Cross-Sex Face Transplantation: Pre-clinical Data to Support Expanding the Facial Allograft Donor Pool
Michael Sosin, M.D., Daniel J. Ceradini, M.D., Alexes Hazen, M.D., Jamie P. Levine, M.D., David A. Staffenberg, M.D., Pierre B. Saadeh, M.D., Roberto L. Flores, M.D., Lawrence E. Brecht, M.D., G Leslie Bernstein, M.P.A., Eduardo D. Rodriguez, M.D., D.D.S..
NYU Langone Medical Center, New York, NY, USA.
PURPOSE: The limited donor pool of facial allografts remains is a major limitation to face transplantation. The purpose of this study is to determine whether cross-sex face transplantation (CSFT) retains craniomaxillofacial anthropomorphic metrics to the standard practice of same-sex face transplantation (SSFT).
METHODS: Seven mock en bloc total face and scalp transplants were completed. Cadavers (n=14) were randomly selected and paired. Anthropomorphic pre- and post-operative CT-guided measurements were obtained. Virtual surgical planning and overlay techniques were used for osteotomy selection, and to evaluate postoperative precision of hard and soft tissue elements. Univariate and paired t-tests were implemented to identify any technical differences between the cross-sex and same-sex cohort.
RESULTS: Five CFTS's (4 female-to-male, 1 male-to-female) and 2 SSFT's (2 male-to-male) were performed. Mean transplant time for CSFT and SSFT was 373 vs. 337 minutes, p = 0.730. As depicted in Table 1, few significant differences between hard or soft tissue measurements were observed between donors and recipients. Regardless of donor to recipient size discrepancy, anthropomorphic values were comparable in the cross-sex cohort vs. same-sex cohort besides medial intercanthal distance (more precise in CSFT) and bigonial distance (less precise in CSFT).
CONCLUSION: Cadaveric cross-sex face transplantation shows that anthropomorphic and cephalometric outcomes are comparable to same-sex face transplantation cadaveric models.
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