title: Airway recovery after face transplantation.
abstract: BACKGROUND
  Severe facial injuries can compromise the upper airway by reducing airway volume, obstructing or obliterating the nasal passage, and interfering with oral airflow. Besides the significant impact on quality of life, upper airway impairments can have life-threatening or life-altering consequences. The authors evaluated improvements in functional airway after face transplantation.
  
  
  METHODS
  Between 2009 and 2011, four patients underwent face transplantation at the authors' institution, the Brigham and Women's Hospital. Patients were examined preoperatively and postoperatively and their records reviewed for upper airway infections and sleeping disorders. The nasal mucosa was biopsied after face transplantation and analyzed using scanning electron microscopy. Volumetric imaging software was used to evaluate computed tomographic scans of the upper airway and assess airway volume changes before and after transplantation.
  
  
  RESULTS
  Before transplantation, two patients presented an exposed naked nasal cavity and two suffered from occlusion of the nasal passage. Two patients required tracheostomy tubes and one had a prosthetic nose. Sleeping disorders were seen in three patients, and chronic cough was diagnosed in one. After transplantation, there was no significant improvement in sleeping disorders. The incidence of sinusitis increased because of mechanical interference of the donor septum and disappeared after surgical correction. All patients were decannulated after transplantation and were capable of nose breathing. Scanning electron micrographs of the respiratory mucosa revealed viable tissue capable of mucin production. Airway volume significantly increased in all patients.
  
  
  CONCLUSIONS
  Face transplantation successfully restored the upper airway in four patients. Unhindered nasal breathing, viable respiratory mucosa, and a significant increase in airway volume contributed to tracheostomy decannulation.
authors.affiliation: Boston, Mass.; and Ludwigshafen, Germany From the Department of Surgery, Divisions of Plastic Surgery and Otolaryngology, and the Division of Dermatopathology, Department of Pathology, Brigham and Women's Hospital, Harvard Medical School; the Department of Plastic Surgery, BG University Hospital Bergmannsheil, Ruhr-University, Bochum, Germany; the Department of Hand-, Plastic and Reconstructive Surgery, Burn Trauma Center, BG Trauma Center Ludwigshafen, University of Heidelberg; and the Dana Farber Cancer Institute.
authors.forename: Sebastian
authors.initials: S
authors.lastname: Fischer
authors.forename: Joe S
authors.initials: JS
authors.lastname: Wallins
authors.forename: Ericka M
authors.initials: EM
authors.lastname: Bueno
authors.forename: Maximilian
authors.initials: M
authors.lastname: Kueckelhaus
authors.forename: Akash
authors.initials: A
authors.lastname: Chandawarkar
authors.forename: J Rodrigo
authors.initials: JR
authors.lastname: Diaz-Siso
authors.forename: Allison
authors.initials: A
authors.lastname: Larson
authors.forename: George F
authors.initials: GF
authors.lastname: Murphy
authors.forename: Donald J
authors.initials: DJ
authors.lastname: Annino
authors.forename: Edward J
authors.initials: EJ
authors.lastname: Caterson
authors.forename: Bohdan
authors.initials: B
authors.lastname: Pomahac
mesh_terms: D000402:Airway Obstruction / Q000000981:diagnostic imaging / Q000209:etiology* / Q000473:pathology; D005151:Facial Injuries / Q000150:complications / Q000000981:diagnostic imaging / Q000601:surgery*; D054445:Facial Transplantation; D006801:Humans; D008297:Male; D009297:Nasal Mucosa / Q000473:pathology; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome