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Also, the term does not discriminate between mild<jats:italic>qualitative<\/jats:italic>defects of development (mild malformations) and<jats:italic>quantitative<\/jats:italic>variants of normal structure. The human face was formed by natural and sexual selection. Morphological and morphogenetic analyses have shown that the human face with its skin, muscles, nerves, arteries, veins, glands, and lymphatics is a complex structure made up of progeny of ectoderm and mesoderm. Holoprosencephaly demonstrates graphically how these embryonic derivatives fit together sequentially. These derivatives are the<jats:italic>adaptive units<\/jats:italic>of the human organism, the result of stringent evolutionary forces uniting essential function to a minimum of structure. Before an \u201cunusual\u201d facial appearance is diagnosed as \u201cabnormal\u201d, phenotype analysis is required to determine if there is a<jats:italic>family resemblance<\/jats:italic>or if it is a<jats:italic>pleiotropic<\/jats:italic>structure. The facial structures of chimps and humans are<jats:italic>homologous<\/jats:italic>by virtue of descent from a common ancestor (Darwin, 1859). Differences in the appearance of these species reflect adaptive divergence over some 6\u20137 million years of evolution while retaining over 98\u201399% genetic identity. Both species may develop Down syndrome, evidence of similarly retained developmental plasticity. It has occurred to us that Dobzhansky's axiom (\u201cNothing in biology makes sense except in the light of evolution\u201d) applies not only to genetics, but to all of medicine.<\/jats:p>","DOI":"10.1002\/ajmg.a.63028","type":"journal-article","created":{"date-parts":[[2022,11,4]],"date-time":"2022-11-04T13:31:39Z","timestamp":1667568699000},"page":"640-646","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["Evolution in the clinic: Maladaptive units and \u201cminor anomalies\u201d"],"prefix":"10.1002","volume":"191","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-6007-8518","authenticated-orcid":false,"given":"John C.","family":"Carey","sequence":"first","affiliation":[{"name":"Department of Pediatrics, Division of Medical Genetics University of Utah Salt Lake City Utah USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6991-8835","authenticated-orcid":false,"given":"John M.","family":"Opitz","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, Division of Medical Genetics University of Utah Salt Lake City Utah USA"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2022,11,4]]},"reference":[{"key":"e_1_2_12_2_1","unstructured":"Aristotle.1538.Aristotelis Stagiritae philosophorum omnium facile principis opera \u2026 commentatio doctissima per Philip. 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