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Functional Outcomes Of Face Transplantation
Sebastian Fischer, MD, Maximilian Kueckelhaus, MD, Mario A. Aycart, MD, Muayyad Alhefzi, MD, Alexander Dermietzel, MD, Luccie Wo, MD, Ericka Bueno, PhD, Bohdan Pomahac, MD.
Brigham and Womens Hospital, Boston, MA, USA.

Purpose
Thirty face transplantations (FT) were performed worldwide between 2005 and 2014. This study describes the pre-operative functional impairments and post-operative outcomes in all cases.
Methods
Functional outcomes assessed included abilities to smell, breathe, eat, speak, generate facial expressions and experience facial sensation. Six FT recipients at the authors’ institution underwent clinical examination, computed tomography (CT) and video/photograph documentation . Outcomes of the remainder 24 FT were researched in peer-reviewed literature.
Results
All 6 patients at the authors’ institution had deficits in breathing, eating, speech, expression and sensory functions before FT. Two had limited ability to smell, 2 needed tracheotomies and 1 was dependent on gastrostomy tubes. After 3.5years of mean follow-up, all functions improved in all six recipients. Progressive re-innervation of skin and muscles facilitated restoration of eating, speech, expression and sensory functions. CT data suggested significant increases in the volume of the upper airway, with observed improvements in breathing and smelling, and removal of all artificial airways and feeding tubes. Of the remainder 24FT cases, 60%of outcomes were not reported in the literature. In those reported, smell, eating and sensory functions improved in all cases, whereas breathing, speech and expression were ameliorated in 93%,71% and76% of cases, respectively.
Conclusion
FT is effective at restoring facial functions. Future reports should be fully descriptive of outcomes in order to increase the available evidence of effectiveness.


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