Complications after the implantation of the face

Complications of implantation for the correction of facial contours include bleeding, hematoma formation, infection, exposure, dislocation, abnormal position, displacement, fistula formation, seroma, permanent edema, inadequate protrusion, constant inflammation, pain and nerve damage. However, most of these complications are rarely associated solely with the material from which the implant is made. It is very difficult to separate the general surgical technique from the circumstances of a particular operation, as well as from individual risk factors that are not related to the implant.

If the technical rules are observed, there should be no dislocation. The large surface area of enlarged or extended implants, fitted to the contours of the middle part of the face and lower jaw, minimizes the risk of an incorrect position. The dissection of the subperiosteal space, sufficient to create adequate posterolateral and mid-lateral tunnels on the lower jaw or pockets in the middle third of the face, will hold the implant in the correct position. With an increase in the lower jaw, the mandibular branch of the facial nerve passes immediately anterior to the middle of the jaw in the mid-range zone. It is important not to injure the tissues that cover this area. The chin nerve is anatomically directed upwards into the lower lip, which also helps to protect it from injury during dissection. Temporary hypersthesia due to contact with the chin nerve can be observed from several days to several weeks after the operation. Persistent nerve damage is extremely rare - in one study, it was less than 0.5% of the statistically significant number of cases. If, as a result of misalignment or improper installation, the contact of the nerve with the implant is noted, the implant must be moved downward as quickly as possible.

The temporal branch of the facial nerve runs posteriorly from the middle part of the zygomatic arch, and caution must also be exercised when working in this area. The risk of infection can be minimized by flushing the pocket at the end of the operation with either saline or bactrazine (50000 U / L sterile saline). It is also recommended to soak the implants in the antibiotic solution. After an increase in the lower jaw in the drainage is usually not necessary, but it may be required after an increase in the middle part of the face, with increased bleeding. We found that immediately pressing the entire surface of the middle part of the face with compression textiles significantly reduces the risk of hematoma, gray, edema and, consequently, postoperative complications associated with the accumulation of fluid in the pocket.

Bone resorption most often occurs after an increase in the area of the lower jaw than after other alloplastic operations. The formation of erosions after implantation in the chin was reported in 1960.

Discussion

Understanding the principles of zonal anatomy, determining the types of face shape and attention to the main technical points lead to predictable changes in the contours of the face. A meticulous analysis of the patient's face and precise interaction of the surgeon and the patient give optimal results. There are many different types of facial implants with which the surgeon can create a variety of contours that meets most of the queries. Reconstruction of more complex contour defects can be performed using individual, modeled on the basis of three-dimensional computer reconstructions and manufactured using CAD / CAM technology (automated design / automated manufacturing) implants. The recent increase in the number of HIV-positive patients taking inhibitors of proteolytic enzymes made it necessary to use this technique to effectively treat such cosmetically disturbing conditions.

If the implant is positioned correctly over the compact bone, the condition usually stabilizes without any noticeable loss of prominence or cosmetic improvements achieved.

[1], [2], [3], [4]