title: Surgical Optimization of Motor Recovery in Face Transplantation.
abstract: BACKGROUND
  Face transplantation (FT) has emerged as a viable option for treating devastating facial injuries. Most reported outcomes have demonstrated satisfactory motor and sensory restoration despite differences in technique. The authors have developed an algorithm of facial nerve management in these challenging patients. Our principles of management are illustrated by 2 specific patients.
  
  
  METHODS
  A retrospective analysis of prospectively collected data on 2 full face transplants was performed. Both patients required nerve grafting during full FT. Patient 1 due to short donor facial nerve stumps and patient 2 due to intraoperative soft tissue swelling. Patient 2 required a nerve transfer 11 months after full FT due to impaired motor recovery opposite the side of nerve grafting. Follow-up examinations consisting of manual muscle testing and Sunnybrook Facial Grading System 6 to 42 months after full FT with selected video examinations were critically reviewed.
  
  
  RESULTS
  Patient 1 had symmetrical motor recovery with gradual improvements noted throughout. At 6 months, Patient 2 had asymmetrically improving motor function. After nerve transfer, the patient showed gradual improvement in motor recovery, symmetry, and tone. Videos for each patient demonstrate the evolution of the patients' ability to smile from 6 to 42 months.
  
  
  CONCLUSIONS
  The authors describe their assessment of motor recovery and management of facial nerve reconstruction as it pertains to FT. Finally, the authors illustrate the principles of nerve transfer are applicable to FT recipients.
authors.affiliation: *Department of Surgery, Division of Plastic Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA†Department of Plastic Surgery, BG University Hospital Bergmannsheil, Ruhr University Bochum, Bochum‡Department of Plastic Surgery, BG University Hospital Ludwigshafen, Heidelberg University, Ludwigshafen, Germany.
authors.forename: Mario A
authors.initials: MA
authors.lastname: Aycart
authors.forename: Bridget
authors.initials: B
authors.lastname: Perry
authors.forename: Muayyad
authors.initials: M
authors.lastname: Alhefzi
authors.forename: Ericka M
authors.initials: EM
authors.lastname: Bueno
authors.forename: Maximilian
authors.initials: M
authors.lastname: Kueckelhaus
authors.forename: Sebastian
authors.initials: S
authors.lastname: Fischer
authors.forename: Bohdan
authors.initials: B
authors.lastname: Pomahac
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D002971:Cleft Lip / Q000150:complications / Q000601:surgery; D002972:Cleft Palate / Q000150:complications / Q000601:surgery; D015331:Cohort Studies; D015897:Comorbidity; D003428:Cross Infection / Q000209:etiology / Q000517:prevention & control / Q000601:surgery; D005152:Facial Muscles / Q000294:innervation; D005154:Facial Nerve / Q000503:physiopathology* / Q000601:surgery*; D054445:Facial Transplantation / Q000379:methods* / Q000534:rehabilitation*; D005260:Female; D006776:Hospitals, Pediatric; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D009046:Motor Neurons / Q000502:physiology; D016067:Nerve Transfer / Q000379:methods*; D011183:Postoperative Complications / Q000209:etiology* / Q000517:prevention & control* / Q000601:surgery; D058996:Quality Improvement / Q000458:organization & administration*; D019651:Plastic Surgery Procedures / Q000379:methods*; D012086:Reoperation; D012189:Retrospective Studies; D020379:Risk Adjustment; D012904:Smiling / Q000502:physiology; D013530:Surgical Wound Infection / Q000209:etiology / Q000517:prevention & control / Q000601:surgery