title: Skeletal Changes of an Osteomyocutaneous Facial Allograft Five Years Following Transplantation.
abstract: BACKGROUND
  More than 30 face transplantations have been performed worldwide, most including part of the facial skeletal framework. In this study, the modifications of the skeletal component of a facial allograft were evaluated.
  
  
  METHODS
  Standard head computed tomography (CT) scans, CT angiogram, and bone mineral densitometry were evaluated. Cephalometric analysis was performed. The pre and postoperative CT images were overlapped and the skeletal changes were expressed in a numeric and color-coded scale. The values of the serum calcium, phosphate, vitamin D, alkaline phosphatase, thyroid and parathyroid hormones, TSH, FHS, LH, estradiol, total protein and albumin, serum creatinine, and creatinine clearance were reviewed.
  
  
  RESULTS
  At 5 years follow-up the patient was 51 years old, asymptomatic and presented good stability of the Le Fort III component of the allograft. Computed tomography images revealed fibrous union of all fixation sites. There was minimal bone resorption at the osteotomy sites, left infraorbital rim and left maxillary buttress, and anterior maxilla (-0.28 mm). Computed tomography angiogram showed segmental absence at the origin of the left external carotid artery, good opacification of the rest of the external carotid arteries and its branches. Bone mineral densitometry evidenced osteopenia of the spine. The patient presented mild hypoalbuminemia (3.4 g/dL) and perimenopausal hormonal levels.
  
  
  CONCLUSIONS
  The skeletal component of the facial allograft was stable over time. Minimal bone resorption was discovered at the level of the left infraorbital rim and anterior maxilla. Transplantation of bone within the facial allograft is a viable reconstructive option.
authors.affiliation: Plastic Surgery Department, Cleveland Clinic, Cleveland, OH.
authors.forename: Bahar Bassiri
authors.initials: BB
authors.lastname: Gharb
authors.forename: Antonio
authors.initials: A
authors.lastname: Rampazzo
authors.forename: Gaby
authors.initials: G
authors.lastname: Doumit
authors.forename: Steven
authors.initials: S
authors.lastname: Bernard
authors.forename: Maria
authors.initials: M
authors.lastname: Siemionow
authors.forename: Francis
authors.initials: F
authors.lastname: Papay
authors.forename: Risal
authors.initials: R
authors.lastname: Djohan
mesh_terms: D015502:Absorptiometry, Photon / Q000379:methods; D064591:Allografts; D002508:Cephalometry / Q000379:methods; D000072226:Computed Tomography Angiography / Q000379:methods; D005147:Facial Bones / Q000378:metabolism / Q000601:surgery; D054445:Facial Transplantation / Q000009:adverse effects / Q000379:methods; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D000069451:Long Term Adverse Effects / Q000175:diagnosis / Q000209:etiology; D008875:Middle Aged; D010024:Osteoporosis / Q000175:diagnosis / Q000209:etiology; D019340:Osteotomy, Le Fort / Q000009:adverse effects / Q000379:methods; D011183:Postoperative Complications / Q000175:diagnosis / Q000209:etiology; D019651:Plastic Surgery Procedures / Q000009:adverse effects / Q000379:methods; D014057:Tomography, X-Ray Computed / Q000379:methods; D014184:Transplantation, Homologous