Reconstructive Surgery in Children with Down Syndrome: Bioethical Implications

Cristina Tornali; Marcello Migliore; Agata Polizzi; Nicola L. Bragazzi; Mariano Martini; Martino Ruggieri; Andrea D. Praticò; Ignazio Vecchio

doi:10.1055/s-0040-1709510

Journal of Pediatric Neurology, Table of Contents

Journal of Pediatric Neurology 2021; 19(01): 001-006
DOI: 10.1055/s-0040-1709510

Review Article

Reconstructive Surgery in Children with Down Syndrome: Bioethical Implications

Authors

Cristina Tornali

¹Department of Biomedical and Biotechnological Sciences, Section of Neurology, University of Catania, Catania, Italy
Marcello Migliore

²Department of Surgical Sciences, Section of Thoracic Surgery, University of Catania, Catania, Italy
Agata Polizzi

³Department of Educational Sciences, University of Catania, Catania, Italy
Nicola L. Bragazzi

⁴Department of Health Sciences, University of Genoa, Genoa, Italy
Mariano Martini

⁵Department of Health Sciences, Section of History of Medicine and Ethics, University of Genoa, Genoa, Italy
Martino Ruggieri

⁶Department of Clinical and Experimental Medicine, Section of Pediatrics and Child Neuropsychiatry, University of Catania, Catania, Italy
Andrea D. Praticò

⁶Department of Clinical and Experimental Medicine, Section of Pediatrics and Child Neuropsychiatry, University of Catania, Catania, Italy
Ignazio Vecchio

⁷Department of Clinical and Experimental Medicine, Section of History of Medicine, University of Catania, Catania, Italy

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.

Keywords

Down's syndrome - plastic surgery - face - neurological outcome - behavior

Full Text

References

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