Diastrophic dysplasia (DTD) is a well characterized, recessively inherited osteochondrodysplasia, Forty-eight patients with DTD were studied for craniofacial characteristics, Of these patients, 58% had cleft palate, A cephalometric analysis based on lateral cephalograms was performed, We observed a short anterior cranial base, vertical nasal bones, short and posteriorly positioned upper and lower jaws, increased anterior facial height, increase in the sagittal length of the body of the cervical vertebrae, and an abnormal dens of the second cervical vertebra, DTDST, in which mutations responsible for the disease occur, is a gene that codes for a sulphate transporter membrane protein, The craniofacial anomalies in DTD most likely result from deficient development and growth of cartilaginous structures and are probably due to defective sulfation of the proteoglycans of the cartilage. (C) 1997 Wiley-Liss, Inc.