Ancillary Procedures Necessary for Translational Research in Experimental Craniomaxillofacial Surgery

Abstract

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's 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 peri-operative management and animal safety related to experimental craniomaxillofacial surgical procedures such as orthotopic, maxillofacial transplantation. Methods Miniature swine (n=9) were used to investigate peri-operative airway management, methods for providing nutrition, and long-dwelling intravenous access. Flap perfusion using near-infrared laser angiography and facial nerve assessment with EMG were explored. Results Bivona(R) tracheostomy was deemed appropriate versus Shiley since soft, wire-reinforced tubing reduced the incidence of tracheal necrosis. PEG tube, as opposed to esophagostomy, provided a reliable route for post-operative 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 EMG 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. Conclusion Face-jaw-teeth transplantation in swine is a complicated procedure which 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 of dislodgement. A reliable veterinarian team is invaluable and critical for long-term success.

Successful management of the supraclavicular artery island flap combined with a sternohyoid muscle flap for hypopharyngeal and laryngeal reconstruction

“…More recently, the use of the supraclavicular fasciocutaneous flap has been described for reconstructing a variety of head and neck defects, including pharyngeal, oral cavity, parotid, lateral skull base, and cutaneous defects. [13–15] This flap has been shown to be well tolerated by the patient, with minimal donor-site morbidity and good viability at the recipient site. [16]…”

Modeling the biomechanics of swine mastication – An inverse dynamics approach

“…Understanding the similarities and differences in kinematics and kinetics between human and swine mastication can aid in better large-animal translational FJTT studies, which are warranted to improve outcomes and allow pre-clinical development of computer-assisted technologies for such surgeries (Al Rakan et al, 2014, Santiago et al, 2014). Among the similarities between swine and human mastication are both the range and profiles of condylar motion (Hannam et al, 2008).…”

“…Previous studies have identified swine as having analogous facial skeletal structures and actions of mastication compared to humans. Therefore, these characteristics make swine the ideal candidate for translational investigation of FJTT (Al Rakan et al, 2014; Farkas et al, 1976; Farkas et al, 1977; Papadaki et al, 2010; Santiago et al, 2014; Strom et al, 1986). However, further understanding of swine mastication and improved opportunities for translating the swine FJTT model to humans requires reliable models of swine jaw biomechanics (Hannam 2011).…”

Computer-assisted, Le Fort-based, face–jaw–teeth transplantation: a pilot study on system feasiblity and translational assessment

“…The pre-clinical CAPE system was initially developed and tested on swine (both cadaveric and live), without incorporating human anatomy from 3D plastic models or cadavers [19,20,23]. As such, this paper addresses the translational capabilities of the CAPE system as applied to human anatomy through mock transplants performed on human plastic models and a single-human cadaver transplant.…”