First near-total face and upper-jaw transplant looks successful

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Washington, Nov 17 (ANI): Scientists have achieved success in the first near-total face and upper jaw transplant, almost a year after it was conducted, according to a new report.

The researchers have observed that the donor tissue appeared to be integrated successfully.

The recipient has experienced no long-term rejection and has regained some functional abilities, including her senses of smell and taste.

Three previous facial transplants were completed prior to this procedure, performed at Cleveland Clinic in December 2008, according to background information in the article.

But, unlike these, the current procedure was performed on a patient who had already undergone 23 major reconstructive procedures following a gunshot wound to the face.

The extensive damage from postoperative scarring and depletion of blood vessels added a complexity to this surgery.

The procedure involved transferring bone and ligaments so that the patient would not experience facial paralysis in the future and would also not require further procedures to elevate facial tissues.

As of July 2009, the patient had experienced no surgical complications, has tolerated the immunosuppressive therapy required to keep her body from rejecting the transplant and has obtained significant functional benefits.

She can breathe through her nose, eat by mouth and has had significant improvement in her speech.

"Sensory and motor recovery is progressing appropriately but will require time to further evaluate final outcomes," wrote the authors.

An additional procedure to remove extra glandular tissue was planned for late 2009, after the patient regains function of the facial nerve.

The authors noted that the successful procedure raises the possibility that future transplants with such large areas of tissue are possible.

"On the basis of our findings, we believe this may be feasible with the facial arterial arcade [blood vessel system] alone. While this is a notable distinction, it may not be the clinically most important one. Unlike the other transplants performed to this point, this patient had undergone multiple failed prior reconstructions and had significant recipient vascular depletion. This raises the important potential role of facial transplant as a salvage procedure in cases in which other operations are unavailable and/or suboptimal.

"As with any novel surgical innovation, information gathered in the nascent stages of the procedure will be vital to define the indications and appropriate patient selection. Our findings will hopefully contribute to this active discussion," they concluded.

The study is published in the latest issue of Archives of Facial Plastic Surgery, one of the JAMA/Archives journals. (ANI)

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