title: Management of the Salivary Glands and Facial Nerve in Face Transplantation.
abstract: BACKGROUND
  Since the first face transplant in 2005, 35 cases have been performed worldwide with acceptable graft survival and satisfactory return of function and appearance. With increasing experience, it is emerging that the salivary glands can contribute to the challenges encountered in the perioperative period.
  
  
  METHODS
  A comprehensive review of the literature regarding management of the salivary glands and facial nerve in facial transplantation was performed. Data gathered included inclusion or exclusion of submandibular and parotid glands in the recipient and allograft, extent of mucosal inclusion in the allograft, salivary complications and treatment, level and method of facial nerve repair, and motor nerve outcomes.
  
  
  RESULTS
  Information on salivary gland management was available for 25 cases. Undesirable salivary events were documented in 12 cases (48 percent). The source of complications was the parotid in five cases (42 percent), a combination of the parotid and submandibular glands in three cases (25 percent), and minor salivary glands in four cases (33 percent). Postoperative botulinum toxin injections resolved salivary collections in four cases. Facial nerve continuity was restored at the level of the trunk/primary divisions (66 percent) or the terminal branches (34 percent), with inclusion of the whole parotid dictating a trunk repair and exclusion of the parotid dictating a terminal branch repair.
  
  
  CONCLUSIONS
  The salivary glands warrant increased attention in surgical planning and postoperative care. Exclusion of the salivary glands from the facial allograft with repair of the terminal branches of the facial nerve appears to be preferable. Botulinum toxin should be considered for prophylaxis and treatment of salivary collections.
  
  
  METHODS
  Therapeutic, V.
authors.affiliation: Cleveland, Ohio.|From the Department of Plastic Surgery, Cleveland Clinic.
authors.forename: Russell
authors.initials: R
authors.lastname: Frautschi
authors.affiliation: Cleveland, Ohio.|From the Department of Plastic Surgery, Cleveland Clinic.
authors.forename: Antonio
authors.initials: A
authors.lastname: Rampazzo
authors.affiliation: Cleveland, Ohio.|From the Department of Plastic Surgery, Cleveland Clinic.
authors.forename: Steven
authors.initials: S
authors.lastname: Bernard
authors.affiliation: Cleveland, Ohio.|From the Department of Plastic Surgery, Cleveland Clinic.
authors.forename: Risal
authors.initials: R
authors.lastname: Djohan
authors.affiliation: Cleveland, Ohio.|From the Department of Plastic Surgery, Cleveland Clinic.
authors.forename: Francis
authors.initials: F
authors.lastname: Papay
authors.affiliation: Cleveland, Ohio.|From the Department of Plastic Surgery, Cleveland Clinic.
authors.forename: Bahar Bassiri
authors.initials: BB
authors.lastname: Gharb
mesh_terms: D000328:Adult; D005154:Facial Nerve / Q000601:surgery*; D054445:Facial Transplantation / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006085:Graft Survival / Q000502:physiology; D006801:Humans; D008297:Male; D008866:Microsurgery / Q000379:methods; D008875:Middle Aged; D009416:Nerve Regeneration / Q000502:physiology; D010306:Parotid Gland / Q000601:surgery / Q000637:transplantation; D010525:Peripheral Nerves / Q000637:transplantation*; D011183:Postoperative Complications / Q000209:etiology / Q000628:therapy; D012469:Salivary Glands / Q000601:surgery* / Q000637:transplantation; D013363:Submandibular Gland / Q000601:surgery / Q000637:transplantation