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Full Facial Allotransplantation Including the Temporomandibular Joints: A Radiologic and Anatomical Cadaveric Study
Teresa Nunez-Villaveiran1, Vahe Fahradyan1, Edoardo Dalla Pozza1
1From the Department of Plastic Surgery, Cleveland Clinic; Cleveland Clinic Lerner College of Medicine of Case Western Reserve University; Physical Anthropology Laboratory, Cleveland Museum of Natural History; and the Department of Intensive Care, University Hospital "La Paz."
Plastic and Reconstructive Surgery
|May 28, 2020
Summary
Facial allotransplantation including temporomandibular joints (TMJs) is feasible. This procedure may enhance functional outcomes for patients needing facial reconstruction, despite anatomical variability.
Area of Science:
- Oral and Maxillofacial Surgery
- Plastic Surgery
- Anatomical Studies
Background:
- Facial allotransplantation aims to restore form and function.
- Temporomandibular joint (TMJ) involvement is crucial for functional outcomes in facial reconstruction.
- Damage or loss of the TMJ presents significant challenges in face transplant candidates.
Purpose of the Study:
- To assess the technical feasibility of facial allotransplantation incorporating the temporomandibular joints.
- To determine the anatomical variability of the temporomandibular joint, glenoid fossa, and mandible.
- To evaluate the surgical technique for harvesting and preparing TMJ-containing facial allografts.
Main Methods:
- Anatomical measurements of 100 dry skulls and 100 CT scans.
- Vascular dissection in six cadaveric heads.
- Mock transplantation of a four-segment facial allograft in four cadaveric heads.
Main Results:
- Significant variability was observed in TMJ and mandibular dimensions, persisting across demographic groups.
- The temporomandibular joint was successfully harvested utilizing superficial temporal and maxillary artery branches.
- Allograft design facilitated fixation to the recipient skull base, preserving the disc-condyle-fossa relationship.
Conclusions:
- Procurement and transplantation of a TMJ-containing total face allograft is technically feasible.
- This cadaveric model demonstrates the potential for improved functional outcomes in facial allotransplantation.
- Addressing anatomical variability is key to successful TMJ allograft integration.
