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Occlusal and Dental Outcomes Following Facial Allotransplantation

Coombs, Demetrius M. MD; Tuncer, Fatma Betul MD; Gharb, Bahar Bassiri MD, PhD; Djohan, Risal MD; Gastman, Brian MD; Bernard, Steven MD; Hendrickson, Mark F. MD; Schwarz, Graham S. MD; Gurunluoglu, Raffi MD, PhD; Siemionow, Maria MD, PhD; Papay, Francis A. MD; Rampazzo, Antonio MD, PhD

Plastic and Reconstructive Surgery - Global Open: August 2019 - Volume 7 - Issue 8S-1 - p 64
doi: 10.1097/01.GOX.0000584576.48658.ff
Craniofacial Abstracts
Open

The Cleveland Clinic, Cleveland, OH

This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial-No Derivatives License 4.0 (CCBY-NC-ND), where it is permissible to download and share the work provided it is properly cited. The work cannot be changed in any way or used commercially without permission from the journal.

INTRODUCTION AND OBJECTIVES: Most of the literature surrounding face transplantation focuses on immunology, function, and psychology. Dental and orthognathic outcomes remain persistently underreported. This study sought to review the worldwide face transplant experience and, for the first time, evaluate dental, orthognathic, and skeletal outcomes.

MATERIALS AND METHODS: All composite allografts containing maxilla and/or mandible with alveolus were examined, and dental and orthognathic complications were recorded. Clinical photographs, radiographs, and/or computerized tomography scans from the literature were analyzed using Angle’s classification, cephalometrics, and facial profile angles. The most recent orthognathic outcomes of our 3 facial transplant patients are also presented.

RESULTS: The worldwide experience consists of 45 face transplantations; 25 patients received allografts containing maxilla or mandible, and 16 (64%) involved double jaw. All documented patients had ≥1 dental/occlusal complication: temporomandibular joint ankylosis (9/25, 36%), dental caries and extractions (32%), palatal fistula (28%), Angle class II malocclusion (24%), class III (12%), open bite (20%), maxillary rotation (8%), skeletal nonunion (8%), and hardware infection (4%); 28% of patients underwent revision surgeries involving LeFort I, III, or mandibular osteotomies. Imaging conducive to Angle, cephalometric, or facial profile angle analysis was available in 100% (7) of reported maxilla and 63% (10) of double jaw transplants. The majority of maxilla-only transplants had insufficient teeth, whereas soft tissue profile was most commonly class II. Double jaws were equally Angle class I, II, or III, but mostly class I or class III with regard to facial angle profile. All of our patients have received maxilla and/or mandible, and all have required dental extractions. Angle classification, cephalometrics, and facial profile angles vary across our patients, whereas class III soft tissue facial profile seems to predominate.

CONCLUSION: Dental and orthognathic complications remain extremely common but underreported after facial allotransplantation involving either single or double jaw composites. In fact, every documented face transplant has ≥1 occlusal or skeletal defect. The risk of malocclusion increases with simultaneous transplantation of maxilla and mandible and often necessitates revision surgery in this unique population. Craniofacial principles and advanced surgical planning should be utilized to achieve facial balance. Additionally, we must standardize the way in which face transplant patients are presented in the literature.

Copyright © 2019 The Authors. Published by Wolters Kluwer Health, Inc. on behalf of The American Society of Plastic Surgeons. All rights reserved.