Draining Orocutaneous Fistula Associated With a Failing Subperiosteal Implant: Report of a Case
The use of mandibular subperiosteal implants was first reported by Dahl in the 1940s. It was followed by a more comprehensive report by Goldberg and Gershkoff, who published the first case series in the United States. We describe a case of an orocutaneous fistula that developed secondary to a chronic infection attributed to a failing subperiosteal implant. Elemental analysis of the metal framework revealed an implant composed of mainly a cobalt-chromium alloy. Cobalt, which was frequently used in subperiosteal implant manufacturing, is associated with a higher corrosion rate than other metals and is no longer used to fabricate subperiosteal implants. The strength of subperiosteal implants is their ability to be used in a mandible with an atrophic alveolar ridge. Unfortunately, this feature of the hardware is also its weakness in that reconstructive procedures after their removal are difficult. The failing subperiosteal implant in our patient was subsequently removed, and primary closure of the intraoral wound and extraoral fistula as well as resolution of the patient's symptoms was obtained with no lasting complications.Abstract
(a) Postoperative photograph of the face (frontal view). (b) Postoperative photograph of the face (lateral view). (c) Postoperative panoramic radiograph, 1 year and 3 months after removal of the mandibular subperiosteal implant showing healed surgical site
Contributor Notes
Michael R. Markiewicz, BS, is a student at the University at Buffalo, School of Dental Medicine, Buffalo, NY, the Harvard School of Public Health, and the Center for Applied Clinical Investigation, Department of Oral and Maxillofacial Surgery, Massachusetts General Hospital, Boston. Address correspondence to Mr Markiewicz at 6490 Main Street, Suite 3, Williamsville, NY 14221 (michaelmarkiewicz@gmail.com).
Kazuhide Nishiyama, DDS, Kaori Yago, DDS, PhD, Meiko Okada, DDS, PhD, and Soichiro Asanami, DDS, PhD, are with the Department of Oral Surgery, School of Medicine, Keio University, Tokyo, Japan.
Masao Yoshinari, PhD, is with the Department of Dental Materials Science, Tokyo Dental College, Tokyo, Japan.
Muneki Hirayama, DMD, is a general practitioner in private practice in Boston, Mass.
Joseph E. Margarone III, DDS, is a clinical assistant professor in the Department of Oral and Maxillofacial Surgery, School of Dental Medicine, University at Buffalo, Buffalo, NY, and is in private practice in Williamsville, NY.
Sung-Kiang Chuang, DMD, MD, DMSc, is an assistant professor with the Center for Applied Clinical Investigation, Department of Oral and Maxillofacial Surgery, Massachusetts General Hospital, Boston.