Restoration of the donor face after facial allotransplantation: digital manufacturing techniques.
BACKGROUND
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.
Gerald T
GT
Grant
Peter
P
Liacouras
Gabriel F
GF
Santiago
Juan R
JR
Garcia
Mohammed
M
Al Rakan
Ryan
R
Murphy
Mehran
M
Armand
Chad R
CR
Gordon
D064595:Composite Tissue Allografts / Q000637:transplantation; D017076:Computer-Aided Design; D054445:Facial Transplantation; D006801:Humans; D007091:Image Processing, Computer-Assisted; D008397:Masks; D011474:Prosthesis Design; D019651:Plastic Surgery Procedures / Q000379:methods*; D012826:Silicone Elastomers; D014057:Tomography, X-Ray Computed
D012826:Silicone Elastomers