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Figure 3.13. This infant with the fetal hydantoin syndrome presented with many of the findings already described. There was growth retardation, hypertelorism, small pug nose, anteverted nostrils, long philtrum, and thin vermilion border of the upper lip, and short neck.

Figure 3.14. The same infant shows the characteristic changes in the fingers. Note the hypoplasia of the distal phalanges with hypoplastic or absent nails and the digital thumbs. There is mild webbing.

Figure 3.15. The same infant with fetal hydantoin syndrome shows the marked hypoplasia of the distal phalanges of the toes and absent or hypoplastic nails.

Figure 3.16. Postnatal growth deficiency and microcephaly are present in two-thirds of children exposed to valproic acid in combination with other anticon-vulsants. It does not occur with monotherapy with valproic acid. This infant with the fetal vaproate syndrome shows the typical craniofacial abnormalities. Note the trigonocephaly with a prominent metopic ridge, bifrontal narrowing, outer orbital ridge deficiency, midface hypoplasia, epicanthic folds, small short upturned nose, and long flat philtrum.

Figure 3.17. A cranial view of the same infant shows the trigonocephaly due to premature closure of the metopic suture, bifrontal narrowing, and outer orbital ridge deficiency.

Figure 3.18. Lateral view of the head and face of the same infant shows the marked metopic ridge, small flat short nose, micrognathia and "square" ears.

Figure 3.17. A cranial view of the same infant shows the trigonocephaly due to premature closure of the metopic suture, bifrontal narrowing, and outer orbital ridge deficiency.

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