Total Eyelid Transplantation in a Face Transplant: Analysis of Postoperative Periorbital Function

Grigos, Maria I.; LeBlanc, Étoile M.; Rifkin, William J.; Kantar, Rami S.; Greenfield, Jason; Diaz-Siso, J. Rodrigo; Rodriguez, Eduardo D.

doi:10.1016/j.jss.2019.07.096

Cited by 10 publications

(9 citation statements)

References 15 publications

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“…23 With prolonged impairment of blinking, the patient may develop exposure keratopathy and corneal scarring, as described in Greenfield et al The correction of the blinking mechanism is vitally important; if left untreated, the patient is at great risk for blindness. 24 Revision procedures may be indicated if complications such as ectropion of the lower lid, canthal dystopia, or lagophthalmos were to arise. 23 If there is persistent ectropion following revisional procedures, topical lubrication and a specialized contact lens may be therapeutic.…”

Section: Ocularmentioning

confidence: 99%

“…An optical facial tracking system can be used preoperatively to determine a baseline and then also at postoperative timepoints to monitor functional improvement. 24 Nerve coaptation and regeneration, specifically of the zygomatic and buccal branches of facial nerve, would also be necessary if underlying musculature and motor function was not preserved. [23][24][25] The supraorbital nerve, zygomaticofacial nerve, and infraorbital nerve (all branches of the trigeminal nerve) are also important for eyelid sensation and appropriate consideration should be given intraoperatively.…”

Section: Ocularmentioning

confidence: 99%

“…24 Nerve coaptation and regeneration, specifically of the zygomatic and buccal branches of facial nerve, would also be necessary if underlying musculature and motor function was not preserved. [23][24][25] The supraorbital nerve, zygomaticofacial nerve, and infraorbital nerve (all branches of the trigeminal nerve) are also important for eyelid sensation and appropriate consideration should be given intraoperatively. 12,23,25,26 Direct coaptation should be attempted to yield the best outcome if recipient nerve function is determined to be impaired through stimulation.…”

Section: Ocularmentioning

confidence: 99%

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Special Considerations in Face Transplantation: A Systematic Review

Shpigel

Othman

Cohn

et al. 2022

Journal of Craniofacial Surgery

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: Vascularized composite allotransplantation of the face is an exceedingly complex procedure, requiring extensive planning and surgical precision in order to successfully manage patients with facial disfigurements. This review aims to present an overview of the salient anatomic considerations in facial transplantation, as well as give attention to unique patient populations and special considerations. A literature review was performed in search of articles pertaining to considerations in facial transplantation using the databases PubMed, Web of Science, and Cochrane. Articles selected for further review included full-text articles with an emphasis on specific anatomic defects and how they were addressed in the transplant process, as well as management of special patient populations undergoing facial transplantation. In total, 19 articles were deemed appropriate for inclusion. The use of computer-assisted technologies for the planning portion of the procedure, as well as intraoperative efficiency, has yielded favorable results and can be considered as part of the operative plan. The ultimate outcome is dependent upon the synchronization of subunits of the allograft and the desired functional outcomes, including osseous, ocular, oral, and otologic considerations. Management of specific pathology and subgroups of patients are critical aspects. Although pediatric face transplantation has not yet been performed, it is a likely a future step in the evolution of this procedure. When performing a face transplantation, many components must be considered pre-, intra-, and post-operatively. This systematic review presents specific anatomic considerations, as well as information about special patient populations within this crosssection of multidisciplinary microsurgery, psychiatry, and transplant immunology.

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Section: Ocularmentioning

confidence: 99%

Section: Ocularmentioning

confidence: 99%

Section: Ocularmentioning

confidence: 99%

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Special Considerations in Face Transplantation: A Systematic Review

Shpigel

Othman

Cohn

et al. 2022

Journal of Craniofacial Surgery

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“…55 Facial tracking technology, video analysis software, and facial surface electromyography have been used to noninvasively track recovery of speech, eyelid function, and facial expression, with results showing at least partial restoration of function after FT and the potential for personalized rehabilitation. [56][57][58] Additionally, objective measures such as timing to tracheostomy decannulation, gastrostomy tube removal and resumption of regular oral diet are important parameters to report for QoL assessment.…”

Section: Quality Of Lifementioning

confidence: 99%

The 2020 Facial Transplantation Update: A 15-Year Compendium

Diep

Berman

Alfonso

et al. 2021

Plastic and Reconstructive Surgery - Global Open

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Summary Over the past 15 years, landmark achievements have established facial transplantation (FT) as a feasible reconstructive option for otherwise irreparable craniofacial defects. However, as the field matures and long-term outcomes begin to emerge, FT teams around the world are now facing new challenges. Data for this review were identified by searches of the PubMed/MEDLINE database from inception through August 2020. All English-language articles pertaining to FT were included. Significant advances in candidate selection, technology, operative technique, posttransplant care, and immunosuppressive management have contributed to the tremendous expansion of the field, culminating in the execution in the past 3 years of 2 facial re-transplantations, and most recently the world’s first successful combined face and double hand transplant in August 2020. Despite these achievements, the allograft donor pool remains limited, with long wait times, requiring surgical experimentation with cross-sex FT. Immunosuppressive management has improved, but significant adverse events continue to be reported. Most recently, the COVID-19 pandemic has placed an unprecedented strain on the healthcare system, with various implications for the practice of reconstructive transplantation. In this article, we provide the most comprehensive and up-to-date FT review, highlighting fundamental lessons learned and recent advancements, while looking toward the challenges ahead. Over the past 15 years, extensive multidisciplinary efforts have been instrumental to the establishment of FT as a feasible reconstructive option. As novel challenges are beginning to emerge, continued collaborative and multispecialty research efforts are needed to further this field.

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“…Of the patients, 28% required revision surgeries involving Le Fort I, III, or mandibular osteotomies. 18,[41][42][43] Reconstitution of cephalometric relationships between the donor craniomaxillofacial skeleton and the recipient's skull base has emerged as an evolving field of active research. 44 With the increased utilization of virtual surgical planning (VSP) techniques, transplantation with confirmation of accurate cephalometric proportions and functional occlusion has become increasingly feasible.…”

Section: Osseous Considerations and Dental Occlusionmentioning

confidence: 99%

Facial Transplantation: Complications, Outcomes, and Long-Term Management Strategies

et al. 2020

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Within the past two decades, vascularized facial composite allotransplantation has evolved into a viable option in the reconstructive surgeons' armamentarium for patients with extensive facial disfigurements. As it has expanded the frontiers of microsurgical reconstructive techniques, facial transplantation has come to garner widespread interest within both the medical community and the general public. The procedure has established itself as an amalgamation of the forefronts of reconstructive microsurgery, immunology, and transplantation science. Therein too lies its complexity as multifaceted scientific developments are met with ethical and social issues. Both patients and physicians are faced with the everlasting challenges of immunosuppression regimens and their inherent complications, long-term aesthetic and functional considerations, the role of revision procedures, and the inevitable psychosocial implications. This article reflects on the medical and surgical advancements in facial transplantation surgery and highlights anticipated future challenges. It aims to encourage discussion regarding anticipated barriers to current practice and suggest future directions as we transition into the next phase of facial allograft transplantation.

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Total Eyelid Transplantation in a Face Transplant: Analysis of Postoperative Periorbital Function

Cited by 10 publications

References 15 publications

Special Considerations in Face Transplantation: A Systematic Review

Special Considerations in Face Transplantation: A Systematic Review

The 2020 Facial Transplantation Update: A 15-Year Compendium

Facial Transplantation: Complications, Outcomes, and Long-Term Management Strategies

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