Speech characteristics one year after first Belgian facial transplantation

Facial transplantation has progressed over the past 8 years. We did the first Belgian facial transplantation by vascularized composite tissue allotransplantation and report the 1-year follow-up regarding speech and oromyofunctional behavior.

Outcome study.

The recipient, a 56-year-old man, had his face severely injured due to a ballistic injury. In January 2012, in a 20-hours surgical procedure, a digitally planned facial composite tissue allotransplantation was performed consisting of a large amount of bone together with the soft tissue of the entire lower two-thirds of the face. Speech intelligibility, voice, resonance, articulation, and oromyofunctional behavior were measured 12 months after the transplantation using objective and subjective assessment techniques.

No intraoperative surgical complications occurred, and the postoperative course was uneventful. Survival of the graft was complete, the bony structures-both maxillae and part of the left mandible-and mucosal lining of the nasal cavities and hard palate could all be vascularized by connecting only the facial vessels. Twelve months after transplantation, the speech intelligibility is normal in words, but slightly impaired in sentences due to moderate hypernasality. Two articulation disorders and lip incompetence are present. Facial emotional readability was present but decreased.

Speech outcome, as one of several determinants of feasibility, can be a positive argument when considering the option of facial allotransplantation.