Journal of Pediatric Neurology
DOI: 10.1055/s-0040-1709510
Review Article
Georg Thieme Verlag KG Stuttgart · New York

Reconstructive Surgery in Children with Down's Syndrome: Bioethical Implications

Cristina Tornali
1  Department of Biomedical and Biotechnological Sciences, Section of Neurology, University of Catania, Catania, Italy
,
Marcello Migliore
2  Department of Surgical Sciences, Section of Thoracic Surgery, University of Catania, Catania, Italy
,
Agata Polizzi
3  Department of Educational Sciences, University of Catania, Catania, Italy
,
Nicola L. Bragazzi
4  Department of Health Sciences, University of Genoa, Genoa, Italy
,
Mariano Martini
5  Department of Health Sciences, Section of History of Medicine and Ethics, University of Genoa, Genoa, Italy
,
Martino Ruggieri
6  Department of Clinical and Experimental Medicine, Section of Pediatrics and Child Neuropsychiatry, University of Catania, Catania, Italy
,
Andrea D. Praticò
6  Department of Clinical and Experimental Medicine, Section of Pediatrics and Child Neuropsychiatry, University of Catania, Catania, Italy
,
Ignazio Vecchio
7  Department of Clinical and Experimental Medicine, Section of History of Medicine, University of Catania, Catania, Italy
› Author Affiliations
Further Information

Publication History

01 August 2019

03 August 2020

Publication Date:
25 April 2020 (online)

Abstract

Down Syndrome is a genetic disorder caused by a third copy of chromosome 21. One of the main feature of the syndrome is the facial dysmorphism, characterized by broad, flat face, oblique eyelid rhymes, skin folds at the inner corner of the eyes (epicanthus), receding chin, protrusion of the tongue. These features are often social and functional obstacles, reducible with surgical interventions. The first facial plastic/cosmetic surgery approaches on Down children were performed in 1960 in Germany, Great Britain and the United States, where plastic surgeons began to reshape the Down patients physiognomy through the surgical correction of the face, tongue, eyes, nose, of the nostrils, of the neck. Recent studies have shown that in spite of the tendency to infections and early pulmonary hypertension in children with DS, surgery is not contraindicated, as previously suggested, but can be performed with very good results. This treatment has aesthetic, functional, rehabilitative, social effects, as well as favorable outcome on the familiar behavior. However different issues emerge in cases of patients presenting intellectual disability and unable to understand the consequences or the side effects related to plastic surgery. In this aspect, different Countries have enacted distinct laws directly regulating the consensuses for such intervention, with the goal to reduce the risks for the affected patients and the respect of their willing and social inclusion.