title: Craniofacial principles in face transplantation.
abstract: BACKGROUND
  Face transplantation allows the reconstruction of the previously nonreconstructible injury. Anthropometric landmarks are fixated to corresponding cephalometric landmarks to restore function and appearance, with emphasis on phonation, mastication, and functional upper airway. Currently, only a few face transplantations have been performed worldwide. A portion of these reconstructions involves combinations of hard and soft tissues of the midface.
  
  
  METHODS
  Craniofacial and orthognathic considerations should be emphasized for functional effect in the planning and execution of face transplants that include both bone and soft tissue elements. These steps are taken to restore normal anatomy by fixating the midface into proper relationship with the skull base. Traditional orthognathic planning, using cephalometric parameters, often involves a line through sella and nasion as a reference for the skull base. Intraoperatively though, without a cephalograph, the sella-nasion plane is not accessible as a reference point.
  
  
  RESULTS
  Postoperative analysis of our first face transplant recipient revealed that the Frankfort horizontal plane can alternatively serve as an accessible skull base reference point to guide the positioning of the midface. We have developed a technique to ensure fixation of the midface donor allograft in a proper functional relationship with the skull base, within 1 SD of Bolton normative data.
  
  
  CONCLUSIONS
  "Reverse craniofacial planning" allows for precise fixation of the hard tissue components of the face transplant in relation to the skull base, as opposed to a "best fit" approach. We believe that this relationship results in the most anatomical restoration of occlusion, speech, and airway function.
authors.affiliation: Division of Plastic Surgery, Brigham and Women's Hospital/Harvard Medical School, Boston, Massachusetts 02115, USA. ecaterson@partners.org
authors.forename: Edward J
authors.initials: EJ
authors.lastname: Caterson
authors.forename: J Rodrigo
authors.initials: JR
authors.lastname: Diaz-Siso
authors.forename: Pradip
authors.initials: P
authors.lastname: Shetye
authors.forename: Johan P E
authors.initials: JP
authors.lastname: Junker
authors.forename: Ericka M
authors.initials: EM
authors.lastname: Bueno
authors.forename: Shigeyoshi
authors.initials: S
authors.lastname: Soga
authors.forename: Frank J
authors.initials: FJ
authors.lastname: Rybicki
authors.forename: Bohdan
authors.initials: B
authors.lastname: Pomahac
mesh_terms: D000886:Anthropometry; D002508:Cephalometry; D054445:Facial Transplantation / Q000379:methods*; D006801:Humans; D008297:Male; D056948:Orthognathic Surgical Procedures; D010347:Patient Care Planning; D011857:Radiographic Image Interpretation, Computer-Assisted; D019651:Plastic Surgery Procedures; D020127:Recovery of Function; D012984:Software; D014057:Tomography, X-Ray Computed