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Retrieval of a Full Facial Allograft Based on the Maxillary Artery: Indications and Technique
Bahar Bassiri Gharb, Gaby Doumit, Antonio Rampazzo, Frank Papay
Cleveland Clinic Craniofacial Surgery Fellowship
2014-03-09
Presenter: Bahar Bassiri Gharb
Affidavit:
The work represents completely the original effort of the fellow. The preliminary part of this study will be presented at ACPA meeting.
Director Name: Francis Papay
Author Category: Fellow Plastic Surgery
Presentation Category: Basic Science Research
Abstract Category: Craniomaxillofacial
Purpose-This study investigates the vascular territories of the maxillary artery and vein and modify the available craniofacial techniques in order to allow reliable harvest of a facial osteomyocutaneous allograft based on the maxillary vessels.
Methods-Eighteen fresh cadaver heads were used in this study. Ten full facial allografts containing mandible, maxilla, zygomatic and nasal bones were harvested through a traditional Le Fort III approach. In 6 cadaver heads, maxillary artery and internal jugular vein were injected with red and blue latex respectively. In two cadaver heads colored lead oxide gel was injected in the maxillary artery (1) or internal jugular vein (1). A modified Le Fort III approach was designed: the orbital floor osteotomy was performed at the posterior-most aspect of the orbit. The zygomatic arch and mandibular condyle were osteotomized and removed. The pterygomaxillary disjunction was performed under direct vision after excising the temporalis and lateral pterygoid muscles. Eight full facial allografts were harvested through the modified approach. Maxillary artery and vein were dissected to assess for damage during the procurement. CT scans were performed of the specimen injected with lead-oxide.
Results-The modified Le Fort III approach preserved the infraorbital and sphenopalatine arteries and allowed the dissection of the maxillary artery and vein under direct vision.
Conclusions-When a major portion of the facial skeleton is to be harvested along with limited amount of facial soft tissues, the modified Le Fort III approach will allow dissection of the maxillary artery and vein, preserving the main blood supply to the facial skeleton.
