Total face, double jaw, and tongue transplant simulation:  a cadaveric study using computer-assisted techniques.
BACKGROUND
With the transplantation of more extensive facial vascularized composite allografts, fundamental craniofacial and aesthetic principles become increasingly important. In addition, computer-assisted planning and intraoperative navigation may improve precision and efficiency in these complex procedures.


METHODS
Ten mock face transplants were performed in 20 cadavers. The vascularized composite allograft consisted of all facial skin, mimetic muscles, the tongue, the midface by means of a Le Fort III osteotomy, and the mandible by means of sagittal split osteotomies. Craniofacial computed tomographic scans were obtained before and after the mock transplants. Surgical planning software was used to virtually plan the osteotomies, and a surgical navigation system guided the osteotomies intraoperatively. Cephalometric analyses were compared between the virtually planned transplants and the actual postoperative results.


RESULTS
The combination of preoperative computerized planning and intraoperative guidance consistently produced a vascularized composite allograft that could be easily fixated to the prepared recipient, with only minimal burring of osteotomy sites necessary. Satisfactory occlusion was maintained, and postoperative computed tomography confirmed accurate skeletal fixation. Insignificant differences with regard to cephalometric analyses were noted when predicted and actual postoperative data were compared.


CONCLUSIONS
The authors' experience treating severe craniofacial injury allowed consistent transfer of facial vascularized composite allografts, maintaining proper occlusion. Preoperative computer planning and intraoperative navigation ensured precise osteotomies and a good donor-recipient skeletal match, which greatly reduced the need for intraoperative adjustments and manipulation. This total facial vascularized composite allograft represents one of the most extensive described and is intended to represent a typical central facial demolition pattern.
Baltimore, Md. From the Division of Plastic Surgery, R Adams Cowley Shock Trauma Center, University of Maryland School of Medicine.
Emile N
EN
Brown
Amir H
AH
Dorafshar
Branko
B
Bojovic
Michael R
MR
Christy
Daniel E
DE
Borsuk
T Nicole
TN
Kelley
Cynthia K
CK
Shaffer
Eduardo D
ED
Rodriguez
D002102:Cadaver; D002508:Cephalometry / Q000379:methods; D054445:Facial Transplantation / Q000379:methods*; D000071938:Fasciotomy; D006801:Humans; D021621:Imaging, Three-Dimensional; D056948:Orthognathic Surgical Procedures; D010027:Osteotomy / Q000379:methods; D019651:Plastic Surgery Procedures / Q000379:methods; D012680:Sensitivity and Specificity; D016038:Skin Transplantation / Q000379:methods; D025321:Surgery, Computer-Assisted / Q000379:methods*; D014059:Tongue / Q000601:surgery*; D014184:Transplantation, Homologous; D014584:User-Computer Interface