You’ve heard of the Seven Wonders of the Ancient World, and the Seven Wonders of the Modern World, but what about the Seven Wonders of the Medical World? I’m referring to the seven successful face transplant surgeries that have been performed at Brigham and Women’s Hospital in Boston between 2009 and 2013. That’s more than any other facility in the world.
Face transplant surgery—the transfer of face tissue from a deceased human donor to a patient with a severe facial deformity—may sound like something right out of science fiction, but, in fact, it’s an innovative reconstructive procedure that every plastic surgeon should know about.
“Even if it’s not something a plastic surgeon is doing himself or herself, it’s good to know what’s possible,” says Thomas C. Lee, MD, assistant section head of Neuroradiology at Brigham and Women’s Hospital. “If your patient needs facial reconstruction and you’ve done your utmost but need to go to the next step, it’s important to know what’s available so you can best help your patients.”
Brigham and Women’s has an expert face transplant team—led by Bohdan Pomahac, MD. They also have state-of-the-art technology, including 3D-printed models that are now mandatory in surgical planning for face-transplantation procedures at the institution.
Specifically, the team at Brigham and Women’s use computed tomography (CT) and 3D printing technology to recreate life-size models of patients’ heads to assist in face transplantation. 3D-printed models for face-transplant procedures provide superior preoperative data and reduces overall procedure time, according to the team’s research, which was conducted at its own facility and presented in late 2014 at the Radiological Society of North America’s annual meeting
CT is the modality of choice for seeing bony structures, and the 3D-printed model provides an efficient way of offering visual guidance to the surgical team, Lee says. “When they bring in the donor face, there is all this soft tissue covering the bones, and so a way of assessing how much of the bone to shave off is by looking at a CT scan, but that can entail thousands of images,” Lee says. “It is much easier to have a 3D-printed model of the bones in one’s hands to be able to rotate and view easily from different angles to determine the best alignments for reconstruction.”
On the Horizon
While CT is excellent for visualizing bones, magnetic resonance imaging (MRI) is the best method for seeing soft tissues. Lee foresees a time when the Brigham and Women’s reconstructive team can have access to yet another kind of 3D-printed model.
“Now that we have an MRI sequence that’s ready to visualize the fine facial nerve branches, the hope is that we can scan the patient and ideally print out a model of the facial nerve branches for the plastic surgery team,” Lee says.
“As radiologists, we are used to scrolling through thousands of images on a computer screen, but when you are talking about a surgical team—particularly one that is under time pressure—they really want something that is easily visible. I think if we can print out those facial nerve branches in a 3D sculpture, it’s the best way to give them the information so they can process it as quickly as possible.”
The long-term goal is to be able to deliver to the surgical team “an entire 3D model of the facial nerve branches, the bone, vessels, muscles, soft tissues—but, of course, that’s much more involved,” he says.
Because face transplants are such a new operation, there is a big focus on safety at Brigham and Women’s, Lee notes.
“But perhaps in the future, if it ever becomes more of a routine operation, there might be more emphasis placed on the cosmetic and aesthetic aspects,” Lee says. “In an ideal future world, for patients who have had accidents to their face but preserved their vision, it would be wonderful to 3D print for them what they would look like after the face transplant so they could see it, and maybe even give their input.” n
Marianne Matthews is a contributing writer for Plastic Surgery Practice magazine. She can be reached via [email protected].