title: Early Complications From the Use of Calcium Phosphate Paste in Mandibular Lengthening Surgery. A Retrospective Study.
abstract: OBJECTIVE
  Calcium phosphate paste is used in mandibular lengthening surgery to avoid unesthetic notching at the lower border and to help stabilize the segments when osteosynthesis slippage is a concern. The aim of this study was to investigate whether the hardened paste increases the incidence of infections.
  
  
  METHODS
  This was a retrospective cohort study of medical charts of all patients who underwent a bilateral sagittal split osteotomy from February 2012 through July 2015. The outcome and predictor variables were postoperative infection and calcium phosphate paste use, respectively. Other study variables included age, gender, tobacco use, type of fixation, type of surgery, antibiotic prophylaxis regimen, third molar extraction, and medical comorbidities. Variables were analyzed using the Fisher exact test and logistic regression.
  
  
  RESULTS
  The sample included 196 patients (115 female and 81 male) 9 to 57 years old. The overall infection rate was 12.2%. Of the 102 patients who received calcium phosphate paste, 18.6% developed an infection compared with 5.3% in the control group. The difference in infection rate was statistically significant (odds ratio = 0.14; 95% confidence interval [CI], 0.04-0.48; P = .002) after adjusting for the other variables. Of the 392 surgical sites, 204 had received calcium phosphate paste, of which 10.3% became infected. Of the 188 sites without defect reconstruction, 6 (3.2%) became infected (P = .008 by bivariate analysis). There was a statistically significant association between third molar removal and infections (odds ratio = 8.01; 95% CI, 1.28-50.1; P = .026) and between the use of amoxicillin plus clavulanate and the use of cefazolin (odds ratio = 3.92; 95% CI, 0.87-17.63; P = .07).
  
  
  CONCLUSIONS
  There was a relevant trend of increased infection with calcium phosphate paste use. Third molar removal also was identified as a risk factor. Prospective studies after procedural modifications are recommended to determine whether the benefits of using calcium phosphate paste outweigh the risks.
authors.affiliation: Resident MOPI, European Face Centre, University Hospital Brussels, Brussels, Belgium.
authors.forename: Erica
authors.initials: E
authors.lastname: Coppey
authors.affiliation: Professor and Department Head, European Face Centre, University Hospital Brussels, Brussels, Belgium. Electronic address: Maurice.Mommaerts@uzbrussel.be.
authors.forename: Maurice Y
authors.initials: MY
authors.lastname: Mommaerts
mesh_terms: D000293:Adolescent; D000328:Adult; D002130:Calcium Phosphates / Q000009:adverse effects*; D002648:Child; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009824:Ointments; D059229:Osteotomy, Sagittal Split Ramus; D012189:Retrospective Studies; D012307:Risk Factors; D013530:Surgical Wound Infection / Q000453:epidemiology*; D016896:Treatment Outcome
chemical_list: D002130:Calcium Phosphates; D009824:Ointments; C020243:calcium phosphate