Best Face Forward

Abstract

Craniofacial vascularized composite allotransplantation is especially challenging when bony components are required. Matching the complex three-dimensional anatomy of the donor and recipient craniofacial skeletons to optimize bony contact and dental occlusion is a time-consuming step in the operating room. Currently, few tools exist to facilitate this process. The authors describe the development of a virtual planning protocol and patient-specific device design to efficiently match the donor and recipient skeletal elements in craniofacial vascularized composite allotransplantation. The protocol was validated in a cadaveric transplant. This innovative planning method allows a "snap-fit" reconstruction using custom surgical guides while maintaining facial height and width and functional occlusion. Postoperative overlay technology in the virtual environment provides an objective outcome analysis.

Virtual Surgical Planning and 3D-Printed Surgical Guides in Facial Allotransplantation

“…VSP and modeling has become routine for many indications including orthognathic surgery and facial allotransplantation over the past decade. 23 24 25 26 27 28…”

Mixed Reality and 3D Printed Models for Planning and Execution of Face Transplantation

“…When combined with cadaveric dissection, 3D printed and digital biomodels of face transplant recipients have been instrumental in facilitating problem-solving and development of operative strategies during live team-based surgical rehearsal. 1,3,4 Upon notification of an available donor, rapid fabrication and assessment of a donor biomodel in tandem with clinical donor evaluation is crucial for the team to manipulate and finalize operative plans. Furthermore, the ability for VCA teams to readily access these models in the operative theater contributes to enhanced communication, operative efficiencies, and intraoperative decision making.…”

“…Facial vascularized composite allotransplantation (VCA) is arguably the most complex form of craniofacial reconstruction. One highly challenging aspect of face transplantation lies in the work of fitting donor and recipient tissues in both size and configuration to provide a functional and aesthetic result 1 . Accurate and rigorous assessment of the recipient's complex bony and soft tissue craniofacial defect is of paramount importance.…”

“…This has resulted in increased predictability and decreased operative time. 1,3,4 These promising technologies have helped to deliver more accurate and precise reconstructions than surgical designs based on traditional 2D modeling.…”

Advanced Three-Dimensional Technologies in Craniofacial Reconstruction

“…Accurate bony contouring and apposition is required for optimal postoperative dental occlusion, speech, mastication, and symmetric facial aesthetics. [50][51][52] This constellation 100e Plastic and Reconstructive Surgery • July 2021 of outcomes in oncology patients affected by various comorbidities results in a narrow margin of error for which modern three-dimensional technologies have been used extensively. 53,54 Free fibula jaw reconstruction, in particular, features multiple comparison studies to conventional surgery that depict three-dimensional technology's value.…”