Outcomes 18 months after the first human partial face transplantation.

BACKGROUND: We performed the first human partial face allograft on November 27, 2005. Here we report outcomes up to 18 months after transplantation. METHODS: The postsurgical induction immunosuppression protocol included thymoglobulins combined with tacrolimus, mycophenolate mofetil, and prednisone. Donor hematopoietic stem cells were infused on postoperative days 4 and 11. Sequential biopsy specimens were taken from a sentinel skin graft, the facial skin, and the oral mucosa. Functional progress was assessed by tests of sensory and motor function performed monthly. Psychological support was provided before and after transplantation. RESULTS: Sensitivity to light touch, as assessed with the use of static monofilaments, and sensitivity to heat and cold had returned to normal at 6 months after transplantation. Motor recovery was slower, and labial contact allowing complete mouth closure was achieved at 10 months. Psychological acceptance of the graft progressed as function improved. Rejection episodes occurred on days 18 and 214 after transplantation and were reversed. A decrease in inulin clearance led to a change in immunosuppressive regimen from tacrolimus to sirolimus at 14 months. Extracorporeal photochemotherapy was introduced at 10 months to prevent recurrence of rejection. There have been no subsequent rejection episodes. At 18 months, the patient is satisfied with the aesthetic result. CONCLUSIONS: In this patient who underwent the first partial face transplantation, the functional and aesthetic results 18 months after transplantation are satisfactory.

Skeletal stability and morbidity with self-reinforced P (L/DL) LA resorbable osteosynthesis in bimaxillary orthognathic surgery.

INTRODUCTION: We present a retrospective study of 30 consecutive cases of bimaxillary orthognathic surgery with biodegradable self-reinforced poly-L/DL-lactide plates and tacks, for the same indication of Angle class III malocclusion. We reported the skeletal stability and morbidity at 1 year after surgery. PATIENTS AND METHODS: All patients underwent bimaxillary procedure. We used self-reinforced poly-L/DL lactic acid copolymer. Stabilization of Lefort I osteotomy was achieved by four plates L-shaped. Sagittal split osteotomies were fixed by two straight-plates. Lateral cephalograms were taken before (T0), soon after (T1) and more than 1 year after surgery (T2). Eight standard landmarks and four angular measurements were taken into account. All differences of the landmarks and angles were measured at T1 and T2. The regular clinical follow-up was scheduled for a minimum period of 1 year. RESULTS: The mean advanced maxillary was 3.33 mm and the mean mandibular setback was 6.13 mm. The mean mandibular relapse was 2.2 mm (non-significant). Horizontal maxilla mean variation was 0.8 mm at 1 year at A-point. Vertical maxilla stability depends on maxillary movements: impaction stability is better as an isolated advancement or associated with pull-down movement. We found six inflammatory reactions and two of them need the removal of the plates. CONCLUSION: Bimaxillary orthognathic procedure with bioresorbable osteosynthesis is a reliable and reproducible method. Angle class III malocclusions could be entirely and successfully managed with bioresorbable osteosynthesis. The stability and suites at 1 year are comparable to titanium osteosynthesis.