J Korean Assoc Oral Maxillofac Surg.  2024 Dec;50(6):350-355. 10.5125/jkaoms.2024.50.6.350.

Delayed inflammation after biodegradable and osteoconductive osteofixation in orthognathic surgery

• Park YW

• KMID: 2563963
• DOI: http://doi.org/10.5125/jkaoms.2024.50.6.350

Abstract

Objectives
This study aims to identify patterns and to describe the clinical course of delayed adverse tissue responses in patients who underwent orthognathic osteotomy with biodegradable osteofixation.
Patients and Methods
Through a retrospective review of cases between 2013 and 2020, we identified three patients who underwent bimaxillary osteotomy and fixation with unsintered-hydroxyapatite/poly-L lactic acid (u-HA/PLLA) devices, after which they developed delayed inflammation. These lesions were treated with drainage and/or removal of the devices. Histological evaluations were conducted using H&E staining, and structural changes in the u-HA/PLLA devices were assessed by scanning electron microscopy (SEM).
Results
Inflammatory lesions developed only in the mandible, with onset ranging from 12 to 35 months postoperation. Histological studies identified foreign-body granulomas or secondarily infected lesions. SEM analysis indicated biodegradation and tissue integration.
Conclusion
Orthognathic patients treated using u-HA/PLLA devices should be informed about the potential for delayed inflammation and monitored for at least 3 years.

Keyword

Biodegradable osteofixation; Delayed inflammation; Foreign-body reaction

Figure

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  Fig. 1 A, D. A localized mucosal swelling was observed on both sides of the mandibular vestibule. B, E. Removal of the fixation devices was performed. Multi-nucleated giant cells were observed phagocytosing granular-shaped foreign materials, accompanied by inflammatory cell infiltration (H&E staining; C, F: ×100).

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  Fig. 2 Scanning electron microscopy images of the explanted unsintered-hydroxyapatite/poly-L lactic acid (u-HA/PLLA) nanocomposite at increasing magnifications 20 months after surgical implantation. At lower magnification (A-C), the surface of the device appears roughened with pores. At higher magnification, cells and exosomes are observed attached to the surface (D), and fibrous fibers have formed bundles and adhered to the surface of the u-HA/PLLA nanocomposite (E, F).

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  Fig. 3 A. Thirty-four months after the operation, the patient in Case 1 complained of a palpable swelling in the right-side lower chin area (marked area). B. A piece of the remaining u-HA/PLLA screw was observed. C. A second debridement was performed.

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  Fig. 4 A. A papule-like mucosal swelling was observed in the left-side mandibular vestibule. B. The lesion exhibited a granuloma with proliferation of plasma cells and lymphocytes (H&E staining, ×40).

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  Fig. 5 A. Unsintered-hydroxyapatite/poly-L lactic acid meshes were applied for fixation of the genial osteotomy. B. Thirty-five months after the operation, a diffuse swelling was detected in the left lower chin area (red circle). Initially, partial debridement was performed through an intraoral vestibular incision. However, the symptoms persisted, and a second debridement was carried out. C. The specimens from the second debridement revealed a suppurative lesion with proliferation of polymorphonuclear leukocytes, plasma cells, and small capillaries (H&E staining, ×100).

Reference

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