Face transplant at University of Maryland - The transplant included jaws, teeth and tongue

in medicine, biology

In a remarkable 36-hour operation transplant surgeons at the University of Maryland performed the most extensive full face transplant.  The face transplant included both jaws, teeth and tongue.  This marks the first time in the world that a full face transplant was performed by a team of plastic and reconstructive surgeons with specialized training and expertise in craniofacial surgery and reconstructive microsurgery.

An important post-operative aspect of any allogeneic transplant is the dependence of the patient on life-long immunosuppression. A recent review in the Journal of Craniofacial Surgery has suggested that the benefits must be balanced against the risks inherent in major surgery and the adverse effects of lifelong immunosuppression. Nevertheless, an allotransplantation may be the only viable option in many cases. 

Early this year a Turkish man who was seriously disfigured in a house fire had a face transplant surgery. That surgery was conducted at Akdeniz University's School of Medicine in southern Turkey. The first such procedure took place in 2005, when a partial face transplant was carried out on a French woman named Isabelle Dinoire. In a review of the first 17 face transplant cases, since the French case, it was found that the overall survival rate was 88% with only two deaths.

The transplant surgery at the University of Maryland involved a multi-disciplinary team of faculty physicians from the University of Maryland School of Medicine and a team of over 150 nurses and professional staff.

The face transplant, formally called a vascularized composite allograft (VCA), was part of a 72-hour marathon of transplant activity at one of the busiest transplant centers in the world. The family of one anonymous donor generously donated his face and also saved five other lives through the heroic gift of organ donation. Four of these transplants took place over the course of two days at the University of Maryland Medical Center.

The face transplant team was led by Eduardo D. Rodriguez, M.D., D.D.S., associate professor of surgery at the University of Maryland School of Medicine and chief of plastic, reconstructive and maxillofacial surgery at the R Adams Cowley Shock Trauma Center at the University of Maryland Medical Center. Dr. Rodriguez is board-certified in plastic and reconstructive surgery as well as in oral and maxillofacial surgery. This marks the first time in the world that a full face transplant was performed by a team of plastic and reconstructive surgeons with specialized training and expertise in craniofacial surgery and reconstructive microsurgery.
 
"We utilized innovative surgical practices and computerized techniques to precisely transplant the mid-face, maxilla and mandible including teeth, and a portion of the tongue. In addition, the transplant included all facial soft tissue from the scalp to the neck, including the underlying muscles to enable facial expression, and sensory and motor nerves to restore feeling and function," explains Dr. Rodriquez. "Our goal is to restore function as well as have aesthetically pleasing results."
 
The face transplant recipient, 37-year-old Richard Lee Norris of Hillsville, Virginia, was injured in 1997 in a gun accident. Since that time, he has undergone multiple life-saving and reconstructive surgeries. Due to the accident, Mr. Norris lost his lips and nose and had limited movement of his mouth. Mr. Norris first came to the University of Maryland Medical Center in 2005 to discuss reconstructive options with Dr. Rodriguez.
 
Grant funding from the Office of Naval Research (ONR) in the Department of Defense to Dr. Stephen Bartlett has supported the University of Maryland basic and clinical research program in vascularized composite transplantation leading up to and supporting this groundbreaking face transplant. The ONR funds medical research to support military operational medicine and clinical care of returning veterans. In addition to conducting research, the University of Maryland supports military medicine in a variety of ways, including training military medical staff prior to deployment and performing organ transplant surgeries for patients at Walter Reed/Bethesda National Naval Medical Center.
 
"The future of medicine depends on rapid translation of research and creating high-performing teams. The face transplant is a perfect example of the life-changing options we can provide for our patients when we combine the expertise of our research and clinical teams to pursue procedures that would have seemed unfathomable not so long ago," says E. Albert Reece, M.D., Ph.D., M.B.A., vice president of medical affairs at the University of Maryland and dean of the University of Maryland School of Medicine.
 
The team of face transplant surgeons benefited greatly from their experience treating high-velocity ballistic facial injuries at the R Adams Cowley Shock Trauma Center at the University of Maryland Medical Center. The team also includes research scientists and physician scientists from the University of Maryland's nationally recognized Division of Transplantation who have been researching ways to reduce rejection of donated organs and minimize the side effects of long-term immunosuppressive use after transplantation.

"A project like the face transplant requires multi-disciplinary collaboration between numerous clinical services and in many ways is very similar to trauma care," says Thomas M. Scalea, M.D., Francis X. Kelly Professor of Trauma Surgery, director, Program in Trauma, University of Maryland School of Medicine, and physician-in-chief, R Adams Cowley Shock Trauma Center. "Because we have an infrastructure built around multi-disciplinary care, it made sense for the facial transplant program to be housed at the Shock Trauma Center in the University of Maryland Medical Center."
 
The scientific team that includes Drs. Stephen Bartlett, Rolf Barth, and Eduardo Rodriguez focused on the anatomic and immunologic challenges to craniofacial transplantation. This work has been the basis for Dr. Rodriguez and his surgical team's groundbreaking surgical achievement.
 
"This accomplishment is the culmination of more than 10 years researching the immune system's response to vascular composite allograft transplants," says Stephen T. Bartlett, M.D., Peter Angelos Distinguished Professor and Chair of the Department of Surgery at the University of Maryland School of Medicine and Surgeon-in-Chief at the University of Maryland Medical Center. "Our solid organ transplant immunosuppressive protocol has led to excellent outcomes for our patients and will be part of the long-term care plan for the face transplant patient."

The face transplant team collaborated with the Living Legacy Foundation of Maryland, the organ and tissue donation program serving most of Maryland. The Living Legacy Foundation of Maryland is a non-profit organization that helps facilitate the donation and recovery of human organs and tissues for transplantation and research, and provides public and professional education on organ donation.
 
"The resources and talent that made this complex organizational effort a reality was months in the making and touched all areas of the hospital," says Jeffrey A. Rivest, president and chief executive officer of the University of Maryland Medical Center. "The Medical Center staff is honored to care for patients and families facing such tremendously complex medical challenges."

Science Story Reference: 

University of Maryland news release

 

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