Dental considerations and the role of prosthodontics and maxillofacial prosthetics in facial transplantation

Plana, Natalie M.; Barbosa, João Malta; Diaz-Siso, J. Rodrigo; Brecht, Lawrence E.; Rodriguez, Eduardo D.

doi:10.1016/j.adaj.2017.09.008

Cited by 19 publications

(23 citation statements)

References 48 publications

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“…Finally, depending on the recipient’s native dentition and the assortment of teeth included in the donor allograft, secondary dental procedures can be planned, including the placement of osseointegrated implants and the extraction of donor teeth as clinically indicated. 8 , 26 , 27 Despite the risks of immunosuppression, dental implants have been safely used with no increased risk compared with the immunocompetent population. 28 …”

Section: Discussionmentioning

confidence: 99%

Enhancing Face Transplant Outcomes: Fundamental Principles of Facial Allograft Revision

Diep

Ramly

Alfonso

et al. 2020

Plastic and Reconstructive Surgery - Global Open

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Background: Facial transplantation (FT) has become a feasible reconstructive solution for patients with devastating facial injuries. Secondary revisions to optimize functional and aesthetic outcomes are to be expected, yet the optimal timing and approach remain to be determined. The purpose of this study was to analyze all facial allograft revisions reported to date, including the senior author’s experience with 3 FTs. Methods: A literature review was performed, with 2 reviewers independently conducting title and abstract screening, followed by a full-text review. All articles mentioning FT revision surgeries were evaluated. The medical records of the senior author’s 3 FT recipients were additionally reviewed. Results: Initially, 721 articles were captured and 37 were included in the final analysis. Thirty-two FTs were reported to have involved posttransplant allograft revisions, with FT recipients undergoing a mean of 4.8 ± 4.6 revision procedures. The mean duration between FT and the first revision procedure was 149 ± 179 days. A wide spectrum of revisions was identified and categorized as involving the soft tissues, craniofacial skeleton, dentition, oronasal cavity, salivary glands, facial nerve, or ocular region. In the senior author’s experience, when indicated, posttransplant occlusal changes and integrity of the donor–recipient intraoral interface were successfully addressed with secondary procedures without allograft compromise or loss. Conclusions: The worldwide experience shows that secondary procedures are nearly ubiquitous after FT and can be safely performed at various timepoints. The authors thereby establish 5 distinct categories of facial allograft revisions and define 7 critical principles to optimize posttransplant procedures.

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Section: Discussionmentioning

confidence: 99%

Enhancing Face Transplant Outcomes: Fundamental Principles of Facial Allograft Revision

Diep

Ramly

Alfonso

et al. 2020

Plastic and Reconstructive Surgery - Global Open

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“…34 Still, a multidisciplinary approach from the start with early involvement of the oral surgery and dental teams can minimize postoperative malocclusion incidence and its sequelae, both cosmetic and functional. 35 Conservative orthodontic treatment may help some cases of malocclusion. Others, however, may require revision surgery with bony osteotomies to correct the bite.…”

Section: Postoperative Considerations and Complicationsmentioning

confidence: 99%

Maxillofacial Bony Considerations in Facial Transplantation

et al. 2021

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Alloplastic facial transplantation has become a new rung on the proverbial reconstructive ladder for severe facial wounds in the past couple of decades. Since the first transfer including bony components in 2006, numerous facial allotransplantations across many countries have been successfully performed, many incorporating multiple bony elements of the face. There are many unique considerations to facial transplantation of bone, however, beyond the considerations of simple soft tissue transfer. Herein, we review the current literature and considerations specific to bony facial transplantation focusing on the pertinent surgical anatomy, preoperative planning needs, intraoperative harvest and inset considerations, and postoperative protocols.

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“…Use of osteomyocutaneous allografts in this setting requires thorough planning and meticulous execution. To improve facial aesthetics and mandibular function, transplantation must not only replace missing or defective mandible; it is also necessary to restore proper spatial relationships between the mandible and other skeletal elements including the midface and skull base [4,7] . Establishing these relationships starts with thoughtful allograft planning based on an understanding of how the skeletal components included in the graft and the locations of osteotomies and osteosyntheses will influence functional outcomes.…”

Section: Introductionmentioning

confidence: 99%

“…Precision in the subsequent steps of allograft harvest and inset is challenging and imperative. In many cases, recipients have endured injuries and reconstructive procedures that can disfigure anatomy and make graft alignment difficult [7,8] . Furthermore, when the recipient's defect warrants an allograft including both the midface and mandible, attachment of the graft is complicated by the paucity of recipient landmarks other than the skull base and the potential for misalignment in three dimensions [4,9] .…”

Section: Introductionmentioning

confidence: 99%

Face transplantation for massive mandibular defects: considerations for allograft design and surgical planning

Palmer¹,

Nelms²

2020

PAR

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Modern face transplant techniques have advanced to allow for the transfer of vascularized skeletal components in addition to overlying soft tissue. This represents significant opportunity for individuals with mandibular defects that are not amenable to traditional reconstruction. Care must be taken when planning and executing transplants with these complex grafts, as satisfactory functional and aesthetic outcomes rely on achieving proper spatial relationships between the mandible, skull base, and midface. Which donor skeletal elements are included in the allograft and how they are harvested are important considerations in this planning and are associated with controversy. To optimize outcomes in the reconstruction of single-jaw defects, some advocate for transplantation of only the affected jaw while others support bimaxillary transplantation. Clinical evidence in this debate is not conclusive at this time. In current practice, including donor dentoalveolar anatomy by utilizing a bilateral sagittal split osteotomy of the mandible is favored to optimize outcomes such as dental occlusion. It has been suggested that harvesting the mandible at the level of the condyle or even the temporal bone may also be possible and may improve temporomandibular joint-related outcomes. Despite encouraging preclinical evidence, these strategies remain controversial. After allograft design, successful mandibular reconstruction with face transplantation relies on surgical precision in the donor and recipient procedures. Computerized surgical planning, computer-aided design and manufacturing, and intraoperative navigation are technologies currently in use to mitigate operative complexity. Results in both cadaveric and clinical face transplantations suggest these technologies are reliable and beneficial, although some room for improvement remains.

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Dental considerations and the role of prosthodontics and maxillofacial prosthetics in facial transplantation

Cited by 19 publications

References 48 publications

Enhancing Face Transplant Outcomes: Fundamental Principles of Facial Allograft Revision

Enhancing Face Transplant Outcomes: Fundamental Principles of Facial Allograft Revision

Maxillofacial Bony Considerations in Facial Transplantation

Face transplantation for massive mandibular defects: considerations for allograft design and surgical planning

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