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Skeletal Changes Five Years Following Osteomyocutaneous Facial Allograft Transplantation
Todd A. Baker, MD; Bahar Bassiri Gharb, MD PhD; Antonio Rampazzo, MD PhD; Kashyap Tadisina, BS; Francis Papay, MD; Maria Siemionow, MD PhD DSc; Risal Djohan, MD
Cleveland Clinic Foundation
2015-03-15
Presenter: Todd A Baker, M.D.
Affidavit:
Steven Bernard
Director Name: Steven Bernard
Author Category: Fellow Plastic Surgery
Presentation Category: Clinical
Abstract Category: Craniomaxillofacial
BACKGROUND- This study evaluates changes to the bone structure of a composite facial allograft under a modified circulatory pattern and immunosuppression.
MATERIALS METHODS- Five-year follow up to subtotal osteomyocutanous facial allograft including: CT facial bones, CT angiogram(CTA) of the neck and bone mineral densitometry(BMD). The pre and postoperative CT images were overlapped for qualitative and quantitative assessment of skeletal changes (Medical Modeling 3D Systems). Laboratory values for metabolic and endocrine function were evaluated.
RESULTS- Patient was 51 year-old asymptomatic female with stability of the LeFort III skeletal allograft component. Five-year CT images revealed fibrous union of all skeletal fixation sites except the right zygomatic arch. Increased bone resorption occurred at osteotomy sites, left infraorbital rim, left maxillary buttress and anterior maxilla. Bone deposition occurred at the septum and alveolar bones. CTA demonstrated segmental absence at the left external carotid artery(ECA) origin with retro-filling of remaining ECA branches with exception of the left lingual artery origin that was distally reopacified. BMD demonstrated spine osteopenia. Labs revealed mild hypoalbuminemia(3.4g/dL) and perimenopausal hormonal CONCLUSIONS-This study is the longest follow-up reported for an osteomyocutaneous facial allograft. Despite numerous patient risk factors for bone resorption, facial allograft osteopenia was only demonstrated at the left infraorbital rim and anterior maxilla and may be explained by the occlusion of the left external carotid system and retrograde revascularization. Bilateral arterial repair is recommended in the event of full-face allotransplantation to maximize normal physiology of the allograft skeletal component.
