Case Report
The patient is a 54-year-old healthy woman who presented in January 2016
to discuss revision rhinoplasty and augmentation genioplasty (Figure 1).
The surgery was performed in September 2016 without complication. A
sublabial incision was used for the approach, and a medium-sized Medpor
implant was inserted using aseptic technique. No anatomic abnormality of
the mandible or dentition was identified. The patient was discharged on
antibiotic prophylaxis. She was pleased with the aesthetic outcome and
had a benign immediate postoperative examination (Figure 1).
Waxing and waning right-sided chin swelling and tenderness began in
October 2016. With a presumed diagnosis of surgical wound infection, she
was treated with multiple courses of oral antibiotics in an attempt to
salvage the chin implant. She reported no dental pain or dental symptoms
at the time. In July 2017 she experienced intraoral abscess formation
requiring drainage at a local emergency room. Cultures grew mixed
bacterial flora. Despite multiple antibiotic courses and chlorhexidine
oral rinse, her symptoms did not resolve completely. Recommendations
were made to remove the implant, but she declined.
Surgical exploration of the chin implant site was first performed in the
clinic in August 2019. Granulation tissue and a scant amount of purulent
drainage were encountered. The granulation tissue was excised, and the
area was copiously irrigated with antibiotic saline solution. She had
temporary resolution of her symptoms until January 2020, when a repeat
incision and drainage was required. Despite initial improvement, the
infection persisted. Implant removal was again advised, but the patient
expressed reluctance. In July 2020 her dentist identified an infected
left mandibular molar that was drilled, but there was no concern for
odontogenic disease directly adjacent to the implant. CT facial bones
was subsequently obtained without evidence of odontogenic infection,
fluid collection, or neoplasm (Figure 2).
She ultimately agreed to proceed with surgical removal in February 2021.
Intraoperative findings were notable for an area around tooth #27 that
was open and exposed. Purulence was encountered and drained. Copious
granulation tissue was discovered underlying the implant on removal,
which was found to be originating from the root of tooth #27. This was
fractured and had eroded through the buccal cortex of the mandible
(Figure 3). The implant was removed and she was referred to her dentist
for further treatment. She has done well since, remaining
infection-free.