The Sensory Recovery in Face Transplantation

Abstract

Recovery of normal function in face transplantation is fundamental to justify the necessity for lifelong immunosuppressive therapy. However, extensive soft tissue damage and scarring in face transplant patients has often hampered the repair of the sensory nerves. Nonetheless, it seems that near full return of sensation has been achieved in these patients. In this chapter we assessed the sensory outcome in face-transplanted patients and investigated the factors which could have impacted the final result. The results were compared to sensory return following replantation of face and scalp, repair of divided sensory nerves of the face, and in innervated and noninnervated vascularized free flaps used for head and neck reconstruction. Sensory recovery following face transplantation, even when the sensory nerves were not repaired, showed results comparable or superior to free autologus innervated tissue. Results were also comparable with the outcome of the microsurgical repair of the peripheral branches of the trigeminal nerve. Therefore, near normal sensory recovery can be expected following facial allotransplantation. Restoration of normal end organ receptors within the facial allograft, repair of the facial nerve, and immunosuppressive therapy with FK506 probably affect and accelerate the final outcome. We suggest a guideline on quantitative sensory testing and timing of the follow-up to allow comparison of results between different centers and improve our understanding of the mechanisms of sensory recovery in face transplantation.