Consideraciones para un alotrasplante de cara total incluyendo las articulaciones temporomandibulares: un estudio radiológico y anatómico en cadáveres

Abstract

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