Removal of miniplates in maxillofacial surgery: University Hospital Birmingham experience

Removal of miniplates in maxillofacial surgery: University Hospital Birmingham experience
May 2003
Vyomesh BhattMDS, FDS, RCS (Eng)*
Richard J. Langford, FDS, FRCS, FRCS (OMFS)ÇƒÜ
Journal of Oral and Maxillofacial Surgery Online
Abstract
Purpose: We sought to study the incidence and causes of removal of osteosynthesis miniplates (plates) in oral and maxillofacial surgery in a single unit over a 13-month period and to identify factors associated with plate removal.
Patients and Methods: We conducted a retrospective study of 172 patients attending the Department of Oral and Maxillofacial Surgery, University Hospital Birmingham, between November 1, 1998, and November 30, 1999, in whom maxillofacial osteosynthesis plates were inserted or removed. Not all patients who had plates removed had them inserted within the same time frame.
Results: During a period of 13 months (November 1, 1998, through November 30, 1999), 308 plates were inserted into 153 patients. During the same period, 51 plates were removed from 28 patients, of whom 9 underwent plate insertion and subsequent removal of 25 plates within the time period of the study. Thirty-four (67%) of the plates removed from 20 patients were symptomatic. Infection was the most common cause for removal, occurring in 14 patients (50% of patients who had plates removed) and accounting for 22 plates (43% of plates removed). Symptoms relating to plates necessitating removal occurred in the first year after insertion in 15 patients (53%), accounting for 21 plates.
Conclusions: Our experience with the removal of miniplates is comparable with that of previous studies. Plate-related problems leading to removal are more likely to occur within the first year after insertion. ¨© 2003 American Association of Oral and Maxillofacial Surgeons J Oral Maxillofac Surg 61:553-556, 2003
Osteosynthesis using miniplates (plates) has been common practice in maxillofacial surgery since Champy et al's1 adaptation in 1978 of Michelet et al's2 1973 technique. In 1986, Persson et al3 reported that Champy et al advocated routine removal of all miniplates at 3 months although no specific reason was given. This was perhaps due to stainless steel plates being used, which are less biocompatible than titanium. There is still no consensus on the need for routine removal of titanium maxillofacial plates. The Strasbourg Osteosynthesis Research Group provided the following recommendations at their symposium held in Volendam, the Netherlands, in November 1991:
Çƒ?A plate which is intended to assist the healing of bone becomes a non-functional implant once this role is completed. It may then be regarded as a foreign body. While there is no clear evidence to date that a plate causes actual harm, our knowledge remains incomplete. It is therefore not possible to state with certainty that an otherwise symptomless plate, left insitu, is harmless.
The removal of a non-functional plate is desirable provided that the procedure does not cause undue risk to the patient.Çƒ?4
Interpretation of these recommendations means that for most patients, assuming titanium plates are used, there is less risk in leaving symptomless plates in situ than in removing them.4
In this report, we present the University Hospital Birmingham experience during a 13-month period with the removal of miniplates in maxillofacial surgery. The purpose of this exercise was to review the incidence of plate removal and the reasons for plate removal and to identify factors associated with plate removal.
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