Gordon Chad R, Susarla Srinivas M, Peacock Zachary S, Kaban Leonard B, Yaremchuk Michael J
Division of Plastic & Reconstructive Surgery, Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA.
J Craniofac Surg. 2012 Jan;23(1):81-7. doi: 10.1097/SCS.0b013e318240ca77.
Following encouraging results from the first 6 maxillofacial allotransplants, there has been a dramatic rise in interest worldwide. Numerous groups are now devoting resources to increase the frequency of these complex procedures, and with this, the craniomaxillofacial surgeon should become familiar with the emerging state of the art. This article reviews the evolution of Le Fort-based cadaveric studies pertaining to maxillofacial allotransplantation, briefly describes the clinical reports through 2010, and introduces a refined technique applying orthognathic applications. Preliminary studies over the last 5 years have highlighted the challenges associated with transplanting skeletal components, and clinical results presented thus far have been extremely promising. However, a notable area for improvement is suboptimal facial-skeletal harmony and profile in the context of sagittal skeletal projection and maxillomandibular relation. To our knowledge, orthognathic planning as applied to osteocutaneous face transplantation has not been described. Many recipients seen thus far demonstrate some degree of malocclusion and suboptimal harmony, as expected, given the donor-to-recipient skeletal/jaw discrepancies. Given that the goal is to improve function as well as form, the importance of orthognathic planning cannot be overstated with respect to optimizing harmony, profile, and occlusion. Preoperative planning, including generation of donor/recipient dental cast models, as described herein for the first time, is essential.
在前6例颌面部同种异体移植取得令人鼓舞的结果之后，全球范围内对此的兴趣急剧上升。众多团队目前正投入资源以增加这些复杂手术的实施频率，因此，颅颌面外科医生应熟悉这一新兴的先进技术。本文回顾了基于勒福（Le Fort）分型的尸体研究在颌面部同种异体移植方面的进展，简要描述了截至2010年的临床报告，并介绍了一种应用正颌技术的改良方法。过去5年的初步研究突出了移植骨骼成分所面临的挑战，而迄今为止公布的临床结果非常令人鼓舞。然而，在矢状面骨骼投影和上下颌关系方面，面部骨骼协调性和轮廓欠佳仍是一个值得改进的显著领域。据我们所知，尚未有关于应用于骨皮瓣面部移植的正颌规划的描述。鉴于供体与受体之间存在骨骼/颌骨差异，目前所见的许多受者都表现出一定程度的错牙合畸形和协调性欠佳。鉴于目标是改善功能和外形，正颌规划对于优化协调性、轮廓和咬合的重要性再怎么强调也不为过。术前规划，包括如本文首次所述制作供体/受体牙模，至关重要。
