Complications and Removal Rates of Miniplates and Screws Used for Maxillofacial Fractures

Abstract

Complications of miniplates and screws used for maxillofacial fractures were analyzed, and complications were evaluated in relation to fracture site. Motor vehicle accidents were the cause of all fractures in this study. During the last 7 years (1994-2001), noncompressive titanium miniplates and screws were used for stabilization of maxillofacial fractures. In 66 patients, 87 fracture sites were stabilized using 296 miniplates and 1,184 screws. The mean age of the patients was 31 years (age range, 6-64 years). The percentage of male patients was 77% and the percentage of female patients was 23%. Miniplates and screws were used in 6 patients (10%) who were younger than 15 years of age at the time of the surgery. The follow-up period ranged between 3 months and 7 years. The overall miniplate and screw removal rate was 7%. The rates of removal according to the fracture site are as follows: mandible, 4.4%; zygomaticofrontal junction, 1.4%; inferior orbital rim, 0.7%; maxilla, 0.3%; and frontal sinus wall, 0.3%. Removal causes were infection, 2%; extrusion, 1.7%; visibility, 1.4%; pain, 1%; malunion, 0.7%; and miniplate fracture, 0.3%. The minimum time period between insertion and removal was 3 months and the maximum period was 14 months. Infection and extrusion were the main complications for removal of miniplates and screws from the mandible, whereas miniplates and screws were removed from the zygoma because of visibility (zygomaticofrontal region) under the skin in the vast majority of the patients. The maxilla was the least operated region for miniplate and screw removal. In all patients in this study, the preoperative physical symptoms were relieved after miniplate and screw removal. Miniplates and screws are very useful tools in maxillofacial fracture management, but sometimes they have to be removed. In the authors' series, the removal rate was 7%, and this rate can vary with the severity of the trauma and location of the fracture.

Symptomatic plate removal after treatment of facial fractures

“…Investigations in which the authors have calculated PR rates per plate show that removal rates vary widely, ranging from 3.7% to 27.2% (Chaushu et al, 2000;Islamoglu et al, 2002;Murthy and Lehman, 2005;Nagase et al, 2005;Rallis et al, 2006). The variability in PR rates per plate is most likely explained by the fact that some surgeons prefer to remove only those plates that cause objective or subjective problems, whereas others choose to remove all inserted plates in tandem with removal of one symptomatic plate.…”

“…Some 20e30% of patients eventually need to have their plates removed (Islamoglu et al, 2002;Nagase et al, 2005;Bakathir et al, 2008), most often because of infections or other complications in the surgical area (Islamoglu et al, 2002;Murthy and Lehman, 2005;Rallis et al, 2006;Bakathir et al, 2008). Subjective discomfort, on the other hand, only rarely leads to plate removal (PR) (Murthy and Lehman, 2005;Bakathir et al, 2008).…”

Histopathologic Effects of Glass Ionomer Bone Cements Application to Maxillofacial Area: An Experimental Study in Rabbits

“…Various alternatives have been described for either skeletal fixation after maxillofacial fracture or bony defects in this region. Among these alternatives, wire fixation, bicortical miniplates, and compressive and noncompressive miniplate systems are reliable options for rigid fixation (8,13,15). An ideal alloplastic material for maxillofacial reconstruction should be biocompatible, available in sufficient quantities, strong enough, and easy to shape to fit the defect and regional anatomy, easily fixable, not prone to migration, and bioresorbable with minimal foreign body reaction (1,15).…”

“…An ideal alloplastic material for maxillofacial reconstruction should be biocompatible, available in sufficient quantities, strong enough, and easy to shape to fit the defect and regional anatomy, easily fixable, not prone to migration, and bioresorbable with minimal foreign body reaction (1,15). Miniplate systems are expensive, and except for biodegradable miniplates, reoperation is needed for removal (8). this might be considered a disadvantage.…”

Exposición Extraoral De Una Placa De Reconstrucción Mandibular: Reporte De Un Caso

“…20 En el caso presentado, una de las causas para la exposición del material mencionado pudo haber sido la extensa resección que se realizó, su situación anatómica, el largo trayecto de la placa, además de la terapia neoadyuvante que el paciente recibió. 21,22 Las placas de titanio han sido utilizadas exitosamente para realizar la fijación rígida en pacientes sometidos a hemimandibulectomias y a los cuales se les haya o no realizado un colgajo libre óseo microvascularizado. No obstante, la mayor parte de estos pacientes deben recibir terapia coadyuvante como radioterapia postoperatoria para complementar el tratamiento ideal de su patología.…”