Dynamic Maxillary Sinus Changes of Facial Vascularized Composite Allotransplants

Summary: Skin is one of the target tissues of rejection in face transplants and, because of its easy accessibility, has become the gold standard in the diagnosis of rejection. The allograft contains deeper tissues where rejection can occur, but samples cannot be obtained because of difficult access. Deep tissue changes were monitored on computed tomographic scans of the midface in six face transplant recipients with the help of image segmentation. The maxillary sinus was identified as a dynamic anatomical compartment. Observed changes in volume of the aeration relative to the opacification (aeration coefficient) of the maxillary sinus were quantified with the help of image segmentation. Changes in the aeration coefficient as a surrogate of mucosal swelling were quantified and related to time, treatment, and skin rejection grade. Lower aeration coefficients were found only in patients with transplanted maxillary sinus mucosa. Pathologic changes were not observed in face transplant recipients with a native maxillary sinus. The data show that the aeration coefficient was significantly lower at the time of biopsy-proven allograft rejection. Neither mechanical, nor infectious, nor medication side effects sufficiently explain the findings presented herein. The authors’ findings are important to consider for clinical management of face transplant patients who receive parts of the sinonasal tract. The authors identify a potential radiologic biomarker of deep tissue allograft rejection. In the future, the proposed methodology might prove useful in monitoring deeper dynamic tissue changes in vascularized composite allografts and might help in designing patient-specific, individualized treatment strategies.

[1]  Anna E. Rutherford,et al.  Accelerated chronic skin changes without allograft vasculopathy: A 10-year outcome report after face transplantation. , 2020, Surgery.

[2]  C. Lian,et al.  Mucosa and Rejection in Facial Vascularized Composite Allotransplantation: A Systematic Review , 2020, Transplantation.

[3]  B. Pomahac,et al.  MMP3 Is a Non-invasive Biomarker of Rejection in Skin-Bearing Vascularized Composite Allotransplantation: A Multicenter Validation Study , 2019, Front. Immunol..

[4]  R. Goldbrunner,et al.  Does Meningioma Volume Correlate With Clinical Disease Manifestation Irrespective of Histopathologic Tumor Grade? , 2019, The Journal of craniofacial surgery.

[5]  B. Pomahac,et al.  Five-Year Follow-up after Face Transplantation. , 2019, The New England journal of medicine.

[6]  C. Lian,et al.  Chronic rejection of human face allografts , 2018, American journal of transplantation : official journal of the American Society of Transplantation and the American Society of Transplant Surgeons.

[7]  Andrea Grandoch,et al.  Image segmentation-based volume approximation-volume as a factor in the clinical management of osteolytic jaw lesions. , 2019, Dento maxillo facial radiology.

[8]  D. Maintz,et al.  Does volumetric measurement of cervical lymph nodes serve as an imaging biomarker for locoregional recurrence of oral squamous cell carcinoma? , 2018, Journal of cranio-maxillo-facial surgery : official publication of the European Association for Cranio-Maxillo-Facial Surgery.

[9]  H. Nickenig,et al.  Size distribution and clinicoradiological signs of aggressiveness in odontogenic myxoma-three-dimensional analysis and systematic review. , 2018, Dento maxillo facial radiology.

[10]  R. Büttner,et al.  Does volumetric measurement serve as an imaging biomarker for tumor aggressiveness of ameloblastomas? , 2018, Oral oncology.

[11]  H. Nickenig,et al.  Age-Related Volumetric Changes in Mandibular Condyles , 2017, The Journal of craniofacial surgery.

[12]  H. Nickenig,et al.  Volumetric Analysis of 700 Mandibular Condyles Based Upon Cone Beam Computed Tomography , 2017, The Journal of craniofacial surgery.

[13]  H. Nickenig,et al.  Volumetric analysis of keratocystic odontogenic tumors and non-neoplastic jaw cysts - Comparison and its clinical relevance. , 2017, Journal of cranio-maxillo-facial surgery : official publication of the European Association for Cranio-Maxillo-Facial Surgery.

[14]  Guido Gerig,et al.  ITK-SNAP: An interactive tool for semi-automatic segmentation of multi-modality biomedical images , 2016, 2016 38th Annual International Conference of the IEEE Engineering in Medicine and Biology Society (EMBC).

[15]  M. Selim,et al.  Vascularized composite allotransplantation: a closer look at the banff working classification , 2016, Transplant international : official journal of the European Society for Organ Transplantation.

[16]  E. Rodriguez,et al.  Defining the Role of Skin and Mucosal Biopsy in Facial Allotransplantation: A 2-Year Review and Analysis of Histology , 2015, Plastic and reconstructive surgery.

[17]  E. Edelman,et al.  Acute rejection in vascularized composite allotransplantation , 2014, Current opinion in organ transplantation.

[18]  C. Mclean,et al.  CMV sinusitis in a HIV-negative renal transplant recipient. , 2014, Transplantation.

[19]  C. Ensor,et al.  Characterization, Prophylaxis, and Treatment of Infectious Complications in Craniomaxillofacial and Upper Extremity Allotransplantation: A Multicenter Perspective , 2014, Plastic and reconstructive surgery.

[20]  W. Bergfeld,et al.  A Four‐Year Pathology Review of the Near Total Face Transplant , 2013, American journal of transplantation : official journal of the American Society of Transplantation and the American Society of Transplant Surgeons.

[21]  A. Kirk,et al.  The Banff 2007 Working Classification of Skin‐Containing Composite Tissue Allograft Pathology , 2008, American journal of transplantation : official journal of the American Society of Transplantation and the American Society of Transplant Surgeons.

[22]  S. Testelin,et al.  Clinicopathologic Monitoring of the Skin and Oral Mucosa of the First Human Face Allograft: Report on the First Eight Months , 2006, Transplantation.