Antibiotic spacers of the lower jaw after complex reconstructive surgery: 10-year single-center experience.

Abstract

Study design: Retrospective cohort study.

Objective: In orthopedic surgery, the use of antibiotic-impregnated spacers is a well-established method for treating periprosthetic joint infections with excellent outcomes. However, their application in head and neck surgery remains poorly documented, despite the high susceptibility of these patients to persistent infections. The objective of this study was to evaluate the 10-year outcomes of antibiotic spacers in the treatment of persistent mandibular infections unresponsive to conventional methods, prior to definitive reconstruction.

Methods: We retrospectively reviewed patients with persistent mandibular infections treated with antibiotic-impregnated spacers between 2014 and 2023. Patient characteristics, surgical details, infection type, and clinical outcomes were assessed. The two-stage surgical protocol was described.

Results: Seven patients (mean age 49 years, range 20-77) were included. Six had undergone complex mandibular reconstructions for malignant tumors (n = 3), benign tumors (n = 1), or congenital anomalies (n = 2). One patient had osteomyelitis of the jaw with extensive necrosis. Following spacer placement, complete resolution of infection occurred in 3/7 patients, a transition to non-suppurative infection in 3/7, and suppurative infection in 1/7. On average, infections recurred 5 months postoperatively. All infections resolved by the time of spacer removal, allowing definitive reconstruction.

Conclusion: Antibiotic-impregnated spacers appear to be a promising adjunct in managing persistent mandibular infections, facilitating successful permanent reconstruction in complex head and neck cases.