Delayed infection after using bone wax in maxillofacial surgery: A rare complication after reduction mandibuloplasty

Background

Although several studies have reported various adverse reactions associated with the use of bone wax in the clinical setting, the incidence of complications after using bone wax during maxillofacial surgery via a transoral approach remains unclear. We aimed to address this scarcity of data and describe the incidence and nature of postoperative infections associated with bone wax treatment during reduction mandibuloplasty.

Materials and methods

A retrospective chart-review study was conducted among patients who underwent reduction mandibuloplasty performed by the same surgeon between January 2010 and December 2014. Delayed postoperative infection was diagnosed based on clinical manifestations, associated treatment strategy (additional antibiotic treatment with or without revision surgery), and results of microbiological investigation. Patients were divided into 2 groups according to whether or not bone wax had been applied during the reduction mandibuloplasty procedure.

Results

A total of 355 patients (44 men; average age, 31.0 years; age range, 19–53 years) underwent reduction mandibuloplasty during the study period. Of these, 19 patients (1 men; age, 26.0 ± 6.62 years) were treated with bone wax applied to the cut surface of the mandibular cancellous bone for controlling bleeding. The infection rate among patients not treated with bone wax was 1.5% (5/336; acute infection), compared to 21.0% (4/19; delayed infection) among patients treated with bone wax. The use of bone wax contributed to an increased risk of developing infection (odds ratio, 14.87 [95% confidence interval, 3.22–68.70], P < 0.003).

Conclusion

This is the first report describing the incidence of infection associated with the use of bone wax for controlling bleeding from the cancellous bone during maxillofacial surgery via a transoral approach.