emanuel syndrome is an inherited chromosomal abnormality resulting from 3 1 meiotic segregation from parental balanced translocation carrier t 11 22 q23 q11 mostly of maternal origin it is characterized by mental retardation microcephaly preauricular tag or sinus ear anomalies cleft or high arched palate micrognathia congenital heart diseases kidney abnormalities structural brain anomalies and genital anomalies in male here in we describe a female patient with supernumerary der 22 syndrome emanuel syndrome due to balanced translocation carrier father t 11 22 q23 q11 she was mentally and physically disabled and had most of the craniofacial dysmorphism of this syndrome our patient had cleft palate maldeveloped corpus callosum and hind brain with normal internal organs additionally arachnodactyly hyperextensibility of hand joints abnormal deep palmar and finger creases extra finger creases and bilateral talipus were evident and not previously described with this syndrome cytogenetic analysis and fish documented that the patient had both translocation chromosomes plus an additional copy of der 22 with karyotyping 47 xx t 11 22 q23 q11 der 22 t 11 22 q23 q11 we postulated that this rare chromosomal complement can arise from 2 2 segregation in the first meiotic division of the balanced translocation father followed by non disjunction at meiosis ii in the balanced spermatocyte.