In some instances a smooth philtrum may be one of the features of a rare disease or genetic syndrome. In this case fast, targeted genetic analysis can give you a more accurate diagnosis. Synonyms: Indistinct philtrum, Simple philtrum, Philtrum, smooth, Flat philtrum, Decreased depth of philtrum, Shallow philtrum. HPO INTELLECTUAL DISABILITY and SMOOTH PHILTRUM related symptoms, diseases, and genetic alterations. Get the complete information with our medical search engine for phenotype-genotype relationships Intellectual disability and Smooth philtrum, related diseases and genetic alterations | MENDELIAN.C Ataxia, and Smooth philtrum. If you liked this article maybe you will also find interesting the following in-depth articles about other rare diseases, like Microphthalmia and Joint laxity, related diseases and genetic alterations Edema and Dysphagia, related diseases and genetic alterations Visual impairment and Hyperreflexia, related diseases and. Short philtrum is associated with cleft lip 10) or Cri-du-chat syndrome 11) a rare genetic disorder caused by either a partial or complete deletion of the short arm of chromosome 5 (chromosome 5p). The name of the Cri-du-chat syndrome, meaning cat cry was coined after the main clinical finding of a high-pitched, monochromatic cat-like cry A flattened or smooth philtrum may be a symptom of fetal alcohol syndrome or Prader-Willi syndrome. A study of boys diagnosed with autism spectrum disorders found that a broader than average philtrum is one of a cluster of physical attributes associated with autism. Society and cultur
smooth philtrum, thin upper lip, upturned nose, flat nasal bridge, epicanthal folds, small head, small palpebral fissure, clinodactyly (curved 5th finger), hockey stick crease what is the relationship between FAS and genetics . [aafp.org] short stature, as well as all three characteristic facial abnormalities-short palpebral fissure length, a thin upper lip, and a smooth philtrum A smooth upper lip philtrum is a trait just like any other that can be influenced by genetic factors as well as factors present in the development of a fetus (like alcohol). It can be seen in fetal alcohol syndrome BUT can also be seen in many normal kids Philtrum, Smooth. Definition: Subjective: Flat skin surface, with no ridge formation in the central region of the upper lip between the nasal base and upper vermilion border (Fig. 1) Comments: There is a spectrum of this finding from total absence of the philtral ridges to a some prominence of the ridges. The central groove varies from absent to. Philtrum, Smooth Definition : Flat skin surface, with no ridge formation in the central region of the upper lip between the nasal base and upper vermilion border (Fig. 53 ). subjectiv
Key Words: FASD, differential diagnosis, pregnancy, ADHD, genetics etal Alcohol Spectrum Disorder (FASD) affects an estimated 1% of all children born in North America.1 About 10% of these individuals exhibit the pathognomonic facial features (short palpebral fissures, smooth philtrum and thin upper lip) (Figure 1) Fetal Alcohol Spectrum Disorder (FASD) affects an estimated 1% of all children born in North America. FASD is a chronic disorder impacting many systems of care. Only a minority of these children exhibit the pathognomonic facial features of Fetal alcohol syndrome (FAS) that include short palpebral fissures, smooth philtrum and thin upper lip Long (HP:0000343) and/or smooth philtrum (HP:0000319) Thin upper lip vermilion (HP:0000219) and/or downturned corners of mouth (HP:0002714) Hand oligodactyly (HP:0001180) and/or adactyly (HP:0009776 . A rare syndrome caused by deletion of genetic material in the short arm of chromosome 17. It is characterized by an abnormally smooth brain with fewer folds and grooves. It results in intellectual disability, developmental delay, seizures, spasticity, hypotonia, and feeding difficulties
The upper lip may have a tented morphology with everted lower lip vermilion. A short philtrum is common. Genetics. A homozygous missense mutation in the MED25 gene (19q13.33) has been reported and the transmission pattern is consistent with autosomal recessive inheritance with trisomy 21, but also with more than 40 other genetic conditions. Measurements of the nasal bone were performed on a mid-sagittal profile in normal singleton fetuses at 14-34 weeks gestation. It was found that the length of the nasal bones increased from 4 mm at 14 weeks to 12 mm at 35 weeks gestation (Guis et al., 1995)
Lip philtrum guide for black South African race and US Caucasians. In both guides, the prominence of the philtrum pillars is lost from 1-5, which can be best appreciated on a 450 view. Only scores 4 and 5 are used for the diagnosis of FAS, These represent a complete absence of the pillars (5) or very faint or incompletely visible pillars (4) smooth philtrum Gene Set. Dataset: HPO Gene-Disease Associations: Category: disease or phenotype associations Type: phenotype: Description: Flat skin surface, with no ridge formation in the central region of the upper lip between the nasal base and upper vermilion border. (Human. Smooth philtrum: Flat skin surface, with no ridge formation in the central region of the upper lip between the nasal base and upper vermilion border. There is a spectrum of this finding from total absence of the philtral ridges to a some prominence of the ridges Philtrum shape. The philtral groove can be thought of as representing the resultant folding effects of bilateral, inwardingly migrating neural crest cells that met at the midline. Smooth patterns however can also be normal variants or can be associated with genetic syndromes or caused by teratogens such as alcohol The typical features of CdLS include thick or long eyebrows, a small nose, small stature, developmental delay, long or smooth philtrum, thin upper lip and downturned mouth.  The syndrome is named after Dutch pediatrician Cornelia Catharina de Lange , who described it in 1933
Chromosome 17q12 duplication syndrome (Smooth philtrum) Chromosome 22q11.2 deletion syndrome, distal (Smooth philtrum) Congenital Disorder Of Glycosylation, Type Ie (Smooth philtrum) Congenital Heart Disease (Smooth philtrum) Congenital disorder of glycosylation (Smooth philtrum) Cornelia De Lange Syndrome type 2 (Smooth philtrum Genetic & Rare Diseases Information Center (GARD) Genetic Disorders Apparently increased distance between the ridges of the philtrum (vide supra). A broad philtrum may be associated with reduced ridge prominence or a shallow groove, a Smooth philtrum, which should be assessed and coded separately. It may be found with a. Smooth philtrum: 0000319 Making a diagnosis for a genetic or rare disease can often be challenging. Healthcare professionals typically look at a person's medical history, symptoms, physical exam, and laboratory test results in order to make a diagnosis Syndrome Genetic Abnormality Facies/body habitus Medical Image; Wolf-Hirschhorn: 4 deletion: Microcephaly; ocular hypertelorism; downturned mouth; short upper lip; short philtrum; micrognathia; prominent glabella; dysplastic ears; preauricular skin tags CONTACT US. CUSTOMER SERVICE email@example.com (800) 752-3805 • (856) 757-4848 Coriell Institute for Medical Researc
Opitz G/BBB syndrome is an inherited condition that affects several structures along the midline of the body. The most common features are wide-spaced eyes and defects of the larynx, trachea, and/or esophagus causing breathing problems and difficulty swallowing. Affected males usually have a urethra opening on the underside of the penis (hypospadias) Smooth philtrum: 0000319 5%-29% of people have these symptoms: peer-reviewed, full-text articles describing the application of genetic testing to the diagnosis, management, and genetic counseling of patients with specific inherited conditions. Online Mendelian Inheritance in Man (OMIM).
Smooth Philtrum The vertical groove between the nose and upper lip is a Rank 4 or 5 on the Lip-Philtrum Guide. Click here to view additional instructional photos on how to identify a Rank 4 or Rank 5 philtrum. Thin Upper Lip Red portion of upper lip is a Rank 4 or 5 on the Lip-Philtrum Guide Subjective: Prominence of a triangular soft tissue area of the philtrum with the apex to the columella Comments: A tented philtrum may accompany a Smooth philtrum. If present this should be coded separately. COMMENTS (0) | Add Comment Childers EL, Fanburg-Smith JC Ann Diagn Pathol 2011 Jun;15(3):157-61. Epub 2011 Mar 10 doi: 10.1016/j.anndiagpath.2010.10.003. PMID: 2139303 Molecular Genetics. depressed nasal bridge, broad nasal tip, long smooth philtrum, small chin, triangular face, low-set and posteriorly rotated ears, and high-arched palate. Most patients had small hands with deep palmar creases, and some had joint hyperlaxity or pes planus Williams syndrome (WS) is a genetic disorder that affects many parts of the body. Facial features frequently include a broad forehead, underdeveloped chin, short nose, and full cheeks. While mild to moderate intellectual disability, with particular problems with visual spatial tasks such as drawing, is typical, verbal skills are generally relatively unaffected
Elements of morphology: Standard terminology for the nose and philtrum. American Journal of Medical Genetics Part A, 2009. John Carey. Download PDF. Download Full PDF Package. This paper. A short summary of this paper. 37 Full PDFs related to this paper. READ PAPER Many translated example sentences containing smooth philtrum - French-English dictionary and search engine for French translations PACS1 syndrome is a condition in which all affected individuals have intellectual disability, speech and language problems, and a distinct facial appearance. Many affected individuals have additional neurological, behavioral, and health problems. In PACS1 syndrome, intellectual disability typically ranges from mild to moderate. Individuals with this condition also have problems with producing. Smooth_Philtrum 24 post karma 12 comment karma send a private message redditor for 3 months. what's this? TROPHY CASE. dust. remember me reset password. . Get an ad-free experience with special benefits, and directly support Reddit. get reddit premium. Welcome to Reddit
If your provider diagnosed a short philtrum, you may want to note that diagnosis in your personal medical record. Images. The face; Philtrum; References. Madan-Khetarpal S, Arnold G. Genetic disorders and dysmorphic conditions. In: Zitelli BJ, McIntire S, Nowalk AJ, eds. Zitelli and Davis' Atlas of Pediatric Physical Diagnosis. 7th. Many translated example sentences containing smooth philtrum - Spanish-English dictionary and search engine for Spanish translations
, Center for Human Genetic Research, Massachusetts General Hospita Characteristics small eye openings smooth philtrum thin upper lip Teratogens from NUR1021 2460c at Pasco-Hernando Community Colleg Published photographs of cases of fetal valproate, fetal carbamazepine, and fetal phenytoin syndromes appear to have some features in common, such as a smooth or shallow philtrum and thin upper lip.6 10 11 This similarity was also evident in our patients who were exposed to monotherapy with these drugs (figs 1, 2, and 3), particularly in early childhood (less than 2 years of age)
A rare genetic multiple congenital anomalies/dysmorphic syndrome with characteristics of short stature, hypertrichosis cubiti, facial dysmorphism (hypertelorism, long eyelashes, thick eyebrows, downslanted, vertically narrow, long palpebral fissures, wide nasal bridge, broad nasal tip, long philtrum), developmental delay and mild to moderate intellectual disability Other genetic disease *Call the free Teratogen Hotline ( 1-855-884-7248 ) for more information regarding exposures during current or post pregnancies. Texas TIPS (Texas Teratogen Information on Pregnancy Services), an affiliate of MotherToBaby, is a free confidential counseling and information resource that provides information about exposures related to pregnancy and breastfeeding Cohen syndrome is an inherited disorder that affects many parts of the body and is characterized by developmental delay, intellectual disability, small head size (microcephaly), and weak muscle tone (hypotonia). Other features common in this condition include worsening nearsightedness (myopia), breakdown (degeneration) of the light-sensitive tissue at the back of the eye (retinal dystrophy.
Some philtrum are more pronounced as it's a physical characteristic that is passed down genetically, while others can make their philtrum disappear entirely by pulling their lips back until the skin stretches tight. What's more, some people's philtrum naturally stretches out smooth when they smile Trichorhinophalangeal syndrome type I (TRPS I) is a condition that causes bone and joint malformations; distinctive facial features; and abnormalities of the skin, hair, teeth, sweat glands, and nails. Explore symptoms, inheritance, genetics of this condition Human Phenotype Ontology, a standardized vocabulary of phenotypic abnormalities encountered in human disease. With unmatched depth it enables clinicians to record and analyse data with extremely accurate computer interpretable ontology terms. Developed by The Monarch Initiative Fryns syndrome is a condition that affects the development of many parts of the body. Explore symptoms, inheritance, genetics of this condition
Background: The physical features of fetal alcohol syndrome include smooth philtrum, thin vermillion border, short palpebral fissures, microcephaly, and growth deficiencies on weight and height. However, little is known about the specific quantities of alcohol exposure, pattern of drinking, timing of exposure, and magnitude of risk for each of these features De très nombreux exemples de phrases traduites contenant smooth philtrum - Dictionnaire français-anglais et moteur de recherche de traductions françaises List of variants reported as pathogenic for Epicanthus; Hypertelorism; Coarctation of aorta; Global developmental delay; Inguinal hernia; Bilateral cryptorchidism; Downslanted palpebral fissures; Short neck; Thin vermilion border; Wide intermamillary distance; Wide nose; Hypospadias, penile; Low-set, posteriorly rotated ears; Thickened helices; Strabismus; Abnormal number of hair whorls. Fetal alcohol syndrome (FAS) and fetal alcohol spectrum disorders (FASD) result from intrauterine exposure to alcohol and are the most common nonheritable causes of intellectual disability. The. I agree your philtrum is a bit long. The best way to address this concern is with a surgical lip lift. The procedure uses an incision under the base of the nose to reduce the philtrum and raise the upper lip to improve the proportion of the lower face. This procedure can be done using local anesthetic and recovery is typically just a few days
I looked up smooth philtrum and the only other condition that causes it is Prader-Willi, which I DEFINITELY do not have. Could it be a genetic thing? Is it possible it was a hereditary/inherited recessive trait? Like I said, no one else in my family has one. Is a smooth philtrum something you can just have Smooth or flattened philtrum with a score of 4 or 5 on the 5-point scale of the lip-philtrum guide ().Download : Download full-size image Fig. 3.. Lip-philtrum guide. A 5-point pictorial scale for assessing philtrum smoothness and upper lip thinness (circularity) As of March 1, 2021, NTD Genetics will no longer accept samples for this test. For questions, long smooth philtrum, high arched or cleft palate, small widely-spaced teeth, micrognathia, and a short neck), growth retardation, hirsuitism, and upper limb reduction deficits. Additional features include intellectual disability,.
Our mission is to make clinical genetic testing available to patients and their families. GeneDx 207 Perry Parkway Gaithersburg, MD 20877 Toll Free: (888) 729-1206 T: (301) 519-2100 F: (201) 421-2010 E: firstname.lastname@example.org Genetic disorders are passed on through DNA. The big data of genomics was once too vast to be acquired entirely. Now, the human genome can be completely sequenced with new sequencing technologies that handle big data and can be used to Smooth philtrum Thin upper li Patient 4 (first two panels) has left epicanthal fold, a broad nasal bridge, smooth philtrum and mild micrognathia; her sister (Patient 4S) has a frontal bossing, slightly posteriorly rotated ears.
•Microcephaly, smooth philtrum, thin upper lip, ADHD-like behavior. Most common cause of mental retardation. •Most common type of MR in boys, CGG repeats on the X-chr w/ anticipation. Macrocephaly, macro-orchidism, large ears. •Autosomal dominant, or assoc w/ advanced paternal age. Short palpebral fissures, white forelock and deafness 35) Fetal alcohol syndrome • Facial abnormalities in FAS: long smooth philtrum, thin vermillion border, small palpebral fissures . 36) Risperidone • Tourette syndrome - onset before age 18 • Tx: Antipsychotics, Tetrabenazine, Alpha-2-agonists (eg, guanfacine, clonidine Genetics: Birth defects and Syndromes study guide by sam_guest1 includes 34 questions covering vocabulary, terms and more. Quizlet flashcards, activities and games help you improve your grades
The philtrum is the vertical groove between the nose and upper lip. The guide reflects the full range of lip thickness and philtrum depth observed among African Americans with Rank 3 representing the population mean. Ranks 4 and 5 reflect the thin lip and smooth philtrum that characterize the FAS facial phenotype As of March 1, 2021, NTD Genetics will no longer accept samples for this test. For questions, please call: 470-378-2200. Mutations in three genes, NIPBL (5p13.1), SMC1A, and SMC3 are currently reported to cause Cornelia de Lange syndrome (CdLS). Mutations in the NIPBL gene more often cause the classical form of CdLS, while mutations in the SMC1A and SMC3 genes often cause a more mild form of CdLS As of March 1, 2021, NTD Genetics will no longer accept samples for this test. For questions, please call: 470-378-2200. Mutations in five genes, HDAC8, NIPBL (5p13.1), RAD21, SMC1A, and SMC3 are currently reported to cause Cornelia de Lange syndrome (CdLS). Mutations in the NIPBL gene more often cause the classical form of CdLS, while mutations in the HDAC8, RAD21, SMC1A, and SMC3 genes often. Unusual presentations of philtrum of the lip. September 2020; Archives of Plastic Surgery 47(5):488-489; DOI: 10.5999/aps.2019.0111 •Smooth philtrum (University of Washington Lip-Philtrum Guide rank 4 or 5) •Thin vermillion border Differential diagnosis from other genetic, teratological, and behavioral disorders was emphasized. In addition to diagnostic guidelines, guidance about medical,.
Besides genetic and environmental contributions, of 2 or more standard deviations below the mean; (2) smooth philtrum (the vertical groove between the nose and upper lip) (Rank 4 or 5 on Lip-Philtrum Guide); (3) thin upper lip (Rank 4 or 5 on Lip-Philtrum Guide). Photo used by permission of Susan Astley,. - Smooth philtrum - Thin upper lip Presence of 3 sentinel facial features : Presence of 0, 1 or 2 sentinel Known medical conditions - including genetic syndromes and other disorders Growth Infants and young children under 6 years of age and older adolescents and adults warran Summary cellular function 4: genetics - Collins. PREMIUM summaries are quality controlled, selected summaries prepared for you to help you achieve your study goals faster INTRODUCTION. Sonographic detection of fetal forearm abnormalities can pose diagnostic dilemmas because the aetiology is diverse and includes teratogenic insults, chromosomal abnormalities and over 200 genetic syndromes. 1 Ultimate prognosis depends on the underlying pathology and so recognition of associations is critical to facilitate accurate prenatal diagnosis and hence informed parental.
. The facial characteristics highlighted in the photograph are small eye opening, smooth philtrum, and a thin upper lip And a smooth philtrum can signal disorders like fetal alcohol syndrome. 'This whole amazing process - the bits coming together to produce a recognisable human face - happens in the womb. Smooth philtrum, thin vermillion, small palpebral fissures, growth deficit CNS abnormalities Klippel-Feil 15% associated with cleft palate Short, webbed neck and fused cervical vertebrae Congenital cardiac diseas Physical signs of FASDs can include abnormal facial features such as narrow eye openings and a smooth philtrum (the ridge between the upper lip and nose), small head size, short stature, and low body weight. In rare cases, there are problems with the heart, kidneys, bones, or hearing
Clinical Information and Genetic Analysis of the Affected Individuals. and nail hypoplasia), individual 8A at birth (note a wide nasal bridge, a long and smooth philtrum, and a thin upper lip), individual 10A at birth, and individual 10B at 2.5 months old (note for both hypertrichosis, a wide nasal bridge, coarse facial. On review of a panel of patient photographs, (Fig. 2) we identified in some but not all patients a triangular face, almond‐shaped palpebral fissures which may slant upwards, synophrys, prominent ears, a high nasal bridge and bulbous nasal tip, prominent cheekbones, a smooth philtrum with thin upper lip, prominent corners of the mouth, and facial hypertrichosis/low hairlines Philtrum, indistinct: see Philtrum, smooth Philtrum, Long Definition: Distance between nasal base and midline upper lip vermilion border more than 2 SD above the mean (Fig. 48). objective OR Apparently increased distance between nasal base and midline upper lip vermilion border. subjective Comments: The length of the philtrum usually shows a relation with the length of the nose Hypoplastic philtrum - Ontology Browser - Rat Genome Database Find Models new Genetic Models Autism Models PhenoMiner (Quantitative Phenotypes) Expected Ranges Smooth philtrum . Tented philtrum . Synonyms: Exact Synonyms: Small philtrum Alternate IDs: HP:0005331. NCBRS is a rare genetic disease that was first identified in 1993 by pediatric neurologist Paola Nicolaides and geneticist Michael Baraitser. 2 NCBRS is caused by sequence variations in SMARCA2 that arise de novo. 3 SMARCA2 encodes the catalytic subunit of a member of the SWI/SNF chromatin remodeling complex, which has important implications in gene expression, differentiation, and development.
Genetic Syndromes & Gene Therapy Tucker et al., J Genet Syndr Gene Ther 2013, 4:11 ear lobe creases, epicanthal folds, a smooth philtrum with thin upper lip, and a broad forehead Alves et al. (2013) reported a 6-year-old boy with lateral meningocele syndrome. He presented at birth with feeding difficulties and hypotonia, and was noted to have dysmorphic features, including ptosis, microretrognathia, long and smooth philtrum, low-set ears, and cryptorchidism. Echocardiography showed a bicuspid aortic valve Tatton-Brown Rahman syndrome. Tatton-Brown Rahman syndrome also known as DNMT3A overgrowth syndrome, Rahman syndrome or TBRS, is a syndrome that produces faster than normal growth both before and after birth, resulting in a severely increased height throughout the child's life, subtle differences in facial features, and intellectual disability genetic osce for dnb pdiatric 1. Genetics -OSCEGenetics -OSCE Dr. Kashmiri PDr. Kashmiri P BadbadeBadbade 2. Policies regarding genetic testing of children The AAP recommendations includePolicies regarding genetic testing of children The AAP recommendations include the followingthe following 11 WD40 repeat-containing proteins form a large family of proteins present in all eukaryotes. Here, we identified five pediatric probands with de novo variants in WDR37, which encodes a member of the WD40 repeat protein family. Two probands shared one variant and the others have variants in nearby amino acids outside the WD40 repeats. The probands exhibited shared phenotypes of epilepsy.
A genetic disorder caused by the presence of all or part of a third copy of chromosome 21. Epicanthic folds Brushfield spots Protruding tongue Smooth philtrum Joint abnormality . Lung hypoplasia. Altered surfactant production: Marfan syndrome An autosomal dominant connective tissue disorder. Hypermobilit Peter HAMMOND, Visiting Professor | Cited by 2,862 | of KU Leuven, Leuven (ku leuven) | Read 138 publications | Contact Peter HAMMON
Upon evaluation, the patient was determined to have severe dehydration, acute renal failure, and metabolic acidosis. Cornelia De Lange syndrome was initially suspected by the geneticists due to dysmorphic facial features, including prominent eyebrows, thin upper lip, and smooth philtrum People will naturally have a longer Philtrum as they age, but there are times when this issue is due to a jaw deformity or other genetic problems 24. An abnormally long Philtrum will be longer than +2 of the standard deviation for the average length Fetal Alcohol Syndrome Definition Fetal alcohol syndrome (FAS) is a pattern of birth defects, learning, and behavioral problems affecting individuals whose mothers consumed alcohol during pregnancy. Description FAS is the most common preventable cause of mental retardation. This condition was first recognized and reported in the medical literature in. If your provider diagnosed a short philtrum, you may want to note that diagnosis in your personal medical record. Images. The face; Philtrum; References. Madan-Khetarpal S, Arnold G. Genetic disorders and dysmorphic conditions. In: Zitelli BJ, McIntire S, Nowalk AJ, eds. Zitelli and Davis' Atlas of Pediatric Physical Diagnosis. 7th.
Metachromatic leukodystrophy is a rare hereditary (genetic) disorder that causes fatty substances (lipids) to build up in cells, particularly in the brain, spinal cord and peripheral nerves. This buildup is caused by a deficiency of an enzyme that helps break down lipids called sulfatides . Results Philtrum depths at P1 ( P = 0.025), P2 ( P = 0.001), P3 ( P < 0.001) and P4 ( P = 0.001) as well as mean philtrum depth P1-P4 ( P < 0.001) differed significantly between patients with and without FAS
Children with fetal alcohol syndrome present with short stature, low birth weight, poor weight gain, microcephaly, epicanthal folds, smooth philtrum, a flat nasal bridge, and a thin upper lip The patient was born with heart defects (atrial septal defect, ventricular septal defect) and a cleft palate. Shortly after birth, he was noticed to have different facial features, including a triangular face, eye folds (epicanthal folds), decreased creases on his hands and feet, and three bones in his thumbs instead of two (triphalangeal thumbs) THE DIAGNOSIS OF FETAL ALCOHOL SPECTRUM DISORDER (FASD) is complex and guidelines are warranted. A subcommittee of the Public Health Agency of Canada's National Advisory Committee on Fetal Alcohol Spectrum Disorder reviewed, analysed and integrated current approaches to diagnosis to reach agreement on a standard in Canada. The purpose of this paper is to review and clarify the use of current.
(f) Proband 5 (note smooth philtrum) and her healthy duplication positive sister. (g) Duplication positive mother of proband 5, who also has a smooth philtrum. (h) Proband 6 (inherited duplication and oliogohydramnios sequence). Note her frontal bossing, receding hairline, hypoplastic supraorbital ridges and smooth philtrum