Background
Gender-specific anthropometrics, skin texture/adnexae mismatch, and social apprehension have prevented cross-gender facial transplantation from evolving. However, the scarce donor pool and extreme waitlist times are currently suboptimal. Our objective was to: 1) perform and assess cadaveric facial transplantation for each gender-mismatch scenario employing virtual panning with cutting guide fabrication and 2) review the advantages/disadvantages of cross-gender facial transplantation.
Methods
Cross-gender facial transplantation feasibility was evaluated through two mock, double-jaw, Le Fort-based cadaveric allotransplants, including female donor-to-male recipient (T1-FM) and male donor-to-female recipient (T2-MF). Hybrid facial-skeletal relationships were investigated using cephalometric measurements, including sellion-nasion-A point (SNA) and sellion-nasion-B point (SNB) angles, and lower-anterior-facial-height to total-anterior-facial-height ratio (LAFH/TAFH). Donor and recipient cutting guides were designed with virtual planning based on our team’s experience in swine dissections and used to optimize the results.
Results
Skeletal proportions and facial-aesthetic harmony of the transplants [n=2] were found to be equivalent to all reported experimental/clinical gender-matched cases by using custom guides and Mimics technology. Cephalometric measurements are shown in Table 1 relative to Eastman Normal Values.
Conclusions
Based on our results, we believe that cross-gender facial transplantation can offer equivalent, anatomical skeletal outcomes to those of gender-matched pairs using pre-operative planning and custom guides for execution. Lack of literature discussion of cross-gender facial transplantation highlights the general stigmata encompassing the subject. We hypothesize that concerns over gender-specific anthropometrics, skin texture/adnexae disparity, and increased immunological resistance have prevented full acceptance thus far. Advantages include an increased donor pool with expedited reconstruction, as well as size-matched donors.