We report the dysmorphological, genetic, and speech therapy aspects of 38 cases of velocardiofacial syndrome presenting to.a craniofacial clinic and a specialised children's hospital, to indicate a relatively low incidence of clefting, good response to pharyngoplasty, considerable variability of the syndrome, and two further familial cases. We emphasise the low index of suspicion by paediatricians and paediatric subspecialists which resulted in delayed diagnosis and delayed treatment for the hypernasal speech and velopharyngeal insufficiency for periods of four months to seven years.Velocardiofacial syndrome (VCFS) was first delineated in 12 children by Shprintzen et al,l though Strong2 had described a familial case previously. The features of the syndrome include overt and submucous clefting of the palate, cardiac anomalies, particularly of the conotruncal type, hypotonia, myopathic and dysmorphic facies, developmental delay and learning difficulties, small stature, velopharyngeal insufficiency, and a variety of other
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