Ocular Considerations in Face Transplantation: Report of 2 Cases and Review of the Literature. Issue 3 (May 2019)

• Record Type: Journal Article
• Authors: Greenfield, Jason A.; Kantar, Rami S.; Rifkin, William J.; Sosin, Michael; Diaz-Siso, J. Rodrigo; Patel, Payal; Fleming, James C.; Iliff, Nicholas T.; Lee, Bradford W.; Rodriguez, Eduardo D.
• Is Part Of: Ophthalmic plastic and reconstructive surgery. Volume 35:Issue 3(2019)
• Publication Date: 2019-05
• Subjects: Eye -- Surgery -- Periodicals; Ophthalmic plastic surgery -- Periodicals; Reconstructive Surgical Procedures -- Periodicals; Ophthalmologic Surgical Procedures -- Periodicals; Ophthalmology -- Periodicals; Surgery -- Periodicals; 617.70592
• DOI: 10.1097/IOP.0000000000001296
• Languages: English
• ISSNs: 0740-9303

Abstract

Abstract : Purpose: Periorbital injuries are common in face transplantation (FT) candidates. It is therefore essential that the ophthalmologist play a central role in the multidisciplinary treatment of these patients. In this study, the authors perform a comprehensive review of all procedures involving periorbital components, provide an update for the ophthalmology community regarding the current state of the field, and present 2 cases. Methods: A comprehensive review of the literature for all FT procedures including periorbital components was performed. The authors also present 2 patients who received FT including periorbital components for extensive facial disfigurement. One patient sustained high-energy avulsive ballistic injury and underwent a total face, double jaw, and tongue transplant in 2012. The second patient received a total face, eyelids, ears, and skeletal subunits transplant for extensive facial burns in 2015. Results: Literature review demonstrated that 22 (54%) of the 41 patients undergoing FT received allografts containing periorbital components. Only 14 cases (64%) reported on the presence of ocular and periocular complications. The most common complications consisted of lower eyelid ectropion and lagophthalmos, and nearly all required revisional procedures. Both patients presented with significant periorbital scarring and demonstrated good visual acuity and aesthetic outcomes at postoperative follow up between 6 and 28 months. Conclusions: Face transplantation can address extensive facial and periorbital disfigurement with satisfactory functional and aesthetic outcomes. The majority of FT performed to date have included periorbital components, and postoperative ocular and periocular complications are common. It is critical for ophthalmologists to play a central role in the care of these patients. Abstract : Face transplantation is an effective reconstructive option for patients with extensive facial and periorbital defect with more than half of all procedures to date involving periorbital components, highlighting the critical role of the Ophthalmologist.