Maxillofacial Surgeon Leaves Screw Fragment in Mandible Causing Osteomyelitis

This case involves a fifty-nine-year-old man. The patient previously had ORIF of the mandible done by a maxillofacial surgeon. The open approach implemented two screws via the lag technique in addition to a plate with four screws. On follow-up, an x-ray revealed the furthest screw distal to the chin was displaced. Given the risk of the hardware, and by his conjecture, healed mandible, the decision was made to remove the hardware. A fistula was also visualized and he had an elevated white blood cell count prior to the procedure. The patient then consulted another maxillofacial surgeon who found a mucosal fistula upon physical examination. He noted that the osteomyelitis/infection/fistula and pain was a result from the retained screw from the original procedure. The second maxillofacial surgeon decided to operate due to persistent osteomyelitis and continued antibiotic use. He removed the retained surgical screw in the neck of the mandible.

Question(s) For Expert Witness

1. Was the retained surgical screw the cause of the ongoing osteomyelitis?

Expert Witness Response

Retained surgical foreign bodies are rare medical errors that have the potential to cause significant harm to the patient and carry profound professional and medico-legal consequences to physicians and hospitals. Risk factors for this problem are well described and include both patient care processes and working environment issues. Foreign bodies have a very high propensity for infection. An infection would have been unlikely in the absence of a foreign body. (ie surgical screw)