The Boston Experience

Bohdan Pomahac, Brigham and Women’s Hospital, Boston, MA, USA.

Pre-operative CT angiogram imaging is superior to other imaging techniques, and provides valuable information on bone and vascular morphology for face transplantation operation planning.

Transplantation of the entire facial soft tissues as well as maxilla and mandibular segment anteriorly to the masseter muscles insertion can be safely performed based on facial vessels alone. Inclusion of hair bearing scalp requires supercharging of superficial temporal vessels in the pre-auricular region. Peripheral neurorhaphy at the exit of the skull base facial nerve trunk leads to less targeted post-operative re-innervation, with potential for synkinesias, and whenever possible, individual peripheral facial nerve branches should be re-connected. Adequate planning for integration of the facial composite allograft requires complete sensory and motor nerve connection, and should be part of each operation. Bilateral external carotid anastomosis may cause significant functional problems including oropharyngeal dysfunction and ocular ischemia.