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.