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Palmer et al. Plast Aesthet Res 2020;7:2 Plastic and
DOI: 10.20517/2347-9264.2019.34 Aesthetic Research

Review Open Access

Face transplantation for massive mandibular
defects: considerations for allograft design and

surgical planning

William Jackson Palmer , Laurel Nelms 2
1

1 Boston University School of Medicine, Boston, MA 02118, USA.
2 University of California Riverside School of Medicine, Riverside, CA 92521, USA.

Correspondence to: Mr. William Jackson Palmer, Boston University School of Medicine, 72 E. Concord St., Boston, MA 02118, USA.
E-mail: wjpalmer@bu.edu

How to cite this article: Palmer WJ, Nelms L. Face transplantation for massive mandibular defects: considerations for allograft design and
surgical planning. Plast Aesthet Res 2020;7:2. http://dx.doi.org/10.20517/2347-9264.2019.34
Received: 2 Oct 2019 First Decision: 30 Dec 2019 Revised: 7 Jan 2020 Accepted: 13 Jan 2020 Published: 20 Jan 2020

Science Editor: Ali-Farid Safi Copy Editor: Jing-Wen Zhang Production Editor: Tian Zhang

Abstract

Modern face transplant techniques have advanced to allow for the transfer of vascularized skeletal components in
addition to overlying soft tissue. This represents significant opportunity for individuals with mandibular defects that
are not amenable to traditional reconstruction. Care must be taken when planning and executing transplants with these
complex grafts, as satisfactory functional and aesthetic outcomes rely on achieving proper spatial relationships between
the mandible, skull base, and midface. Which donor skeletal elements are included in the allograft and how they are
harvested are important considerations in this planning and are associated with controversy. To optimize outcomes in
the reconstruction of single-jaw defects, some advocate for transplantation of only the affected jaw while others support
bimaxillary transplantation. Clinical evidence in this debate is not conclusive at this time. In current practice, including
donor dentoalveolar anatomy by utilizing a bilateral sagittal split osteotomy of the mandible is favored to optimize
outcomes such as dental occlusion. It has been suggested that harvesting the mandible at the level of the condyle or
even the temporal bone may also be possible and may improve temporomandibular joint-related outcomes. Despite
encouraging preclinical evidence, these strategies remain controversial. After allograft design, successful mandibular
reconstruction with face transplantation relies on surgical precision in the donor and recipient procedures. Computerized
surgical planning, computer-aided design and manufacturing, and intraoperative navigation are technologies currently
in use to mitigate operative complexity. Results in both cadaveric and clinical face transplantations suggest these
technologies are reliable and beneficial, although some room for improvement remains.

© The Author(s) 2020. Open Access This article is licensed under a Creative Commons Attribution 4.0
International License (https://creativecommons.org/licenses/by/4.0/), which permits unrestricted use,
sharing, adaptation, distribution and reproduction in any medium or format, for any purpose, even commercially, as long
as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license,
and indicate if changes were made.

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