Overcoming cross-gender differences and challenges in le fort-based, craniomaxillofacial transplantation with enhanced computer-assisted technology

Chad R. Gordon, Edward W. Swanson, Srinivas M. Susarla, Devin Coon, Erin Rada, Mohammed Al Rakan, Gabriel F. Santiago, Jaimie T. Shores, Steven C. Bonawitz, Elliot K. Fishman, Ryan Murphy, Mehran Armand, Peter Liacouras, Gerald T. Grant, Gerald Brandacher, Wei Ping Andrew Lee

Research output: Contribution to journalArticle

10 Citations (Scopus)

Abstract

BACKGROUND: Sex-specific anthropometrics, skin texture/adnexae mismatch, and social apprehension have prevented cross-gender facial transplantation from evolving. However, the scarce donor pool and extreme waitlist times are currently suboptimal. Our objective was to (1) perform and assess cadaveric facial transplantation for each sex-mismatched scenario using virtual planning with cutting guide fabrication and (2) review the advantages/disadvantages of cross-gender facial transplantation. METHODS: Cross-gender facial transplantation feasibility was evaluated through 2 mock, double-jaw, Le Fort-based cadaveric allotransplants, including female donor-to-male recipient and male donor-to-female recipient. Hybrid facial-skeletal relationships were investigated using cephalometric measurements, including sellion-nasion-A point and sellion-nasion-B point angles, and lower-anterior-facial-height to total-anterior-facial-height ratio. Donor and recipient cutting guides were designed with virtual planning based on our team's experience in swine dissections and used to optimize the results. RESULTS: Skeletal proportions and facial-aesthetic harmony of the transplants (n = 2) were found to be equivalent to all reported experimental/clinical sex-matched cases by using custom guides and Mimics technology. Cephalometric measurements relative to Eastman Normal Values are shown. CONCLUSIONS: On the basis of our results, we believe that cross-gender facial transplantation can offer equivalent, anatomical skeletal outcomes to those of sex-matched pairs using preoperative planning and custom guides for execution. Lack of literature discussion of cross-gender facial transplantation highlights the general stigmata encompassing the subject. We hypothesize that concerns over sex-specific anthropometrics, skin texture/adnexae disparity, and increased immunological resistance have prevented full acceptance thus far. Advantages include an increased donor pool with expedited reconstruction, as well as size-matched donors.

Original languageEnglish (US)
Pages (from-to)421-428
Number of pages8
JournalAnnals of plastic surgery
Volume71
Issue number4
DOIs
StatePublished - Oct 1 2013
Externally publishedYes

Fingerprint

Facial Transplantation
Transplantation
Technology
Cephalometry
Christianity
Skin
Jaw
Esthetics
Dissection
Reference Values
Swine
Transplants

Keywords

  • Craniomaxillofacial
  • Cross-gender
  • Face transplant
  • Intraoperative cutting guide
  • Sex
  • Vascularized composite allotransplantation (VCA)

ASJC Scopus subject areas

  • Surgery

Cite this

Overcoming cross-gender differences and challenges in le fort-based, craniomaxillofacial transplantation with enhanced computer-assisted technology. / Gordon, Chad R.; Swanson, Edward W.; Susarla, Srinivas M.; Coon, Devin; Rada, Erin; Rakan, Mohammed Al; Santiago, Gabriel F.; Shores, Jaimie T.; Bonawitz, Steven C.; Fishman, Elliot K.; Murphy, Ryan; Armand, Mehran; Liacouras, Peter; Grant, Gerald T.; Brandacher, Gerald; Lee, Wei Ping Andrew.

In: Annals of plastic surgery, Vol. 71, No. 4, 01.10.2013, p. 421-428.

Research output: Contribution to journalArticle

Gordon, CR, Swanson, EW, Susarla, SM, Coon, D, Rada, E, Rakan, MA, Santiago, GF, Shores, JT, Bonawitz, SC, Fishman, EK, Murphy, R, Armand, M, Liacouras, P, Grant, GT, Brandacher, G & Lee, WPA 2013, 'Overcoming cross-gender differences and challenges in le fort-based, craniomaxillofacial transplantation with enhanced computer-assisted technology', Annals of plastic surgery, vol. 71, no. 4, pp. 421-428. https://doi.org/10.1097/SAP.0b013e3182a0df45
Gordon, Chad R. ; Swanson, Edward W. ; Susarla, Srinivas M. ; Coon, Devin ; Rada, Erin ; Rakan, Mohammed Al ; Santiago, Gabriel F. ; Shores, Jaimie T. ; Bonawitz, Steven C. ; Fishman, Elliot K. ; Murphy, Ryan ; Armand, Mehran ; Liacouras, Peter ; Grant, Gerald T. ; Brandacher, Gerald ; Lee, Wei Ping Andrew. / Overcoming cross-gender differences and challenges in le fort-based, craniomaxillofacial transplantation with enhanced computer-assisted technology. In: Annals of plastic surgery. 2013 ; Vol. 71, No. 4. pp. 421-428.
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