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Ethical dilemmas in orthognathic surgery involving minors.
Thesis (MPhil)--Stellenbosch University, 2024.
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| Format: | Thesis |
| Language: | English |
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Stellenbosch : Stellenbosch University
2025
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| _version_ | 1867614037987033088 |
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| access_status_str | Open Access |
| author | Beukes, Jureenus Botha |
| author2 | Van Niekerk, Anton A. |
| author_browse | Beukes, Jureenus Botha Van Niekerk, Anton A. |
| author_facet | Van Niekerk, Anton A. Beukes, Jureenus Botha |
| author_sort | Beukes, Jureenus Botha |
| collection | Thesis |
| dc_rights_str_mv | Stellenbosch University |
| description |
Thesis (MPhil)--Stellenbosch University, 2024. |
| format | Thesis |
| id | oai:scholar.sun.ac.za:10019.1/131576 |
| institution | Stellenbosch University (South Africa) |
| language | English |
| last_indexed | 2026-06-10T12:45:40.774Z |
| license_str | Other — see source repository |
| provenance_str_mv | Harvested via OAI-PMH from SUNScholar — Stellenbosch University Repository |
| publishDate | 2025 |
| publishDateRange | 2025 |
| publishDateSort | 2025 |
| publisher | Stellenbosch : Stellenbosch University |
| publisherStr | Stellenbosch : Stellenbosch University |
| record_format | dspace |
| source_str | SUNScholar — Stellenbosch University Repository |
| spelling | oai:scholar.sun.ac.za:10019.1/131576 Ethical dilemmas in orthognathic surgery involving minors. Beukes, Jureenus Botha Van Niekerk, Anton A. Stellenbosch University. Faculty of Arts and Social Sciences. Dept. of Philosophy. Surgeons -- Professional ethics Minors -- Surgery -- Moral and ethical aspects Informed consent (Medical law) UCTD Thesis (MPhil)--Stellenbosch University, 2024. ENGLISH ABSTRACT: The surgical correction of facial deformities is a treatment modality that falls within the field of Oral Maxillofacial Surgery. Such procedures, also known as orthognathic surgery, aim to restore both esthesis and functionality. Except where trauma may be the causative factor of aetiology, most of these patients were born with a specific skeletal facial deformity, or with a genetic malformation that then presents during development. Patients will present with the main complaint of the inability to eat food, or because of aesthetic facial deformities. Correcting such deformities involves a multidisciplinary approach that will include a speech therapist, dietitian, plastic surgeon and possibly a neurosurgeon. The correction of such deformities can be subtle or extremely dramatic. There is usually no concern with obtaining informed consent for correcting major deformities because of the absolute necessity of such procedures. However, the potential problem arises when patients present as minors, under the age of 18 years old, and where the potential outcome is not fully understood by the patient. The cosmetic defect might be minor, but a functional component is the main complaint where mastication is the problem. The problem arises when surgical correction is done and the result is not as expected – either immediately post-surgery, or at some time thereafter. Certainly, the biggest varying factor for the surgeon is the potential growth spurt that the patient may experience in the future. The growth phase in young people may last until the age of 22 years in boys. The initial surgical result may be acceptable, but change over time, e.g. during an enhanced growth phase of the patient, can give rise to an unacceptable outcome in the future. Obtaining informed consent is a very important part in the preparation of the patient for having surgery. The information given by the doctor to the patient regarding consent is not internationally standardised and may differ within the medical fraternity. Information offered to the patient may differ in presentation and outcomes. As part of the outcome explanation, the doctor may use a visual treatment objective (VTO) as a modality, which is a current speculative image of the possible outcome after the surgery. The question posed is what is the role of the visual treatment objective in obtaining informed consent, and should it be used as part of obtaining informed consent from the minor patient? Using this technology creates an outcome expectation in the patient. The question that arises is what is the outcome expectation of the minor patient when the VTO is used? Surgeons are concerned about using this modality as part of informed consent due to the possible inability of a minor to understand its shortcomings. The question also arises, what is “enough” information to present to the patient prior to surgery? Can the fact that the minor’s inability in most cases to internalise information, at least compared to adults, gives the doctor the right not to reveal information, such as presenting the expected visual treatment objective? Considering the long list of possible complications, and where not all complications are mentioned, is it within the physician's right not to objectively show the visuals of the anticipated outcome to the patient? The author is of the opinion that the physician can use good judgement not to pass on certain information if there is a possible deviance between the computerised expected visual outcome and the possible reality. Certainly, the most important complications should not be shied away from, but equally so not all can be presented. It is possible in this situation that certain information, such as the visual treatment objective, may be withheld. The suggestion is made that the professional society that represents oral and maxillofacial surgeons in South Africa should construct a protocol of all the major complications involved in the field of orthognathic surgery and motivate the omission of the use of the visual treatment objective as a modality prior to surgery. AFRIKAANSE OPSOMMING: Die chirurgiese korrigering van gesigsdeformiteite is ‘n behandelingsmodaliteit wat ressorteer in die veld van Kaak-, Gesig- en Mondchirurgie. Sulke prosedures, ook bekend as ortognatiese chirurgie, het ten doel om beide estese asook funksionaliteit te herstel. Behalwe waar trauma die oorsaaklike faktor van etiologie kan wees, is die meeste van hierdie pasiënte met ‘n spesifieke skeletale gesigsmisvormings of met ‘n genetiese misvorming gebore, wat dan tydens ontwikkeling presenteer. Pasiënte sal dan klasiek presenteer met die hoofklagte van die onvermoë om voedsel te eet of weens estetiese gesigsmisvormings. Die korreksie van sulke misvormings behels ‘n multidissiplinêre benadering wat sal insluit ‘n spraakterapeut, dieetkundige, plastiese chirurg en ook moontlik ‘n neurochirurg. Die korreksie van sulke misvormings kan subtiel wees, of uiters dramaties. In die geval van die regstel van dramatiese misvormings is dit gewoonlik nie ‘n bekommernis om ingeligte toestemming te verkry nie weens die absolute noodsaaklikheid van so ‘n prosedure. Die potensiële probleem ontstaan egter met pasiënte wat as minderjariges presenteer – onder die ouderdom van 18 jaar – in welke geval die potensiële uitkoms nie volledig bespreek word nie. Die kosmetiese defek is gering, maar daar bestaan wel ‘n funksionele komponent. Ná chirurgiese regstelling gedoen is, is die eindresultaat onmiddellik post-chirurgies, of een of ander tyd daarna, moontlik nie soos verwag nie. Die grootste wisselende faktor vir die chirurg is moontlik die potensiële vinnige groeispoed wat die spesifieke pasiënt kan ervaar. Jongmense is in ‘n groeifase wat by seuns kan duur tot die ouderdom van 22 jaar. Die aanvanklike chirurgiese resultaat mag dalk aanvanklik aanvaarbaar wees, maar met tyd kan dit in ‘n onaanvaarbare uitkoms verander tydens verdere groei van die pasiënt. Die verkryging van ingeligte toestemming is ‘n kardinale asook uiters belangrike deel in die voorbereiding van die pasiënt vir chirurgie. Die inligting wat voor chirurgie deur die dokter aan pasiënte deurgegee word, is nie internasionaal gestandaardiseer nie en wissel binne die beroep. Inligting wat aan pasiënte oorgedra word, wissel van die voorlegging van komplikasies tot uitkomste. As deel van uitkomsbeskrywing word daar soms gebruik gemaak van ‘n chirurgiese visuele doelwit. Die vraag wat gestel word, is wat is die rol van die chirurgiese visuele behandelingsdoelwit in die verkryging van ingeligte toestemming en moet dit gebruik word as deel van die verkryging van ingeligte toestemming by die minderjarige pasiënt? Deur gebruik te maak van hierdie tegnologie skep dit ‘n uitkomsverwagting by die pasiënt, maar dit sal verseker dat die pasiënt so goed moontlik https://scholar.sun.ac.za vi ingelig sal wees om ‘n besluit te neem. Die vraag ontstaan egter – wat is die verwagtingsperspektief van ‘n minderjarige pasiënt? Tans is chirurge bekommerd om hierdie modaliteit as deel van die verkryging van toestemming te gebruik, en word die vraag al hoe meer gevra of die minderjarige pasiënt die vermoë besit om bogenoemde inligting volledig te verwerk? Die vraag ontstaan ook rakende wat “genoeg” inligting sal wees wat aan die pasiënt gegee moet word? Gee die feit dat die internaliseringsvermoë van die minderjarige in die meerderheid van gevalle minder is as by volwassenes die dokter die reg om inligting nie te openbaar nie, soos die deurgee van die verwagte visuele behandelingsdoelwit? Inaggenome die lang lys van moontlike komplikasies, en in gevalle waar nie alle komplikasies genoem (kan) word nie, is dit binne die geneesheer se reg om nie die beeldmateriaal van die visuele behandelingsdoelwit aan die pasiënt te wys nie? Die gevoel van die skrywer is dat die geneesheer goeie oordeel kan gebruik om wel sekere inligting nie deur te gee nie. Daar moet nie weggeskram word van die oordra van die moontlikste komplikasies nie, maar net soos almal nie genoem kan word nie, is dit moontlik tot die pasiënt se voordeel dat sekere inligting, soos byvoorbeeld die visuele behandelingsdoeltwit, weerhou word. Die voorstel word gemaak dat die professionele vereniging wat kaak-, gesig- en mondchirurge in Suid-Afrika verteenwoordig, ‘n protokol daar moet stel van alle hoë-risiko komplikasies van ortognatiese chirurgie, asook die weglating van die gebruik van die visuele behandelingsdoelwit tydens die bespreking van die ingeligte toestemming moet motiveer. Masters 2025-01-27T14:14:51Z 2025-01-27T14:14:51Z 2024-12 Thesis https://scholar.sun.ac.za/handle/10019.1/131576 en Stellenbosch University xii, 43 pages : illustrations application/pdf Stellenbosch : Stellenbosch University |
| spellingShingle | Surgeons -- Professional ethics Minors -- Surgery -- Moral and ethical aspects Informed consent (Medical law) UCTD Beukes, Jureenus Botha Ethical dilemmas in orthognathic surgery involving minors. |
| title | Ethical dilemmas in orthognathic surgery involving minors. |
| title_full | Ethical dilemmas in orthognathic surgery involving minors. |
| title_fullStr | Ethical dilemmas in orthognathic surgery involving minors. |
| title_full_unstemmed | Ethical dilemmas in orthognathic surgery involving minors. |
| title_short | Ethical dilemmas in orthognathic surgery involving minors. |
| title_sort | ethical dilemmas in orthognathic surgery involving minors |
| topic | Surgeons -- Professional ethics Minors -- Surgery -- Moral and ethical aspects Informed consent (Medical law) UCTD |
| url | https://scholar.sun.ac.za/handle/10019.1/131576 |
| work_keys_str_mv | AT beukesjureenusbotha ethicaldilemmasinorthognathicsurgeryinvolvingminors |