TY - JOUR
T1 - Overcoming cross-gender differences and challenges in le fort-based, craniomaxillofacial transplantation with enhanced computer-assisted technology
AU - Gordon, Chad R.
AU - Swanson, Edward W.
AU - Susarla, Srinivas M.
AU - Coon, Devin
AU - Rada, Erin
AU - Rakan, Mohammed Al
AU - Santiago, Gabriel F.
AU - Shores, Jaimie T.
AU - Bonawitz, Steven C.
AU - Fishman, Elliot K.
AU - Murphy, Ryan
AU - Armand, Mehran
AU - Liacouras, Peter
AU - Grant, Gerald T.
AU - Brandacher, Gerald
AU - Lee, Wei Ping Andrew
PY - 2013/10
Y1 - 2013/10
N2 - BACKGROUND: Sex-specific anthropometrics, skin texture/adnexae mismatch, and social apprehension have prevented cross-gender facial transplantation from evolving. However, the scarce donor pool and extreme waitlist times are currently suboptimal. Our objective was to (1) perform and assess cadaveric facial transplantation for each sex-mismatched scenario using virtual planning with cutting guide fabrication and (2) review the advantages/disadvantages of cross-gender facial transplantation. METHODS: Cross-gender facial transplantation feasibility was evaluated through 2 mock, double-jaw, Le Fort-based cadaveric allotransplants, including female donor-to-male recipient and male donor-to-female recipient. Hybrid facial-skeletal relationships were investigated using cephalometric measurements, including sellion-nasion-A point and sellion-nasion-B point angles, and lower-anterior-facial-height to total-anterior-facial-height ratio. Donor and recipient cutting guides were designed with virtual planning based on our team's experience in swine dissections and used to optimize the results. RESULTS: Skeletal proportions and facial-aesthetic harmony of the transplants (n = 2) were found to be equivalent to all reported experimental/clinical sex-matched cases by using custom guides and Mimics technology. Cephalometric measurements relative to Eastman Normal Values are shown. CONCLUSIONS: On the basis of our results, we believe that cross-gender facial transplantation can offer equivalent, anatomical skeletal outcomes to those of sex-matched pairs using preoperative planning and custom guides for execution. Lack of literature discussion of cross-gender facial transplantation highlights the general stigmata encompassing the subject. We hypothesize that concerns over sex-specific anthropometrics, skin texture/adnexae disparity, and increased immunological resistance have prevented full acceptance thus far. Advantages include an increased donor pool with expedited reconstruction, as well as size-matched donors.
AB - BACKGROUND: Sex-specific anthropometrics, skin texture/adnexae mismatch, and social apprehension have prevented cross-gender facial transplantation from evolving. However, the scarce donor pool and extreme waitlist times are currently suboptimal. Our objective was to (1) perform and assess cadaveric facial transplantation for each sex-mismatched scenario using virtual planning with cutting guide fabrication and (2) review the advantages/disadvantages of cross-gender facial transplantation. METHODS: Cross-gender facial transplantation feasibility was evaluated through 2 mock, double-jaw, Le Fort-based cadaveric allotransplants, including female donor-to-male recipient and male donor-to-female recipient. Hybrid facial-skeletal relationships were investigated using cephalometric measurements, including sellion-nasion-A point and sellion-nasion-B point angles, and lower-anterior-facial-height to total-anterior-facial-height ratio. Donor and recipient cutting guides were designed with virtual planning based on our team's experience in swine dissections and used to optimize the results. RESULTS: Skeletal proportions and facial-aesthetic harmony of the transplants (n = 2) were found to be equivalent to all reported experimental/clinical sex-matched cases by using custom guides and Mimics technology. Cephalometric measurements relative to Eastman Normal Values are shown. CONCLUSIONS: On the basis of our results, we believe that cross-gender facial transplantation can offer equivalent, anatomical skeletal outcomes to those of sex-matched pairs using preoperative planning and custom guides for execution. Lack of literature discussion of cross-gender facial transplantation highlights the general stigmata encompassing the subject. We hypothesize that concerns over sex-specific anthropometrics, skin texture/adnexae disparity, and increased immunological resistance have prevented full acceptance thus far. Advantages include an increased donor pool with expedited reconstruction, as well as size-matched donors.
KW - Craniomaxillofacial
KW - Cross-gender
KW - Face transplant
KW - Intraoperative cutting guide
KW - Sex
KW - Vascularized composite allotransplantation (VCA)
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U2 - 10.1097/SAP.0b013e3182a0df45
DO - 10.1097/SAP.0b013e3182a0df45
M3 - Article
C2 - 24025655
AN - SCOPUS:84884704699
SN - 0148-7043
VL - 71
SP - 421
EP - 428
JO - Annals of plastic surgery
JF - Annals of plastic surgery
IS - 4
ER -