Original Article
Cheiloscopy and dermatoglyphics as genetic
markers in the transmission of cleft lip and palate:
A case-control study
Saujanya K, Ghanashyam Prasad M1, Sushma B1, Raghavendra Kumar J1, Reddy YSN2, Niranjani K1
Departments of Pedodontics and 2Oral and Maxillofacial Surgery, Sree Sai Dental College and Research Institute, Srikakulam,
1
Department of Pedodontics, St Joseph Dental College, Eluru, Andhra Pradesh, India
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
Introduction
Cleft lip with or without cleft palate (CL/P) is a common
birth defect with complex etiology and a prevalence that
48 © 2015 Journal of Indian Society of Pedodontics and Preventive Dentistry | Published by Wolters Kluwer - Medknow
Address for correspondence:
Dr. M. Ghanashyam Prasad,
Department of Pedodontics,
St Joseph Dental College,
Eluru - 534 003, Andhra Pradesh, India.
E-mail: drghanasyam@gmail.com
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DOI:
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varies by population from 1:500 to 1:2000.[1] Children
who have CL[P] often experience feeding, swallowing,
speech, and cosmetic problems as well as poor dental
health.[2] 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.[3] 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
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How to cite this article: Saujanya K, Prasad MG,
S u s h m a B , K u m a r J R , R e d d y Y, N i r a n j a n i 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.
 Saujanya, et al.: Cheiloscopy and dermatoglyphics as genetic markers
directly related embryologically, anatomically, and/or
genetically to the inheritance of the clefted lips to the
offsprings that is the lip prints and dermatoglyphics.[4]
Lip prints are unique and do not change during life of a
person.[5] Lip print pattern is an anatomical character of
the human lips, which may be useful in identification and
diagnosis of congenital diseases and anomalies.[4] 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.[1]
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
Figure 1: Collection of lip prints from father
Figure 3: Topographical areas of the lips by Hassan and Fahmy
Journal of Indian Society of Pedodontics and Preventive Dentistry | Jan-Mar 2016 | Vol 34 | Issue 1 |
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 [Figures 1 and 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
Figure 2: Collection of lip prints from mother
Figure 4: Lip pattern classification given by Afaf
49
Saujanya, et al.: Cheiloscopy and dermatoglyphics as genetic markers
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).
Figure 5: Type O lip pattern
Figure 7: Collection of palm prints
Figure 9: Loop pattern
50 Journal of Indian Society of Pedodontics and Preventive Dentistry | Jan-Mar 2016 | Vol 34 | Issue 1 |
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
Figure 6: Collection of finger prints
Figure 8: Arch pattern
Figure 10: Whorl pattern
 Saujanya, et al.: Cheiloscopy and dermatoglyphics as genetic markers

location can vary on the proximal palm from just distal In the control group, type IIb followed by type III were
to the wrist up to the center of the palm. higher in both fathers and mothers [Graphs 1-4].

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.
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

Results Table 1: Upper lip prints analysis in study group

Upper lip print analysis in Table 1 have shown that Type Father upper lip (%) Mother upper lip
among the mothers of the study participant group, Ia 15 (16.1) 7 (7.8)
type O (21.1%) and type IIa (21.1%) lip patterns were IIa 20 (21.5) 19 (21.1)
found to be significantly higher and in fathers type Ib 10 (10.8) 7 (7.8)
IIa (21.1%) followed by type O (16.1%) patterns were IIb 9 (9.7) 15 (16.7)
significantly higher, whereas type III (5.4% and 1.1% IIC 5 (5.4) 2 (2.2)
in fathers and mothers, respectively) was significantly O 15 (16.1) 19 (21.1)
lower in fathers and mothers. III 5 (5.4) 1 (1.1)
IV 6 (6.5) 13 (14.4)
V 8 (8.6) 7 (7.8)
Lower lip print analysis in Table 2 has shown
Total 93 (100) 90 (100)
that among both mothers and fathers type IIa was
Statistical analysis: Chi-square test. Statistically significant if P < 0.05. χ2 =
significantly higher (27.8% and 29%, respectively). 17.591, P = 0.024; significant

Graph 1: Fathers upper lip prints analysis

Graph 2: Fathers lower lip prints analysis

Graph 3: Mothers upper lip prints analysis Graph 4: Mothers lower lip prints analysis

Journal of Indian Society of Pedodontics and Preventive Dentistry | Jan-Mar 2016 | Vol 34 | Issue 1 | 51
Saujanya, et al.: Cheiloscopy and dermatoglyphics as genetic markers

angle asymmetry was found to be significant between Discussion

study and control group [Graph 5] which implies
that a genetic mechanism in the parents of affected
children may account for this congenital disorder and
concomitantly increased asymmetry.
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.

Table 2: Lower lip print analysis in study group

Type Father lower lip (%) Mother lower lip (%)
Ia 7 (7.5) 10 (11.1)
IIa 27 (29.0) 25 (27.8)
Ib 5 (5.4) 8 (8.9)
IIb 8 (8.6) 2 (2.2)
IIC 18 (19.4) 13 (14.4)
O 10 (10.8) 16 (17.8)
III 2 (2.2) 1 (1.1)
IV 10 (10.8) 9 (10.0)
V 6 (6.5) 6 (6.7)
Total 93 (100) 90 (100)
Statistical analysis: Chi-square test. Statistically significant if P < 0.05.
χ2 = 17.826, P = 0.023; significant Graph 5: Asymmetry of atd angles among mothers and fathers

Table 3: TRC of study and control groups

Total ridge count (TRC) Side Mean ± SD P#
Study group (n = 31) Control group (n = 31)
Men/fathers
Digit I Right 11.40±5.00 11.10±5.27 0.988NS
Left 10.97±5.77 11.40±5.38 0.958NS
Right versus left (P$) 0.883NS 0.164NS
Digit II Right 8.97±6.22 9.73±5.60 0.928NS
Left 9.20±6.28 10.87±5.08 0.532NS
Right versus left (P) 0.449NS 0.018*
Digit III Right 9.70±5.76 10.50±4.92 0.958NS
Left 8.67±5.96 9.13±5.75 0.780NS
Right versus left (P) 0.191NS 0.045*
Digit IV Right 9.37±5.47 7.73±5.64 0.128NS
Left 9.33±5.37 6.97±5.84 0.044*
Right versus left (P) 0.952NS 0.513NS
Digit V Right 8.90±5.27 7.47±5.83 0.528NS
Left 8.70±5.48 6.67±5.63 0.079NS
Right versus left (P) 0.849NS 0.048*
Women/mothers
Digit I Right 9.80±6.62 11.30±5.33 0.751NS
Left 10.40±6.47 11.70±5.42 0.797NS
Right versus left (P) 0.463NS 0.059NS
Digit II Right 9.30±6.34 8.40±6.59 0.592NS
Left 9.70±6.55 9.87±6.12 0.767NS
Right versus left (P) 0.505NS 0.027*
Digit III Right 9.47±5.90 7.23±6.47 0.160NS
Left 8.93±6.05 6.97±6.67 0.480NS
Right versus left (P) 0.459NS 0.666NS
Digit IV Right 10.37±4.32 9.67±5.01 0.545NS
Left 8.43±6.14 8.27±6.00 0.721NS
Right versus left (P) 0.309NS 0.573NS
Digit V Right 9.33±4.92 8.87±5.05 0.716NS
Left 8.83±5.51 7.83±5.68 0.288NS
Right versus left (P) 0.955NS 0.415NS
#
Mann-Whitney U-test, $Wilcoxon signed rank test, *P < 0.05; Significant, NSP > 0.05; not significant, TRC = Total ridge count

52 Journal of Indian Society of Pedodontics and Preventive Dentistry | Jan-Mar 2016 | Vol 34 | Issue 1 |
 Saujanya, et al.: Cheiloscopy and dermatoglyphics as genetic markers

Table 4: Pattern types in study and control groups

Pattern types Side Pattern P#
Study group (n = 31) Control group (n = 31)
Arch Loop Whorl Arch Loop Whorl
Men/fathers
Digit I Right 4 14 12 5 13 12 0.929NS
Left 6 11 13 5 6 19 0.261NS
Digit II Right 9 13 8 7 15 8 0.822NS
Left 9 13 8 5 11 14 0.229NS
Digit III Right 7 16 7 6 15 9 0.836NS
Left 9 16 5 8 12 10 0.317NS
Digit IV Right 7 18 5 10 19 1 0.200NS
Left 7 18 5 12 15 3 0.352NS
Digit V Right 7 19 4 11 18 1 0.257NS
Left 8 17 5 12 17 1 0.177NS
Women/mothers
Digit I Right 9 12 9 6 8 16 0.186NS
Left 8 5 17 5 5 20 0.626NS
Digit II Right 9 14 7 11 5 14 0.033*
Left 9 9 12 8 7 15 0.725NS
Digit III Right 8 17 5 13 10 7 0.188NS
Left 9 15 6 14 6 10 0.051NS
Digit IV Right 4 24 2 6 21 3 0.670NS
Left 10 14 6 10 12 8 0.803NS
Digit V Right 6 22 2 7 22 1 0.815NS
Left 8 19 3 10 17 3 0.846NS
χ test, NSP>0.05; not significant, *P<0.05; significant
# 2

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).[6]
and palm prints are formed during the 6th-7th 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.[10]

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.[7-9] Finger
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.[10]
In a study conducted by Neiswanger et al.,[8] 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

Journal of Indian Society of Pedodontics and Preventive Dentistry | Jan-Mar 2016 | Vol 34 | Issue 1 | 53
Saujanya, et al.: Cheiloscopy and dermatoglyphics as genetic markers
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,[11] 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.[12] 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.[13]
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
Nil.
54 Journal of Indian Society of Pedodontics and Preventive Dentistry | Jan-Mar 2016 | Vol 34 | Issue 1 |
Conflicts of interest
There are no conflicts of interest.
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