Policy of Removal of Bone Plates in Craniomaxillofacial Trauma and Orthognathic Surgery: A 10-Year Review

Purpose. Removal of miniplates is a controversial topic in maxillofacial surgery. The introduction of titanium miniplates determined an important decrease of the routine removal of plates on completion of bone healing. The aim of this 10-year retrospective study was to assess the incidence and causes of the removal of plates following osteosynthesis in maxillofacial trauma and orthognathic surgery.

Methods.

The medical records of all patients who underwent removal of bone plates after facial trauma or orthognathic surgery between 2001 and 2010 at the Division of Maxillofacial Surgery, University of Turin, Turin, Italy were retrospectively reviewed. Data collected included age and gender, time between insertion and removal, indication for plating, reason for removal, presence of teeth in the line of fracture, and site and number of removed plates.

Results.

A total of 239 plates were removed from 211 patients (73 females, 138 males) (mean age, 34 years).

Out of 211 patients, 145 patients had undergone plate insertion because of facial trauma, whereas 66 had undergone orthognathic surgery.

The most common indication for removal was the presence of subjective discomfort (120 patients, 56.87%), followed by infection (42 patients, 19.9%), prophylactic reason (third molar in fracture line)(33 patients, 15.64%), exposure of the plate in the oral cavity (15 patients, 7.1%), and young age (1 patient, 0.47%).

The most common sites of removal were mandibular angle and maxillomalar buttress (with 49 removed plates each) followed by mandibular symphisis, with 39 removed plates.

Mean time between insertion and removal was 27.4 months. Statistical analysis using Fisher exact test found a significant association between trauma patients and timing of plate removal within 24 months after surgery (relative risk, 4.6; 95% confidence interval, 2.35 to 9.01; P < .000005), and between trauma patients and infection (+ prophylactic reason) as indication for plate removal (relative risk, 2.4; 95% confidence interval, 1.19 to 5.01; P < .05)

Conclusion

Routine removal of titanium plates is not clinically indicated. Plate-related problems leading to removal occur more frequently within the first 2/3 years after insertion. The most common indication for plate removal was subjective discomfort. Special attention should be given to fractures of the mandibular angle with involvement of third molars in fracture line. Long-term follow-up after facial bone osteosynthesis is indicated.