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The Sensory Recovery in Face Transplantation

  • Bahar Bassiri Gharb
  • Antonio Rampazzo
  • Maria Z. Siemionow
Chapter

Abstract

Recovery of normal function in face transplantation is fundamental to justify the necessity for lifelong immunosuppressive therapy. However, extensive soft tissue damage and scarring in face transplant patients has often hampered the repair of the sensory nerves. Nonetheless, it seems that near full return of sensation has been achieved in these patients. In this chapter we assessed the sensory outcome in face-transplanted patients and investigated the factors which could have impacted the final result. The results were compared to sensory return following replantation of face and scalp, repair of divided sensory nerves of the face, and in innervated and noninnervated vascularized free flaps used for head and neck reconstruction. Sensory recovery following face transplantation, even when the sensory nerves were not repaired, showed results comparable or superior to free autologus innervated tissue. Results were also comparable with the outcome of the microsurgical repair of the peripheral branches of the trigeminal nerve. Therefore, near normal sensory recovery can be expected following facial allotransplantation. Restoration of normal end organ receptors within the facial allograft, repair of the facial nerve, and immunosuppressive therapy with FK506 probably affect and accelerate the final outcome. We suggest a guideline on quantitative sensory testing and timing of the follow-up to allow comparison of results between different centers and improve our understanding of the mechanisms of sensory recovery in face transplantation.

Keywords

Facial Nerve Trigeminal Nerve Free Flap Quantitative Sensory Testing Infraorbital Nerve 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

References

  1. 1.
    Siemionow M, Papay F, Alam D, et al. Near-total human face transplantation for a severely disfigured patient in the USA. Lancet. 2009;374:203-209.PubMedCrossRefGoogle Scholar
  2. 2.
    Siemionow MZ, Papay F, Djohan R, et al. First U.S. near-total human face transplantation: a paradigm shift for massive complex injuries. Plast Reconstr Surg. 2010;125:111-122.PubMedGoogle Scholar
  3. 3.
    Mackinnon SE, Dellon AL. Surgery of the Peripheral Nerve. 1st ed. New York: Thieme Medical Publishers; 1988.Google Scholar
  4. 4.
    Devauchelle B, Badet L, Lengele B, et al. First human face allograft: early report. Lancet. 2006;368:203-209.PubMedCrossRefGoogle Scholar
  5. 5.
    Dubernard JM, Lengele B, Morelon E, et al. Outcomes 18 months after the first human partial face transplantation. N Engl J Med. 2007;357:2451-2460.PubMedCrossRefGoogle Scholar
  6. 6.
    Lantieri L, Meningaud JP, Grimbert P, et al. Repair of the lower and middle parts of the face by composite tissue allotransplantation in a patient with massive plexiform neurofibroma: a 1-year follow-up study. Lancet. 2008;372:639-645.PubMedCrossRefGoogle Scholar
  7. 7.
    Guo S, Han Y, Zhang X, et al. Human facial allotransplantation: a 2-year follow-up study. Lancet. 2008;372:631-638.PubMedCrossRefGoogle Scholar
  8. 8.
    Cheng K, Zhou S, Jiang K, et al. Microsurgical replantation of the avulsed scalp: report of 20 cases. Plast Reconstr Surg. 1996;97:1099-1106. Discussion 1107-1108.PubMedCrossRefGoogle Scholar
  9. 9.
    Ueda K, Nomatsi T, Omiya Y, Tajima S. Replanted scalp recovers normal sensation without nerve anastomosis. Plast Reconstr Surg. 2000;106:1651-1652.PubMedCrossRefGoogle Scholar
  10. 10.
    Nahai F, Hester TR, Jurkiewicz MJ. Microsurgical replantation of the scalp. J Trauma. 1985;25:897-902.PubMedCrossRefGoogle Scholar
  11. 11.
    Yin JW, Matsuo JM, Hsieh CH, Yeh MC, Liao WC, Jeng SF. Replantation of total avulsed scalp with microsurgery: experience of eight cases and literature review. J Trauma. 2008;64:796-802.PubMedCrossRefGoogle Scholar
  12. 12.
    Cho BC, Lee DH, Park JW, Byun JS, Baik BS. Replantation of avulsed scalps and secondary aesthetic correction. Ann Plast Surg. 2000;44:361-366.PubMedCrossRefGoogle Scholar
  13. 13.
    Chen IC, Wan HL. Microsurgical replantation of avulsed scalps. J Reconstr Microsurg. 1996;12:105-112.PubMedCrossRefGoogle Scholar
  14. 14.
    Chou CK, Lin SD, Yang CC, Lai CS, Lin GT. Microsurgical replantation of avulsed scalp – two cases report. Gaoxiong Yi Xue Ke Xue Za Zhi. 1992;8:285-289.PubMedGoogle Scholar
  15. 15.
    Fogdestam I, Lilja J. Microsurgical replantation of a total scalp avulsion. Case report. Scand J Plast Reconstr Surg. 1986;20:319-322.PubMedCrossRefGoogle Scholar
  16. 16.
    Zhou S, Chang TS, Guan WX, et al. Microsurgical replantation of the avulsed scalp: report of six cases. J Reconstr Microsurg. 1993;9:121-125. Discussion 125-129.PubMedCrossRefGoogle Scholar
  17. 17.
    Topalan M, Ermis I. Replantation and triple expansion of a three-piece total scalp avulsion: six-year follow-up. Ann Plast Surg. 2001;46:167-169.PubMedCrossRefGoogle Scholar
  18. 18.
    Sabapathy SR, Venkatramani H, Bharathi RR, D’Silva J. Technical considerations in replantation of total scalp avulsions. J Plast Reconstr Aesthet Surg. 2006;59:2-10.PubMedCrossRefGoogle Scholar
  19. 19.
    Robinson PP, Smith KG. A study on the efficacy of late lingual nerve repair. Br J Oral Maxillofac Surg. 1996;34:96-103.PubMedCrossRefGoogle Scholar
  20. 20.
    Robinson PP, Loescher AR, Smith KG. A prospective, quantitative study on the clinical outcome of lingual nerve repair. Br J Oral Maxillofac Surg. 2000;38:255-263.PubMedCrossRefGoogle Scholar
  21. 21.
    Hillerup S, Stoltze K. Lingual nerve injury II. observations on sensory recovery after micro-neurosurgical reconstruction. Int J Oral Maxillofac Surg. 2007;36:1139-1145.PubMedCrossRefGoogle Scholar
  22. 22.
    Tay AB, Poon CY, Teh LY. Immediate repair of transected inferior alveolar nerves in sagittal split osteotomies. J Oral Maxillofac Surg. 2008;66:2476-2481.PubMedCrossRefGoogle Scholar
  23. 23.
    Kerawala CJ, Newlands C, Martin I. Spontaneous sensory recovery in non-innervated radial forearm flaps used for head and neck reconstruction. Int J Oral Maxillofac Surg. 2006;35:714-717.PubMedCrossRefGoogle Scholar
  24. 24.
    Boyd B, Mulholland S, Gullane P, et al. Reinnervated lateral antebrachial cutaneous neurosome flaps in oral reconstruction: are we making sense? Plast Reconstr Surg. 1994;93:1350-1359. Discussion 1360-1362.PubMedCrossRefGoogle Scholar
  25. 25.
    Lahteenmaki T, Waris T, Asko-Seljavaara S, Sundell B. Recovery of sensation in free flaps. Scand J Plast Reconstr Surg Hand Surg. 1989;23:217-222.PubMedCrossRefGoogle Scholar
  26. 26.
    Katou F, Shirai N, Kamakura S, et al. Intraoral reconstruction with innervated forearm flap: a comparison of sensibility and reinnervation in innervated versus noninnervated forearm flap. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 1995;80:638-644.PubMedCrossRefGoogle Scholar
  27. 27.
    Close LG, Truelson JM, Milledge RA, Schweitzer C. Sensory recovery in noninnervated flaps used for oral cavity and oropharyngeal reconstruction. Arch Otolaryngol Head Neck Surg. 1995;121:967-972.PubMedGoogle Scholar
  28. 28.
    Shindo ML, Sinha UK, Rice DH. Sensory recovery in noninnervated free flaps for head and neck reconstruction. Laryngoscope. 1995;105:1290-1293.PubMedCrossRefGoogle Scholar
  29. 29.
    Vriens JP, Acosta R, Soutar DS, Webster MH. Recovery of sensation in the radial forearm free flap in oral reconstruction. Plast Reconstr Surg. 1996;98:649-656.PubMedCrossRefGoogle Scholar
  30. 30.
    Kimata Y, Uchiyama K, Ebihara S, et al. Comparison of innervated and noninnervated free flaps in oral reconstruction. Plast Reconstr Surg. 1999;104:1307-1313.PubMedCrossRefGoogle Scholar
  31. 31.
    Yu P. Reinnervated anterolateral thigh flap for tongue reconstruction. Head Neck. 2004;26:1038-1044.PubMedCrossRefGoogle Scholar
  32. 32.
    Avery CM, Iqbal M, Hayter JP. Recovery of sensation in the skin of non-innervated radial flaps after subfascial and suprafascial dissection. Br J Oral Maxillofac Surg. 2006;44:213-216.PubMedCrossRefGoogle Scholar
  33. 33.
    Shibahara T, Mohammed AF, Katakura A, Nomura T. Long-term results of free radial forearm flap used for oral reconstruction: functional and histological evaluation. J Oral Maxillofac Surg. 2006;64:1255-1260.PubMedCrossRefGoogle Scholar
  34. 34.
    Kim JH, Rho YS, Ahn HY, Chung CH. Comparison of sensory recovery and morphologic change between sensate and nonsensate flaps in oral cavity and oropharyngeal reconstruction. Head Neck. 2008;30:1099-1104.PubMedCrossRefGoogle Scholar
  35. 35.
    Sabesan T, Ramchandani PL, Ilankovan V. Sensory recovery of noninnervated free flap in oral and oropharyngeal reconstruction. Int J Oral Maxillofac Surg. 2008;37:819-823.PubMedCrossRefGoogle Scholar
  36. 36.
    Santamaria E, Wei FC, Chen IH, Chuang DC. Sensation recovery on innervated radial forearm flap for hemiglossectomy reconstruction by using different recipient nerves. Plast Reconstr Surg. 1999;103:450-457.PubMedCrossRefGoogle Scholar
  37. 37.
    Kuriakose MA, Loree TR, Spies A, Meyers S, Hicks WL Jr. Sensate radial forearm free flaps in tongue reconstruction. Arch Otolaryngol Head Neck Surg. 2001;127:1463-1466.PubMedGoogle Scholar
  38. 38.
    Dodson TB, Kaban LB. Recommendations for management of trigeminal nerve defects based on a critical appraisal of the literature. J Oral Maxillofac Surg. 1997;55:1380-1386. Discussion 1387.PubMedCrossRefGoogle Scholar
  39. 39.
    Wyrick JD, Stern PJ. Secondary nerve reconstruction. Hand Clin. 1992;8:587-598.PubMedGoogle Scholar
  40. 40.
    Hermanson A, Dalsgaard CJ, Arnander C, Lindblom U. Sensibility and cutaneous reinnervation in free flaps. Plast Reconstr Surg. 1987;79:422-427.PubMedCrossRefGoogle Scholar
  41. 41.
    Sonmez A, Bayramicli M, Sonmez B, Numanoglu A. Reconstruction of the weight-bearing surface of the foot with nonneurosensory free flaps. Plast Reconstr Surg. 2003;111:2230-2236.PubMedCrossRefGoogle Scholar
  42. 42.
    Lahteenmaki T, Waris T, Asko-Seljavaara S, Astrand K, Sundell B, Jarvilehto T. The return of sensitivity to cold, warmth and pain from excessive heat in free microvascular flaps. Scand J Plast Reconstr Surg Hand Surg. 1991;25:143-150.PubMedCrossRefGoogle Scholar
  43. 43.
    Santanelli F, Tenna S, Pace A, Scuderi N. Free flap reconstruction of the sole of the foot with or without sensory nerve coaptation. Plast Reconstr Surg. 2002;109:2314-2322. discussion 2323–4.PubMedCrossRefGoogle Scholar
  44. 44.
    Brown CJ, Mackinnon SE, Dellon AL, Bain JR. The sensory potential of free flap donor sites. Ann Plast Surg. 1989;23:135-140.PubMedCrossRefGoogle Scholar
  45. 45.
    Turkof E, Jurecka W, Sikos G, Piza-Katzer H. Sensory recovery in myocutaneous, noninnervated free flaps: a morphologic, immunohistochemical, and electron microscopic study. Plast Reconstr Surg. 1993;92:238-247.PubMedCrossRefGoogle Scholar
  46. 46.
    Thomander L, Arvidsson J, Aldskogius H. Distribution of sensory ganglion cells innervating facial muscles in the cat. an anatomical study with the horseradish peroxidase technique. Acta Otolaryngol. 1982;94:81-92.PubMedCrossRefGoogle Scholar
  47. 47.
    Baumel JJ. Trigeminal-facial nerve communications. their function in facial muscle innervation and reinnervation. Arch Otolaryngol. 1974;99:34-44.PubMedGoogle Scholar
  48. 48.
    Han DG. Pain around the ear in bell’s palsy is referred pain of facial nerve origin: the role of nervi nervorum. Med Hypotheses. 2010;74:235-236.PubMedCrossRefGoogle Scholar
  49. 49.
    Tindholdt TT, Tonseth KA. Spontaneous reinnervation of deep inferior epigastric artery perforator flaps after secondary breast reconstruction. Scand J Plast Reconstr Surg Hand Surg. 2008;42:28-31.PubMedCrossRefGoogle Scholar
  50. 50.
    Place MJ, Song T, Hardesty RA, Hendricks DL. Sensory reinnervation of autologous tissue TRAM flaps after breast reconstruction. Ann Plast Surg. 1997;38:19-22.PubMedCrossRefGoogle Scholar
  51. 51.
    Blondeel PN, Demuynck M, Mete D, et al. Sensory nerve repair in perforator flaps for autologous breast reconstruction: sensational or senseless? Br J Plast Surg. 1999;52:37-44.PubMedCrossRefGoogle Scholar
  52. 52.
    Schultes G, Gaggl A, Karcher H. Neuronal anastomosis of the cutaneous ramus of the intercostal nerve to achieve sensibility in the latissimus dorsi transplant. J Oral Maxillofac Surg. 2000;58:36-39.PubMedCrossRefGoogle Scholar
  53. 53.
    Carmichael EA, Woolard HH. Some observations on the fifth and seventh cranial nerves. Brain. 1933;56:109-125.CrossRefGoogle Scholar
  54. 54.
    Ley A, Guitart JM. Clinical observations on sensory effects of trigeminal dorsal root section. J Neurol Neurosurg Psychiatry. 1971;34:260-264.PubMedCrossRefGoogle Scholar
  55. 55.
    Davis LE. The deep sensibility of the face. Arch Neurol Psychiatry. 1923;9:283.Google Scholar
  56. 56.
    Trulsson M, Johansson RS. Orofacial mechanoreceptors in humans: encoding characteristics and responses during natural orofacial behaviors. Behav Brain Res. 2002;135:27-33.PubMedCrossRefGoogle Scholar
  57. 57.
    Thomas PK. The anatomical substratum of pain: evidence derived from morphometric studies on peripheral nerve. Can J Neurol Sci. 2004;31:398-403.PubMedGoogle Scholar
  58. 58.
    Wang MS, Zeleny-Pooley M, Gold BG. Comparative dose-dependence study of FK506 and cyclosporin A on the rate of axonal regeneration in the rat sciatic nerve. J Pharmacol Exp Ther. 1997;282:1084-1093.PubMedGoogle Scholar
  59. 59.
    Udina E, Voda J, Gold BG, Navarro X. Comparative dose-dependence study of FK506 on transected mouse sciatic nerve repaired by allograft or xenograft. J Peripher Nerv Syst. 2003;8:145-154.PubMedCrossRefGoogle Scholar
  60. 60.
    Sulaiman OA, Voda J, Gold BG, Gordon T. FK506 increases peripheral nerve regeneration after chronic axotomy but not after chronic Schwann cell denervation. Exp Neurol. 2002;175:127-137.PubMedCrossRefGoogle Scholar
  61. 61.
    Sosa I, Reyes O, Kuffler DP. Immunosuppressants: neuroprotection and promoting neurological recovery following peripheral nerve and spinal cord lesions. Exp Neurol. 2005;195:7-15.PubMedCrossRefGoogle Scholar
  62. 62.
    Gold BG. FK506 and the role of the immunophilin FKBP-52 in nerve regeneration. Drug Metab Rev. 1999;31:649-663.PubMedCrossRefGoogle Scholar
  63. 63.
    Dubernard JM, Owen E, Herzberg G, et al. Human hand allograft: report on first 6 months. Lancet. 1999;353:1315-1320.PubMedCrossRefGoogle Scholar
  64. 64.
    Bain JR. Peripheral nerve and neuromuscular allotransplantation: current status. Microsurgery. 2000;20:384-388.PubMedCrossRefGoogle Scholar
  65. 65.
    Bell-Krotoski J, Tomancik E. The repeatability of testing with Semmes-Weinstein monofilaments. J Hand Surg Am. 1987;12:155-161.PubMedGoogle Scholar
  66. 66.
    Dellon AL, Andonian E, DeJesus RA. Measuring sensibility of the trigeminal nerve. Plast Reconstr Surg. 2007;120:1546-1550.PubMedCrossRefGoogle Scholar
  67. 67.
    Essick GK, Phillips C, Kim SH, Zuniga J. Sensory retraining following orthognathic surgery: effect on threshold measures of sensory function. J Oral Rehabil. 2009;36:415-426.PubMedCrossRefGoogle Scholar
  68. 68.
    Graham B, Dellon AL. Sensory recovery in innervated free-tissue transfers. J Reconstr Microsurg. 1995;11:157-166.PubMedCrossRefGoogle Scholar

Copyright information

© Springer London 2011

Authors and Affiliations

  • Bahar Bassiri Gharb
  • Antonio Rampazzo
  • Maria Z. Siemionow
    • 1
  1. 1.Department of Plastic SurgeryCleveland ClinicClevelandUSA

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