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

doi:10.1016/0007-1226(82)90163-1

British Journal of Plastic Surgery

Volume 35, Issue 2, April 1982, Pages 195-200

https://doi.org/10.1016/0007-1226(82)90163-1 Get rights and content

Abstract

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.

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Cited by (37)

Selected Complex Malformations that Frequently Require Maxillofacial Reconstruction: Evaluation & Treatment
2013, Orthognathic Surgery: Principles and Practice
New modification of Reynwald macroglossia reduction
2011, Otolaryngologia Polska
Macroglossia usually occurs as isolated malformation, however it can coexist with some of the hereditary defect. Enlargement of the tongue can cause cosmetic and functional difficulties.
The aim of this paper was to analyzed patients with macroglossia operated with own modified Reynwald method. It was based on analysis of surgical treatment and rehabilitation of patients with: Down syndrome, oral-facial-digital syndrome and cerebral palsy, treated at the Department of Plastic, Reconstructive and Aesthetic Surgery, Medical University of Lodz.
63 patients (32 females and 31 males) with Down syndrome (60), oral-facial-digital syndrome (2) and cerebral palsy (1) were operated at the Department of Plastic, Reconstructive and Aesthetic Surgery, Medical University of Lodz, because of hypertrophy of the tongue. 42 patients were operated with partial resection of macroglossia, 2 of them with additional correction of the tongue border and 21 patients with own modified Reynwald method.
Postoperative treatment was non-complicated in all the patients. Early and long-lasting postoperative results were regard as satisfactory, and lead to improvement of basic physiological functions.
- 1.
  3–6 years are the optimal age to partial macroglossia reduction.
- 2.
  Analyze of surgical macroglossia treatment showed effectiveness of methods based on partial resection of tongue. Surgical treatment with own modified Reynwald method lead to increase of number of satisfied postoperative results.
- 3.
  Partial resection of macroglossia influence on patients look, integration and environment acceptance; in children with deep retardation it simplify nursing.
Orthognathic surgery for mentally retarded patients
1991, Oral Surgery, Oral Medicine, Oral Pathology
Downs Syndrome and congenital heart erects part 1: anatomical end functional anomalies, prognosis and treatment
1991, Intensive Care Nursing
Elevated concentrations of elements and abnormalities of neuromuscular junctions in tongue muscles of Down's syndrome
1987, Journal of the Neurological Sciences
X-ray spectrometry was used to measure the concentrations of calcium, iron, copper and zinc in tongue muscles from patients with Down's syndrome (DS) undergoing partial glossectomy. Similar measurements on samples from autopsies served as controls. Electron microscopy was used to examine neuromuscular junctions. The calcium and copper were significantly elevated and correlated in DS while the iron and zinc showed little change. The copper increase is probably connected with the known high level of Zn-Cu superoxide dismutase (SOD), coded for by chromosome 21. (In DS there is a trisomy 21.) The excess of SOD may interfere with free radicals needed for excitation-contraction coupling and may be instrumental in damaging junctional membranes. The high calcium may result from such membrane damage. It is suggested that neuromuscular junction pathology, either genetic or free radical induced, may cause the tongue weakness in DS.
Fact and fantasy: psychosocial consequences of facial surgery in 24 Down syndrome children
1986, British Journal of Plastic Surgery
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.

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

Abstract

British Journal of Plastic Surgery

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

Aesthetic Plastic Surgery

Facial plastic surgery in children with Down's syndrome

Plastic and Reconstructive Surgery