Sensory and Motor Functional Outcomes of Four Patients 1 and 3 Years After Face Transplantation

The fundamental goal of facial transplantation is to restore aesthetic, motor, and sensory functions. Adequate integration of the facial allograft requires successful re-establishment of blood flow, and return of both motor and sensory functions that over time provide proprioceptive feedback facilitating cortical reintegration. Our fundamental design of each operation therefore emphasizes on technical simplicity of the vascular design as well as coaptation of all major sensory nerves and motor facial nerve branches. To maximize the targeted reinnervation of transplanted muscle and limit synkinesias, facial nerve coaptation is performed as distally as recipient anatomy allows. Following this principle, we have performed four face allotransplantations. Major sensory nerves were missing in two patients, one of which had an infraorbital nerve re-connected only on one side, serving as his own control in sensory recovery. Extensive damage of one side of the face also led to coaptation of only upper and lower division of the facial nerve in the same patient. Post-operatively, patients adhere to a strict rehabilitation regimen, and measures of facial function are taken regularly. Here, we present the results of motor and sensory testing used to monitor the recovery of facial function after face transplant.

Sensory recovery was evaluated using Semmes-Weinstein monofilament (SWm) testing and two-point discrimination exam. Motor function was catalogued using digital photography and videotaping during the performance of motor tasks.

Return of sensory and motor function was observed in all recipients (Patients 1-3) at 3, 6, and 9 months. Patient 1's gradual recovery of sensory function over 9 months is illustrated in the figure. In general, sensory recovery was not observed in areas where sensory nerves could not be connected. SWm testing shows graded improvement in sensation over the first nine postoperative months. Motor function recovery was significant but variable at nine months, with mild synkinesias in all, and severe synkinesis in one patient with only upper and lower division of facial nerve coaptation. A partial face transplant recipient (Patient 4) had sensation at 4g of pressure in 100% of the allograft and substantial motor recovery with noted improvements in speech, mastication, and social interaction after 2.5 years.