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Total Face, Double Jaw, and Tongue Transplantation: An Evolutionary Concept

Dorafshar, Amir H. M.B.Ch.B.; Bojovic, Branko M.D.; Christy, Michael R. M.D.; Borsuk, Daniel E. M.D., M.B.A.; Iliff, Nicholas T. M.D.; Brown, Emile N. M.D.; Shaffer, Cynthia K. M.S., M.B.A.; Kelley, T. Nicole M.S., C.R.N.P.; Kukuruga, Debra L. Ph.D., D.(A.B.H.I.); Barth, Rolf N. M.D.; Bartlett, Stephen T. M.D.; Rodriguez, Eduardo D. M.D., D.D.S.

Plastic & Reconstructive Surgery: February 2013 - Volume 131 - Issue 2 - p 241–251
doi: 10.1097/PRS.0b013e3182789d38
Reconstructive: Head and Neck: Original Articles

Background: The central face high-energy avulsive injury has been frequently encountered and predictably managed at the R Adams Cowley Shock Trauma Center. However, despite significant surgical advances and multiple surgical procedures, the ultimate outcome continues to reveal an inanimate, insensate, and suboptimal aesthetic result.

Methods: To effectively address this challenging deformity, a comprehensive multidisciplinary approach was devised. The strategy involved the foundation of a basic science laboratory, the cultivation of a supportive institutional clinical environment, the innovative application of technologies, cadaveric simulations, a real-time clinical rehearsal, and an informed and willing recipient who had the characteristic deformity.

Results: After institutional review board and organ procurement organization approval, a total face, double jaw, and tongue transplantation was performed on a 37-year-old man with a central face high-energy avulsive ballistic injury.

Conclusions: This facial transplant represents the most comprehensive transplant performed to date. Through a systematic approach and clinical adherence to fundamental principles of aesthetic surgery, craniofacial surgery, and microsurgery and the innovative application of technologies, restoration of human appearance and function for individuals with a devastating composite disfigurement is now a reality.

CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, V.

Baltimore, Md.

From the R Adams Cowley Shock Trauma Center, University of Maryland Medical Center, University of Maryland School of Medicine.

Received for publication July 24, 2012; accepted August 17, 2012.

Disclosure: The authors have no financial interest in any of the products, devices, or drugs mentioned in this article.

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Eduardo D. Rodriguez, M.D., D.D.S.; R Adams Cowley Shock Trauma Center, University of Maryland School of Medicine, 22 South Greene Street, Baltimore, Md. 21201, erodriguez@umm.edu

©2013American Society of Plastic Surgeons