Facial Transplantation

Abstract

The face has functional and aesthetic importance. It represents the most identifiable aspect of an individual's physical being. Its role in a person's identity and ability to communicate can therefore not be overstated. The face also plays an important role in certain functional needs such as speech, communicative competence, eye protection, and emotional expressiveness. The latter function bears significant social and psychological import, because two thirds of our communication takes place through nonverbal facial expressions. Accordingly, the significance of reconstruction of the face is indisputable. Yet despite application of meticulous techniques and the development of innovative approaches, full functional and aesthetic reconstruction of the face remains challenging. This is because optimal reconstruction of specialized units of the face have to address both the functional and aesthetic roles of the face.

Long-Term Survival of Composite Hemiface/Mandible/Tongue Allografts Correlates With Multilineage Chimerism Development in the Lymphoid and Myeloid Compartments of Recipients

“…Limitations of classical microsurgical reconstruction of orofacial deficits include (1) difficulty to match skin quality and color; (2) lack of tissues resembling oral lining of cheek and oral mucosa; and (3) lack of spare, intraoral mobile structures such as tongue and pharyngeal musculature (5). For these reasons, application of composite tissue allografts (CTAs) for complex orofacial reconstruction would maximize the aesthetic and functional outcomes (5)(6)(7)(8)(9)(10). CTA may be considered for these multitissue reconstructions because of development of modern immunosuppressive agents, applied in clinical cases of hand and face transplants (11,12).…”

Tongue Transplantation

“…Freedom from immunosuppression can only be achieved by inducing mixed chimerism and allograft tolerance. Her work suggests that the inclusion of donor allograft containing lymphoid and vascularized bone marrow may be the key to developing and maintaining donorspecific chimerism [21,28,29]. The previously described full face, double jaw, and tongue transplant included vascularized bone marrow within the mandible and may offer additional insight into the development of donor tolerance [24].…”

Manipulating Stress Receptor Signaling to Enhance Immunosuppression and Prolong Survival of Vascularized Composite Tissue

“…This difficult situation has generated interest in testing new transplant protocols using body parts from cadaveric donors in a procedure known as vascularized composite tissue allotransplantation (VCA). With more than 90 patients receiving VCA over the past decade, this novel transplantation is raising hope for patients with devastating deformities and complex tissue defects [4][5][6][7] . In large part, these successes have been achieved both by improved microsurgical techniques (e.g., anastomoses of vessels and nerves) and the use of large doses of potent pharmacological agents to induce immunosuppression, including cyclosporine A, tacrolimus and mycophenolic acid [8][9][10][11] .…”