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The resistance of maxillofacial reconstruction plates to biofilm formation in vitro

Authors

  • Brian E. Emery MD,

    Corresponding author
    1. Department of Otolaryngology—Head and Neck Surgery, University of Maryland Medical System, Baltimore, Maryland, U.S.A.
    • Brian E. Emery, MD, University of Maryland Medical System, 16 South Eutaw Street, Suite 500, Baltimore, MD 21201, U.S.A.
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  • Rahul Dixit,

    1. Department of Otolaryngology—Head and Neck Surgery, University of Maryland Medical System, Baltimore, Maryland, U.S.A.
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  • C. Craig Formby PhD,

    1. Department of Otolaryngology—Head and Neck Surgery, University of Maryland Medical System, Baltimore, Maryland, U.S.A.
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  • John F. Biedlingmaier MD

    1. Department of Otolaryngology—Head and Neck Surgery, University of Maryland Medical System, Baltimore, Maryland, U.S.A.
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Abstract

Objectives/Hypothesis: Bacterial biofilms, bacteria surrounded by a protective glycocalyx, have been demonstrated on bioimplants placed within and outside of the head and neck region. The presence of the biofilm often makes decontamination of an infected implant impossible, requiring removal of the implant. Infections attributable to biofilm formation within the facial skeleton after reconstruction with implants may result in delayed union, fibrous union, malunion, nonunion, and malocclusion. These complications often require removal of the implant and secondary surgery. Although the incidence of infections necessitating implant removal is relatively low, the increased numbers of implants being placed make this a growing problem. Previous work in the authors laboratory has demonstrated a resistance to biofilm formation on different types of pressure-equalizing tubes. The hypothesis evaluated in the study is that such resistance to biofilm formation is due to the inability of bacteria to adhere to the tubes because of the material's smoothness or surface charge. Study Design: A controlled observational study. Methods: Scanning electron microscopy was used to evaluate the formation of biofilms in vitro for a common strain of Staphylococcus aureus on four implantable materials. The implantable materials included titanium and polylactide resorbable plates. Results: Consistent with the authors' prior findings, they were able to produce bacterial biofilm reliably on a silicone pressure equalizing tube but were unable to demonstrate biofilm formation on the titanium or resorbable implants. Conclusion: The absence of biofilm formation on these implants can best be explained by the surface charge or polarity properties of these materials. These findings are consistent with the relatively low incidence of infections among patients receiving these implants in maxillofacial applications.

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