title: Overcoming cross-gender differences and challenges in Le Fort-based, craniomaxillofacial transplantation with enhanced computer-assisted technology.
abstract: BACKGROUND
  Sex-specific anthropometrics, skin texture/adnexae mismatch, and social apprehension have prevented cross-gender facial transplantation from evolving. However, the scarce donor pool and extreme waitlist times are currently suboptimal. Our objective was to (1) perform and assess cadaveric facial transplantation for each sex-mismatched scenario using virtual planning with cutting guide fabrication and (2) review the advantages/disadvantages of cross-gender facial transplantation.
  
  
  METHODS
  Cross-gender facial transplantation feasibility was evaluated through 2 mock, double-jaw, Le Fort-based cadaveric allotransplants, including female donor-to-male recipient and male donor-to-female recipient. Hybrid facial-skeletal relationships were investigated using cephalometric measurements, including sellion-nasion-A point and sellion-nasion-B point angles, and lower-anterior-facial-height to total-anterior-facial-height ratio. Donor and recipient cutting guides were designed with virtual planning based on our team's experience in swine dissections and used to optimize the results.
  
  
  RESULTS
  Skeletal proportions and facial-aesthetic harmony of the transplants (n = 2) were found to be equivalent to all reported experimental/clinical sex-matched cases by using custom guides and Mimics technology. Cephalometric measurements relative to Eastman Normal Values are shown.
  
  
  CONCLUSIONS
  On the basis of our results, we believe that cross-gender facial transplantation can offer equivalent, anatomical skeletal outcomes to those of sex-matched pairs using preoperative planning and custom guides for execution. Lack of literature discussion of cross-gender facial transplantation highlights the general stigmata encompassing the subject. We hypothesize that concerns over sex-specific anthropometrics, skin texture/adnexae disparity, and increased immunological resistance have prevented full acceptance thus far. Advantages include an increased donor pool with expedited reconstruction, as well as size-matched donors.
authors.affiliation: From the *Department of Plastic and Reconstructive Surgery, The Johns Hopkins Hospital, Johns Hopkins University School of Medicine, Baltimore, MD; †Department of Oral and Maxillofacial Surgery, Massachusetts General Hospital, Harvard School of Dental Medicine, Boston, MA; ‡Department of Radiology, The Johns Hopkins Hospital, Johns Hopkins University School of Medicine, Baltimore; §The Johns Hopkins University Applied Physics Laboratory, Laurel; and ∥3D Medical Applications Center, Department of Radiology, Walter Reed National Military Medical Center, Bethesda, MD.
authors.forename: Chad R
authors.initials: CR
authors.lastname: Gordon
authors.forename: Edward W
authors.initials: EW
authors.lastname: Swanson
authors.forename: Srinivas M
authors.initials: SM
authors.lastname: Susarla
authors.forename: Devin
authors.initials: D
authors.lastname: Coon
authors.forename: Erin
authors.initials: E
authors.lastname: Rada
authors.forename: Mohammed Al
authors.initials: MA
authors.lastname: Rakan
authors.forename: Gabriel F
authors.initials: GF
authors.lastname: Santiago
authors.forename: Jaimie T
authors.initials: JT
authors.lastname: Shores
authors.forename: Steven C
authors.initials: SC
authors.lastname: Bonawitz
authors.forename: Elliot K
authors.initials: EK
authors.lastname: Fishman
authors.forename: Ryan
authors.initials: R
authors.lastname: Murphy
authors.forename: Mehran
authors.initials: M
authors.lastname: Armand
authors.forename: Peter
authors.initials: P
authors.lastname: Liacouras
authors.forename: Gerald T
authors.initials: GT
authors.lastname: Grant
authors.forename: Gerald
authors.initials: G
authors.lastname: Brandacher
authors.forename: Wei-Ping Andrew
authors.initials: WP
authors.lastname: Lee
mesh_terms: D064595:Composite Tissue Allografts / Q000637:transplantation*; D054445:Facial Transplantation / Q000379:methods*; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D007091:Image Processing, Computer-Assisted; D008297:Male; D019340:Osteotomy, Le Fort; D011300:Preoperative Care; D012727:Sex Characteristics; D014019:Tissue Donors
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