ZFHX4 and Intellectual disability: While the initial patient in this study presented with nsCL/P, individuals with ZFHX4 variants or CNVs that disrupt ZFHX4 exhibit both nonsyndromic and syndromic orofacial clefts, including nervous system abnormalities (e.g., developmental delay or intellectual disability), musculoskeletal or limb abnormalities, and craniofacial abnormalities in addition to the cleft such as microcephaly or micrognathia, with the latter being present in the majority of individuals with syndromic forms of clefting (Table 1).