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Watershed Areas in Facial Artery Based Face Transplantation
Kashyap Komarraju Tadisina BS, Bahar Bassiri Gharb MD PhD, Antonio Rampazzo MD PhD, Gaby Doumit MD MSc, Todd Baker MD , Risal Djohan MD, Francis Papay MD
Cleveland Clinic
2015-03-15
Presenter: Kashyap Komarraju Tadisina
Affidavit:
This abstract has not been published in any scientific journal or previously presented at a major meeting. This project represents the original work of the authors.
Director Name: Steven Bernard
Author Category: Medical Student
Presentation Category: Clinical
Abstract Category: Craniomaxillofacial
Introduction:
The facial artery is the most commonly used blood supply for facial allotransplantation. In this procedure, however, delayed palate necrosis and oronasal fistulas have been reported. The aim of this study was to define the watershed areas of the facial artery in face transplantation and explore the feasibility of harvesting the allograft based on the maxillary artery.
Methods:
A literature review was performed to evaluate the presence of partial allograft necrosis, palate necrosis, and oronasal fistulas following face transplantation. Ten cadaver heads underwent LeFort III face allograft harvesting to examine vascular integrity of the maxillary artery. Six cadaver heads were injected with latex to evaluate the extent of maxillary artery perfusion. A modified Le Fort III technique was designed and executed in 3 additional cadaveric heads.
Results:
Six of 34 cases reviewed (18%) reported oronasal fistulas. Two cases required surgical correction and three reported obturator placement. Traditional LeFort III technique resulted in injury of the sphenopalatine artery (SPA), infraorbital artery (IOA), and pterygoid plexus veins. Maxillary artery injection showed successful perfusion of the maxilla, zygoma, and nasal cavities. Preservation of the maxillary artery was feasible through the modified Le Fort III
approach.
Conclusion:
Facial artery based allografts containing a Le Fort III bone component can experience compromised posterior palate perfusion. An alternate LeFort III technique is recommended to preserve the maxillary artery in select cases of facial allotransplantation.
