Sensory return in relationship with nerve adaption following face transplant: A multicenter cohort study

Sensory recovery is a critical determinant of functional outcomes following face transplant. We evaluated sensory recovery and nerve coaptation in a multi-center approach.

We collected data from 18 face transplant procedures (eleven full and seven partial transplants), across five centers. Surgical nerve coaptation details, number of coaptated trigeminus nerve branches (V1-3), and sensory outcomes using the Weinstein Enhanced Sensory Test (WEST) as well as hot/cold discrimination at two time points: early (T1, median 30 months WEST and median 24 months hot/cold discrimination) and late (T2 and median 109 months) were collected. The Mann-Whitney U test was performed to compare sensory outcomes at T2 between partial and full face transplants.

Nerve grafting was performed in seven cases (five full and two partial face transplants). All transplants achieved pressure sensation, and all but one transplant achieved hot/cold discrimination at T2. Full face transplant recipients achieved improved pressure sensation (median, 90%) compared to partial transplants (median, 74%) at T2 (p=0.051). Hot/cold discrimination showed similar results with greater interpatient variability. Median hot/cold discrimination in the full face group was 85%, whereas the partial face group had a median of 64% (p=0.459).

Full face transplant with extensive nerve coaptation may be associated with better sensory recovery. However, variability in outcomes suggests that factors beyond coaptation number, including nerve grafting techniques and individual patient factors, such as type of injury, influence long-term sensory function. Standardized protocols and further research into nerve regeneration strategies are essential to optimize post-transplant recovery.