Titanium osteosynthesis hardware in maxillofacial trauma surgery: to remove or remain? A retrospective study.

INTRODUCTION: A 5-year retrospective study evaluated the incidence and causes for removal of titanium miniplates. MATERIAL AND METHODS: The surgical records of 156 patients treated with rigid internal fixation after maxillofacial traumas were reviewed. Study variables included age, sex, site of fracture, site and number of plates, time of plate removal and reasons for plate removal. RESULTS: Of 384 plates used for fixation, 35 plates (9 %) in 21 patients (13.5 %) were removed due to hardware related complications. Statistical significance (p < 0.01) was observed in mandibular body and parasymphysis fractures with regards to both fracture site location and plate removal rates. Most plates were removed within the first year after placement (p < 0.01). The highest number of fractures were observed in the 20-30 years group (p < 0.01) while most cases of removal were in the 30-40 years group (p < 0.01). Secondary reconstruction/growth facilitation (11/156, 7 %) (p < 0.01) was the main cause of plate removal while infection/wound dehiscence (9/156, 6 %) (p < 0.01) was the main cause for complication related plate removal. A significantly greater number of plates placed via intraoral incisions (p < 0.01) needed removal. CONCLUSIONS: The low incidence of complication related plate removal (7 %) in the mid and upper face in this study suggests that routine removal of asymptomatic titanium miniplates after maxillofacial trauma at these sites may not be beneficial. The high rate of mandibular site complications (19 %) in this study suggests that routine removal of titanium hardware from mandibular sites may be indicated.