Severe Facial Disfigurement Research Articles

Composite tissue allotransplantation of the face: Decision analysis model.

Facial composite tissue allotransplantation is a potential reconstructive option for severe facial disfigurement. The purpose of the present investigation was to use decision analysis modelling to ascertain the expected quality-adjusted life years (QALYs) gained with face transplantation (versus remaining in a disfigured state) in an effort to assist surgeons with the decision of whether to adopt this procedure. The probabilities of potential complications associated with facial allotransplantation were identified by a comprehensive review of kidney and hand transplant literature. A decision analysis tree illustrating possible health states for face allotransplantation was then constructed. Utilities were obtained from 30 participants, using the standard gamble and time trade-off measures. The utilities were then translated into QALYs, and the expected QALYs gained with transplantation were computed. Severe facial deformity was associated with an average of 7.34 QALYs. Allotransplantation of the face imparted an expected gain in QALYs of between 16.2 and 27.3 years. The current debate within the medical community surrounding facial composite tissue allotransplantation has centred on the issue of inducing a state of immunocompromise in a physically healthy individual for a non-life-saving procedure. However, the latter must be weighed against the potential social and psychological benefits that transplantation would confer. As demonstrated by a gain of 26.9 QALYs, participants' valuation of quality of life is notably greater for face transplantation with its side effects of immunosuppression than for a state of uncompromised physical health with severe facial disfigurement.

A Novel Approach to the Management of Severe Facial Disfigurement in Neurofibromatosis Type 1

A 12-year-old girl with neurofibromatosis type 1 underwent subtotal anterior exenteration of a blind, unsightly, buphthalmic eye and orbital/eyelid plexiform neurofibroma. Simultaneously, a channeled Medpor orbital implant was positioned to reduce a meningoencephalocele resulting from severe sphenoid wing dysgenesis. Two-stage osseointegration was subsequently performed to permit secure fitting of an orbital prosthesis. This patient's cosmesis and social interaction were improved markedly with this surgical approach for disfiguring ocular, eyelid, and orbital disease due to neurofibromatosis type 1.

Careers in Anesthesiology IX: Three Pioneer British Anaesthetists.

Careers in Anesthesiology IX: Three Pioneer British Anaesthetists.

Composite tissue allotransplantation of the hand and face: a new frontier in transplant and reconstructive surgery

Each year an estimated 7-million people in the USA need composite tissue reconstruction because of surgical excision of tumors, accidents and congenital malformations. Limb amputees alone comprise over 1.2 million of these. This figure is more than double the number of solid organs needed for transplantation. Composite tissue allotransplantation in the form of hand and facial tissue transplantation are now a clinical reality. The discovery, in the late 1990s, that the same immunotherapy used routinely in kidney transplantation was also effective in preventing skin rejection made this possible. While these new treatments seem like major advancements most of the surgical, immunological and ethical methods used are not new at all and have been around and routinely used in clinical practice for some time. In this review of composite tissue allotransplantation, we: (i) outline the limitations of conventional reconstructive methods for treating severe facial disfigurement, (ii) review the history of composite tissue allotransplantation, (iii) discuss the chronological scientific advances that have made it possible, (iv) focus on the two unique clinical scenarios of hand and face transplantation, and (v) reflect on the critical issues that must be addressed as we move this new frontier toward becoming a treatment in mainstream medicine.

From experimental rat hindlimb to clinical face composite tissue allotransplantation: Historical background and current status

The purpose of this article is to review the historical background and clinical status of composite tissue allotransplantation and to discuss the scientific evolution of clinical face transplantation. Composite tissue allotransplantation (CTA) rapidly progressed in the 1980s with the discovery of cyclosporine. Although the most success has been achieved with hand transplantation, others have made progress with allografts of trachea, peripheral nerve, flexor tendon apparatus, vascularized knee, larynx, abdominal wall, and most recently, partial face. The world's first partial face allotransplantation occurred in November 2005 in France. In April of 2006, there was a second performed in China. As of today, there are now multiple institutions with plans to attempt the world's first full facial/scalp transplant. Complete facial/scalp allotransplantation offers a viable alternative for unfortunate individuals suffering severe facial disfigurement and is a product of many decades of experimental research, beginning with rat hindlimb allografts.

Indication of Contralateral Temporalis Muscle Myotomy in Temporomandibular Joint Ankylosis

Statement of the Problem: Ankylosis of the temporomandibular joint is a serious disabling and distressing structural condition which causes severe facial disfigurement and psychological stress. When it occurs early in childhood it produces micrognathia, deviation of mandible to the affected side, difficulties in eating, and breathing during sleep. Trauma has been reported as the most common factor in TMJ ankylosis followed by local and systemic infections. Kazanjian classified ankylosis as True and False. Sawhney grouped TMJ ankylosis into Type I, Type II, Type III, and Type IV, depending on the pathological changes seen in his operative findings. The degree of limitation in mandibular motion varies considerably and depends on the type and amount of tissue connecting the mandible. This necessitates additional procedures along with condylectomy like ipsilateral and contralateral coronoidectomy. The aim of this study was to correlate the size of blob of bone around the TMJ based on classification with contralateral temporalis muscle myotomy through an intraoral approach.

Massive Nasal Polyposis in Pediatric Cystic Fibrosis: Report of an Unusually Severe Case

Nasal polyposis is common among children with cystic fibrosis. We report the case of a 14-year-old girl with cystic fibrosis who experienced severe facial disfigurement as a result of massive polyposis. Her polyps were removed surgically, and she was referred for cosmetic surgery.

Cephalometric measurements and facial deformities in subjects with -thalassaemia major

This study was performed to identify cephalometric and facial features of patients with beta-thalassaemia major. A total of 54 thalassaemic subjects were examined for craniofacial deformities, including 37 patients (24 males and 13 females, aged 5-16 years) who had lateral cephalometric radiographs. The thalassaemic groups were compared with a normal control group matched for sex and dental age, using a t-test. All thalassaemic patients had a Class II skeletal base relationship. The average ANB angle was significantly larger than the controls in dental stages 2 and 3 (P < 0.05). Mandibular base length (Ar-Gn) was significantly less in thalassaemic patients than in controls, with the greatest differences (P < 0.001) found in the younger age group. The maxilla was of normal length (PNS-ANS, Ptm'-ANS') and appeared prominent (3.3 mm in males and 5.1 mm in females) due to a reduced cranial base length (Ar'-S') and a short mandible (Ar'-P'). Vertically, thalassaemic patients showed a significantly increased maxillary/mandibular planes angle in all groups, with differences ranging between 6.19 and 12.55 degrees (P < 0.001). Thalassaemic patients also showed a reduced posterior facial height (S-Go, Ar-Go) and increased anterior facial proportions. Of the 54 thalassaemic patients examined, 17 per cent had severe facial disfigurements (grade 3).

Complex fetal disorders: effect of MR imaging on management--preliminary clinical experience.

To determine the effect of magnetic resonance (MR) imaging findings on management of complex fetal disorders. MR imaging of the fetus was performed in 25 consecutive pregnant patients referred because of possible complex fetal disorders suspected on the basis of ultrasonographic (US) findings. Spoiled gradient-echo and single-shot rapid acquisition with relaxation enhancement MR imaging were performed in multiple planes anatomic to the fetus during maternal breath holding. In the fetuses in 24 of 25 women, MR studies were technically satisfactory. MR imaging directly influenced fetal care in four (17%) of 24 cases by demonstrating congenital high airway obstruction syndrome, congenital hemochromatosis, unilateral cerebellar deficiency in association with congenital diaphragmatic hernia, and severe facial disfigurement due to a giant anterior neck mass. In eight (33%) cases, MR imaging provided supplementary findings, but did not affect fetal care. In 12 (50%) cases, MR imaging results confirmed US findings. In cases of complex fetal disorders, MR imaging results can be used to supplement or confirm US findings and may directly affect management.

Prosthetic-Surgical Collaborations In The Rehabilitation Of Patients With Head And Neck Defects

Resection of head and neck tumors often results in severe facial disfigurement and functional disabilities. Superior rehabilitation efforts rely on close collaboration between the resection surgeon, reconstructive surgeon, and the maxillofacial prosthodontist. Trauma patients are best rehabilitated surgically, whereas patients with head and neck tumors are best rehabilitated prosthetically in combination with specific surgical reconstruction procedures. This article describes these modifications. Surgical advancements such as microvascular free flaps and endosseous implants have greatly enhanced rehabilitative efforts.

Management of severe facial injuries by local tissue traction.

To evaluate the technique of tissue traction for the management of severe facial injuries. Twenty patients, 15 adults and five children, with severe soft tissue facial disfigurement resulting from war injuries were treated by the tissue traction technique. This procedure provides a cosmetically acceptable appearance when used as an immediate measure. A few complications were encountered in delayed cases such as areas of skin breakdown and some stiffness. The described technique proved to have several advantages over other more commonly used methods for closure of large wounds.

Facial disfigurement after cancer resection: a problem with an extra dimension.

Treatment of patients with maxillofacial defects includes not only the technical procedures involved in producing a prosthesis, but also the psychosocial aspects. In all cases, these patients must learn to live with a severe facial disfigurement. People born with congenital defects grow up with disfigurement. For cancer patients, in addition to the mutilation, fear of the tumor plays a significant role. This paper reports on research into this specific treatment aspect. Such patients first must learn to cope with the possibility of premature death. They then must learn to accept facial disfigurement and the fact that society will respond differently to them.

Rehabilitation of a patient with complete mandibulectomy and partial glossectomy

Following a number of radiologic and surgical procedures for the treatment of oral cancer, a patient with severe facial disfigurement and alteration of the vocal tract acquired acceptable speech. Consultation among referring physicians and speech pathologists can aid such a patient by facilitating the rehabilitative process through improvement of communicative skills.

Severe scarring secondary to chickenpox a case report

A case of severe facial disfigurement secondary to chickenpox and its subsequent management is presented.