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Full Facial Allotransplantation Including the Temporomandibular Joints: An Anatomical Study and Surgical Protocol

Vahe Fahradyan, MD, Teresa Nunez-Villaveiran, MD, Edoardo Dalla Pozza, MD, Majid Rezaei, DDS, Richard L Drake, PhD, Lyman Jellema, Bahar Bassiri Gharb, MD, PhD, Frank Papay, MD, Antonio Rampazzo, MD
Cleveland Clinic Foundation
2018-03-01

Presenter: Vahe Fahradyan, MD

Affidavit:
I certify that the material proposed for presentation in this abstract has not been published in any scientific journal or previously presented at a major meeting.

Director Name: Bahar Bassiri Gharb, MD, PhD

Author Category: Fellow Plastic Surgery
Presentation Category: Clinical
Abstract Category: Craniomaxillofacial

Introduction: Face allotransplantation shifted the reconstruction paradigm of complex facial defects. Incorporation of temporomandibular joint (TMJ) in total face allotransplant can further improve functional outcome in these patients. The purpose of our study was to develop a surgical protocol of a total face allotransplantation including TMJ.
Methods: 100 skulls and mandibles and 100 facial CT scans were evaluated to characterize the variability of TMJ dimensions. Eight fresh cadavers were injected with red-colored latex and dissected for visualization of the vascular branches entering the TMJ. Four fresh cadavers were used to perform a TMJ-included full face transplantation. Donor allografts were harvested using a Le Fort III approach combined with a bilateral sagittal split osteotomy and temporal craniotomy to include the total TMJ. The allograft was transferred to the recipient's face. TMJs were secured on the zygomatic processes of temporal bones.
Results: Statistically significant difference between genders were observed in all parameters measured on dry skulls except for intercondylar and condyle-symphysis angles. There was a statistically significant difference of frontal ramal inclination between genders in CT measurements. The TMJ received 1-3 direct branches (maximal diameter 0.7-0.8mm) from the maxillary and middle meningeal arteries medially, and the superficial temporal artery laterally. Transplanted TMJs were located more lateral, inferior and anterior compared to their normal anatomical position. Class 1 original donor occlusion was achieved with a normal mandibular range of motion.
Conclusion: To our knowledge, this was the first study demonstrating the technical feasibility of cadaveric TMJ-included full face allograft procurement and transplantation.

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