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New Cadaver Model for Restoration of Temporalis and Masseter Muscle Function After Face Transplantation
Cleveland Clinic Foundation
2012-02-15
Presenter: Michael Yoo
Affidavit:
100%
Director Name: Dr. Steven L. Bernard
Author Category: Chief Resident Plastic Surgery
Presentation Category: Basic Science Research
Abstract Category: Craniomaxillofacial
How does this presentation meet the established conference educational objectives?
This anatomical study presents in great detail, a novel extracranial approach to selectively harvesting a neurovascularly intact composite mandible with temporalis and masseter muscles for restoration of their function. Functional mandible transfers is a new area of exploration in facial transplantation. This research confirms its feasibility in a cadaver model.
How will your presentation be used by practicing physicians in the audience?
The material in this presentation will be applicable to reconstructive and craniofacial surgeons who deal with complex composite facial defects. This study explores anatomical regions of the head and neck which are unfamiliar to most plastic surgeons. Specifically, it presents in anatomical detail the complex anatomy of the skull base in the area of the 3rd division of the trigeminal nerve, the course of the internal maxillary artery and its vascular territories.
Reconstruction of large composite facial defects often fall short of the ideal with current autologous methods. The result of these extreme reconstructive procedures shows an aesthetically compromising mosaic of different tissue types randomly assembled on the face with poor functional outcomes.This shortcoming has led to the introduction of face transplantation as Vascularized Composite Allografts (VCA). In order to truly be considered a success these transplants must have favorable aesthetic and functional outcomes.
The limited centers performing face transplantation thus far have claimed to perform ever greater percentages of a "full face transplant." The majority of these transplants, however, comprised composite midfacial transfers with the main function provided via restoration of the facial nerve. However, restoration of human facial function is much more complex than just facial expression.
This anatomical study used 15 fresh cadaver hemifaces to assess the limits of facial transplantation surgery as it pertains to transferring a neurovascularly intact and potentially functional mandible by preserving both the motor division of the trigeminal nerve and the internal maxillary artery. Specifically, we describe a novel extracranial approach to harvesting a composite mandible with neurovascularly intact temporalis and masseter muscles for restoration of their function. Injection studies were performed to confirm integrity of vascular territories based on the facial and internal maxillary arteries.
We are introducing a new technique in the cadaver model confirming feasibility of harvesting a neurovascularly intact mandible with preserved motor division of the trigeminal nerve and intact temporalis and masseter muscles for restoration of their function.
