Secondary Jaw Angle Implant Surgery
Q: Dr. Eppley, I am in need of secondary jaw angle implant surgery. I have had medlar jaw angle implants done twice and both times they had to be removed due to infection. In addition on one side I developed masseter muscle dehiscence. If I go for third jaw angle implants try what can I do to reduce the risk of infection? Can I get the masseter muscle dehiscence fixed at the same time as placement of new jaw angle implants?
A: My overall assessment of your situation, by just reading it, remains me of the old motto…’past history predicts future behavior’. Jaw angle implants have the highest incidence of infection of any facial implant (about 4% to 5% in my experience compared to other facial sites of about 1% to 2%) and the Medpor material due to its surface roughness has a higher risk of infection than silicone. I do not know why your implants got infected (placement inoculation vs postop wound dehiscence and implant seeding) but if you have to give a third try silicone jaw angle implants would clearly be the better material choice to lower the infection risk.
In regards to master muscle dehiscence, once that has occurred it is a very difficult problem to try and improve. Muscle repositioning is incredibly difficult and unpredicatable and most certainly would not be performed concomitantly with new implant placement.
Dr. Barry Eppley