A lot of maxillofacial surgeons inform their patients to come back after six months or one year to remove the internal fixed plates after ORIF of mandibular fractures of mid-face fractures. Is that a wrong Belief or Is it indicated to remove the plate even if it is asymptomatic? To much percent of subjective or objective symptoms can we decide that it is indicated to remove the plates finally?
Some cases come back after more than a couple of years remove this plate because exposure or infection and in that time the removal become to some extent difficult! Is there any evidence based study to clear this issue?
Miniplates can be left in place permanently if they do not cause any symptoms or problems like exposure or infection. However, it is also a matter of protocol, some institutes require their removal after about 6 months.
Miniplates whether titanium or not, doesn't require removal as long as asymptomatic, only in case of growing children one should consider removal, for the fear of migration of miniplates .
I agree with Kedernath NS and Salwan Bede. In my practice, removal rate of the miniplates because of complications such as infection or pain is not exceed 2-3%. So I do not feel obligation for miniplate removal in elective circumstances.
The question of retaining o removing miniplates in maxillofacial trauma patients has been subject of controversy for a long time; see for instance:
Haug, R.H.: Retention of asymptomatic bone plates used for orthognathic surgery and facial fractures. J. Oral Maxillofac. Surg., 1996, 54, s. 611-617.
Alpert, B., Seligson, D.: Removal of asymptomatic bone plates used for orthognathic surgery and facial fractures. J. Oral Maxillofac. Surg., 1996, 54, s. 618-621.
The undisputed indications for removal are wound dehiscence, infection, and loose or broken hardware. Another important factor is patient’s discomfort or wish to not retain any foreign material in his/her body. Subjective discomfort is a notable reason for plate removal among patients living in cold climate:
Thorén H, Snäll J, Kormi E, Lindqvist C, Suominen-Taipale L, Törnwall J. Symptomatic plate removal after treatment of facial fractures J Craniomaxillofac Surg. 2010;38(7):505-10.
Since titanium is the same material as used in dental implants, which are desired to remain implanted as long as possible, there seems to be no medical reason to remove asymptomatic titanium miniplates. The exception might be a plate located in area of mandibular angle, especially in the presence of un-erupted wisdom tooth:
Yamamoto K, Matsusue Y, Horita S, Murakami K, Sugiura T, Kirita T. Routine removal of the plate after surgical treatment for mandibular angle fracture with a third molar in relation to the fracture line. Ann Maxillofac Surg. 2015;5(1):77-81.
Also the health insurance issues my play a role in indications for plate removal.
In my own experience plate removal is necessary in less then 10% of trauma and orthognathic cases.
If the patient is asymptomatic there is no indication to remove titanium plates and screws. The exception in our practice is in the growing skeleton.
I completely agree with dr schutz. no medical reason to remove plates unless they are syntomatic.
only possible exception removal of miniplate placed according to champy lines in the angular region in presence of unerupted wisdom teeth.
in such a case you cam plan removal of the plate together with tooth extraction 4-6 months after surgical treatment.
Miniplates do not have to be removed, as long they are asymptomatic and they do not cause any discomfort to the patients. However, the removal in growing children should be considered
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