Facial, oral, digital, psychomotor delays, and skeletal anomalies are major systemic features of OFD IX. The oral manifestations include a high arched palate, cleft lip (sometimes subtle), bifid tongue, hemartomas on the tongue, abnormal tongue frenulation, and dental anomalies (supernumerary teeth). Digital anomalies consist of mild syndactyly and occasionally polydactyly, brachydactyly, and bifid large toes. Some patients have short stature. Psychomotor delay is common and some patients have been described as mentally retarded.