Outcomes After Tooth-Bearing Maxillomandibular Facial Transplantation: Insights and Lessons Learned

Ramly, Elie P.; Kantar, Rami S.; Diaz-Siso, J. Rodrigo; Alfonso, Allyson R.; Shetye, Pradip R.; Rodriguez, Eduardo D.

doi:10.1016/j.joms.2019.05.011

Cited by 29 publications

(69 citation statements)

References 44 publications

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“…Of the 46 FTs performed to date, 9 have included either the maxilla or mandible in isolation, while 17 have included both, with a varying number of teeth. 21 Malocclusion after jaw-containing FT has been described in at least half of these cases, including 2 of our patients. 21 This has been seen to develop throughout posttransplant recovery, despite a class I occlusion immediately posttransplantation.…”

Section: Discussionmentioning

confidence: 60%

“… 21 Malocclusion after jaw-containing FT has been described in at least half of these cases, including 2 of our patients. 21 This has been seen to develop throughout posttransplant recovery, despite a class I occlusion immediately posttransplantation. 9 , 22 This is thought to be related to the lack of proprioceptive registration and motor tone in the months following transplantation.…”

Section: Discussionmentioning

confidence: 60%

“…4 ). 21 If surgical correction remains necessary, our experience has shown that revisional Le Fort osteotomies can be safely performed with satisfactory outcomes. In an effort to protect the allograft’s vascular pedicles, class III malocclusion in a type 3B FT can be corrected through a LeFort III advancement via the patient’s coronal incision, rather than through a posterior mandibular setback at the bilateral sagittal split osteotomy site (Fig.…”

Section: Discussionmentioning

confidence: 98%

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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: 60%

Section: Discussionmentioning

confidence: 60%

Section: Discussionmentioning

confidence: 98%

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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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“…Early complications also included palate and floor of mouth dehiscence requiring revision, with subsequent appropriate recovery. 28 …”

Section: Resultsmentioning

confidence: 99%

“… 12 , 99 Recipient age has ranged from 19 to 64 years at the time of transplantation. 28 , 37 Significant medical comorbidities have included hepatitis C infection (stable viral loads after alpha-interferon and ribavirin), HIV infection (on highly active antiretroviral therapy, CD4 >400/mL, negative viral load), hypertension, non–insulin-dependent diabetes mellitus, granulomatosis with polyangiitis associated with pyoderma gangrenosum, generalized epilepsy, surgically clipped cerebral aneurysm, glaucoma, cardiac septal hypokinesia on echocardiography, and lower extremity phlebitis. 17 , 32 , 72 , 76 , 83 , 100 Other comorbidities have included a history of alcohol and substance use disorders, smoking history, posttraumatic stress disorder, major depressive disorder, and bipolar disorder.…”

Section: Discussionmentioning

confidence: 99%

Anesthetic Considerations in Facial Transplantation: Experience at NYU Langone Health and Systematic Review

Alfonso

Ramly

Kantar

et al. 2020

Plastic and Reconstructive Surgery - Global Open

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Background: Anesthetic considerations are integral to the success of facial transplantation (FT), yet limited evidence exists to guide quality improvement. This study presents an institutional anesthesia protocol, defines reported anesthetic considerations, and provides a comprehensive update to inform future directions of the field. Methods: An institutional “FT Anesthesia Protocol” was developed and applied to 2 face transplants. A systematic review of 3 databases captured FTs in the peer-reviewed literature up to February 2020. Two reviewers independently screened titles and abstracts to include all clinical articles with FT recipient and/or donor-specific preoperative, intraoperative, and relevant postoperative anesthetic variables. Data charting guided a narrative synthesis, and quantitative synthesis reported variables as median (range). Results: Our institutional experience emphasizes the importance of on-site rehearsals, anticipation of patient-specific anesthetic and resuscitative requirements, and long-term pain management. Systematic search identified 1092 unique records, and 129 met inclusion criteria. Reports of 37 FTs in the literature informed the following anesthetic axes: donor pre- and intraoperative management during facial allograft procurement, recipient perioperative care, immunotherapy, antimicrobial prophylaxis, and pain management. Quantitative synthesis of 30 articles showed a median operative time of 18 hours (range, 9–28) and fluid replacement with 13 L (5–18) of crystalloids, 13 units (0–66) of packed red blood cells, 10 units (0–63) of fresh frozen plasma, and 1 unit (0–9) of platelets. Conclusions: Anesthetic considerations in FT span the continuum of care. Future efforts should guide standard reporting to establish evidence-based strategies that promote quality improvement and patient safety.

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Transplantation Medicine

Sharon¹,

Laryea²,

Yarom³

2021

Burket's Oral Medicine

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Outcomes After Tooth-Bearing Maxillomandibular Facial Transplantation: Insights and Lessons Learned

Cited by 29 publications

References 44 publications

Enhancing Face Transplant Outcomes: Fundamental Principles of Facial Allograft Revision

Enhancing Face Transplant Outcomes: Fundamental Principles of Facial Allograft Revision

Anesthetic Considerations in Facial Transplantation: Experience at NYU Langone Health and Systematic Review

Transplantation Medicine

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