All transplants — whether heart, lung, kidney or cornea — are significant, life-changing procedures.

A face transplant, however, is unlike any other, integrating multiple functional components (nose, lips, nasal cavity, eyelids, palate and teeth) and various types of tissue (skin, muscles, bony structures, arteries, veins and nerves).

Very few places in the world have the assembled talent and expertise to successfully complete such a complex undertaking.

Truly Functioning as a Team
Last year, a team of 11 Cleveland Clinic surgeons performed the hospital’s third face transplant – and its first total face transplant – on a 21-year-old woman who suffered severe facial trauma from a gunshot wound as a teenager.

At some point before, during or after the 31-hour surgical procedure, more than a dozen specialties were involved: plastic surgery, neurology, endocrinology, nursing, transplant surgery, anaesthesia, bioethics, dentistry, ophthalmology, infectious disease, pharmacy, psychiatry, nutrition, plastics research, internal medicine, physical medicine and rehabilitation (physical, occupational and speech therapies), vascular medicine, and vascular surgery.

Only an institution that truly functions as a team can pull together that many people for a shared sense of purpose. It requires not only expertise, planning and leadership, but also the humility to focus on the patient’s outcome rather than who gets the credit. On a team comprised of about 20 specialties, it’s clear we are better together than we are individually.

Taken in its totality, the face transplant illustrates what Cleveland Clinic is all about. Exceptional clinical and surgical care, combined with research and innovation, has the power to improve patient lives in dramatic ways.

A Story of Resilience
Today, our most recent face transplant patient is 22-year-old Katie Stubblefield. Her story is one of resilience, from the self-inflicted gunshot wound to the 31-hour surgery to how her life has changed after her face transplant.

She is thinking about college (with plans of becoming a counsellor or a teacher). She has talked about simply walking down the street “and blending in.” As part of the pre-surgical screening process, Katie often was asked whether she was certain about going through with the surgery. She did not hesitate. “I can’t go backward. I have to go forward,” she told our ethics committee. She later reiterated that sentiment to a member of her care team: “I want to be able to go out in the world. And not be looked at like this.”

Form and function are intertwined. We cannot view this in only a strictly medical sense. Yes, function — breathing, eating, talking, seeing — is crucial. But so is form. Our face is what defines us. It’s how we socially and emotionally communicate with each other as human beings. And now — to paraphrase Dr. Maria Siemionow, who led Cleveland Clinic’s first face transplant in 2008 — Katie has a face to face the world.

A new procedure that allows surgeons to access and remove the thyroid and parathyroid glands through small incisions on the inside of the mouth provides successful results with no visible scarring on the neck. Dr. Raymon Grogan, associate professor in the Michael E. DeBakey Department of Surgery at Baylor College of Medicine, describes how the procedure works and outlines its benefits.

The thyroid gland releases hormones to control metabolism. Parathyroid glands are found next to or behind the thyroid glands and control calcium levels in the blood and bones. If cancer or benign nodules are found, or if these glands become overactive, the affected gland needs to be removed.

Traditionally, surgeons remove the thyroid and parathyroid glands using a small horizontal incision in the centre of the neck. The scar size depends on the size of the gland, with the average size being four to six centimetres long.

Dr. Raymon Grogan

The procedure that Grogan performs, transoral endocrine surgery, applies the same laparoscopic or endoscopic techniques that are used to remove the gall bladder, appendix or colon. Cancers less than two centimetres and benign nodules under six centimetres can be removed using this procedure. He conducts these surgeries at Baylor St. Luke’s Medical Center, where he is section chief of endocrine surgery.

In this procedure, three small incisions are made on the inside of the lower lip. Through these incisions, the surgeon is able to place endoscopic instruments between the jaw and the skin to open up the working space needed to remove the gland, which is a short distance from the incision site. The procedure is performed under general anaesthesia and patients are required to stay in the hospital overnight.

Numerous other procedures have been developed to reduce the size of the incision on the neck or to get rid of it entirely.

“This approach is the culmination of work that has been done over the last 20 to 30 years internationally as well as in the United States,” Grogan said.

However, the other ‘scarless’ procedures that have been tried involve going through the armpit, the hairline in the back of the neck, or even the nipples, meaning that the patient would still have a scar, just not on the neck. The transoral endocrine procedure is the only procedure where there are no visible incisions. In addition, with the transoral procedure the lower lip incisions are very close to the target anatomy, so there is minimal increase in dissection relative to the traditional approach. This is in contrast to the other ‘scarless’ techniques where the incisions are made much further from the target anatomy. This is important since larger dissections can lead to increased pain, complications and recovery time. 

The incisions on the inside of the lip are minimally painful, and patients usually take pain medication for a day or two after the surgery before switching to anti-inflammatory medication. Grogan recommends staying on a liquid diet for the first day after the surgery and then switching to soft foods for the following couple of days.

Patients are encouraged not to drive while they are on pain medication or if they have a stiff neck. They can experience bruising, swelling, tingling and temporary numbness of the lower lip, chin and upper neck, which should only last one to two weeks. Grogan usually recommends one week off from work after the procedure. The recovery time is similar to the traditional open approach.

As for the risks, published data from a series of cases done internationally has found that the complication rates for this procedure are comparable to the traditional open approach. These known complication risks include injury to the recurrent laryngeal nerve and injury to the parathyroids. There has been one surgical site infection in over 1,500 cases to date. The additional possible risk for this procedure is numbness of the chin or lip, which has been found in one in 1,500 of the cases studied in the international population so far. Grogan said that it is possible that anatomic differences between an American population and the international population could alter that risk profile, therefore more data needs to be collected to see how these data in an international population compares to the U.S. population.  

MORE INFO
Contact International Services at Baylor St Luke’s Medical Center via email at international@stlukeshealth.org or call +1 832 355 3350 or visit StLukesInternational.org 
Location: Texas Medical Center, Houston, Texas, U.S.

RAK Hospital: One-Stop Treatment Destination

The Emirate of Ras Al Khaimah (RAK) is located at the north end of the coast of the UAE. It is nestled between the Hajjar mountains on the east and the Arabian Gulf on the west and shares mountainous borders with the Sultanate of Oman. Away from the hub and hectic pace of big cities, this beautiful emirate, blessed with breathtaking natural beauty, offers you the peace, solitude, and privacy you seek while undergoing elective treatment, along with a bouquet of exciting attractions for your family to explore.

RAK Hospital is a private, tertiary care, multi-specialty hospital under the Arabian Healthcare Group, a joint venture with the Government of Ras Al Khaimah, under the aegis of His Highness Sheikh Saud bin Saqr Al Qasimi. We have received the Joint Commission International, a U.S. based hospital accreditation. The hospital is housed in a sprawling complex, specially designed as a premium healthcare and hospitality destination by U.S.-based Ellerbe Becket of Mayo clinic repute. The building boasts a built-up area of 140,000 sq ft, across three levels, and the rooms are of premium category, with a capacity of 65 beds.

In addition to superior and modern infrastructure, RAK Hospital also has state-of-the-art accident and emergency services, with a 24-hour pharmacy and a European café serving a diverse range of food and beverages.

At RAK Hospital we believe that our patients are our utmost priority, which is why our ‘Premium Healthcare, Premium Hospitality’ ethos shines bright through all our services. With us, you can be sure that you are receiving the best in quality in healthcare, treatment, and support.
The hospital is a centre of excellence in:
– Bone and Joint Centre 
– Neurosciences
– Cardiology and Cardiac Surgery
– General, GI, Minimal Access and Laparoscopic Surgery
– Bariatric Surgeries and Aesthetic Treatments

Apart from the above mentioned, there are 20 other specialties available. Furthermore, RAK Hospital is the first to introduce Stem cell therapy of bone and joints problems in the UAE.
RAK Hospital is the UAE’s healthcare provider of choice serving thousands of local, regional and international patients. Located just 45 minutes away from Dubai International Airport, it is one of the most trusted and is a one-stop treatment destination for international medical tourism patients. The hospital provides premium personalised and compassionate care. 

At RAK Hospital, premium stands for the latest and most exclusive treatment offerings along with ultramodern diagnostic facility. The hospital offers the most comprehensive range of state-of-the-art diagnostic equipment and treatment tools including cardiac catheterization laboratory, 1.5 Tesla MRI, 64 slice CT scan, Modular Operation Theatres, Femto Lasik machines, Hydrotherapy machine, Gait Analyzer, and many more.

International Patient Experience
1. Get in touch
Contact RAK Hospital International Patient Desk on:
Email: mail@rakhospital.com, Phone: +971 7207 4444, Fax: +971 7207 4455

2. Send your medical history
To assess your treatment, we encourage you to send us the results of your tests, i.e. angiography, or echo- cardiogram, MRI, CT Scans or the other documents for the further review and evaluation.

3. Online consultation or tailor making your treatment 
Our doctors start by assessing your medical history and existing condition and will discuss the following:
– The best treatment for you.
– New surgical, minimal invasive techniques, ensuring reduced hospital stay and recovery.
– Regional or general anaesthesia and the lowest infection rates at our hospital.
– Advanced medicines that ensure the relief of pain and maximise the ability of patients to enjoy an active life.
– Physical therapy programmes for your speedy recovery.
– Making your flight back home pain free and comfortable.

4. Arrange your trip
You can start to arrange your flight tickets. Visa to the UAE will be provided by RAK Hospital on submission of your passport copy and recent size photograph.

5. Arrival
RAK Hospital Representative (English speaking) will meet you at Dubai/Abu Dhabi/RAK/Sharjah Airport and transfer you to RAK Hospital.

6. Pre-Op/ Procedure check up
The first examination will take place the next morning (general examination, ECG, echocardiogram, laboratory test, exercise, test).

7. Procedure 
You will undergo the required procedures/treatments performed by a team of specialist doctors.

8. Post OP
After the treatment you will stay the prescribed days of stay in hospital with one attendant (choice).

9. Leave to your country.

10. Medical Follow up.