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Restoration of the Donor Face After Facial Allotransplantation: Digital Manufacturing Techniques

Grant, Gerald T. DMD, MS, CAPT, DC, USN*; Liacouras, Peter PhD*; Santiago, Gabriel F. MD; Garcia, Juan R. MA; Al Rakan, Mohammed MD§; Murphy, Ryan MSE; Armand, Mehran PhD; Gordon, Chad R. DO§

doi: 10.1097/SAP.0000000000000189
Transplantation Surgery and Research

Introduction Current protocols for facial transplantation include the mandatory fabrication of an alloplastic “mask” to restore the congruency of the donor site in the setting of “open casket” burial. However, there is currently a paucity of literature describing the current state-of-the-art and available options.

Methods During this study, we identified that most of donor masks are fabricated using conventional methods of impression, molds, silicone, and/or acrylic application by an experienced anaplastologist or maxillofacial prosthetics technician. However, with the recent introduction of several enhanced computer-assisted technologies, our facial transplant team hypothesized that there were areas for improvement with respect to cost and preparation time.

Results The use of digital imaging for virtual surgical manipulation, computer-assisted planning, and prefabricated surgical cutting guides—in the setting of facial transplantation—provided us a novel opportunity for digital design and fabrication of a donor mask. The results shown here demonstrate an acceptable appearance for “open-casket” burial while maintaining donor identity after facial organ recovery.

Conclusions Several newer techniques for fabrication of facial transplant donor masks exist currently and are described within the article. These encompass digital impression, digital design, and additive manufacturing technology.

From the *3D Medical Applications Center, Department of Radiology, and †Department of Otolaryngology, Walter Reed National Military Medical Center, Bethesda; Departments of ‡Art as Applied to Medicine, and §Plastic and Reconstructive Surgery, Johns Hopkins University School of Medicine, Baltimore; and ∥The Johns Hopkins University Applied Physics Laboratory, Laurel, MD.

Received November 24, 2013, and accepted for publication, after revision, February 3, 2014.

Conflicts of interest and sources of funding: Outside funding from various grants were used for a portion of this study. This includes grant support by the American Society of Maxillofacial Surgery’s (2011 ASMS Basic Science Research grant), American Association of Plastic Surgeons (2012–14 Furnas’ Academic Scholar Award), and the Accelerated Translational Incubator Program at Johns Hopkins (funded by the National Institutes of Health).

This publication was made possible by the Johns Hopkins Institute for Clinical and Translational Research (ICTR) which is funded in part by the National Center for Advancing Translational Sciences (NCATS), a component of the National Institutes of Health (NIH), and NIH Roadmap for Medical Research. Its contents are solely the responsibility of the authors and do not necessarily represent the official view of the Johns Hopkins ICTR, NCATS or NIH [NCATS Grant UL1TR000424-06].

The views expressed in this article are those of the authors and do not necessarily reflect the official policy, position, or endorsement of the Department of the Navy, Army, Department of Defense, nor the US Government.

Reprints: Gerald T. Grant, DMD, MS, CAPT, DC, USN, 3D Medical Applications Center, Department of Radiology, Walter Reed National Military Medical Center, 8901 Wisconsin Ave, Bethesda, MD 20889. E-mail:

© 2014 by Lippincott Williams & Wilkins