Laterality will need to be indicated another way. The newborn with this disorder will have frothing, excessive drooling, and periods of respiratory distress with choking and cyanosis. Here are some of the things I have tried myself at different times as decided by myself and my girlfriend: Sudocrem every night. All newborns undergo an examination of the. Results: The most common LsCMs were bifurcated/duplicated gluteal folds (33%), gluteal asymmetry (19%), and sacral dimples (14%). Dimples that may require further investigation are those that are large. ICD-10-CM Diagnosis Code R19. Duplicated Gluteal Cleft a Aju1985 Posted 06-05-18 Had our first well check today and scheduled an ultrasound. Flashcards. Therefore, a deviated or duplicated (“split”) gluteal cleft (Fig. vaginal cyst. Careful inspection of the natal cleft for dimples and symmetry may reveal a dimple below the top of the gluteal crease in 2% to 4% of normal newborns. The gluteal region comprises of superficial and deep muscle groups. B. in2007 on newborns with lumbosacral skin anomalies (i. Body habitus may contribute to additional intertriginous sites, such as inframammary skin and. hemangioma, telangiectasiaThe 2024 edition of ICD-10-CM P01. Q79. Applicable To. basically, the top of his bum crack makes a y shape…Of 1096 infants included in the study, 24. The STL. 6% had dimples, and 24. SPINE: Normal curvature with no defects or dimples. Of 1096 infants included in the study, 24. Gluteus Maximus are a group of muscles. Present On Admission. Feb 4, 2023 at 3:55 PM. Had our first well check today and scheduled an ultrasound. Open the PDF for in another window. The 2024 edition of ICD-10-CM Q82. A duplicated gluteal cleft associated with occult spinal dysraphism. 04%). Ahn, MD ; Molly J. Findings present in 11% of healthy newborns are unlikely to be useful markers for a rare condition like OSD (estimated incidence 0. Figure 2. 5 became effective on October 1, 2023. Usually occur in combination of other masses, e. Subcutaneous lipomas. Free returns. non-midline lesion, forked gluteal cleft, coccygeal pit, simple. R. a. Setting: Community private practice with extensive. They believe everything is okay after her Neurodevelopmental eval but we monitor her for any changes in behavior as she gets older. A prototypical benign sacral dimple that is located within the gluteal cleft (less than 2. A Caucasian female neonate with abnormal gluteal cleft had ventriculus terminalis cyst with an extra-axial cyst at the conus–filar junction and taut lipomatous filum on ultrasound examination and magnetic resonance imaging. This is the American ICD-10-CM version of Q92. The urethra is absent: A fibrous cord into the anterior wall of the rectum:. 06 [convert to ICD-9-CM] Epigastric swelling, mass or lump. It is a common skin condition affecting opposing cutaneous or muco-cutaneous surfaces. has demonstrated the high failure rate of the excisional procedures . split; divided; a crack or crevice; an indentation between two parts, as of the chin Not to be confused with: clef –. 1a,b). About 3 to 8 percent of the population has a sacral dimple. 6 - other international versions of ICD-10 Q82. 8% had deviated or duplicated gluteal creases, 15. Asymmetrical buttock creases can suggest hip dysplasia in infants but, like a hip click, an ultrasound or x-ray study will need to be done to determine whether the hips are normal or not. Applicable To. 155 Other ear, nose, mouth and throat diagnoses with cc. e. Z87. Messages 1,130 Location Hibbing, MN Best answers 0. The gluteal cleft and the gluteal fold both occur normally in humans. Ems0. To assess the clinical and economic consequences of different diagnostic strategies in newborns with suspected occult spinal dysraphism. basically, the top of his bum crack makes a y shape…The sacrotuberous ligament (STL) is a stabiliser of the sacroiliac joint and connects the bony pelvis to the vertebral column [1]. A duplicated gluteal cleft associated with occult spinal dysraphism. Notable increase of both sacral and coccygeal hair. Bilateral gluteal tendinitis; Gluteal tendinitis of left hip; Left gluteal tendinitis; Tendinitis of bilateral gluteal tendons. 6 - Congenital sacral dimple. 730 is a billable/specific ICD-10-CM code that can be used to indicate a diagnosis for reimbursement purposes. Q36. This can cause problems starting around age 2-3 (potty training age) is when parents start to see some signs. Histology showed a benign intradermal naevus. . Pregnancy was complicated by maternal obesity, mild intermittent asthma, hyperthyroidism, allergic rhinitis, anemia, and sickle cell trait. 02) and (2) deviated gluteal crease (P = . ANSWER: SACRAL DIMPLE. 9 became effective on October 1, 2023. Now I’m freaking myself out because everything you see on google says tethered spinal cord. A cleft palate happens if the tissue that makes up the roof of the mouth does not join together completely during pregnancy. From icd10data. Had our first well check today and scheduled an ultrasound. Intertrigo may present as diaper. Congenital dermal sinus form due to a focal failure of dysjunction between the cutaneous ectoderm and. nervous system sacral dimples Pediatrics in. 6 is a billable/specific ICD-10-CM code that can be used to indicate a diagnosis for reimbursement purposes. Figure 4. Some aren't visible, while others can look like a small pit or dimple in the skin. P92. 419 is a billable/specific ICD-10-CM code that can be used to indicate a diagnosis for reimbursement purposes. MeSH Code: D010864. Perianal tinea is uncommon. Introduction. - "A Cross-Sectional Assessment of Cutaneous Lumbosacral. It has over 40,000 names organized gluteal cleft newborn. There was no perforation in the left gluteal cleft. Variation in Management of Cutaneous Lumbosacral Findings in Newborns. Based on your photo, it looks like it could be improved with surgery. The code is exempt from present on admission (POA) reporting for. Samir Shureih MD. (1) (2) These defects, which result from abnormal fusion of the neural tube during embryonic development, are placed into two broad categories: open and closed. In most cases, there are no problems at birth. There are several names for this area: natal cleft, gluteal crease, gluteal crevice. My 1st has a duplicate gluteal cleft and 2 sacral dimples. non-midline lesion, forked gluteal cleft, coccygeal pit, simple. The 2024 edition of ICD-10-CM P92. M67. Of course google isn’t my friend and everything I’m reading mentions a tethered spinal cord. ASSESSMENT/PLAN: 2 day old with normal growth and development. 8 became effective on October 1, 2023. View all the articles associated with any code, right from the code page! Thank you for choosing Find-A. The authors gathered clinical illustrations of gluteal cleft wounds and conducted a literature search as a basis for presentation to conference attendees, with the goal of gaining consensus. Y shaped gluteal waiting for scan. The patient has an unusual sacral crease and sacral dimple. Fourteen (21%) of the 67 patients had an abnormal spinal ultrasound; 5 of. We have been told our 6 week old son has a forked gluteal (naval) cleft or I y-shaped crease at the top of his button crack. Case reports of median tongue clefts in the literature show mostly a combination with a cleft of the median lower. OSD. Pediatricians should be familiarOBJECTIVE. Sacral dimple newborn – a prototypical benign sacral dimple that is located within the gluteal cleft (less than 2. A duplicated gluteal cleft associated with occult spinal dysraphism. Venus dimples are two dimples that appear on the lower back, just above the gluteal cleft. Gluteal cleft Meaning - YouTube. Remove femur after distal mobilization and disarticulate hip posteriorly through the decubitus ulcer. ), and relevant articles were selected by mutual agreement. (1)(2) These defects, which result from abnormal fusion of the neural tube during embryonic development, are placed into two broad categories: open and closed. 중복 엉덩이 틈새 (duplicated gluteal cleft)로 OSD와 연관되어 있어요. This means that the butt crack will appear off-center. A decision-analytic model was constructed to project the cost and health outcomes of magnetic resonance imaging (MRI), ultrasound (US), plain radiographs, and no imaging in newborns with suspected occult spinal dysraphism. A prototypical benign sacral dimple that is located within the gluteal cleft (less than 2. View article titled, Lumbosacral Nevus Simplex in a Newborn Girl with an Asymmetrical Y-Shaped Gluteal Cleft. Spinal sonography showed a polycyclic echo-free mass mea- suring 29 18 mm (l " Fig. 8% had deviated or duplicated gluteal creases, 15. 8 is a billable/specific ICD-10-CM code that can be used to indicate a diagnosis for reimbursement purposes. There is no dimple, hairs or discolouration but the doctor wasn't sure if we should see a paediatrician. Fig. 4%) presented with isolated markers (200 with solitary dimples, 6 with deviated or duplicated gluteal furrows, four with cutaneous masses, and one with hypertrichosis). He seems completely healthy otherwise. Is composed mainly of collagen fibres, it is strong enough to support the sacrum. 1 The underlying cause of pilonidal disease is. This type of back dimple is directly superficial to the two sacroiliac joints, where the sacrum attaches to the ilium of the pelvis. 1% (in Germany) to as high as 6. and E. The 2024 edition of ICD-10-CM Q36. 1 is a billable/specific ICD-10-CM code that can be used to indicate a diagnosis for reimbursement purposes. The 2024 edition of ICD-10-CM Q84. The hip joint is the most stable joint in the body and is supported by a very strong capsule and several. little man has a duplicated gluteal cleft. The aim of this article was to summarize results of the consensus sessions that occurred. Although fistulas above the gluteal cleft may be associated with spinal dysraphism, coccygeal pits are benign and do not need imaging. Synonyms: aberrant forearm flexor muscle, aberrant. By Perrine Juillion / October 25, 2019. 6 became effective on October 1, 2021. Code. Home. Figure 4. Motor/sensory grossly normal. It extends from sacral level S3 or S4 and ends just inferior to the apex of the sacrum, at the level of the anus. Hi moms! I am a FTM with 2 week old. from publication: Spinal Sonography in Infants with Cutaneous birth Markers in the Lumbo-Sacral Region – an Important Sign of Occult Spinal Dysrhaphism and Tethered. Q82. Page 1 and 2: March 13 th 2012; Page 4 and 5: • Vitals: 36. 6 - Congenital sacral dimple. from anal verge, multiple dimples, Skin lesions and Associations (duplicate gluteal cleft, asymmetrical intergluteal crease, skin tag, tail like appendages, hairy tuft, pigmentation,Had our first well check today and scheduled an ultrasound. Babies with congenital hip dislocation can also have asymmetrical gluteal folds. A total of 34 (24%) patients had an abnormal spinal US; 15 (44%. In 2 cases, there were differences in respondents' choice to image or consult a subspecialist depending on their percent clinical full time equivalent spent taking care of neonates <1 month of age: (1) coccygeal hair (P = . The primary intertriginous skin areas include the groin folds, axillae, and gluteal cleft. This is the American ICD-10-CM version of Q82. 21 A skin dimple is present on the flat portion of the sacrum well above the upper end of the gluteal cleft. 5 is a billable/specific ICD-10-CM code that can be used to indicate a diagnosis for reimbursement purposes. E. The most common lumbosacral cutaneous manifestations were bifurcated/duplicated gluteal folds (33%), gluteal asymmetry (19%), and sacral dimples (14%). Newborn: Duplicated aorta and internal iliac arteries join as a common vessel: Unilateral hydroureteronephrosis, the other side; cystic dysplastic. The birthing room suddenly becomes very quiet, and the birth team seems somber. 7% had lumbosacral and/or coccygeal hairiness. Tinea cruris is usually due to T. The depth of gluteal cleft varies and depend upon the developed gluteal muscles. Telephone. Fourteen (21%) of the 67 patients had an abnormal spinal ultrasound; 5 of the 14 infants underwent a lumbar magnetic resonance imaging. basically, the top of his bum crack makes a y. We have been told our 6 week old son has a forked gluteal (naval) cleft or I y-shaped crease at the top of his button crack. 4%, which is normal, will expect to be at birth weight at 2 weeks. So, Ortolani-Barlow – not a great test for picking up DDH – in that a normal test doesn’t rule. P01. Sacral dimple ultrasound – sagittal ultrasound showing normal conus level and no underlying spinal dysraphism (red circle is approximate area of cutaneous sacral dimple)A bifurcated gluteal cleft or bifurcated gluteal fold certainly can be a concern, it puts the child at risk for what’s called tethered cord syndrome. Pilonidal disease is an infection under the skin in the gluteal cleft. A decision-analytic model was constructed to project the cost and health outcomes of magnetic resonance imaging (MRI), ultrasound (US), plain radiographs, and no imaging. The 2024 edition of ICD-10-CM Z87. there is a duplicated gluteal cleft; there is more than one dimple; the dimple lies outside the sacrococcygeal region; there are any neurological abnormalities noted; The above may be associated with an underlying neurological problem, for example spinal dysraphism. The lesions appeared to spare the central crease and were tender. He presented with a verrucous wart-like midline mass on the superior gluteal cleft that had grown since his last resection. Almost always, if the dimple is within the gluteal crease, there is no underlying spinal abnormality and no investigation is necessary. Other names. 6 Therefore, we could consider these patients low risk for having OSD. 99/year. A lump of the lower back. The intergluteal cleft or just gluteal cleft, also known by a number of synonyms, including natal cleft, butt crack, and cluneal cleft, is the groove between the buttocks that runs from just below the sacrum to the perineum, [1] so named because it forms the visible border between the external rounded protrusions of the gluteus maximus muscles. Infantile psoriasis is uncommon, and when it occurs it most typically affects the inguinal folds and gluteal cleft. Download the Guidance Document. It is designed by a fashion designer named Kimberly brewer. 438 Clarendon Street, South Melbourne, VIC 3205. Asymmetric Y-shaped gluteal cleft that is moderately associated with spinal dysraphism except if present with other lesions. gluteal cleft newborn Our baby’s name creator can help you find a new and unique name for your child. Business, Economics, and Finance. 딤플보다 엉덩이 틈새 (gluteal cleft) 기형 은 경증 OSD와 연관성이 있어 꼭 추가적인 검사 를 해야해요. 0): 154 Other ear, nose, mouth and throat diagnoses with mcc. The 2024 edition of ICD-10-CM M67. Concerning findings warranting further work -up: dimples located superior to natal cleft or more than 2. • Gluteal cleft anomalies other than dimples also have a weak association with milder forms of OSD and warrant further evaluation. 5 cm above the anus) and solitary. Sacral dimples can be “typical” or “atypical”. 04%). Sacral dimples are relatively common, occurring in 2-4% of newborn infants. A pilonidal cyst, also referred to as a pilonidal abscess, pilonidal sinus or sacrococcygeal fistula, is a cyst or abscess near or on the natal cleft of the buttocks that often contains hair and skin debris. Five hundred twenty-two patients with a mean age of 6. Urinary and bowel dysfunction are nearly universal. I almost thought they just made that up!The presence of phosphatidylglycerol indicates lung maturity. This causes a number of eating and breathing problems. Similar. Neural tube defects are among the most common forms of birth defect, affecting 1 in every 1,000 pregnancies. A duplicated gluteal cleft associated with occult spinal dysraphism. Pressure injuries, however, are ischemic injuries to the skin and underlying soft tissue that can result in full-thickness tissue damage. NO BIGGIE, unless it's really deep, which you didn't mention. 3 March 2011 111 Each referred participant was risk stratified based on specific physical exam findings. All racial/ethnic groups had double to quadruple the risk of lumbosacral hair when compared with. generally speaking, scoliosis can cause asymmetry of back and buttocks. 9 became effective on October 1, 2023. In 2 cases, there were differences in respondents' choice to image or consult a subspecialist depending on their percent clinical full time equivalent spent taking care of neonates <1 month of age: (1) coccygeal hair (P = . Congenital earlobe deformities come in a variety of shapes, including earlobes with clefts, duplicate earlobes, and earlobes with skin tags. 5 became effective on October 1, 2023. 419 became effective on October 1, 2023. Our content is doctor approved and evidence based, and our community is moderated, lively, and welcoming. This is the American ICD-10-CM version of Q63. , hemangiomas. 5cm · >5mm diameter · Not midline in location · Base not visible (Schenk, 2006) Return to Referral and Diagnosis Return to Surgery and Follow-up Simple Sacral Intragluteal Dimple Dimple within a symmetric gluteal crease AND less than 5 m i nd a etrWITH h sc u abno m l it es A soc ia t. The gluteal cleft shield is directly applied on the skin and fixes itself above the waistband. Sacral Dimple. Gluteal tendinitis; Gluteal tendonitis. basically, the top of his bum crack makes a y shape…Red Flags! •Midline (or near-midline) tuft of hair (hypertrichosis) •Midline (or near-midline) capillary hemangioma •Midline (or near-midline) subcutaneous mass (lipoma) •Caudal appendage •Deviated or duplicated gluteal cleft •Expression of fluid from dimple •Dimple located more caudally •Inability to see base •Swelling/erythema around. Has anyone had any expierence with this ?Answer: Gluteal cleft. Lumbosacral and/or coccygeal hairiness could be found in some neonates, together with dimples and deviated or duplicated gluteal creases, which may be insignificant findings in low-risk newborns. Caudal duplication syndrome (CDS) is a rare disease entity with prevalence of less than 1 per 100,000 at birth. Q82. In the pressure ulcer, the most important etiologic factor is pressure. A total of 34 (24%) patients had an abnormal spinal ultrasound; 15 (44%) of these infants underwent a lumbar magnetic resonance imaging. Prevention. It is also called butt crack or ass crack. This causes the affected foot to have missing toes, a V-shaped cleft, and other anatomical differences. 120 Q36. Type 1 Excludes. The purpose of this study was to illustrate the spectrum of solitary gluteal lesions in children. Aju1985. @lblake907, in some cases it’s a sacral dimple and can be a sign of spina bifida occulta, but if the spine is closed then it can be (in very rare occurrences) a sign of a tethered cord. The hub of the catheter was secured in the , and the patient's features of sepsis improved over. Typically, pilonidal cysts occur after puberty. Medially, it is separated by an intergluteal cleft, while laterally, it is bordered by the hip region. For patients with certain risk factors and a normal examination the Guidelines of the American Academy of Pediatrics state, “…imaging with an. Body habitus may contribute to additional intertriginous sites, such as inframammary skin and. 9 is a billable/specific ICD-10-CM code that can be used to indicate a diagnosis for reimbursement purposes. 2 is a billable/specific ICD-10-CM code that can be used to indicate a diagnosis for reimbursement purposes. She has had RSV, Brinchiolitis, surgery to detether her Tethered Spinal cord. 821A is grouped within Diagnostic Related Group(s) (MS-DRG v 41. Keep the skin of the diaper area clean and dry. They can rule out a tethered spinal cord for her through an MRI when she is older. 5 - other international versions of ICD-10 Q92. This is the American ICD-10-CM version of Q84. BACKGROUND AND INCIDENCE. Some of the lesions had a raised hyperkeratotic border, whereas others were scaly and/or erosive (Fig. Low-risk findings included “simple dimple,” defined as a soft tissue depression appearing up to 2. The rotating of tissue causes the gluteal cleft to shift. Study with Quizlet and memorize flashcards containing terms like Comprehensive newborn exam must be done within, Tips for newborn exam, Newborn temp: method and normal range and more. The overall frequency of each physical. The patient subsequently underwent resection of the mass with bilateral gluteal rotational flaps. A bifid uvula, also known as a cleft uvula, is a uvula that is split in two. But these lesions are limited to the gluteal cleft whereas a dermal sinus tract originates above the cleft and can interconnect with the spinal canal and dura mater. The purpose of this study is to describe the range and frequency of cutaneous lumbosacral and coccygeal findings encountered during the newborn examination in a population of apparently healthy. com. 2%. Methods. Duplicated Gluteal cleft. P01. 6% had dimples, and 24. Attempted resection of a bicornuate uterus "septum". Combinations of deviated or duplicated gluteal crease + dimple, deviated or duplicated crease + hair, and dimple + hair were common groupings. A cleft lip and cleft palate are openings in a baby's upper lip or roof of the mouth (palate). They did an ultrasound of his booty & spine when he was like a week old. The cystic mass extended into a dilation of the central canal due to. Some consider the term spina bifida occulta. What an incredible first year. Cute vs. 6%, and flat vascular macules in 1. Sacral epidermal anomalies include dimples, tracts, lipomas, hemangiomas, and tufts of hair and may be associated with a neural tube defect, such as spina bifida. The purpose of this study is to describe the range and frequency of cutaneous lumbosacral and coccygeal findings encountered during the newborn examination in a population of apparently healthy. Feb 4, 2023 at 3:55 PM. Myalgia is pain in muscles, and since your Dr. 8 may differ. The purpose of this study is to describe the range and frequency of cutaneous lumbosacral and coccygeal findings encountered during the newborn examination in a population of apparently healthy. She previously was diagnosed by her periodontist with erosive lichen planus and was prescribed topical and oral steroids with minimal improvement. Posted 06-24-17. Non-duplicate identified articles were independently reviewed by two authors (J. 0 - other international versions of ICD-10 Q36. Figure 4. Some asian groups have as high as 1 in 250 births with cleft, caucasians about. The most common cutaneous manifestations were duplicated or bifurcated (46%) gluteal folds and gluteal asymmetry (16%). 4. 4 GUIDELINE FOR INVESTIGATION OF LUMBOSACRAL. Background Pilonidal disease classically presents as an abscess or soft tissue swelling which classically occurs in the intergluteal cleft, just above the anus. It is also known as the “butt crack” and “intergluteal cleft. Some consider the term spina bifida occulta. A total of 34 (24%) patients had an abnormal spinal ultrasound; 15 (44%) of these infants underwent a lumbar magnetic resonance imaging. Applicable To. The 2024 edition of ICD-10-CM Q35. Specialty: General Surgery. Gluteal cleft is the vertical partition which separates buttocks. Similar. Specialty: General Surgery. Ask parent/carer how the baby is feeding and if there has been any vomiting, and if so, what colour. basically, the top of his bum crack makes a y shape…Had our first well check today and scheduled an ultrasound. 27 This study also evaluated 207 neonates with cutaneous stigmas and found that none of the infants with a simple midline dimple (meeting none of the criteria listed above) had spinal dysraphism. Spina Bifida Occulta (Occult Spinal Dysraphism) Spina bifida occulta is a common anomaly consisting of a midline defect of the vertebral bodies without protrusion of the spinal cord or meninges. At 2 week app pediatrician said baby has a y shaped butt crack which could be a indicator of spina bifida or tethered cord. Almost always, if the dimple is within the gluteal crease, there is no underlying spinal abnormality and no investigation is necessary. This was the first year ICD-10-CM was implemented into the HIPAA code set. This shear stress mechanism of bruising has been reported as vertical linear bruises along an apparent strain line where the buttocks arch into the gluteal cleft. 2 became effective on October 1, 2023. Combinations of deviated or duplicated gluteal crease + dimple, deviated or duplicated crease + hair, and dimple + hair were common groupings. The 2024 edition of ICD-10-CM Q82. The coccygeal region and anus are prepared with iodine or chlorhexidine. 00 [convert to ICD-9-CM] Gluteal tendinitis, unspecified hip. 04%). , four cases of asymmetrical gluteal fold, two cases of dermal sinus, one case of hairy tuft, one. 8. 2 is grouped within Diagnostic Related Group (s) (MS-DRG v41. 8%. Approximate Synonyms. ICD-10-CM Diagnosis Code M76. ”. 중복 엉덩이 틈새 (duplicated gluteal cleft)로 OSD와 연관되어 있어요. Asymmetric gluteal cleft. The most common lumbosacral cutaneous manifestations were bifurcated/duplicated gluteal folds (33%), gluteal asymmetry (19%), and sacral dimples (14%). All racial/ethnic groups had double to quadruple the risk of lumbosacral hair when compared with Caucasians. The estimated overall incidence of pilonidal disease is 26:100,000. Q82. I think getting the ultrasound is a great idea because we do want to see if there is an issue with the lower part of the spinal cord. Bodily secretions. Cleft lip, bilateral. 4. little man has a duplicated gluteal cleft. Applicable To. May 6, 2021 at 5:44 AM. Perianal candidal intertrigo presents as soreness and irritation with bright red erythema and satellite lesions extending into the natal cleft. The gluteal region, commonly known as the buttocks or glutes, is the posterior part of the pelvic area. 2 is considered exempt from POA reporting. It extends from the upper iliac crests to the lower gluteal fold of the skin. g. A total of 34 (24%) patients had an abnormal spinal ultrasound; 15 (44%) of these infants underwent a lumbar magnetic resonance imaging. 2 - other international versions of ICD-10 Q84. Q63. Created for people with ongoing healthcare needs but benefits everyone. Because most studies on gluteal cleft shaving have used an arbitrary manner and method, effective frequency and extent of shaving have not been systematically studied. Spina Bifida Occulta (Occult Spinal Dysraphism) Spina bifida occulta is a common anomaly consisting of a midline defect of the vertebral bodies without protrusion of the spinal cord or meninges. The code is valid during the current fiscal year for the submission of HIPAA-covered transactions from October 01, 2023 through September 30, 2024. A sacral dimple is a small, usually shallow indentation in the small of the back, just above or within the crease of the buttocks.