Abstract
The aim of this study was to describe the 3D planning process used in our two composite face transplantations and to analyze the accuracy of a virtual transplantation in predicting the end-result of face transplantation. The study material consists of two bimaxillary composite face transplantations performed in the Helsinki University Hospital in 2016 and 2018. Computed tomography (CT) scans of the recipient and donor were used to define the osteotomy lines and perform the virtual face transplantation and to 3D print customized osteotomy guides for recipient and donor. Differences between cephalometric linear and angular measurements of the virtually simulated and the actual postoperative face transplantation were calculated. No changes to the planned osteotomy lines were needed during surgery. The differences in skeletal linear and angular measurements of the virtually simulated predictions and the actual postoperative face transplantations of the two patients varied between 0.1-5.6 mm and 0.7°-4°. The postoperative skeletal relationship between maxilla and mandible in both patients were almost identical in comparison to the predictions. 3D planning is feasible and provides close to accurate bone reconstruction in face transplantation. Preoperative virtual transplantation assists planning and improves the outcome in bimaxillary face transplantation.
Highlights
After the first face transplantation (FT) in France in 20051, to date at least 45 FTs have been performed worldwide[2]
No changes to the planned osteotomy lines were needed and the manufacturing of the guides proceeded exactly as planned beforehand. For both donor facial harvests, the donor-specific osteotomy guides were applied to the planned positions and secured with screws
The maxilla was cut in situ according to the osteotomy guides whereas the mandible was first cut in situ horizontally at the ramus level and later with the osteotomy guides on the back table
Summary
After the first face transplantation (FT) in France in 20051, to date at least 45 FTs have been performed worldwide[2]. Since 2016, two composite FTs have been performed in the Helsinki University Hospital In both cases, thorough 3D planning was used, and customized osteotomy guides were implemented in both the patient and the donor. The aim of this study is to describe the 3D planning process in our two composite FTs and to analyze the accuracy of virtual transplantation in predicting the endresult of transplantation. The study material consists of two bimaxillary composite face transplantations performed in the Helsinki University Hospital in 2016 and 2018. The differences in skeletal linear and angular measurements of the virtually simulated predictions and the actual postoperative face transplantations of the two patients varied between 0.1 - 5.6 millimeters and 0.7 - 4 degrees. Preoperative virtual transplantation assists planning and improves the outcome in bimaxillary face transplantation. 199 words
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