Plastic Reconstructive Surgery & Down Syndrome Abstracts

Ment Retard 41 (1): 29-34 (2003 Feb)

Parental opinions about facial plastic surgery for individuals with Down syndrome

Goeke J, Kassow D, May D, Kundert D
Graduate School of Education, 10 Seminary Place, Rutgers University, New Brunswick, NJ 08901

Facial plastic surgery is an intervention that some have proposed to improve the physical functioning, appearance, and social acceptance of individuals with Down syndrome. Our purpose in this study was to examine the opinions of parents of children with Down syndrome about this practice. Two hundred and fifty parents responded with usable surveys and were generally familiar with the practice, yet the majority of respondents did not support the surgery. The literature on this topic is reviewed, and related issues are discussed.
J Med Ethics 26 (2): 101-2 (2000 Apr)

Parental consent to cosmetic facial surgery in Down's syndrome

Jones RB
Retired Consultant Paediatrician, London

It is suggested that the practice of attempting to normalise children with Down's syndrome by subjecting them to major facial plastic surgery has no therapeutic benefit, and should be seen as multilating surgery comparable to female circumcision.
Br J Nurs 8 (1): 33-8 (1999 Jan 14-27)

Should children with Down's syndrome have cosmetic surgery?

Aylott J
School of Health and Community Studies, Sheffield Hallam University

This article explores the rise in the uptake of cosmetic surgery for children with Down's syndrome. The pursuit of such surgical intervention is often a response to society's discriminatory attitude towards Down's syndrome and difference. Such an action raises many ethical concerns, e.g. should a child be subjected to cosmetic surgery when he/she does not understand what is happening to him/her? Much time, effort and resources are needed to work with children with Down's syndrome to ensure their full and active development through childhood. There have been changes in challenging discriminatory attitudes towards people with a disability in society. This, however, is the result of the public coming into contact and building relationships with people with disabilities in the wider community and not cosmetic surgery.
Acta Chir Plast 37 (2): 40-4 (1995)

The indications and the plan of plastic operations in children with Down's syndrome

Lewandowicz E, Kruk-Jeromin J
Department of Plastic Surgery, Medical University of Lodz, Poland.

During the past ten years (1984-1993), 52 children with Down's syndrome aged 3-16 years were treated surgically at the Department of Plastic Surgery at the Medical University of Lodz. The authors present the indications and the treatment plan in selected patients, the optimal timing of surgical treatment, the choice of surgical methods for the correction of facial deformity and for the limpness of tongue depending on its form and intensity. Elimination of mongoloid features of the face (tongue, lower lip, eyelids, nose) has a positive influence on rehabilitation of children with Down's syndrome. This procedure was used in Poland for the first time.
Plast Reconstr Surg 91 (6): 1159-62 (1993 May)

Central tongue reduction for macroglossia

Mixter RC, Ewanowski SJ, Carson LV
Center for Plastic and Reconstructive Surgery, Mercy Hospital, Janesville, WI

Unhappy with our postoperative results from standard tongue reduction methods, we have developed a central tongue reduction technique. This technique allows for alteration of the tongue base as well as tongue height and width while minimizing postoperative scarring. Although the technique and its associated surgical complications are in some ways comparable with the standard tongue reduction methods, our postoperative polysomnographic and tongue functioning results are improved. It is noteworthy that none of our patients had worse speech postoperatively and that our one Down syndrome patient had improved speech. Our indication for central tongue reduction is macroglossia of any sort in appropriate patients.
Research in Developmental Disabilities 13 (2): 145-156 (1992 Jul)

Plastic Surgery on Children with Down Syndrome: Parents' Perceptions and Physical, Personal, and Social Functioning

Kravetz Shlomo, Weller A, Tennenbaum R, Tzuriel D, Mintzker Y
Department of Psychology, Bar-Ilan University, Ramat-Gan, Israel

Plastic facial surgery is being carried out on children with Down syndrome with the objective of improving these children's physical, personal, and social functioning. This study investigated the effect of such surgery on parents' perceptions, both of the current status of their children's functioning and of changes in this functioning. Perceptions of parents of children who had undergone this surgery in Israel in the years 1982 and 1983 were compared with perceptions of parents of children who had not undergone the operation. This comparison produced little evidence for the positive impact of the surgery on parents' perceptions of their children's physical, personal, and social functioning.
J Intellect Disabil Res 36 (2): 143-55 (1992 Apr)

Teachers' attitudes towards plastic surgery in children with Down's syndrome

Saviolo-Negrin N, Cristante F
Dipartmento di Psicologia Generale, Universita di Padova, Italy

The problem of whether to improve on the physical appearance of children with Down's syndrome by means of plastic surgery is a much debated question which involves bio-ethical and ideological concepts. In this research, the opinions of a group (n = 132) of Italian elementary and junior school teachers are investigated on the basis of a questionnaire. Data are analysed through the application of log-linear models, and parameter estimates are calculated for each response category and interactions between response categories and types of teachers. Results show a greater acceptance of children with Down's syndrome as they are by people who have daily experience of them and who can get to know them better from all points of view. On the other hand, plastic surgery for children with Down's syndrome is considered with more favour by people who are less psychologically involved with them.
Mental Retardation 30 (1): 29-33 (1992 Feb)

Plastic Surgeon's Opinions of Facial Surgery for Individuals with Down Syndrome

May, Deborah C.; Turnball, Nancy
Department of Educational Psychology and Statistics, State University of New York, Albany 12222

Plastic surgeons from Los Angeles and New York (N = 182) were surveyed on their opinions of facial plastic surgery for individuals with Down syndrome. Of the 100 respondents, 88 were familiar with the procedures, and 24 had performed the surgery. The surgeons indicated the circumstances for recommending the surgery, who would be required to give consent, the degree to which they thought individuals with Down syndrome could understand the nature of the surgery, and their opinion of the degree of discomfort associated with the surgery.
Nederlands Tijdschrift Voor Geneeskunde 135 (42): 1963-6 (1991 Oct 19)

Tongue Reducation in Children with Down's Syndrome; A Functional Operation

Starmans, JL; Bloem, JJ
Academisch Ziekenhuis Vrije Universiteit, afd. Plastiche en Reconstuctieve Chirurgie

The results of tongue reduction in a group of seven children with Down's syndrome are described. This surgical procedure was performed because of macroglossia, present in all seven children. Postoperatively all children eat and drink better, drooling has stopped and both articulation and phonation have improved. Therefore tongue reduction should be considered a functional operation that can improve the quality of life of the child and its family.
American Journal of Mental Retardation 94 (2): 101-10 (1989 Sep)

Facial Plastic Surgery for Persons with Down Syndrome: Research Findings and Their Professional and Social Implications

Katz, Shlomo; Kravetz, Shlomo
Bar-Ilan University, Ramat-Gan, Israel

The literature on the effectiveness of facial surgery for persons with Down syndrome was reviewed. Research based on impressions of involved persons (e.g., parents and doctors) generally provided evidence for the surgery's effectiveness. However, studies that used before-after research designs, control groups, indirect measures, and ratings of less involved persons were less supportive of the operation's positive effects. Certain of these studies indicated that the operation failed to achieve its goals. Furthermore, in evaluations of the operation, investigators generally did not critically examine the assumptions upon which the operation is based and the professional and social implications of facial surgery for persons with Down syndrome.
Cleft Palate J 26 (3): 186-90 (1989 Jul)

Facial reconstruction in Down syndrome: perceptions of the results by parents and normal adolescents

Klaiman P, Arndt E
Craniofacial Research and Treatment Centre, Hospital for Sick Children, Toronto, Ontario, Canada

Randomized videotaped samples of conversational speech recorded preoperatively and 6 months postoperatively in 15 patients with Down syndrome who had undergone facial reconstruction were studied. The videotapes were rated by 34 normal adolescent students for appearance, friendliness, intelligence, and speech. In addition, the opinions of the patients' parents regarding their child's appearance and speech were surveyed. Results indicated that, although most parents reported improvements in their child's speech and appearance, independent raters could not readily discern improvement in any of the four areas studied. The use of videotape recordings to assess improvements in these traits after surgery in children with Down syndrome has not been previously reported.
Plast Reconstr Surg 81 (6): 841-51 (1988 Jun)

Social perceptions of the effects of Down syndrome facial surgery: a school-based study of ratings by normal adolescents

Strauss RP, Mintzker Y, Feuerstein R, Wexler MR, Rand Y
School of Dentistry, University of North Carolina, Chapel Hill

This study examines how 277 normal adolescents from five Israeli schools perceive the Down syndrome face before and after plastic surgery. A seven-point Likert scale was used to rate slides of normal and Down syndrome faces on four dimensions. Down syndrome patients were seen as less attractive, intelligent, good-hearted, and socially appealing than normal individuals. The slides were in nonapparent order and contained preoperative and 1-year postoperative views of eight plastic surgical patients. Paired t tests were used to examine operative changes, and all four dimensions showed overall postoperative improvement (p < 0.001), but case-to-case variation was considerable. A linear relationship was found between change in appearance ratings and change in intelligence ratings. Findings suggest that when improvements in facial appearance are realized, peer normal social perceptions of the Down syndrome child may be enhanced. The relationship between school placement, intellectual level, and surgical decision making is discussed.
Mental Retardation 26 (1): 17-19 (1988 Jan)

Plastic Surgery for Children with Down Syndrome: Normalization or Extremism?

May, Deborah C.
Plast Reconstr Surg 82 (3): 403-8 (1988 Sep)

Changes in Aesthetic Appearance and Intelligibility of Speech after Partial Glossectomy in Patients with Down Syndrome

Klaiman P; Witzel MA; Margar-Bacal F; Munro IR
Department of Speech Pathology, Hospital for Sick Children, Toronto, Ontario, Canada

Eight patients with Down syndrome, aged 9 years and 10 months to 25 years and 4 months, underwent partial glossectomy. Preoperative and postoperative videotaped samples of spoken words and connected speech were randomized and rated by two groups of listeners, only one of which knew of the surgery. Aesthetic appearance of speech or visual acceptability of the patient while speaking was judged from visual information only. Judgments of speech intelligibility were made from the auditory portion of the videotapes. Acceptability and intelligibility also were judged together during audiovisual presentation. Statistical analysis revealed that speech was significantly more acceptable aesthetically after surgery. No significant difference was found in speech intelligibility preoperatively and postoperatively. Ratings did not differ significantly depending on whether the rater knew of the surgery. Analysis of results obtained in various presentation modes revealed that the aesthetics of speech did not significantly affect judgment of intelligibility. Conversely, speech acceptability was greater in the presence of higher levels of intelligibility.
Plast Reconstr Surg 79 (1): 44-9 (1987 Jan)

Speech Intelligibility after Partial Glossectomy in Children with Down's Syndrome

Margar-Bacal, Frances; Witzel, Mary Anne; Munro, Ian R.
Department of Speech Pathology and Department of Plastic Surgery, Hospital for Sick Children, Toronto, Ontario, Canada

Twenty-three children with Down's syndrome, aged between 3.7 and 17.5 years, underwent partial glossectomy for improvement of cosmetic appearance. Improved speech was also expected. Preoperative and postoperative audiotaped samples of spoken words and connected speech on a standardized articulation test were rated by three lay and three expert listeners on a five-point intelligibility scale. Five subjects were eliminated from both tasks and another four from connected-speech testing because of inability to complete the experimental tasks. Statistical analyses of ratings for words in 18 subjects and connected speech in 14 of them revealed no significant difference in acoustic speech intelligibility preoperatively and postoperatively. The findings suggest that a wedge-excision partial glossectomy in children with Down's syndrome does not result in significant improvement in acoustic speech intelligibility; in some patients, however, there may be an aesthetic improvement during speech.
American Journal of Mental Deficiency 91 (4): 328-332 (1987)

Effect of Tongue Reduction on Articulation in Children with Down's Syndrome

Parsons, Carl L.; Iacono, Teresa A.; Rozner, Leo
Lincoln Institute of Health Sciences, School of Communication Disorders, Carlton, Australia

Tongue-reduction surgery was completed on 18 children (aged 5-19.6 yrs) with Down's syndrome. Changes in articulation were evaluated pre- and postoperatively and at a 6-mo follow-up. No significant differences were found in the number of articulation errors, and no significant difference was found when Ss were compared to 9 nonsurgery controls, although parents of all the Ss claimed that speech had improved over the 6-mo time period.
Plastic and Reconstructive Surgery 77 (3): 383-393 (1986 Mar)

Rehabilitation of the face in patients with Down's syndrome

Wexler MR, Peled IJ, Rand Y, Mintzker Y, Feuerstein R

Fifty patients with Down's syndrome underwent surgery for improvement of the facial stigmata. Partial glossectomy, lateral canthoplasty, and nose, cheek, and chin augmentation were the common procedures. With a follow-up of 18 to 24 months, the results were recorded by a multidisciplinary team with similar judgments on the glossectomy, the most satisfactory procedure, and some discrepancy on the other procedures, canthoplasty, and cheek augmentation. There were no infections or extrusion of prostheses, and a rather high incidence of extrusion of prostheses, and a rather high incidence of bone resorption was noted in the mandibular area. The facial changes were satisfactory in the majority of the cases in both medical and nonmedical evaluation and improved self-confidence, especially in the older patients. The satisfactory results here presented advocate certain procedures for attenuation of the Down's syndrome stigmata and improvement of some functions by diminishing the size of the tongue.
J Ment Defic Res30 (1): 71-9 (1986 Mar)

Parents and physicians perceptions of facial plastic surgery in children with Down syndrome

Pueschel SM, Monteiro LA, Erickson M

This study was designed to investigate both parents' and physicians' attitudes and perceptions concerning facial plastic surgery in persons with Down's syndrome. The results of this inquiry revealed that more physicians (63%) than parents (28%) feel that the children's facial features negatively affect their social development; most parents (85%) see their children well accepted by society whereas only 4% of physicians do so; approximately half of the physicians (51%) and parents (41%) thought that after hypothetical facial plastic surgery a child with Down's syndrome may accomplish more socially; the majority of the parents (92%) and physicians (76%) were concerned with the risk of the operation; and only 13% of parents but 44% of physicians indicated that facial plastic surgery should be done on children with Down's syndrome.
Br J Plast Surg 39 (4): 498-504 (1986 Oct)

Fact and fantasy: Pyschological consequences of facial surgery in 24 Down syndrome children

Arndt EM, Lefebvre A, Travis F, Munro IR

Twenty-four children with Down syndrome were evaluated to investigate whether appearance, family functioning and intellectual functioning improved after facial reconstruction. Pre- and postoperatively, families were interviewed by a psychosocial team, the children's intellectual functioning was measured and parents were asked to rate their child's facial appearance on the Hay's Scale and to complete the FACES II, a questionnaire determining family functioning. Parents' ratings were compared with the scores of lay raters who viewed randomly presented pre- and postoperative photographs. Measurements of intelligence and family functioning revealed no postoperative improvement and lay raters considered postoperative appearance as slightly less attractive. However, parents rated their children's appearance as noticeably improved and reported happier personal, family and social lives. Thus, positive psychosocial consequences may largely be the result of parents' satisfaction with surgical results, providing them with hope for the future. Presurgical family assessment to clarify surgical limitations and parental expectations is essential.
Aesthetic Plastic Surgery 9 (4): 241-248 (1985)

Plastic and Aesthetic Surgery on Children with Down's Syndrome

Olbrisch, RR

Since 1978, 300 children with Down's syndrome have received plastic- and aesthetic-surgical corrections of the face-to the tongue, nose, and less frequently, ears and chin-so that they will be less conspicuous. The parents' satisfaction in 95% of the cases indicates that the children's situation has been improved by the operations. The children are less stigmatized and their social integration became easier.
Rehabil Lit 46: 72-7 (1985)

Facial surgery and an active modification approach for children with Down syndrome: Some psychological and ethical issues

Mearig J
Lancet 1 (8337): 1320-3 (1983 June 11)

Facial plastic surgery for Down's syndrome

Rozner, L.
Br J Plast Surg 35 (2): 195-200 (1982 Apr)

Plastic surgical management of children with Down's syndrome: Indications and results

Olbrisch, RR

The face of a child with Down's syndrome is stigmatised by the large tongue, open mouth, saddle nose and epicanthal folds. Operative reduction of macroglossia facilitates nose-breathing, comprehensible speech and eating. Raising the nasal bridge with Cialit-preserved homograft cartilage obliterates the epicanthal folds and conceals the oblique slant of the eyelids. The child should be operated on from the third year onwards.
Plast Reconstr Surg 66 (3): 337-45 (1980 Sep)

Facial plastic surgery in children with Down's syndrome

Lemberle G, Radu D

Six minor corrections in the face of children with Down's syndrome can clearly improve their facial expression. Reduction of macroglossia facilitates phonation. Augmentation of the bridge of the nose effaces the epicanthus. The lid axis, the hypotonic lower lip, and microgenia can be repaired. While the parents have been satisfied with the results of surgery, a positive effect on social behavior and mental development of the children has not yet been proven.
Fortschr Med 97 (34): 1475-7 (1979 Sep 13)

Plastic surgery in mongoloid children

Olbrisch RR

The aim of plastic surgery in children with Down-syndrome is the improvement of speech as well as improvement of cosmetic appearance. Altering the typical mongoloid physiognomy facilitates the integration of these children into the community. In our Department during the past 6 months plastic surgery was performed in 27 children for the correction of macroglossia, saddle nose deformity, epicanthic folds, receding chin, fatty neck and deformity of the ears. Macroglossia was present in every case, the extent of further surgery varies according to the clinical deformity. It is essential to discuss the implications of surgery in these children with the parents in order to avoid later disappointment.
Aesthetic Plast Surg 1: 245 (1977)

Changes in the facial expression as a result of plastic surgery in mongoloid children

Höhler H