Assessing how well a patient blinks after a face transplant can lead to better quality of life and sight after surgery, a new study reveals.
The retrospective study at New York University Langone Medical Center led by Dr Eduardo Rodriguez, Director of the Institute of Reconstructive and Plastic Surgery, highlights the important need for thorough and methodical eyelid assessment as the loss of proper function can lead to blindness.
“There is no guarantee that the eyelids will function normally after transplantation,” says Dr Rodriguez. "Careful and methodical preparation prior to facial transplantation, and attentiveness to post-surgical eyelid function, is essential to preserving vision in these cases."
Facial transplantation is an extremely rare procedure, and the first occurrence was in India in 1994 when Sandeep Kaur, then nine years old, had her face torn off in a threshing machine accident. Her face was reattached by the leading surgeon, Abraham Thomas.
In 2005, the first non-self, partial face transplantation took place in France. It wasn’t until 2010 that the first whole-face transplantation was performed, which involved a team of 30 doctors. Since then, only a handful of transplants have been performed, with varying degrees of success.
Dr Rodriguez and his co-authors discuss whole-face transplantation and the procedures used which preserve and restore blinking function, though nerve injury still occurs in handling and dissecting the tissue for transplantation.
"We have to work carefully to preserve the underlying muscle, the eyelids structures and their innervation. Blinking may seem like a simple, automatic function to many people. However, if you can't blink, your corneas are susceptible to the extremes of weather and exposure of the corneas while you sleep due to incomplete closure. This ultimately results in painful corneal exposure and potential scarring over part of the pupil which will ultimately impair vision,” Dr Rodriguez explains.
The team hopes their study will prompt those in post-operative care to pay closer attention to their patients’ blinking habits to prevent unnecessary eye damage and loss of quality of life after facial transplantation.