A 12-year-old boy, born of a co-sanguinous marriage, came to the institute with a complaint of crowding of teeth. The patient showed an obvious deformity of neck; which on questioning was said to be present for the last 5 years. Medical and dental history was non-contributory. Family history revealed several birth defects in patient's mother, sister and some cousins.

1. Facial features: > Facial asymmetry of right side > Low set ears > Inter-canthal distance is unequal > Rhi neck

2. Digital features: > Long thumbs > Syndactyly: fused skin of fore finger and middle finger > Brachydactyly > Square palm and single palmer crease of right side > Flat feet > Syndactyly: fused skin of 2nd and 3rd metatarsals > Mild hallus valgus

3. Oral features: > High arched palate > Cleft on the dorsum of the tongue > Congenitally missing maxillary right 2nd premolar > Mal-occlusion: malaligned mandibular anteriors, increased vertical and reduced horizontal overlap anteriorly

4. Other Associated Features: > Spina bifida, Scoliosis > Sternal groove