Craniofacial Surgery in Children With Down Syndrome: A 6-decade Scoping Review.

BACKGROUND

Children with Down syndrome often present with craniofacial anomalies, some of which may be addressed through early surgical interventions. Unfortunately, there is limited guidance on considerations surrounding these procedures. This study aimed to examine craniofacial procedures across different countries, highlighting geographic variations and the availability of interventions and guidelines regarding craniofacial aspects of care for children with Down syndrome.

METHODS

PubMed, Web of Science, and African Journals OnLine were searched from January 1, 1960, to March 31, 2024. Eligible studies reported elective craniofacial surgical, dental, or orthodontic interventions in pediatric Down syndrome patients and included at least 1 age statistic.

RESULTS

The 92 eligible studies comprised 2815 procedures. The United States contributed the largest number of procedures (1727, 61.4%), followed by Canada (345, 12.3%) and Germany (226, 8.0%). No recorded procedures were performed within Africa or South Asia. Globally, the mean ages of patients (in years) at the time of surgery, along with SD and coefficient of variation, were as follows: palatal plate therapy, 2.2 (3.1) (141.4%); tonsillectomy, 5.5 (3.9) (70.6%); extraocular muscle realignment, 6.9 (4.4) (63.5%); mastoidectomy, 10.1 (4.3) (42.7%); glossectomy, 10.0 (3.5) (35.1%); and hypoglossal nerve stimulator implantation, 14.8 (3.1) (21.2%). Although no established craniofacial guidelines were identified, 4 algorithms addressing craniofacial aspects of care were found.

CONCLUSIONS

To address this gap, we propose the development of preliminary craniofacial care guidelines for children with Down syndrome, prioritizing early screening measures to facilitate timely access to reconstructive care. Subsequent studies will be essential to validate and refine these guidelines.