How Can I Resolve My Jaw Implant Infection?

Q: Dr. Eppley, I am writing to you because I recently had a chin implant infection, after a chin implant and mandible implant surgery. I am  now3 months post op, my surgeon had to remove the chin implant and the infection was resolved for a bit, then it seemed to have returned. I’d like to see if you possibly had any input on my case to see if there was a way me or the surgeon could do something to prevent infection upon re implantation. Here’s a quick timeline:

•I had 2 size medium stock implantech widening mandibular implants implanted intraorally and a “custom” chin implant – a stock anatomical chin implant size medium sutured to a stock vertical lengthening chin implant size medium inserted through the skin (under the chin). This “custom” implant was the suggestion of my surgeon to give me vertical and horizontal chin projection. The “custom” chin was anchored with 2 screws and the mandible implants were anchored with one each.

• The surgeon doing this had a good track record with implant infections, he claims he’s done around 4,000 before and never had an infection in his career. He used the implant sizers as developers for the pocket, inserted the chin through the skin, and applied vancomycin powder on top of the implant before closing.

A: I can only make some general comments in regards to your case:

1) There are only two reasons the infection is not fully resolved by the chin implant removal…1) all of the chin implant is not fully removed or 2) the jaw angle implant(s) behind the chin have also become infected and are draining anteriorly through the path of least resistance. (chin implant pocket/incision)

2) Almost all implant infections are the result of intraoperative inoculation….the mouth can never be sterilized completely…this is the risk of an intraoral implant surgery. It doesn ‘t matter if one has done 4, 40, 400 or 4,000 implant surgeries it is simply a matter of statistics….eventually it is going to happen to someone. This is never the result of what the patient did or didn’t do.

3) Once an implant gets infected…it is over. It doesn’t matter what maneuvers are done to try and treat it. The biofilm can not be eradicated, only implant removal can solve it.

Dr. Barry Eppley

World Renowned Plastic Surgeon