From the Bench with Francis: The Potential of Face Transplant for Craniofacial Reconstruction

From the Bench with Francis

A regular column on craniofacial news and technology by Dr. Francis Smith

Over the years, since the first partial face transplant in France in 2005 and the first full face surgery in Spain in 2010, surgeons in Europe and the USA have pioneered the transplantation of entire faces from cadaver donors to patients whose faces were destroyed by trauma, burns, and disease The current National Geographic magazine (September 2018) cover story features the case of a young lady, Katie Stubblefield, who lost her face to gunshot trauma and had a cadaveric face transplant. So far, all the cases of face transplant I am aware of were done on patients for burns, facial trauma, and disease, but this procedure holds potential benefit for patients with congenital craniofacial anomalies.

The surgery involves removing the face from a donor cadaver, often with its underlying tissues (muscles, bones, blood vessels, fat, and nerves), and attaching it to the patient after his own disfigured face is removed. A large team of specialist surgeons not only sew the donated face onto the recipient, but must meticulously attach every blood vessel, nerve, bone, and other components to their exact counterparts in the recipient’s head (often using surgical microscopes and microsurgical techniques). The procedure, being so complicated, can take over a day’s time to complete (8 to 36 hours), and results in a 10-14 day hospital stay postoperatively. Since this is a transplant, like any organ transplant, the patient is subject to lifelong immunosuppressive therapy which opens him or her up to potentially fatal opportunistic infections, kidney damage, and cancer. There are ethical considerations surrounding the surgery itself and the aftereffects on quality of life.

Could this one day help children and adults with congenital craniofacial conditions, such as Treacher Collins syndrome? The medical challenges, including lifelong anti-rejection immunosuppression therapy, would be the same as for others undergoing face transplantation; this might be even more challenging in children with craniofacial anomalies as they already deal with medical complications stemming from their congenital conditions. Perhaps the biggest challenge may be the ethics of having another person’s face (in the case of a child, a deceased child’s donated face) replacing their own, sense of identity, and other concerns not yet imagined. It might be meant to replace current craniofacial reconstructive surgical techniques that mostly rely on grafting the patient’s own tissues into his face. If this ever becomes an option for reconstruction in congenital craniofacial anomalies, there may be ethical considerations we cannot yet begin to imagine. It will be an interesting debate, and I hope to encourage such debate.