Case reportsThe parents were first cousin Moslem Arabs, The two children reported here were born of the seventh and eighth pregnancies when the mother was 35 and 37 years old respectively and the father 37 and 39 years old. Both pregnancies were normal and the mother did not take any medication. Seven children, born before the two reported here had no malformations. There were two males and five females and one of them, a male twin of an unlike sexed pair, died suddenly in infancy.The proband was first examined at the age of four months when referred for correction of his cleft lip. The child appeared retarded for his age and there was complete head lag. The head circumference was normal for age, the hair was sparse, the ears were protruding and malformed, and micrognathia and bilateral cleft lip and palate were evident (figs 1 and 2). There was partial syndactyly of the left third and fourth fingers and the third and fourth toes on both feet. A simian line was present on the left palm and a Sydney line on the right. The karyotype was normal 46,XY.
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