PMC3551643_01
Facial view showing bulging calvaria, depressed nasal bridge, and hypoplastic maxillary and zygomatic bones.
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F1
Facial examination showed a brachycephalic head with frontal and parental bossing, hypoplastic maxillary and zygomatic bones, bulging calvarium, and depressed nasal bridge with a broad alar base (Figure 1).
Facial view showing a brachycephalic head and hypermobility of the shoulders. (From Kolokitha OE, Papadopoulou AK with permission).
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F2
Further examination showed an abnormal facility in opposing his shoulders (Figure 2) due to malformed or absent clavicles, which was later confirmed with chest radiographs (Figure 3).
Chest radiograph showing hypoplastic clavicles. (From Kolokitha OE, Papadopoulou AK with permission).
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F3
Further examination showed an abnormal facility in opposing his shoulders (Figure 2) due to malformed or absent clavicles, which was later confirmed with chest radiographs (Figure 3). The chest radiograph showed a very narrow thorax with oblique ribs and hypoplastic clavicles (Figure 3).
Hand photo showing finger abnormalities.
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F4
A short middle phalanx of the fifth finger and curved nails were also noted (Figure 4).
Intraoral view showing persistence of primary dentition, class III malocclusion, and posterior crossbite.
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F5
Intraoral examination revealed persistence of the primary dentition, delayed eruption of the permanent teeth, an Angle class III malocclusion, negative overjet, bilateral posterior crossbite (Figure 5), and high arched palate.
Panoramic X-ray showing supernumerary teeth and impaction of the upper anterior teeth. (From Kolokitha OE, Papadopoulou AK with permission).
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F6
A panoramic X-ray showed the presence of two supernumerary teeth in the area of the maxillary incisors, impaction of the anterior maxillary teeth, and caries in several teeth (Figure 6).
Anteroposterior cephalogram showing open sutures of the skull, small maxillary sinuses, and missing nasal bone. (From Kolokitha OE, Papadopoulou AK with permission).
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F7
The anterior-posterior (Figure 7) and lateral cephalogram (Figure 8) showed open sutures of the skull, large fontanelles, small maxillary sinuses, numerous Wormian bones in the lambdoidal sutures, a missing nasal bone, a hypoplastic maxilla, and a prognathic mandible.
Lateral cephalometric X-ray showing numerous Wormian bones, large fontanelles, hypoplastic maxilla, and prognathic mandible. (From Kolokitha OE, Papadopoulou AK with permission).
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F8
The anterior-posterior (Figure 7) and lateral cephalogram (Figure 8) showed open sutures of the skull, large fontanelles, small maxillary sinuses, numerous Wormian bones in the lambdoidal sutures, a missing nasal bone, a hypoplastic maxilla, and a prognathic mandible.
Extraction of deciduous and supernumerary teeth.
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F9
The treatment plan comprised orthodontic treatment for the skeletal malocclusion with Hyrax appliance and Delaire mask extraction of the deciduous teeth and supernumerary teeth (Figure 9) and surgical exposure and orthodontic traction of the permanent teeth (Figure 10).
Surgical exposure of impacted teeth and bracket bonding for orthodontic traction of permanent teeth.
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F10
The treatment plan comprised orthodontic treatment for the skeletal malocclusion with Hyrax appliance and Delaire mask extraction of the deciduous teeth and supernumerary teeth (Figure 9) and surgical exposure and orthodontic traction of the permanent teeth (Figure 10).