Delayed Infection of Porous Polyethylene Implants After Oncologic Maxillectomy and Reconstruction: 2 Case Reports and Review of Literature

Abstract

Medpor porous polyethylene implants are commonly used for facial skeletal reconstruction due to reported biocompatibility, fibrovascularization, and durability. While uncommon, late implant infections are an important consideration. We report delayed infections in 2 patients after unilateral total oncologic maxillectomy and reconstruction using Medpor implants for an ossifying fibroma and squamous cell carcinoma, respectively. In the first patient, annual interval computed tomography (CT) scans showed no recurrence of tumor or inflammatory changes. The second was lost to follow-up after adjuvant chemoradiation 1 year after resection. Patients both presented with swelling, drainage, and erythema around the implant at a mean of 4.5 years following maxillectomy. Both failed several attempts at conservative treatment. Cultures of implants removed at a mean of 2.5 months after infection grew α-hemolytic Streptococcus in the first and multiple organisms in the second, showing that the potential for delayed infection should be considered years after reconstruction.

The Latest Craniofacial Reconstructive Techniques Using Anchored Implants after Surgical Treatment of Nasal and Paranasal Sinuses Tumors

“…The use of autological grafts can be combined with the use of Medpor porous polyethylene, commonly used for facial skeletal reconstruction due to its biocompatibility and durability; however, based on systematic review, Medpor has a higher rate of extrusion and infection than autologous materials [ 21 , 45 ]. Unfortunately, in the case of patients who have had a significant part of their external nose removed or who have had it completely amputated, the results of this method are not satisfactory due to poor functional and cosmetic outcomes [ 16 , 44 , 46 ]. Both patients and specialists performing the reconstructions assessed the aesthetic effect of the prostheses much better than autologous grafts of the nose [ 16 ].…”

Maxillofacial osteosarcoma -- report of two cases with presentation of a two-staged reconstructive strategy and dental rehabilitation

“…Alloplastic materials represent an alternative option for osseous reshaping yet require enough available soft tissue to cover the graft and are generally associated with higher rates of complications such as infection and/or exposure of the material (31). This tendency aggravates in case of adjuvant treatment such as radiation (32). A further, less invasive option for maxillary reconstruction is the use of an obturator prosthesis.…”