DESCRIPTIONCleidocranial dysostosis (CCD) is a rare autosomaldominant skeletal disorder presenting with a variety of unique clinical and radiological features that can prove to be a diagnostic challenge.1 2 A 15-year-old boy, born of non-consanguineous parents, presented with short stature, delay in eruption of permanent teeth and facial dysmorphism. On examination, his height was 155 cm at the 10th centile on Agarwal's growth chart, with a midparenteral height of 165.5 cm. He had a triangular face and hypertelorism with the lower part of his face being hypoplastic. Oral examination revealed persistent temporary milk teeth. The patient had normal secondary sexual characters. He was able to approximate his shoulders due to the presence of hypoplastic clavicles (figure 1). Laboratory tests showed a normal haemogram. His renal functions were normal with corrected serum calcium 9.2 mg/ dL (8.3-10.4), phosphate 3.2 mg/dL (2.6-4.5), alkaline phosphatase 74 IU/dL (40-125) and 25-hydroxyvitamin D levels 38 ng/dL. X-ray of the skull was suggestive of open anterior and posterior fontanelles with hypoplastic maxillae and absent frontal sinuses (figure 2). X-ray of the chest showed hypoplastic clavicles bilaterally (figure 3). In view of the clinical and radiological presentation, a diagnosis of CCD caused by mutations in the RUNX2 gene (6p21), which is involved in osteoblast differentiation and bone formation, was made. It is known that mutations with large penetrance and