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Semin Plast Surg 2024; 38(03): 242-252
DOI: 10.1055/s-0044-1786991
Review Article

Computerized Surgical Planning in Face Transplantation

Alay Shah
1   Hansjorg Wyss Department of Plastic Surgery, New York University Langone Health, New York, New York
,
Sachin Chinta
1   Hansjorg Wyss Department of Plastic Surgery, New York University Langone Health, New York, New York
,
Eduardo D. Rodriguez
1   Hansjorg Wyss Department of Plastic Surgery, New York University Langone Health, New York, New York
› Author Affiliations Funding None.
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Abstract

Face transplantation (FT) has emerged as a critical intervention for patients with complex facial deformities unsuitable for conventional reconstructive methods. It aims to restore essential functions such as facial expression, mastication, and speech, while also improving psychosocial health. The procedure utilizes various surgical principles, addressing unique challenges of craniofacial complexity and diverse injury patterns. The integration of Computerized Surgical Planning (CSP) leverages computer-aided technologies to enhance preoperative strategy, intraoperative navigation, and postoperative assessment. CSP utilizes three-dimensional computed tomography, printing, angiography, and navigation systems, enabling surgeons to anticipate challenges and reduce intraoperative trial and error. Through four clinical cases, including a groundbreaking combined face and bilateral hand transplant, CSP's role in FT is highlighted by its ability to streamline operative processes and minimize surgical revisions. The adoption of CSP has led to fewer cadaveric rehearsals, heightened operative precision, and greater alignment with preoperative plans. Despite CSP's advancements, it remains complementary to, rather than a replacement for, clinical expertise. The demand for technological resources and multidisciplinary teamwork is high, but the improved surgical outcomes and patient quality of life affirm CSP's value in FT. The technology has become a staple in reconstructive surgery, signaling a step forward in the evolution of complex surgical interventions.

Keywords

Computerized Surgical Planning - CSP - face transplant - transplant - vascularized composite allografts - VCA - facial trauma - facial reconstruction


Publication History

Article published online:
27 May 2024

© 2024. Thieme. All rights reserved.

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  • References

  • 1 Rifkin WJ, David JA, Plana NM. et al. Achievements and challenges in facial transplantation. Ann Surg 2018; 268 (02) 260-270
    CrossrefPubMedGoogle Scholar
  • 2 Ramly EP, Kantar RS, Diaz-Siso JR, Alfonso AR, Rodriguez ED. Computerized approach to facial transplantation: evolution and application in 3 consecutive face transplants. Plast Reconstr Surg Glob Open 2019; 7 (08) e2379
    CrossrefPubMedGoogle Scholar
  • 3 Vyas K, Bakri K, Gibreel W, Cotofana S, Amer H, Mardini S. Facial Transplantation. Facial Plast Surg Clin North Am 2022; 30 (02) 255-269
    CrossrefPubMedGoogle Scholar
  • 4 Coffman KL, Gordon C, Siemionow M. Psychological outcomes with face transplantation: overview and case report. Curr Opin Organ Transplant 2010; 15 (02) 236-240
    CrossrefPubMedGoogle Scholar
  • 5 Meningaud JP, Hivelin M, Benjoar MD, Toure G, Hermeziu O, Lantieri L. The procurement of allotransplants for ballistic trauma: a preclinical study and a report of two clinical cases. Plast Reconstr Surg 2011; 127 (05) 1892-1900
    CrossrefPubMedGoogle Scholar
  • 6 Pomahac B, Pribaz J, Eriksson E. et al. Restoration of facial form and function after severe disfigurement from burn injury by a composite facial allograft. Am J Transplant 2011; 11 (02) 386-393
    CrossrefPubMedGoogle Scholar
  • 7 Guntinas-Lichius O, Finkensieper M. Three patients with full facial transplantation. N Engl J Med 2012; 366 (19) 1841 , author reply 1841–1842
    CrossrefPubMedGoogle Scholar
  • 8 Roche NA, Vermeersch HF, Stillaert FB. et al. Complex facial reconstruction by vascularized composite allotransplantation: the first Belgian case. J Plast Reconstr Aesthet Surg 2015; 68 (03) 362-371
    CrossrefPubMedGoogle Scholar
  • 9 Siemionow MZ, Papay F, Djohan R. et al. First U.S. near-total human face transplantation: a paradigm shift for massive complex injuries. Plast Reconstr Surg 2010; 125 (01) 111-122
    CrossrefPubMedGoogle Scholar
  • 10 Siemionow M. The decade of face transplant outcomes. J Mater Sci Mater Med 2017; 28 (05) 64
    CrossrefPubMedGoogle Scholar
  • 11 Mohan R, Borsuk DE, Dorafshar AH. et al. Aesthetic and functional facial transplantation: a classification system and treatment algorithm. Plast Reconstr Surg 2014; 133 (02) 386-397
    CrossrefPubMedGoogle Scholar
  • 12 Lantieri L, Grimbert P, Ortonne N. et al. Face transplant: long-term follow-up and results of a prospective open study. Lancet 2016; 388 (10052): 1398-1407
    CrossrefPubMedGoogle Scholar
  • 13 Dorafshar AH, Brazio PS, Mundinger GS, Mohan R, Brown EN, Rodriguez ED. Found in space: computer-assisted orthognathic alignment of a total face allograft in six degrees of freedom. J Oral Maxillofac Surg 2014; 72 (09) 1788-1800
    CrossrefPubMedGoogle Scholar
  • 14 Dorafshar AH, Bojovic B, Christy MR. et al. Total face, double jaw, and tongue transplantation: an evolutionary concept. Plast Reconstr Surg 2013; 131 (02) 241-251
    CrossrefPubMedGoogle Scholar
  • 15 Sosin M, Ceradini DJ, Levine JP. et al. Total face, eyelids, ears, scalp, and skeletal subunit transplant: a reconstructive solution for the full face and total scalp burn. Plast Reconstr Surg 2016; 138 (01) 205-219
    CrossrefPubMedGoogle Scholar
  • 16 Kollar B, Pomahac B. Facial restoration by transplantation. Surgeon 2018; 16 (04) 245-249
    CrossrefPubMedGoogle Scholar
  • 17 Suchyta M, Mardini S. Innovations and future directions in head and neck microsurgical reconstruction. Clin Plast Surg 2020; 47 (04) 573-593
    CrossrefPubMedGoogle Scholar
  • 18 Rodby KA, Turin S, Jacobs RJ. et al. Advances in oncologic head and neck reconstruction: systematic review and future considerations of virtual surgical planning and computer aided design/computer aided modeling. J Plast Reconstr Aesthet Surg 2014; 67 (09) 1171-1185
    CrossrefPubMedGoogle Scholar
  • 19 Bly RA, Chang SH, Cudejkova M, Liu JJ, Moe KS. Computer-guided orbital reconstruction to improve outcomes. JAMA Facial Plast Surg 2013; 15 (02) 113-120
    CrossrefPubMedGoogle Scholar
  • 20 Foley BD, Thayer WP, Honeybrook A, McKenna S, Press S. Mandibular reconstruction using computer-aided design and computer-aided manufacturing: an analysis of surgical results. J Oral Maxillofac Surg 2013; 71 (02) e111-e119
    CrossrefPubMedGoogle Scholar
  • 21 Hierl T, Arnold S, Kruber D, Schulze FP, Hümpfner-Hierl H. CAD-CAM-assisted esthetic facial surgery. J Oral Maxillofac Surg 2013; 71 (01) e15-e23
    CrossrefPubMedGoogle Scholar
  • 22 Kantar RS, Rifkin WJ, Diaz-Siso JR, Bernstein GL, Rodriguez ED. Quality improvement in facial transplantation: standard approach for novel procedures. Plast Reconstr Surg Glob Open 2018; 6 (01) e1653
    CrossrefPubMedGoogle Scholar
  • 23 Chim H, Wetjen N, Mardini S. Virtual surgical planning in craniofacial surgery. Semin Plast Surg 2014; 28 (03) 150-158
    Article in Thieme ConnectPubMedGoogle Scholar
  • 24 Cammarata MJ, Wake N, Kantar RS. et al. Three-dimensional analysis of donor masks for facial transplantation. Plast Reconstr Surg 2019; 143 (06) 1290e-1297e
    CrossrefPubMedGoogle Scholar
  • 25 Zhang JS, Qu L, Wang Q. et al. Intraoperative visualisation of functional structures facilitates safe frameless stereotactic biopsy in the motor eloquent regions of the brain. Br J Neurosurg 2018; 32 (04) 372-380
    CrossrefPubMedGoogle Scholar
  • 26 Zhang S, Gui H, Lin Y, Shen G, Xu B. Navigation-guided correction of midfacial post-traumatic deformities (Shanghai experience with 40 cases). J Oral Maxillofac Surg 2012; 70 (06) 1426-1433
    CrossrefPubMedGoogle Scholar
  • 27 Du JP, Fan Y, Wu QN, Wang DH, Zhang J, Hao DJ. Accuracy of pedicle screw insertion among 3 image-guided navigation systems: systematic review and meta-analysis. World Neurosurg 2018; 109: 24-30
    CrossrefPubMedGoogle Scholar
  • 28 He Y, Zhang Y, An JG, Gong X, Feng ZQ, Guo CB. Zygomatic surface marker-assisted surgical navigation: a new computer-assisted navigation method for accurate treatment of delayed zygomatic fractures. J Oral Maxillofac Surg 2013; 71 (12) 2101-2114
    CrossrefPubMedGoogle Scholar
  • 29 Andrews BT, Surek CC, Tanna N, Bradley JP. Utilization of computed tomography image-guided navigation in orbit fracture repair. Laryngoscope 2013; 123 (06) 1389-1393
    CrossrefPubMedGoogle Scholar
  • 30 Yu H, Shen SG, Wang X, Zhang L, Zhang S. The indication and application of computer-assisted navigation in oral and maxillofacial surgery-Shanghai's experience based on 104 cases. J Craniomaxillofac Surg 2013; 41 (08) 770-774
    CrossrefPubMedGoogle Scholar
  • 31 Azarmehr I, Stokbro K, Bell RB, Thygesen T. Surgical navigation: a systematic review of indications, treatments, and outcomes in oral and maxillofacial surgery. J Oral Maxillofac Surg 2017; 75 (09) 1987-2005
    CrossrefPubMedGoogle Scholar
  • 32 Marmulla R, Hilbert M, Niederdellmann H. Inherent precision of mechanical, infrared and laser-guided navigation systems for computer-assisted surgery. J Craniomaxillofac Surg 1997; 25 (04) 192-197
    CrossrefPubMedGoogle Scholar
  • 33 Strong EB, Rafii A, Holhweg-Majert B, Fuller SC, Metzger MC. Comparison of 3 optical navigation systems for computer-aided maxillofacial surgery. Arch Otolaryngol Head Neck Surg 2008; 134 (10) 1080-1084
    CrossrefPubMedGoogle Scholar
  • 34 Krezdorn N, Alhefzi M, Perry B. et al. Trismus in face transplantation following ballistic trauma. J Craniofac Surg 2018; 29 (04) 843-847
    CrossrefPubMedGoogle Scholar
  • 35 Kantar RS, Ceradini DJ, Gelb BE. et al. Facial transplantation for an irreparable central and lower face injury: a modernized approach to a classic challenge. Plast Reconstr Surg 2019; 144 (02) 264e-283e
    CrossrefPubMedGoogle Scholar
  • 36 Ramly EP, Alfonso AR, Berman ZP. et al. The first successful combined full face and bilateral hand transplant. Plast Reconstr Surg 2022; 150 (02) 414-428
    CrossrefPubMedGoogle Scholar
  • 37 Devauchelle B, Badet L, Lengelé B. et al. First human face allograft: early report. Lancet 2006; 368 (9531) 203-209
    CrossrefPubMedGoogle Scholar
  • 38 Guntinas-Lichius O. Outcomes 18 months after the first human partial face transplantation. N Engl J Med 2008; 358 (20) 2179-2180 , author reply 2180
    CrossrefPubMedGoogle Scholar
  • 39 Siemionow M, Papay F, Alam D. et al. Near-total human face transplantation for a severely disfigured patient in the USA. Lancet 2009; 374 (9685) 203-209
    CrossrefPubMedGoogle Scholar