Recovery of blinking function is a critical but easily overlooked outcome after facial transplantation, according to a case study in the January issue of Plastic and Reconstructive Surgery®.
The study involved detailed assessments of blinking function following facial vascularized composite tissue allotransplantation to treat an injury to the central and lower face caused by an accidental gunshot. The extensive operation included a total face, double jaw, and tongue transplantation. The facial transplant was performed in March of 2012.
“The fact that we are now researching blinking outcomes for these patients—when face transplantation likely seemed more science fiction than science just a decade ago—shows how dedicated plastic and reconstructive surgeons around the globe have been in developing and refining this amazing, life-changing procedure.” —Rod J. Rohrich, MD
Recovery of Blinking Function Possible with Careful Planning
Vision and blinking function were evaluated before facial transplantation and for up to several months afterward. Assessments included slow-motion video analysis of blinking—particularly involuntary or “reflex” blinking, which is essential to protect the eye.
Before transplantation, the patient had 100% voluntary blinking function in both eyes. Reflex blinking was significantly impaired immediately following the surgery, with only 40% reflex blinking on the right side. On the left side, the patient had 90% reflex blinking function.
Six months after the transplantation, visual acuity and eye movement remained normal on both sides. Meanwhile, involuntary reflex blinking improved substantially: 70% in the right eye and 100% in the left eye.
Vision and blinking function again decreased as the patient went through a series of revision surgeries to improve functioning and appearance in the months after transplantation. These issues likely resulted from nerve injury caused by tissue handling during surgery. Both vision and blinking recovered several weeks after these procedures.
Lead author Eduardo DeJesus Rodriguez, MD, DDS—chair of the Department of Plastic Surgery at NYU Langone Medical Center and director of its Institute for Reconstructive Plastic Surgery—and colleagues call for careful surgical planning and technique to achieve optimal voluntary and reflex blinking—essential to protect long-term visual outcomes—in facial transplant recipients. The team believes its successful results reflect careful preservation of periorbital tissues from both the recipient and donor, followed by ingrowth of critical facial nerves. They encourage other facial transplant groups to perform similar evaluations of blinking function.
The effort to monitor restoration of blinking ability is an example of refinements to improve the long-term outcomes of facial transplantation, says Rod J. Rohrich, MD, editor in chief of Plastic and Reconstructive Surgery in a video release. “The fact that we are now researching blinking outcomes for these patients—when face transplantation likely seemed more science fiction than science just a decade ago—shows how dedicated plastic and reconstructive surgeons around the globe have been in developing and refining this amazing, life-changing procedure.”