Ethical Implications of Cleft Lip and Palate Repair in Patients with Trisomy 13 and Trisomy 18.

Autor:	Appel R; Division of Plastic Surgery, Department of Surgery, Texas Children's Hospital, Houston, TX, USA.; Division of Plastic Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, TX, USA., Grush AE; Division of Plastic Surgery, Department of Surgery, Texas Children's Hospital, Houston, TX, USA.; Division of Plastic Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, TX, USA., Upadhyaya RM; Division of Plastic Surgery, Department of Surgery, Texas Children's Hospital, Houston, TX, USA.; Division of Plastic Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, TX, USA., Mann DG; Department of Pediatric Anesthesiology, Perioperative, and Pain Medicine, Clinical Ethics, Texas Children's Hospital, Baylor College of Medicine, 6621 Fannin Street, Suite A3300, Houston, TX 77030, USA., Buchanan EP; Division of Plastic Surgery, Department of Surgery, Texas Children's Hospital, Houston, TX, USA.; Division of Plastic Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, TX, USA.
Jazyk:	angličtina
Zdroj:	The Cleft palate-craniofacial journal : official publication of the American Cleft Palate-Craniofacial Association [Cleft Palate Craniofac J] 2024 Aug; Vol. 61 (8), pp. 1383-1388. Date of Electronic Publication: 2023 Mar 21.
DOI:	10.1177/10556656231163722
Abstrakt:	Background: Children born with Trisomy 13 or 18 (T13/18) often have multiple congenital anomalies, many of which drastically shorten their lifespan. Among these defects are cleft lip and palate, the repair of which presents an ethical dilemma to the surgeon given the underlying comorbidities associated with T13/18. The authors present an ethical discussion and institutional experience in navigating this dilemma. Methods: The authors analyzed existing literature on T13 and T18 surgery and mortality. A retrospective study over ten years was also conducted to identify pediatric patients who underwent surgical correction of cleft lip and/or palate secondary to a confirmed diagnosis of T13/18. The authors identified two patients and examined their treatment course. Results: The authors' review of literature coupled with their institution's experience builds on the published successes of correcting cleft lip and palate in the setting of T13/18. It was found that both patients identified in the case series underwent successful correction with no surgical complications. Conclusion: A careful balance must be struck between improved quality of life, benefits of treatment, and risks of surgery in children with T13/T18. Careful consideration should be given to the medical status of these complex patients. If the remaining medical comorbidities are well managed and under control, there is an ethical precedent for performing cleft lip and palate surgeries on these children. A diagnosis of T13/T18 alone is not enough to disqualify patients from cleft lip/palate surgery. Competing Interests: Conflict of InterestThe authors have no conflicts of interest to disclose.
Databáze:	MEDLINE
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