ABSTRACT
INDICATIONS n Facial defects in adults with functional deficits that cannot be reconstructed using conventional
techniques • Nonreconstructible injury to the central face: eyes, nose, and mouth Responsible for facial expression, communication, airway, eating, and control of oral
secretions Divided into three anatomic classifications: upper face, lower face, entire face
• .25% of the facial area with or without loss of a central facial feature • Cleveland Clinic FACES score (Table 43-1) Scoring system to identify ideal candidates for face transplantation based on the
following factors: Functional status Aesthetic deficit Comorbid conditions Exposed tissue Surgical history
Designed to facilitate patient selection and communication between centers, but has not been validated
Table 43-1 The Cleveland Clinic FACES Scoring System for Face Transplant Candidate Evaluation
CONTRAINDICATIONS n Psychiatric
• Active psychiatric disorder • Substance abuse • Cognitive and perceptual inability to understand risks of procedure
n Medical • Cancer: Active cancer diagnosis or high risk of cancer recurrence • Active infectious disease: HIV, hepatitis • Hematologic and immunologic conditions: Hypercoagulable disorders, systemic lupus
erythematosus (SLE), scleroderma n Psychosocial
• History of medical noncompliance • Inadequate support network • Pregnancy • Congenital malformations: Difference with hand allotransplantation, based on a patient with
neurofibromatosis who has undergone transplant
n Vascular perfusion • The entire facial vascularized composite allograft (VCA) • Including oral mucosa and bony skeleton; can be based on perfusion from one side because
of robust collateral circulation • External carotid and external/internal jugular system
n Nerve reconstruction • Facial nerve Coaptation of nerves as close to donor muscle as possible to avoid synkinesis Based on length of recipient facial nerve; donor nerve may have to include the entire
facial nerve trunk 6 parotid gland • Trigeminal nerve branches for sensation May require ostetomies to achieve greater length on the donor nerves Recipient’s sensory nerves may not be present because of injury.
