguo-facial
vein, anastomosing cranially to the ophthalmic veins (Figs. 1 and 2).
10 E. Frederiks:
Padgets basic vascular pattern with its changes in various stages of develop
ment did not cover in more precise detail the area in which the nose and the
primary and secondary palate are formed. Ifthere were a detailed patternis this
area, it would stand to reason that during the various stages of formation of
primary palate, primary choanae and secondarypalate changeswould occur also.
In 1961 Frederiksdescribedthe vascular pattern and the changestherein con
cerning the regions of the nose, the primary palate and the primary choanae in
normal embryos of the 8-25mm. stages. These will be summarised in the next
chapter, followed by a description of the pattern in both primary and secondary
palatein normal embryos of 29-35mm. and 40 and 50mm.
The VascularPattern and its Changes
During Development ofthe Primary and Secondary Palate
in Normal Embryos of8-50 mm.
In order to make the vascular pattern and its changes clear, a description is
needed of the boundaries of the areas through which the vessels pass. These
concern the regions destined to form the nasal fossa, the nasal floor and the
primary palate and for which we have held to the simplestnomenclaturein using
the terms processus nasalis medialis, processus nasalis lateralis and processus
maxillaris.Inourseriesofembryoswehave tracedwhichofthesethreestructures
blend together to formtheroofofthemouth, where in relation to each other, and
in which developmental stage.
We found that the demarcation between the processus is formed by strips of
loose reticular mesenchym in contrast to the areas of greater density which are
characteristic of the processus. This in itself vaguedemarcationcouldbepursued
in the whole series of embryos.
Yet the situation in various embryos of nearly the same age group differs
especiallyregardingtheareasofthelateralnasalandmaxillary processus, slightly
different directions of serial sections giving rise to heated debates about this
problem.Assoonasthenasolacrimalductisformedthesituationisclearer,ventro
cranial ofits plane lies the lateral nasal process, caudal the maxillary process.
For the younger embryos in our series, the only thing that can be stated is
that the utmost ventral part of the primary palate is formed by both medial and
lateralnasalprocessusand that the maxillaryprocessverysoontakes part, caudal
ofthe lateralnasal process. Thislatter covers a three-cornered area with the base
along the lateral side of the nasal rim, the point at the medial canthus of the
eyelids. This area of course changes in positionduring growth.
These vague demarcations can efficiently enough be used for our purpose.
In the embryo of 8mm. we find in the medial nasal process the branches of
the arteria olfactoria cranioventral to the place where both nasal processus meet
caudally. There are no arteries in the lateral nasal process. The branches of the
primitive maxillary vein are situated in both nasal processus but mostly on the
medial side and caudodorsal to the blind ending of the olfactory pit. In the
embryo of 11.5mm. the arterial plexus is extended but lies in the sameregion as
before. In the lateral nasal process, the venous branch pushes ventralward and
VascularPatternin EmbryoswithCleftsofPrimaryand SecondaryPalate 11
a.oll. v.max.prim.
Fig.3.Embryo11.5mm.- W.K.582- serie12,magnification80X .Branchesoftheolfactory
artery medially to the nasal fossa, medial and lateral branches of the primitive maxillary
veinintheregionoftheprimarypalate.From: BritishJournalof Surgery25,207-223 (1972)
Fig.4. Embryo 11.5mm.- W.K.582- serie12. On the left side: arterial pattern, medial
branches of olfactory artery only, medioventrally to the nasal fossa (cranial view in the
nasalfossa). On the rightside: venous pattern, medial and lateral branches of the primitive
maxillary vein with a lateral branch reaching far ventrally (caudal view in the primary
palate)
12 E.Frederiks:
Cl.olr. v.max. branch bucconasalmembrane
prim. in proc.
nas.lat.
Fig.5. Embryo12mm.- W.K.576- serie4,magnification80X • Branchesoftheolfactory
artery mediallyand laterallyandextendedmore dorsallyto thenasalfossa, branchesofthe
primitivemaxillary vein extended in maxillary process.From:BritishJournalof Surgery25,
207-223 (1972)
Fig.6. Embryo van12mm.- W.K.576- serie4. Onthe leftside: arterial pattern, medial
and lateral branches of olfactory artery surroundingthe ventral part of the nasal fossa. On
the right side: venous pattern, extension of lateral branches of primitive maxillary vein in
maxillary process, and oneespeciallylateral branch in the lateral nasal process
anastomoses immediately dorsal to the caudal rim of the nostril with the branch
in the medial nasal process (Figs. 3 and 4).
In the embryo of 12mm. the arteria olfactoria has entered the lateral nasal
process and encompasses the nostril till deep caudally in both processus. The