The successful management of an infected revision TMJ prosthesis using Stimulan® cement impregnated with gentamicin – a case report

Abstract

We discuss a case of a 51 year old female who underwent bilateral revision temporomandibular joint replacement and simultaneous Le Fort 1 osteotomy with additional asymmetrical advancement genioplasty. Six weeks later she developed a unilateral facial swelling, draining sinus over the site of the prosthesis and worsening mouth restriction, in addition to raised inflammatory markers. She was successfully treated with intravenous antibiotics and underwent open surgery for washout and removal of the prosthesis. The infected prosthesis and screws were removed and washed in vancomycin solution. Gentamicin mixed with Stimulan® cement beads were left in situ within the wound cavity. The TMJ prosthesis was then re-implanted. The patient was then discharged with a PICC line and six weeks of intravenous antibiotics. She continues to make good progress and the TMJ prosthesis remains with osseointegration. The inflammatory markers have fallen. It is well documented that an infected TMJ prosthesis is a difficult situation to manage. To our knowledge, this is the first case described for the successful management of an infected TMJ prosthesis using antibiotic impregnated cement.