Otologic considerations in a full face transplant recipient

Abstract

Facial transplantation provides a functional and aesthetic solution to severe facial disfigurement previously unresolved by conventional reconstruction. Few facial allografts have been ear containing; hence, there is limited knowledge of the postoperative otologic considerations. We describe the case of a 44‐year‐old man who underwent transplantation of the total face, eyelids, ears, scalp, and skeletal subunits in 2015 after an extensive thermal injury. We detail the patient's transition from osseointegrated prosthetic ears to an ear‐containing facial allograft, and describe the unique surgical approach and challenges encountered. Subsequent bilateral revision meatoplasties were performed, which provided relief from stenosis of the external auditory meatus. Laryngoscope, 129:2008–2011, 2019

Special Considerations in Face Transplantation: A Systematic Review

“…20 In 1 case, the patient had over 70 prior reconstructive procedures following substantial thermal injury. 21 As a result, there was extensive scarring and contractures present.…”

“…Because the ears are so susceptible to thermal injury, cases of face transplantation for burn victims often include a recipient in need of an ear-containing allograft. 21 A feared complication is stenosis of the external auditory canal, which can occur postoperatively due to cartilage misalignment. 21 This would then predispose the recipient to development of chronic otitis media and other otologic 21 pathology, such as cerumen impaction and diminished hearing.…”

“…External auditory canal stenosis can be later corrected with meatoplasty. 21 To prevent acute otitis media postoperatively, antibiotic ear drops should be administered. 21 For best cosmetic outcome, the attachment site can be hidden within the conchal bowl once the remnant skin is pulled through the external auditory meatus of the allograft.…”

“…21 To prevent acute otitis media postoperatively, antibiotic ear drops should be administered. 21 For best cosmetic outcome, the attachment site can be hidden within the conchal bowl once the remnant skin is pulled through the external auditory meatus of the allograft. 18 The anastomoses between the posterior auricular and occipital arteries can be used to provide blood supply to the ear allograft subunits.…”

Trasplante facial generalidades

“…De estos casos, 15 corresponden a trauma balístico,10 a quemaduras, 4 a neurofibromatosis, 3 a ataques de animales, 2 a lesiones vasculares, 2 a trauma facial y 1 a secuelas de cáncer y radioterapia 1 . Adicionalmente, en la literatura se ha reportado que concomitante a su patología de base, los pacientes receptores presentan trastornos psiquiátricos, entre los cuales predominan la ansiedad y la depresión, en su mayoría secundarias al aislamiento social y la discriminación 2,3 .…”