Facial Transplantation Could Repair Severe Disfigurement

Facial transplantation can be a useful treatment for severe disfigurement, although it is not without risks, according to two case reports.

In the first report, surgeons from the Fourth Military Medical University (Xian, China) describe the two-year outcomes of a partial facial allotransplantation performed on a 30-year-old man in 2006 who was attacked by a bear, causing severe damage to the right side of his face. The transplantation involved anastomoses of the right mandibular artery, anterior facial vein, and facial nerve, as well as whole repair of the nose, upper lip, parotid gland, zygomatic bone, frontal wall of the maxillary sinus, and part of the infraorbital wall. The subject's immunomodulatory regimen included tacrolimus, mycophenolate mofetil, corticosteroids, and humanized IL-2 receptor monoclonal antibody. Good survival of the tissue flap was seen, although acute rejection episodes occurred at 3, 5, and 17 months following surgery. All of these episodes were effectively controlled with adjustments in the immunomodulatory regimen. The patient had no impairments in renal or hepatic function and no infections arose. Hyperglycemia occurred soon after surgery and then reappeared 3 months later. After being effectively treated with insulin therapy, the patient successfully switched to oral agents. Although the facial nerve was not fully functional, the patient was able to speak, eat, and drink normally, the report indicates.

The second report describes the one-year results of a 29-year-old man who underwent facial transplantation for damage caused by massive plexiform neurofibroma at the CHU Henri Mondor (Creteil, France). Resection of the tumor, which diffusely infiltrated the patient's middle and lower face, and composite tissue allotransplantation took place in January 2007. The main goal of the facial reconstruction operation was to restore the cutaneous appearance and function of the face, with a particular focus on contraction of the orbicularis oculi and oris muscles. The patient's immunosuppressive regimen included antilymphocyte serum, tacrolimus, mycophenolate mofetil, and prednisone. Following an uneventful immediate postoperative course, the patient experienced rejection episodes 28 and 64 days after surgery, the latter of which was complicated by Cytomegalovirus (CMV) infection. Both episodes, however, resolved without any further evidence of rejection and the patient's immunosuppressive regimen could be reduced. At one year, the functional results were very good, and both sensory and motor reinnervations of the graft was noted. Both reports were published in the August 23, 2008, issue of The Lancet; lead authors of the studies were Shuzhong Guo, M.D., of the Fourth Military Medical University, and Laurent Lantieri, M.D., of CHU Henri Mondor.

"Important contributions of the teams from Xi'an and Paris in addressing the issues of face transplantations have shown the need for progress in three directions: surgery, immunology, and psychology,” commented Dr. Jean-Michel Dubernard, of University Lyon I Hospital (France), and Dr. Bernard Devauchelle, from Amiens-Nord University Hospital (France). "Cooperation among teams will be needed to answer the many technical, functional, immunological, and psychological questions raised by face transplantation.”

Related Links:
Fourth Military Medical University
CHU Henri Mondor