Oral and maxillofacial surgery
Plate removal following orthognathic surgery

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Objectives

The objectives of this study were to analyze outcomes with miniplates in orthognathic surgery and define risk factors resulting in plate removal.

Study design

Clinical files of 570 orthognathic surgery patients operated between 2004 and 2009 were reviewed: 203 had a bimaxillary operation, 310 a lower jaw osteotomy, and 57 an upper jaw osteotomy. Age, sex, and jaw movement were analyzed. Reasons for hardware removal were recorded.

Results

Hardware was removed in 157 patients (27.5%). Seventy-eight patients (13.7%) needed removal because of plate-related infection; 66 (11.6%) because of clinical irritation; 5 (0.9%) for dental implant placement; and 8 (1.4%) for other reasons. Average time between operation and removal was 9.9 months. More women (31.7%) than men (20.3%) had plates removed, but age was not a factor except with infection.

Conclusions

More than a quarter of patients developed complications from plates and screws, necessitating their removal, and infection occurred in 13.7%. Prompt removal constituted adequate management.

Section snippets

Material and Methods

Records for 570 consecutive patients operated between 2004 and 2009 were reviewed retrospectively (Table II). All patients had undergone either a bimaxillary, a Le Fort I, or bilateral sagittal split ramus osteotomies (BSSO) performed by 1 of the 3 senior staff members of the Department of Oral and Maxillofacial Surgery at St. John's Hospital in Genk. Records were included only of orthognathic patients for which the same operative technique and the same postoperative clinical attitude toward

Results

A total of 157 (27.5%) of the 570 patients had at least a portion of the hardware removed because they either requested removal or required removal secondary to complications related to the plates or screws. Of the 3197 plates that were placed, 622 (19.5%) were removed. The patients having hardware removal consisted of 115 females (31.7% of all female patients) and 42 males (20.3% of all male patients). This difference was significant (P = .0091).

In 78 patients (13.7%), the plates were removed

Discussion

Various complications can arise after miniplate and screw fixation, such as infection, miniplate fracture, nonunion, and mental nerve paralysis or dysesthesia.18 Plate removal after orthognathic surgery varies between 1.0% and 18.6% of patients.7, 8, 9, 10, 11 Some German centers advocate routine removal of titanium osteosynthesis material after treatment of fractures or operations for dysgnathia.4

Alpha et al.8 reported plate removal in only 10% of its BSSOs, although they described

Conclusions

This study reports an important percentage of patients (27.6%) developing complications from plates and screws that required their removal. Bimaxillary operations had higher removal rates than monomaxillary operations, and women were more likely to have their plates removed than men. Age had no significant influence on miniplate removal, except in some cases when an infectious episode caused the removals.

Almost 80% of the removed plates are removed within the first year. One of the advantages

References (30)

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    Citation Excerpt :

    The fixation plates may have to be removed postoperatively for various reasons, such as infection, tenderness and pain, sinusitis, temperature sensitivity, palpability of plate, plate exposure, or patient request without complaints (Schmidt et al., 1998; Haraji et al., 2009; Little et al., 2015; Verweij et al., 2016). The plate removal rate has been reported to be between 2.0% and 24.6% (Ho et al., 2010; Falter et al., 2011; Verweij et al., 2016). In our study, the plate removal rate was 5.1%.

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