The head showed microcephaly, dolichocephaly, fron tal bossing, high frontal hairline, prominent glabella, hypertelorism, broad nose, down slanting palpebral fis sures, exotropia, micrognathia, downturned mouth (carp like mouth), high-arched palate and large misshapen ears (Figure 1).

 The trunk was relatively long and the chest was long and narrow. There were cervical spine anomalies (agenesis of bodies of vertebrae C4 and C5), long fingers and hypo plasia of great toes (Figure 2). There was partial agenesis of the corpus callosum. The heart showed foramen ovale apertum, without a septal defect. There was a cyst of the right kidney. The patient was hypotonic, with feeding diffi culties and clinical manifestation of seizures. The karyo type was 46;XX,del(4) (p15-p16) (Figure 3).

Second Case. This was the first female child of young parents, resulting from an uneventful pregnancy. The child was born by cesarean section, due to intrapartal asphyxia, 2 weeks after term. The birth weight was 2.200 g (<10 p), birth lenght 44 cm (<10p), head circumference 30.5 cm. (<10p). Hypotonia and feeding difficulties were present from the beginning.

Figure 4. Typical craniofacial anomalies.

The head was dysmorhic, with a bird like face, wide nasal bridge and a broad, bent nose (Greek warrior helmet face), cleft palate, hypertelorism, micrognathia and low positioned misshapen ears (Figure 4). The fingers were long and slender, with abnormal palmar and plantar finger position. There was partial enlargement of the left lobe of the liver and spleen malrotation with the hilus pointed towards the stomach. The left kidney was dislocated and low positioned, with bilateral pyelectasia. The heart showed a 6 mm long atrial septal defect, with an obvious left-to-right shunt. The karyotype was 46, XX, del (4) (p15.2-p16.3)