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

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 shownthat inspite of the tendency toinfections andearlypulmonaryhypertension in children with DS, surgery is not contraindicated, as previously suggested, but can be performed with verygoodresults. This treatmenthas aesthetic, functional, rehabilitative, social effects, aswell 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

La sindrome di Down è una malattia genetica causata da una terza copia del cromosoma 21. Una delle caratteristiche principali della sindrome è il dismorfismo facciale, caratterizzato da viso largo e piatto, rime palpebrali oblique, pieghe della pelle all'angolo interno degli occhi (epicanto ), mento sfuggente, protrusione della lingua. Queste caratteristiche sono spesso ostacoli sociali e funzionali, riducibili con interventi chirurgici. Storia e bioetica della prima plastica facciale