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Ancillary procedures necessary for translational research in experimental craniomaxillofacial surgery
Mohammed Al-Rakan1, Jaimie T Shores, Steve Bonawitz
1*Department of Plastic & Reconstructive Surgery, Johns Hopkins University School of Medicine; Departments of †Otolaryngology-Head & Neck Surgery and ‡Radiology, 3D Medical Applications Center, Naval Postgraduate Dental School, Walter Reed National Military Medical Center, Bethesda; §Robotics and Autonomy Group, Research and Engineering Development Department, The Johns Hopkins University Applied Physics Laboratory, Laurel; ∥Laboratory for Computational Sensing & Robotics, Johns Hopkins University; and Departments of ¶Molecular and Comparative Pathobiology and #Surgery, Johns Hopkins University School of Medicine, Baltimore, MD.
Introduction:
Swine are often regarded as having analogous facial skeletons to humans and therefore serve as an ideal animal model for translational investigation. However, there is a dearth of literature describing the pertinent ancillary procedures required for craniomaxillofacial research. With this in mind, our objective was to evaluate all necessary procedures required for perioperative management and animal safety related to experimental craniomaxillofacial surgical procedures such as orthotopic, maxillofacial transplantation.
Methods:
Miniature swine (n = 9) were used to investigate perioperative airway management, methods for providing nutrition, and long-dwelling intravenous access. Flap perfusion using near-infrared laser angiography and facial nerve assessment with electromyoneurography were explored.
Results:
Bivona tracheostomy was deemed appropriate versus Shiley because soft, wire-reinforced tubing reduced the incidence of tracheal necrosis. Percutaneous endoscopic gastrostomy tube, as opposed to esophagostomy, provided a reliable route for postoperative feeding. Femoral venous access with dorsal tunneling proved to be an ideal option being far from pertinent neck vessels. Laser angiography was beneficial for real-time evaluation of graft perfusion. Facial electromyoneurography techniques for tracing capture were found most optimal using percutaneous leads near the oral commissure.Experience shows that ancillary procedures are critical, and malpositioning of devices may lead to irreversible sequelae with premature animal death.
Conclusions:
Face-jaw-teeth transplantation in swine is a complicated procedure that demands special attention to airway, feeding, and intravascular access. It is critical that each ancillary procedure be performed by a dedicated team familiar with relevant anatomy and protocol. Emphasis should be placed on secure skin-level fixation for all tube/lines to minimize risk for dislodgement. A reliable veterinarian team is invaluable and critical for long-term success.
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