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Objective In this case report, we present an unusual combination of three congenital malformations: median cleft of the lower lip, lip pits, and unilateral cleft of the lip and palate without familial occurrence. Conclusions From an etiological point of view, this combination of malformations could have happened during the late embryogenic period. Why this combination is uncommon is not known.

Abstract. Hydroxyapatite (HA) formation is one of the most important aspects of bone regeneration. Because domestically made chitosan-hydroxyapatite-collagen composite scaffolding from crab shell and bovine bone and tendon has potential as a maxillofacial reconstruction material, the material's HA-forming ability requires evaluation. The aim of this research is to investigate chitosan-hydroxyapatite-collagen composite scaffold's potential as a maxillofacial reconstruction material by observing the scaffold's compositional changes. Scaffold specimens were immersed in 37°C simulated body fluid (SBF) for periods of 2, 4, 6, and 8 days. Scaffold composition was then evaluated by using energy dispersive spectroscopy (EDS). The calcium (Ca) and phosphorus (P) percentages of the scaffold were found to increase following SBF immersion. The high Ca/P ratio (3.82) on the scaffold indicated HA formation. Ion exchange played a significant role in the increased percentages of Ca and P, which led to new HA layer formation. The scaffold's HA acted as a nucleation site of Ca and P from the SBF, with collagen and chitosan as the scaffold's matrix. Chitosan-hydroxyapatitecollagen composite scaffold shows potential as a maxillofacial reconstruction material, since its composition favors HA formation.

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From an etiological point of view, this combination of malformations could have happened during the late embryogenic period. Why this combination is uncommon is not known.