利用先进的计算机辅助技术克服基于勒福氏骨折的颅颌面移植中的跨性别差异和挑战。
Overcoming cross-gender differences and challenges in Le Fort-based, craniomaxillofacial transplantation with enhanced computer-assisted technology.
作者信息
Gordon Chad R, Swanson Edward W, Susarla Srinivas M, Coon Devin, Rada Erin, Rakan Mohammed Al, Santiago Gabriel F, Shores Jaimie T, Bonawitz Steven C, Fishman Elliot K, Murphy Ryan, Armand Mehran, Liacouras Peter, Grant Gerald T, Brandacher Gerald, Lee Wei-Ping Andrew
机构信息
From the *Department of Plastic and Reconstructive Surgery, The Johns Hopkins Hospital, Johns Hopkins University School of Medicine, Baltimore, MD; †Department of Oral and Maxillofacial Surgery, Massachusetts General Hospital, Harvard School of Dental Medicine, Boston, MA; ‡Department of Radiology, The Johns Hopkins Hospital, Johns Hopkins University School of Medicine, Baltimore; §The Johns Hopkins University Applied Physics Laboratory, Laurel; and ∥3D Medical Applications Center, Department of Radiology, Walter Reed National Military Medical Center, Bethesda, MD.
出版信息
Ann Plast Surg. 2013 Oct;71(4):421-8. doi: 10.1097/SAP.0b013e3182a0df45.
BACKGROUND
Sex-specific anthropometrics, skin texture/adnexae mismatch, and social apprehension have prevented cross-gender facial transplantation from evolving. However, the scarce donor pool and extreme waitlist times are currently suboptimal. Our objective was to (1) perform and assess cadaveric facial transplantation for each sex-mismatched scenario using virtual planning with cutting guide fabrication and (2) review the advantages/disadvantages of cross-gender facial transplantation.
METHODS
Cross-gender facial transplantation feasibility was evaluated through 2 mock, double-jaw, Le Fort-based cadaveric allotransplants, including female donor-to-male recipient and male donor-to-female recipient. Hybrid facial-skeletal relationships were investigated using cephalometric measurements, including sellion-nasion-A point and sellion-nasion-B point angles, and lower-anterior-facial-height to total-anterior-facial-height ratio. Donor and recipient cutting guides were designed with virtual planning based on our team's experience in swine dissections and used to optimize the results.
RESULTS
Skeletal proportions and facial-aesthetic harmony of the transplants (n = 2) were found to be equivalent to all reported experimental/clinical sex-matched cases by using custom guides and Mimics technology. Cephalometric measurements relative to Eastman Normal Values are shown.
CONCLUSIONS
On the basis of our results, we believe that cross-gender facial transplantation can offer equivalent, anatomical skeletal outcomes to those of sex-matched pairs using preoperative planning and custom guides for execution. Lack of literature discussion of cross-gender facial transplantation highlights the general stigmata encompassing the subject. We hypothesize that concerns over sex-specific anthropometrics, skin texture/adnexae disparity, and increased immunological resistance have prevented full acceptance thus far. Advantages include an increased donor pool with expedited reconstruction, as well as size-matched donors.
背景
性别特异性人体测量学、皮肤质地/附属器不匹配以及社会顾虑阻碍了跨性别面部移植的发展。然而，目前供体库稀缺且等待名单时间极长，情况并不理想。我们的目标是：（1）针对每种性别不匹配的情况，使用虚拟规划和切割导板制作技术进行并评估尸体面部移植；（2）回顾跨性别面部移植的优缺点。
方法
通过2例模拟的、基于双颌Le Fort的尸体同种异体移植评估跨性别面部移植的可行性，包括女性供体至男性受体以及男性供体至女性受体。使用头影测量法研究混合面部骨骼关系，包括蝶鞍-鼻根-A点和蝶鞍-鼻根-B点角度，以及下前面部高度与总前面部高度之比。根据我们团队在猪解剖方面的经验，通过虚拟规划设计供体和受体切割导板，并用于优化结果。
结果
通过使用定制导板和Mimics技术，发现移植体（n = 2）的骨骼比例和面部美学协调性与所有已报道的实验/临床性别匹配病例相当。显示了相对于伊士曼正常值的头影测量结果。
结论
基于我们的结果，我们认为跨性别面部移植通过术前规划和定制导板执行，可以提供与性别匹配对等同的解剖骨骼结果。缺乏关于跨性别面部移植的文献讨论凸显了围绕该主题的普遍污名。我们假设，对性别特异性人体测量学、皮肤质地/附属器差异以及免疫抵抗增加的担忧至今阻碍了其被完全接受。优点包括增加供体库、加快重建速度以及供体尺寸匹配。
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