JIOS
Original article
10.5005/jp-journals-10021-1240
Dermatoglyphics and Cheiloscopy in the Inheritance of Cleft Lip
and Palate: Unraveling the Mystery
Dermatoglyphics and Cheiloscopy in the Inheritance of
Cleft Lip and Palate: Unraveling the Mystery
1
5
Naveen Reddy Admala, 2Sharmila Arjunan, 3Gopinath Adusumilli, 4Jayaprakash Reddy Thirumala
Raghu Devanna, 6Saravanan Pichai
ABSTRACT
INTRODUCTION
Introduction: Dermatoglyphic and cheiloscopic analysis
have been useful in understanding basic questions in biology,
medicine, genetics, evolution and forensics. They are now
begin­ning to prove themselves as an extremely useful tool
for preliminary investigations into conditions with a suspected
genetic basis.
Over the past 150 years, dermatoglyphics has been a useful tool
in understanding basic questions in biology, medicine, genetics
and evolution, in addition to being the best and most widely
used method for personal identification.1 The last few decades
have seen the development of the importance of lip prints as
another skin impression, which may be useful in identification
and diagnosis of congenital diseases and anomalies.2
Cummins and Midlo (1926) were the first to coin the term
‘Dermatoglyphics’. It is the science and art of the study of
surface markings/patterns of ridges on the skin of the fingers,
palm, toes and soles. The main thrust of their research was
on Down’s syndrome and the characteristic hand pattern
formations.3,4 External surface of the lip has many elevations
and depressions forming a characteristic pattern called lip
prints, examination of which is referred to as cheiloscopy.
This is unique for individuals like the finger prints.
In humans, the development of the primary palate and
the lip is completed by the seventh week of intrauterine
life and that of the secondary palate by the 12th week. The
dermal ridges develop in relation to the volar pads, which
are formed by the sixth week of gestation and reach maxi­
mum size between twelth and thirteenth weeks. This means
that the genetic message contained in the genome – normal
or abnormal is deciphered during this period and is also
reflected by dermatoglyphics.5,6
The current state of medical dermatoglyphics is such,
that the diagnosis of some illnesses can now be done on the
basis of dermatoglyphic analysis alone and currently, several
dermatoglyphic researches claim a very high degree of
accuracy in their prognostic ability from the hand features.1
The aim of our study:
1. To determine if parents of nonsyndromic cleft lip with
or without cleft palate CL(P) children display more
dermatoglyphic asymmetry than parents of normal
unaffected children.
2. To study the various pattern types of lip prints in parents
of CL(P) children to detect if any specific pattern can
be considered as a genetic marker in the transmission of
CL(P) deformity.
Materials and methods: Case-control type of study consisting
of two groups of thirty parents each of cleft lip with/without palate,
CL(P) affected children (Group A) and normal children (Group B).
Study aims to determine the presence of any dermatoglyphic
asymmetry and correlation between finger prints and lip pattern,
among the two groups.
Prints of all ten fingers were taken by Ink method and recor­ded
on white paper. Lip patterns were obtained by direct photo­­graphy
of the subjects in natural head position.
Results: Chi-square test was done to determine the significance
of occurrence of different patterns among the two study groups.
Increased dermatoglyphic asymmetry with higher ulnar loop
patterns was seen in Group A. Whorl patterns were increased
in Group B.
An increase in type I (straight grooves) and II (branches) in
Group A and type III (intersected lines) in Group B was seen in
lip patterns.
Conclusion: A highly significant correlation was observed in
finger prints and lip patterns in parents with CL(P) affected
children and hence can prove to be an extremely useful
screening tool for CL(P) and other associated genetic ano­
malies.
Keywords: CL (P), Finger prints, Lip patterns, Dermatoglyphics,
Cheiloscopy.
How to cite this article: Admala NR, Arjunan S Adusumilli
G, Thirumala JR, Devanna R, Pichai S. Dermatoglyphics
and Cheiloscopy in the Inheritance of Cleft Lip and Palate:
Unraveling the Mystery. J Ind Orthod Soc 2014;48(3):175-179.
Source of support: Nil
Conflict of interest: None
Received on: 25/12/12
Accepted after Revision: 31/3/13
1
3
Professor and Head, 2Former Postgraduate Student
Professor, 4,5Reader, 6Senior Lecturer
1-6
Department of Orthodontics, AME’s Dental College and
Hospital, Raichur, Karnataka, India
Corresponding Author: Naveen Reddy Admala, Professor and
Head, Department of Orthodontics, AME’s Dental College and
Hospital, Raichur, Karnataka, India, e-mail: drnaveenadmala@
gmail.com
Materials and methods
The subjects examined in this study were divided into two
groups—Group A and B.
The Journal of Indian Orthodontic Society, July-September 2014;48(3):175-179
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Naveen Reddy Admala et al
Group A comprised of 30 parents (mother and father)
who:
1. Had atleast one child affected by nonsyndromic cleft
lip alone, cleft palate or cleft lip and palate without any
other systemic manifestations.
2. Were normal healthy individuals not affected themselves
by CL(P).
The age range of mothers in Group A was between 17
and 29 years (mean age of 23.4 years).
The age range of fathers in Group A was between 24
and 35 years (mean age of 30.0 years). The distribution of
children affected in Group A is given in Table 1.
Group B consisted of 30 parents (mother and father) who:
1. Had normal, healthy children without any medical or
congenital anomalies.
2. Provided no history of relatives affected by CL(P).
The age range of mothers in Group B was between
18 and 30 years (mean age of 24.5 years).
The age range of fathers in Group B was between 28 and
35 years (mean age of 31.1 years).
repeated on a plain white paper to record the finger print
(Fig. 1).
5. Similarly, the distal phalanx of all ten digits were
recorded to analyse the symmetry in pattern between
corres­ponding fingers on the right and left hand.
Method of Obtaining Finger Prints
1. The subjects were asked to wash their hands with
detergent and after thorough drying, their finger prints
were recorded.
2. The finger prints were collected using standard ink
method.
3. Blue duplicating ink was evenly spread over a clean glass
slab using a brush.
4. The subjects distal phalanx of each finger was rolled gently
from left to right on the glass slab and the procedure was
1. The finger prints of all the ten digits of the samples
(30 parents each of CL(P) patients and normal, healthy
children) were collected using the method mentioned
above.
2. Galton (1892) divided the ridge patterns on the distal
phalanges of the fingertips into three groups namely
Arches, Loops and Whorls (Fig. 3). Although numerous
subclassifications have been subsequently offered, this
simple classification is still recognized and used by
majority of investigators today.
Fig. 1: Method of recording finger prints
Fig. 2: Method of recording lip patterns by photography
Method of Recording Lip Pattern
1. The subjects were made to stand upright in natural head
position with lips relaxed without any strain.
2. Lip prints were recorded by direct photography under
natural lighting using a D-SLR camera.2 The photographs
included only the lower third of the face focussing on
the upper and lower lips to conceal the identity of the
subjects (Fig. 2).
Ethical clearance was obtained from the institutional
review board for the conduction of this study and the subjects
were duly informed about the purpose of the investigations
made and consent was taken for the same.
Analysis of Finger Prints
Table 1: The distribution of children affected by CL(P) whose parents were sampled
in Group A to study dermatoglyphic and cheiloscopic peculiarities
Cleft lip
Left
Right
05
07
176
Cleft palate
Left
Right
0
0
Cleft lip and palate
Left
Right Bilateral
09
03
06
Total
30
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Dermatoglyphics and Cheiloscopy in the Inheritance of Cleft Lip and Palate: Unraveling the Mystery
Fig. 3: Analysis of finger prints
a. Arches: It is the simplest pattern found on fingertips.
It is formed by succession of more or less parallel
ridges, which traverse the pattern area and form a
curve that is concave proximally.
b. Loops: It is the most common pattern on the fingertip.
A series of ridges enter the pattern on one side of the
digit, recurve abruptly, and leave the pattern area on the
same side. If the ridge opens on the ulnar side, resul­ting
loop is termed as ulnar loop (UL). If the ridge opens
toward the radial margin, it is called a radial loop (RL).
c. Whorls: It is any ridge configuration with two or more
triradii. One triradius is on radial and the other on the
ulnar side of the pattern. Henry (1937) limited the
designation of the term ‘Whorl’ to those configurations
having ridges that actually encircle a core.
3. Asymmetry score was calculated between corresponding
fingers of right and left hands. A score of ‘0’ was assigned
if the patterns matched between the fingers and a score
of ‘1’ was given if the patterns were not similar.7
4. Following the study of Woolf and Gianas, the radial and
ulnar loops were scored as identical patterns.8
5. Thus, for each individual the dissimilarity score could
range from 0 (when all five pairs of digits had identical
patterns) to 5 (when all five pairs had different patterns).
Analysis of Lip Patterns
1. The lips are divided into 6 topographical areas9 as shown
in (Fig. 4).
2. The pattern of lip prints given by Suzuki and Tsuchihashi
in 197010 were used (Fig. 5).
3. The frequency of each type of lip print patterns in the
6 topographical areas was statistically correlated and
its percentage was estimated p-value was calculated for
each one in comparison to control.
Three investigators who were blind to the subjects’
group, independently categorized the finger print and lip
patterns into the corresponding classifications mentioned.
Any dispute which arose among the three was decided based
on consensus.
Results
Data entry and analysis was performed using SPSS statistical
software. The significance values were calculated using chisquare test.
Our study indicated that subjects of Group A had more
dermatoglyphic asymmetry than subjects of Group B with
the values being highly statistically significant (Table 2).
There was more inter digital asymmetry (with an
increased score) seen in mothers and fathers of Group A,
i.e. parents with children affected with CL(P) as compared
to parents of Group B who had a lesser asymmetry score.
The individual comparison of ridge patterns of mothers
and fathers of Groups A and B are as depicted in Graphs 1
and 2.
In the study of lip patterns, the lips which were divided
into 6 topographical area were assigned pattern types I, II,
III, IV or V based on nearest resemblance to the classified
patterns by Suzuki and Tsuchihashi (1970).
It was observed that there was an increase in pattern types
I and II in parents of CL(P) affected children (Group A) and
a increased frequency of pattern type III in parents of normal
children (Group B).
Fig. 4: Lip divided into 6 topographical areas
The Journal of Indian Orthodontic Society, July-September 2014;48(3):175-179
Fig. 5: Analysis of lip patterns
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Naveen Reddy Admala et al
Our study concluded that there was a statistically significant
correlation between increased dermatoglyphic asymmetry
of ridges in parents of CL(P) children. An increased loop
pattern in genetically susceptible individuals were observed
whereas in parents of normal, healthy children, an increase
in whorl count was recorded.
Similarly among the lip patterns, an increase in pattern I
(straight grooves) and II (branched) were observed in geneti­
cally susceptible parents as opposed to increased pattern III
(intersected) in parents of normal children.
Genes in their optimal state are nearly symmetrical.
Asymmetry will be illustrated in various human bilateral
struc­­­­­tures like eyes, teeth, hands, etc. where genes have been
damaged. Thus, dermatoglyphic analysis can be an extremely
use­ful diagnostic tool for the preliminary investi­gation into
conditions with suspected genetic base.
Dermal ridge differentiation takes place early in fetal
develop­ment. The resulting ridge configurations are geneti­­
cally determined and are influenced and modified by environ­
mental factors.4
It is known that finger and palm prints are formed during
the first 6 to 7 weeks of the embryonic period and are com­
pleted after 10 to 20 weeks of gestation. Abnormalities in
these areas are influenced by a combination of hereditary
and environmental forces, but only when the combined
fac­tors exceed a certain level, can these abnormalities be
expected to appear.
Graph 1: Comparison of finger print patterns between
fathers of Groups A and B
Graph 2: Comparison of finger print patterns between
mothers of Groups A and B
Graph 3: Comparison of lip prints of fathers of Groups A and B
Graph 4: Comparison of lip prints of mothers of Groups A and B
Table 2: The asymmetry scores of subjects of
Groups A and B
Total scores
Mothers
Group A
Group B
(30)
(30)
0
9
17
1
1
9
2
12
4
3
7
0
4
1
0
p* value, significant p < 0.001 (HS)
Fathers
Group A Group B
(30)
(30)
3
14
6
8
11
8
5
0
5
0
p < 0.001 (HS)
A comparison between the frequency of occurrence of
different lip patterns among mothers and fathers of cases
and controls are depicted in Graphs 3 and 4.
Discussion
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Dermatoglyphics and Cheiloscopy in the Inheritance of Cleft Lip and Palate: Unraveling the Mystery
The epidermal ridges of the fingers and palms as well
as the facial structures like the lip, alveolus and palate are
formed from the same embryonic tissues (ectoderm) during
the same embryonic period (6-9 weeks). Thus Nobaru
et al (1986)11 stated that the genetic and environmental
factors which are responsible for causing CLP may cause
peculiarities in dermatoglyphic patterns.
According to Charles Woolf et al (1977)8 the asymmetry
analysis found that probands in families with a positive
family history of clefting had significantly more asymmetry
in their pattern types than all other groups. They also saw an
increase in mean dissimilarity scores among probands with
a positive family history, compared either with probands
without a family history or with controls. Thus, in families
with multiple occurrences of clefting, unaffected relatives
show the same degree of pattern asymmetry as controls,
while affected probands show a higher degree of pattern
asymmetry. The results were similar to our study were in
increased asymmetry between dermal patterns were seen
among the parents of affected children as compared to
normal children.
The wrinkles and grooves on labial mucosa called as
sulci labiorum form a characteristic pattern called ‘lip prints’
and the study of which is referred to as chieloscopy. Lip
prints develop in the same first few weeks of embryological
life as the lips. Lip prints, as one of the dermatoglyphics,
have been used as genetic markers in many congenital and
clinical diseases.13 In our present study, there are important
statistically significant differences between the studied lip
prints and the control ones.
Predilection of CL (P) as one of the congenital disorders
is considered a major advance in prevention of its occurrence
or lowering its incidence than surgical repair. This primary
prevention may be aided by finding something in parents’
lips directly related embryologically, anatomically and/or
genetically to the inheritance of the clefted lips of children,
that is the lip prints.9,12 Lip prints develop in the same first
few weeks of embryological life as the lips.12
Wael M Saad et al (2005)2 concluded that there was
an increased frequency of patterns I (straight lines) and
II (branched grooves) in parents of CLP subjects with an
increase in pattern III (intersected lines) in normal children’s
parents which were similar to the results of our present study.
They also came across a new pattern ‘O’ in the centre of the
upper lip, which was never documented previously, among
parents of case group.
Dermatoglyphic and cheiloscopic analysis is now
beginning to prove itself as an extremely useful tool for
preli­minary investigations into conditions with a suspected
genetic basis. In many respects, it has been used as an
adjunct to other disciplines, serving as a vehicle to resolve
broader biomedical problems. Thus in biology, anthropology,
genetics and medicine, dermatoglyphics serves as a tool to
describe, compare and contrast, and at times predict occur­
rences and risks for biomedical events studied by these major
disciplinary areas.
Acknowledgment
Our sincere thanks to Dr Dinesh Singh Chauhan, MDS,
Depart­ment of Oral and Maxillofacial surgery, AME’s
Dental College and Hospital, Raichur and Mr Husenappa for
their kind collaboration in sample selection for this study.
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