|Year : 2016 | Volume
| Issue : 1 | Page : 48-54
Cheiloscopy and dermatoglyphics as genetic markers in the transmission of cleft lip and palate: A case-control study
K Saujanya1, M Ghanashyam Prasad2, B Sushma2, J Raghavendra Kumar2, YSN Reddy3, K Niranjani2
1 Department of Pedodontics, Sree Sai Dental College and Research Institute, Srikakulam, India
2 Department of Pedodontics, St Joseph Dental College, Eluru, Andhra Pradesh, India
3 Department of Oral and Maxillofacial Surgery, Sree Sai Dental College and Research Institute, Srikakulam, India
|Date of Web Publication||2-Feb-2016|
M Ghanashyam Prasad
Department of Pedodontics, St Joseph Dental College, Eluru - 534 003, Andhra Pradesh
Source of Support: None, Conflict of Interest: None
| Abstract|| |
Background: Determining the relative risk of cleft lip and palate (CL[P]) on the basis of lip prints and dermatoglyphics as genetic background may be useful for genetic counseling, and the development of future preventive measures. Aims and Objectives: (1) To analyze the various pattern types of lip prints and dermatoglyphics in parents of CL(P) children and to detect if any specific type can be contemplated as a genetic marker in the transmission of CL(P). (2) To compare these patterns with that of parents of unaffected children. Materials and Methods: 31 parents of children with CL(P) as a study group, and 31 parents of unaffected children as control group were included. Lip prints and finger prints were collected from all subjects and analysis of both patterns was carried out followed by a comparison of the patterns of unaffected parents with the controls statistically. Results: Among the mothers of the study group, type O followed by type IIa lip patterns were found to be significantly higher in upper and lower lips, and in fathers type IIa followed by type O were significantly higher. In the control group, type IIb followed by type III were higher in both fathers and mothers. Dermatoglyphic analysis of palm and finger prints revealed no significant difference in the pattern types and total ridge counts, but the Atd angle asymmetry was found to be significant between study and control group. Conclusion: Types IIa and O lip patterns, asymmetry of Atd angles can be considered as genetic markers for the transmission of CL(P) deformity to offsprings.
Keywords: Atd angles, cleft lip and palate, dermatoglyphics, genetic markers, lip prints
|How to cite this article:|
Saujanya K, Prasad M G, Sushma B, Kumar J R, Reddy Y, Niranjani K. Cheiloscopy and dermatoglyphics as genetic markers in the transmission of cleft lip and palate: A case-control study. J Indian Soc Pedod Prev Dent 2016;34:48-54
|How to cite this URL:|
Saujanya K, Prasad M G, Sushma B, Kumar J R, Reddy Y, Niranjani K. Cheiloscopy and dermatoglyphics as genetic markers in the transmission of cleft lip and palate: A case-control study. J Indian Soc Pedod Prev Dent [serial online] 2016 [cited 2019 Oct 19];34:48-54. Available from: http://www.jisppd.com/text.asp?2016/34/1/48/175512
| Introduction|| |
Cleft lip with or without cleft palate (CL/P) is a common birth defect with complex etiology and a prevalence that varies by population from 1:500 to 1:2000.  Children who have CL[P] often experience feeding, swallowing, speech, and cosmetic problems as well as poor dental health.  The complexity of these problems not only causes psychological trauma both to the child as well as parents but also requires multidisciplinary sequencing of treatment to ensure comprehensive care.  Hence, the predilection of CL(P) as one of the congenital disorders is considered a major advance in the prevention of its occurrence or lowering its incidence than surgical repair. This primary prevention may be aided by finding something in parents' lips or dermatoglyphics directly related embryologically, anatomically, and/or genetically to the inheritance of the clefted lips to the offsprings that is the lip prints and dermatoglyphics. 
Lip prints are unique and do not change during life of a person.  Lip print pattern is an anatomical character of the human lips, which may be useful in identification and diagnosis of congenital diseases and anomalies.  Several studies have associated altered dermatoglyphic patterns with congenital defects, syndromes, and other types of developmental disorders. The excessive asymmetry between dermatoglyphic patterns of the left and right hands may signify relatively unstable genetic control during embryogenesis and in turn may contribute to the development of congenital malformations. 
Hence, this study was aimed to analyze the various pattern types of lip prints and dermatoglyphics in parents of CL(P) siblings to detect if any specific type can be contemplated as a genetic marker in the transmission of CL(P) and to compare these patterns with that of parents of unaffected children.
| Materials and Methods|| |
Thirty-one parents of CL(P) children comprising as the study group and 31 parents of at least two unaffected children making up the control group were included in the study.
Collection and analysis of lip prints
Lip prints were recorded from all subjects by direct photography of the lips [Figure 1] and [Figure 2] using a digital camera with colored films. A scale divided into centimeters was fixed to the inferior border of the lower lip for groove counting/cm. Later, each lip was divided into six topographical areas as described by Hassan and Fahmy [Figure 3], and analysis of each area was carried out by using lip pattern classification given by Afaf [Figure 4], which includes:
- Type (I): Longitudinal grooves running through the whole width of the lip.
- Type (I'): Partial longitudinal grooves.
- Type (II)a: Proximal branched grooves.
- Type (II)b: Distal branched grooves
- Type (II)c: Secondary branched type
- Type (III): Intersected grooves
- Type (IV): Reticular grooves.
- Type (V): Undifferentiated grooves.
Recently, Saad, 2005 identified type (O) [Figure 5].
Collection and analysis of palm prints
Palm prints and finger prints were individually taken from each participant using the Ink method, in which the digits were inked by rolling them across the ink pad one by one followed by imprinting the inked fingers to a strip of paper [Figure 6]. The finger imprints were labeled by sides of the hand, they belong to (right or left) and each digit was identified by using roman numerals (thumb = I, index finger II, middle finger III, ring finger IV, and little finger = V).
For palmar printing, a sheet of foam rubber pad was placed on a flat, stable surface. The foam pad was used to feel the concavity of the palm. Then, the wrist was placed on the bottom of the paper, and the rest of the palm was pressed onto the paper followed by gentle placement of each digit to make sure it also appeared on the palm print [Figure 7] (Durham and Plato, 1990; American Dermatoglyphic Association, 1990).
After the completion of printing, finger print patterns were classified as arches, loops, or whorls. Arch has no triradius and is the simplest pattern [Figure 8], the loop has one triradius and one core [Figure 9], and the whorl has usually two triradii [Figure 10]. Then, by drawing straight lines between the center of the fingerprint pattern and the center of the corresponding triradius, total ridge counts (TRC) were calculated.
Atd angles were measured for each palm print by drawing two straight lines through the a and t triradii, and the d and t triradii and the resulting angles were measured [Figure 7]. A is the feature of the palm that captures the relative position of three triradii; d is usually located on the distal palm just inferior to the second and fifth fingers, respectively; and t, whose location can vary on the proximal palm from just distal to the wrist up to the center of the palm.
All measures were assessed by a trained rater who was blind to the subject group's status. Asymmetry between right and left hands was determined for each measurement.
Statistical analysis for lip prints was carried out by Chi-square test and for dermatoglyphic analysis (TRC, pattern asymmetry, and Atd angle asymmetry) Mann-Whitney and Wilcoxon signed rank test were used.
| Results|| |
Upper lip print analysis in [Table 1] have shown that among the mothers of the study participant group, type O (21.1%) and type IIa (21.1%) lip patterns were found to be significantly higher and in fathers type IIa (21.1%) followed by type O (16.1%) patterns were significantly higher, whereas type III (5.4% and 1.1% in fathers and mothers, respectively) was significantly lower in fathers and mothers.
Lower lip print analysis in [Table 2] has shown that among both mothers and fathers type IIa was significantly higher (27.8% and 29%, respectively).
In the control group, type IIb followed by type III were higher in both fathers and mothers [Graph 1[Additional file 1], Graph 2[Additional file 2], Graph 3[Additional file 3] and Graph 4[Additional file 4]].
Dermatoglyphic analysis of palm and finger prints by Mann-Whitney U-test and Wilcoxon signed rank test [Table 3] revealed that there was no significant difference in the TRC between study and control groups except for digit IV in fathers (P = 0.044).
Similarly, there was no significant difference in the pattern types [Table 4] of study and control groups except for digit II in mothers (P = 0.033), whereas the Atd angle asymmetry was found to be significant between study and control group [Graph 5][Additional file 5] which implies that a genetic mechanism in the parents of affected children may account for this congenital disorder and concomitantly increased asymmetry.
| Discussion|| |
The predilection of CL(P) as one of the congenital disorders is considered a major advance in the prevention of its occurrence or lowering its incidence than surgical repair.
The epidermal ridges of fingers and palms as well as facial structures such as lips, alveolus, and palate form from the same embryonic tissues (ectoderm) during the same embryonic period; thus, these features may serve as proxy markers altering early development in CL(P). 
Saad et al., conducted a similar study in Egypt and they have identified a new pattern type O in the parents' of clefted children, which was not described earlier in literature. This type O was significantly higher in the mothers than fathers of CL(P) children, and type IIa was second most frequent pattern observed and there was the absolute absence of type III in both parents.
In the present study too, which has been conducted among South Indians similar results were obtained wherein, type IIa followed by type O were significantly higher in both mothers and fathers of children with CL(P). Type III was significantly lower in both parents. In addition, type III was significantly higher in the control group. The significantly high percentage of types IIa and O declares that these types can be transmitted as recessive gene-phenotype by the same major recessive gene which is primarily responsible for the genetic predisposition to CL(P).
Dermatoglyphics has been considered as a genetic marker in many congenital and clinical diseases such as Down's syndrome, apert syndrome, and diabetes. ,, Finger and palm prints are formed during the 6 th -7 th week of embryonic period and are completed after 10-20 weeks of gestation. Abnormalities in these areas are influenced by a combination of hereditary and environmental factors, but only when the combined factors exceed a certain level, can these abnormalities be expected to appear. 
A correlation has been found between dermatoglyphic patterns and salivary streptococcus mutans levels in which the subject group had decreased the frequency of loops, whereas control group had increased frequency of loops on all palmar digits. 
In a study conducted by Neiswanger et al.,  probands with a positive family history of clefting showed significantly more asymmetry in the pattern types than probands without a family history or controls.
Furthermore, Adams and Neiswanger (1967) found enhancement in the fluctuation of Atd angles in the parents of clefted children. These findings were similar to this study, where there was a significant asymmetry of Atd angles found between study and control group.
This study found no significant difference between the TRC means of unaffected parent and study group except for digit II of men and digits I and II of women. These findings are in contrast to the findings of a similar study conducted by Jahanbin et al. (2010) in Iran where there was no significant difference between unaffected parent and study group except for digit I of women. This might be due to the difference in the population groups.
Similar to our study, Balgir,  showed a greater frequency of loops than arches and whorls in CL(P) parents compared with controls. However, in contrast to this Jahanbin et al. found a significant number of arches in male subjects.
Admala et al.  conducted a similar study and concluded that increased dermatoglyphic asymmetry with higher loop patterns were seen in the parents with clefted children and increased whorl patterns in parents with normal children.
In a study carried out by Gupta and Karjodkar in individuals with squamous cell carcinoma and oral submucous fibrosis, there was an increase in the frequency of arch and ulnar loop patterns on fingertips and decrease in the frequency of simple whorl patterns on fingertips in these individuals. 
| Conclusion|| |
Based on the observations from our study the following conclusions have been drawn:
1. An increase in type IIa and type O lip patterns in parents of CL(P) affected children
2. Increased frequency of type III pattern in parents of unaffected children
3. No significant difference in TRC and arch patterns among study and control groups
4. Atd angle asymmetry was found to be significant between study and control groups.
In conclusion, type IIa and type O lip patterns and dermatoglyphic asymmetry of Atd angles provide positive objective criteria for estimating the relative risk and could be used as genetic markers. However, further studies with large sample size are required. For a complex trait like CL(P), these noninvasive tools are an effort to take a step forward in shedding light on the prediction of transmission of CL(P) deformity to the offsprings.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
| References|| |
Jahanbin A, Mahdavishahri N, Naseri MM, Sardari Y, Rezaian S. Dermatoglyphic analysis in parents with nonfamilial bilateral cleft lip and palate children. Cleft Palate Craniofac J 2010;47:9-14.
Hazza'a AM, Rawashdeh MA, Al-Nimri K, Al Habashneh R. Dental and oral hygiene status in Jordanian children with cleft lip and palate: A comparison between unilateral and bilateral clefts. Int J Dent Hyg 2011;9:30-6.
Jones JE, Sadove AM, Dean JA, Huebner DV. Multidisciplinary team approach to cleft lip and palate management. In: Dean JA, McDonald RE, Avery DR, editors. Mcdonald and Avery's Dentistry for the Child and Adolescent. 9 th
ed. Missouri: Mosby Publishers; 2011. p. 614-37.
Saad WM, Kamel AH, Hassan FZ, Elotiefy MA. Genetic studies on the inheritance of lip prints in-cleft lip and palate. Egypt J Plast Reconstr Surg 2005;29:9-12.
Reddy LV. Lip prints: An overview in forensic dentistry. J Adv Dent Res 2011;2:17-20.
Mathew L, Hegde AM, Rai K. Dermatoglyphic peculiarities in children with oral clefts. J Indian Soc Pedod Prev Dent 2005;23:179-82.
Vormittag W, Weninger M, Hollmann K, Hoffmann D. Heterogeneity of cleft lip and/or palate and dermatoglyphics. Birth Defects Orig Artic Ser 1979;15:649-59.
Neiswanger K, Cooper ME, Weinberg SM, Flodman P, Keglovits AB, Liu Y, et al.
Cleft lip with or without cleft palate and dermatoglyphic asymmetry: Evaluation of a Chinese population. Orthod Craniofac Res 2002;5:140-6.
Platilová H, Pôbisová Z, Zamrazil V, Vondra K, Dvoráková L. Dermatoglyphics - An attempt to predict diabetes. Vnitr Lek 1996;42:757-60.
Sharma A, Somani R. Dermatoglyphic interpretation of dental caries and its correlation to salivary bacteria interactions: An in vivo
study. J Indian Soc Pedod Prev Dent 2009;27:17-21.
Balgir RS. Dermatoglyphics in cleft lip and cleft palate anomalies. Indian Pediatr 1993;30:341-6.
Admala NR, Arjun S, Adusumili G, Thirumala JR, Devanna R, Pichai S. Dermatoglyphics and cheiloscopy in the inheritance of cleft lip and palate: Unraveling the mystery. J Indian Orthod Soc 2014;48:175-9.
Gupta A, Karjodkar FR. Role of dermatoglyphics as an indicator of precancerous and cancerous lesions of the oral cavity. Contemp Clin Dent 2013;4:448-53.
[Figure 1], [Figure 2], [Figure 3], [Figure 4], [Figure 5], [Figure 6], [Figure 7], [Figure 8], [Figure 9], [Figure 10]
[Table 1], [Table 2], [Table 3], [Table 4]