Early Postoperative Imaging and Image-Guided Procedures on Patients with Face Transplants

T.C. Lee; T. Chansakul; R.Y. Huang; G.L. Wrubel; S. Mukundan; D.J. Annino; J.J. Pribaz; B. Pomahac

doi:10.3174/ajnr.A4141

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Fig 1.
A, Preoperative 3D volume-rendered CT image shows posttraumatic and postreconstruction changes including absent nasal bones, anterior walls of the maxillary antra, and most of the hard palate. B, Postoperative 3D volume-rendered image shows fixations of the nasion and bilateral zygoma (red lines). C and D, Postoperative CT shows soft-tissue swelling of the left masseter, sternocleidomastoid muscle, parotid gland, and left lateral pharyngeal wall (arrows). The degree of swelling is more prominent in recipient native tissues than in the allograft. These findings resolved with antibiotic treatment.
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Fig 2.
A, Preoperative 3D volume-rendered CT image demonstrates posttraumatic changes from a severe electrical burn. B, Postoperative 3D volume-rendered CT image shows facial swelling. C, Postoperative CT image demonstrates a submental fluid collection (orange arrow). Sonography-guided needle aspiration of this fluid collection yielded high amylase and low pH, consistent with salivary collection from donor submandibular glands. The fluid collection was subsequently treated with botulinum toxin injection.
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Fig 3.
A, Preoperative 3D volume-rendered CT scan demonstrates a severely disfigured face. Note a detachable prosthetic nose. B, Postoperative 3D volume-rendered MR imaging performed 3 weeks following the transplantation demonstrates facial swelling. C, Postoperative T2-weighted MR imaging shows a small left submandibular fluid collection, presumed seroma (circle with dotted line), and an enlarged left submandibular lymph node (circle with solid line). A skin-punch biopsy was consistent with grade I/II rejection. The patient's symptoms resolved with pulse steroid therapy.
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Fig 4.
A, Preoperative 3D volume-rendered CT image of the patient whose face was mauled by a chimpanzee. B, Postoperative 3D volume-rendered CT image obtained for persistent fever and facial swelling 4 weeks following the surgery demonstrates facial swelling. C, Postoperative CT scan shows a necrotic-appearing right submandibular lymph node (arrow). CT-guided biopsy of this lymph node showed inflammation without evidence of infection or rejection. D, Postoperative CT also demonstrates a small fluid collection adjacent to the native right zygoma (circle), which was aspirated under CT guidance. Culture grew Enterococcus species.
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Fig 5.
A, Preoperative 3D volume-rendered CT image demonstrates facial deformity due to a severe lye burn. B, Postoperative 3D volume-rendered CT image shows mild facial swelling. C and D, Postoperative axial CT images show edema without a fluid collection. Note the normal-sized recipient submandibular glands (red arrows) and, more caudally, the symmetrically swollen bilateral donor submandibular glands (green arrows), which had been injected with botulinum toxin at the time of transplantation.
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Fig 6.
A, Preoperative 3D volume-rendered CT demonstrates facial deformity from a gunshot injury. B, Frontal photograph of the patient at 1 week following partial face transplantation shows right lower face and neck swelling. C, Posttransplantation CT demonstrates bilateral donor submandibular glands (white arrows), which had been injected with botulinum toxin at the time of transplantation. CT also shows a possible posteriorly displaced native right submandibular gland (green arrow), surrounded by fluid. Because the gland is altered in both shape and position, a differential consideration at this point includes an enlarged lymph node. D, Axial T2-weighted image obtained during MR imaging–guided aspiration of the fluid collection (red arrow). Aspirated fluid had a high amylase level, in keeping with salivary leak. E and F, Axial T2-weighted images obtained as the needles (yellow arrows) were advanced for botulinum toxin injection in the superficial right parotid gland at the site of suspected leak, determined by a tapered narrowing of the fluid collection toward the lateral aspect of the gland (E), and in the suspected posteriorly displaced native right submandibular gland (F). Injection of the native right submandibular gland was targeted at its anterior portion, closest to the adjacent fluid collection.