Late infections associated with alloplastic facial implants

Mechanical deformation of elastomer medical devices can enable microbial surface colonization

Elastomers such as silicone are common in medical devices (catheters, prosthetic implants, endoscopes), but they remain prone to microbial colonization and biofilm infections. For the first time, our work shows that rates of microbial surface attachment to polydimethylsiloxane (PDMS) silicone can be significantly affected by mechanical deformation. For a section of bent commercial catheter tubing, bacteria (P. aeruginosa) show a strong preference for the 'convex' side compared to the 'concave' side, by a factor of 4.2. Further testing of cast PDMS materials in bending only showed a significant difference for samples that were manually wiped (damaged) beforehand (1.75 × 10⁴ and 6.02 × 10³ cells/mm² on the convex and concave sides, respectively). We demonstrate that surface microcracks in elastomers are opened under tensile stress (convex bending) to become 'activated' as sites for microbial colonization. This work demonstrates that the high elastic limit of elastomers enables these microcracks to reversibly open and close, as 'dynamic defects'. Commercial catheters have relatively high surface roughness inherent to manufacturing, but we show that even manual wiping of newly-cast PDMS is sufficient to generate surface microcracks. We consider the implication for medical devices that feature sustained, surgical, or cyclic deformation, in which localized tensile conditions may expose these surface defects to opportunistic microbes. As a result, our work showcases serious potential problems in the widespread usage and development of elastomers in medical devices.

Unusual complication after augmentation genioplasty: Odontogenic infection requiring implant removal

Augmentation genioplasty is a common surgical procedure with extremely low infection rates. We present the case of a healthy middle‐aged woman who experienced years of chronic infection after chin implantation due to an exposed mandibular canine root, which is exceedingly rare. Awareness of this potential complication may reduce patient morbidity.

INFECTED SILICONE CHIN IMPLANT AFTER IMPLANT-SUPPORTED JAW REHABILITATION: CASE REPORT AND LITERATURE REVIEW

To report the infected silicone chin implant due to the non-ideal placement of dental implants, in female patient, 67 years old. A patient unsatisfied with her facial profile had installed a silicone chin implant 25 years ago. Recently underwent surgery for the placement of dental implants in a region close to the silicone implant. The non-ideal positioning of the dental implants and close contact with the silicone implant led to the absence of osseointegration, with consequent mobility and infection of both. The silicone implant was removed with dental implant that shows mobility. In the imaging exams could be noted others complications of silicone implant like bone resorption and the formation of a narrow bone layer around the inferior border of implant. Alloplastic implants are an option for the esthetic correction of chin deformities. Solid silicone is biocompatible and highly resistant to degradation, with a minimal allergic reaction and risk of toxicity. However, a number of postoperative complications may arise, such as migration or displacement, extrusion, foreign body reaction, bone resorption, heterotopic bone formation and infection. The precise imaging exams are critical to arrive at a diagnosis and the best treatment plan.

Treatment of Infected Facial Implants

Alloplastic facial implants have a wide range of uses to achieve the appropriate facial contour. A variety of materials such as metals, polymers, ceramics and synthetic injectable fillers are available to the reconstructive and aesthetic surgeon. Besides choosing the right surgical technique and the adequate material, the surgeon must be prepared to treat complications. Infection is an uncommon but serious complication that can cause displeasing consequences for the patient. There are few references in literature regarding treatment and management of facial implant-related infections. This study aims to discuss the role of biofilm in predisposing alloplastic materials to infection, to provide a review of literature, to describe our own institutional experience, and to define a patient care pathway for facial implant-associated infection.

Computer-aided design and rapid prototyping-assisted contouring of costal cartilage graft for facial reconstructive surgery

Complex 3-D defects of the facial skeleton are difficult to reconstruct with freehand carving of autogenous bone grafts. Onlay bone grafts are hard to carve and are associated with imprecise graft-bone interface contact and bony resorption. Autologous cartilage is well established in ear reconstruction as it is easy to carve and is associated with minimal resorption. In the present study, we aimed to reconstruct the hypoplastic orbitozygomatic region in a patient with left hemifacial microsomia using computer-aided design and rapid prototyping to facilitate costal cartilage carving and grafting. A three-step process of (1) 3-D reconstruction of the computed tomographic image, (2) mirroring the facial skeleton, and (3) modeling and rapid prototyping of the left orbitozygomaticomalar region and reconstruction template was performed. The template aided in donor site selection and extracorporeal contouring of the rib cartilage graft to allow for an accurate fit of the graft to the bony model prior to final fixation in the patient. We are able to refine the existing computer-aided design and rapid prototyping methods to allow for extracorporeal contouring of grafts and present rib cartilage as a good alternative to bone for autologous reconstruction.

Complications of facial implants

Facial implants are readily used for aesthetic and reconstructive efforts in lieu of autogenous materials due to obvious benefits. Alloplastic facial augmentation is not without potential complications. This article discusses the major factors that contribute to complications of facial implant surgery, based on alloplast composition, surgical technique, and facial region. Also discussed are the most common complications as well as both their prevention and management.