––

In the 4th week, on the anterior wall of the primitive esophagus appears a
protrusion called the LARYNGOTRACHEAL DIVERTICULUM. By deepening a
2 lateral envelopes, the diverticulum separates from the esophagus downwards upwards. The two
structures communicate in the primitive pharynx.
Formation of the larynx:
The supraglottic region of the larynx develops from the primitive larynx.
The infraglottic region develops from the laryngotracheal diverticulum.
Formation of the primitive opening (atticus) of the larynx:
Initially, a sagittally oriented orifice appears in the primitive pharynx and delimited by 2
side flaps. These envelopes are the future vocal folds and the space between them is
future glottis.
Formation of the epiglottis:
The arytenoid grows superiority and gives rise to the secondary orifice of the larynx named Aditus of
larynx.. Initially, the epiglottis is behindthe nose.
Formation of the secondary laryngeal orifice:
The arytenoinds grow far superiorly and leave the vocal folds in depth
and glottis. Consequently, at this stage the secondary laryngeal orifice will
it had a T-shape.

In the laryngeal cavity there is an epithelial septum located in the frontal plane. The lower parts of this
septum have the appearance of full buds. The septum quickly resorbs and
the larynx will finally open into the laryngopharynx, the buds resorb and result in a
space called laryngeal ventricles. They will be limited superiorly by the vocal folds
false and inferior to the true ones, among which is the glottis.
The thyroid cartilage is formed in the seventh week of the brachial arch 4, and
laryngeal muscles in arches 5 and 6.
Development of trachea and bronchi:
The laryngotracheal diverticulum grows inferiorly in the thickness of a ligament
called the DORSAL MESOCARD. The diverticulum takes the mesenchyme
together with which it forms a complex called LUNG BUDS
.
The diverticulum bifurcates and forms the main bronchi. In fact, from
diverticulum is formed only in the EPITHELIUM of the bronchi and alveoli. The rest of the tissue
lung is formed from mesenchyme. By birth, the bronchi divide 18 times.
By the age of 8, they divide 6 more times!!!

Stages of lung development:

Lungs develop in 4 stages:
a) Pseudoglandular stage (weeks 5-16):
At this stage there is a lot of mesenchyme between bronchioles.
Abundant peribronchial results in a gland-like appearance. There are no peribronchial vessels
results in no gas exchange.

b) Canalicular stage (weeks 16-25):

The term canalicular refers to the existence of partial respiratory bronchioles
alveolized. Terminal sacs with immature alveoli appear. Bronchial branching is more
wide, the mesenchyme is reduced and there are vessels in contact with the alveolar sacs
results in the possibility of gas exchange at the level of the bronchiole wall
respiratory. ---- FORMATION OF RESPIRATORY BRONCHIOLES
c) Stage of terminal sacs (week 24-birth):
There are numerous terminal sacs with alveoli protruding from the walls, but they are still there
immature In the alveoli there are 2 types of cells (I, II). At week 24, the cells
type II alveoli begin to secrete surfactant, a surface-active liquid responsible for
2/3 of lung elasticity and which keeps the lung alveoli open.
Production increases greatly in the last 2 weeks of pregnancy under the influence of thyroxine.
The time when production begins is when the preemie is likely to
survive. In its absence, HYALINE MEMBRANE DISEASE occurs
(alveoli do not stay open).

d) Alveolar stage (birth-10 years):

The alveolar wall is very thin and the vessels protrude into the alveoli. In the first 2 months, alveoli are
formed intensively, especially up to 3 years and continue up to 10 years.
Respiratory movements begin when the fetus inhales amniotic fluid. At birth, o
part of the lung fluid is represented by amniotic fluid. It resorbs in 4-5
days by lymphatic and vascular route and by the compression of the thorax when the fetus passes through
the pelvis
SEROSAS

Serosas are structures of mesodermal origin. At the level of the primitive line,
ectodermal cells migrate deeply between the two layers of the didemic disc,
forming the mesoderm.
Serous membrane which permits the formation of the serum. 2 types: normal without protein named
transudate, pathology with proteins is exudate.

Segmentation of the mesoderm:

On either side of the notochord, the mesoderm is organized into:
paraxial mesoderm (from which the somites are formed), intermediate mesoderm (from
which form the nephrotomes) and lateral mesoderm that splits into 2 blades:
intraembryonic somatopleura and splahnopleura.

Formation of the pleuroperitoneal sulcus:

The embryo folds transversely under the increasing pressure of the liquid
Amniotic. The amniotic membrane will form lateral amniotic envelopes that tend to
merge anteriorly on the midline, closing the walls of the trunk. In that
movement, the lateral mesoderm divides the yolk cavity into the primitive gut and
yolk sac communicating through the VITELLINE DUCT.
Between the somatopleura and splahnopleura the pleuroperitoneal channels ( INTRA-EMBRYONIC
CELOMAE ) are formed, which initially communicates broadly with the extraembryonic coelom.
In that way appears the PPP canal ( pleuro pericardial peritoneal canal).

The pleuroperitoneal channel merges with the primitive pericardium and forms o
on either side of the primitive intestine the pleuropericardioperitoneal canal.
Forming the diaphragm:
The primordia from which the diaphragm is formed are: the mesoesophagus (insertion
lumbar), pleuroperitoneal envelopes (diaphragm muscle) and transverse septum
(the cardiac part of the diaphragm). Between them there are temporarily free spaces called
pleuroperitoneal hiatuses (right and left) that close. Otherwise, does appear congenital hernias
diphragmatic.

FIRST it is fusing on the right side. This explains why the diaphragmatic congenital hernia appears often in
the left side. The formation of the diaphragm occurs into the cervical region of the embryo and the
diaphragm has the nervous supply from the cervical spinal nerves. Then diaphragm under goes a pseudo
dissensus and pulls down the phrenic nerve.
Pericardial separation:
On the anterolateral wall of the chest are found the cardinal veins that lead
blood to the primitive heart tube. During the longitudinal bending, they
move away from the wall and form the pleuropericardial envelopes (between them is a hiatus
temporarily called pleuropericardial hiatus). By fusing the 2 envelopes it is formed
the definitive pericardial cavity, which will thus be separated from the pulmonary pleura.

The main features of the serous membranes

The normal features of the membranes are:

1.It glows/shines when this aspect disappears it becomes matt.
2. Transparency when this disappears, it becomes opacity.
3. They are tiny membrane when the disease is very old, the membrane becomes thick.

The most important feature is the membranes having a very intens nerves supply. So intense that incase of
the rapture of the membrane, the patient compares the pain to a knife stab. It is so intense that the pain is
associate with the vegetative storm: it means anxiety, tachycardia /bradycardia,the pale color of the skin
and cold skin.

HEART DEVELOPMENT

Vascular system appears in the middle of the third week •

Cardiac progenitor cells lie in the epiblast, lateral to the primitive streak •
Cells developing cranial segments of the heart, the outflow tract, migrate first, and cells developing caudal
portions, right ventricle, left ventricle, and sinus venosus, respectively, migrate in sequential order

Rostral to buccopharyngeal membrane and neural folds they reside in the splanchnic layer of the lateral
plate mesoderm
Late in the presomite stage of development, they are induced by the underlying pharyngeal endoderm to
develop cardiac myoblasts
Blood islands also appear in this mesoderm, where they will form blood cells and vessels by the process of
vasculogenesis
The disc undergoes 3 types of movements:
1. Sagittal curvature by which cardio genetic mesoderm reaches the ventral part of the body.
2. Transversal curvature by which the endocardial tube become nentral , fuse and generate the straight
cardiac tube.
3. Pseudodescensus of the heart- means the cervical region grows fast and the heart remains in thorax.
the islands unite and form a horseshoe-shaped ( U SHAPED ) endothelial-lined tube surrounded by
myoblasts.
This region is known as the cardiogenic field; the intraembryonic cavity over it later develops into the
pericardial cavity

Blood islands appear bilaterally, parallel and close to the midline of the embryonic shield to develop a pair
of longitudinal vessels, the dorsal aortae

As the result of growth of brain and cephalic folding of the embryo, the buccopharyngeal membrane is
pulled forward, while the heart and pericardial cavity move first to the cervical region and finally to the
thorax
Developing heart tube bulges more and more into the pericardial cavity attached to the dorsal side of the
pericardial cavity by a fold of mesodermal tissue, the dorsal mesocardium
No ventral mesocardium is ever formed. With further development, the dorsal mesocardium disappears,
creating the transverse pericardial sinus, which connects both sides of the pericardial cavity. The heart is
now suspended in the cavity by blood vessels at its cranial and caudal poles

Myocardium thickens and secretes a thick layer of extracellular matrix, rich in hyaluronic acid, that
separates it from the endothelium

Mesothelial cells from the region of the sinus venosus migrate over the heart to form the epicardium.

The heart tube consists of three layers:

(a) the endocardium, forming the internal endothelial lining of the heart;
(b) the myocardium, forming the muscular wall
(c) the epicardium or visceral pericardium, covering the outside of the tube. This outer layer is responsible
for formation of the coronary arteries, including their endothelial lining and smooth muscle

Cardiac Loop development

The heart tube continues to elongate and bend on day 23. The cephalic portion of the tube bends ventrally,
caudally, and to the right, and the atrial (caudal) portion turns dorsocranially and to the left
The bending, which may be due to cell shape changes, creates the cardiac loop which is complete by day
28.
As the cardiac loop is developing, local expansions become visible throughout the length of the tube. The
atrial portion, initially a paired structure outside the pericardial cavity, forms a common atrium and is
incorporated into the pericardial cavity
The atrioventricular junction remains narrow and forms the atrioventricular canal, which connects the
common atrium and the early embryonic ventricle

The bulbus cordis is narrow except for its proximal third. This portion will form the trabeculated part of the
right ventricle T
he midportion, the conus cordis, will form the outflow tracts of both ventricles. The distal part of the bulbus,
the truncus arteriosus, will form the roots and proximal portion of the aorta and pulmonary artery
The evolution of the rectilinear heart tube:
Development of the face

The development of the face starts when the cells from the neural crest migrate in the wall of the
mesencephalon and in the mesenchyme of the branchial arches. There are 6 pairs of arches and every
arch has an artery and a nerve. Every arch gives rise to the derivatives except the fifth’s pair of arches.
Only the first arch fuse, it’s name mandibular arch. The development of the face have 3 periods /parts:
1. Fish part
2. Amphibian part
3. Mammal part of the development
1. Fish part: in that phase appears the buds of the face. The biggest one is the fronto nasal bud, which has
inferiorly 2 olfactory plecods. On the superior margins of the mandibular arch appears the maxillary buds.
On the lateral side of the head appears the optic plecods, which are the primordials of the eyes. Those
plecods under goes a frontal movement and in the 8th week,the eyes are in the final position.
If the plecods continues to move,they fuse and give rise to a single modified eye and this situation named
cyclopia. Between the mouth and the optic plecods, there is an orbita nasal sulcus.

The olfactory plecods become deeper and transform into the olfactory sac,in the same time appears the
medial and later nasal buds.
The maxillary bud grows and fuses with the medial nasal buds. If the fusion fails appears cheilo schesis
( chailo lips, schesis open) it’s also called rabbit lip.
Maxillary and lateral nasal prominences are separated by a deep furrow, nasolacrimal groove • After
canalization, cord forms the nasolacrimal duct; its upper end widens to form lacrimal sac. • Maxillary
prominences enlarge to form cheeks and maxillae
Philtrum -Globular part of median nasal swelling

Finally the globus process realizes the fusion between medial and lateral nasal buds.

2. The amphibian period: Main feature of this stage is there is a large communication between the nase
and the mouth by a large orifice named primary choana. Palatoschesis / wolf mouth: when the
communication remains.
It is characterized by the existence of a single ORAL CAVITY, result of the deepening of the olfactory
grooves and their communication with the primitive mouth.
The olfactory grooves deepen and communicate with the primitive mouth, thus existinga single bucconasal
cavity.

3. Mammal period: mainly appears the separation between the nose and mouth by formation of the
palatine bones. We have an incisory orifice on the anterior part of the palate which is Y shaped for the
nasal palatine nerve.

ABNORMALITIES
1. Aprosopia: is the absence of the face
2. Coloboma: when the oribitonasal sulcus remains open
3. Atresia: when the orbitonasal cord fails to delaminate and general a canal.
4. Cheiloschisis
5. Pataloschisis / wolf mount
6. Renoschisis: when we have a nose with one olfactory plecod.
7. Cyclopia
8. Agnatis: when the mandible is absent.
9. Micrognathia: when the mandible is very small.
The most typical feature in development of the head and neck is formed by the pharyngeal or branchial
arches.
These arches appear in the fourth and fifth weeks of development and contribute to the characteristic
external appearance of the embryo
Initially, they consist of bars of mesenchymal tissue separated by deep clefts known as pharyngeal
(branchial) clefts.
Simultaneously, with development of the arches and clefts, a number of outpocketings, the pharyngeal
pouches, appear along the lateral walls of the pharyngeal gut, the most cranial part of the foregut.

Pharyngeal arches play an important role in formation of the face.

At the end of the fourth week, the center of the face is formed by the stomodeum, surrounded by the first
pair of pharyngeal arches

When the embryo is 42 weeks old, five mesenchymal prominences can be recognized: the mandibular
prominences
(first pharyngeal arch), caudal to the stomodeum; the maxillary
prominences (dorsal portion of the first pharyngeal arch), lateral
to the stomodeum; and the frontonasal prominence, a slightly
rounded elevation cranial to the stomodeum.
Development of the face is later complemented by formation of the nasal prominences

The original mesoderm of the arches gives rise to the musculature of the face and neck. Thus, each
pharyngeal arch is characterized by its own muscular components. The muscular components of each
arch have their own cranial nerve, and wherever the muscle cells migrate, they carry their nerve
component with them
In addition, each arch has its own arterial component