Tesis doctoral inédita leída en la Universidad Autónoma de Madrid, Facultad de Medicina, Departamento de Cirugía. Fecha de lectura: 16-09-2020Background: Facial allotransplantation including the temporo-mandibular
joints (TMJ) may improve the functional outcomes in face transplant
candidates who have lost or damaged this joint.
Methods: Linear and angular measurements were taken in hundred dry
skulls and mandibles, and in hundred 3D-reconstructed facial CT-scans, to
determine the variability of the TMJ, glenoid fossa and mandible. A vascular
study was performed in 6 fresh cadaveric heads, followed by harvest of the
face allograft in 3 heads. Next, four heads were used for mock
transplantation (two donors and two recipients). The full facial allograft
included 4 different segments: a LeFort 3, a mandibular tooth bearing and
two condyle and TMJ bearing segments. Statistical analysis was performed
with the SAS software.
Results: Only in one-third of the skulls, the condylar shape was symmetric
between right and left sides. There was a wide variability in the condylar
coronal (range 14.3-23.62 mm) and sagittal dimensions (range 5.64-10.96
mm), medial intercondylar distance (range 66.55-89.91 mm) and
intercondylar angles (range 85.27 to 166.94 degrees). This high variability
persisted after stratification by gender, ethnicity and age. The TMJ was
harvested based on the branches of the superficial temporal and maxillary
arteries. The design of the allograft allowed fixation of the two condyle and
TMJ-bearing segments to the recipient skull base, preserving the articular
diskcondyle-fossa relationship and differences were adjusted at the bilateral
sagittal split osteotomy sites.
Conclusions: Procurement and transplantation of a TMJ containing total face
allograft is technically feasible in a cadaveric mode