Hardware Removal in Orthognathic Surgery Patients: A 20 Year Retrospective Study

Risk Factors for Hardware Removal Following Bimaxillary Surgery: A National Database Analysis

“…The past few decades have seen a shift from stainless steel hardware to titanium hardware for the fixation of maxillomandibular fractures due to claims of increased biocompatibility, more physiologic rigidity, improved immunogenicity, and greater resistance to cyclic load. Notably, discourse on titanium’s practical ability to offer enhanced protection against plate failure and other complications remains mixed 1,4,15,32,33 . Over our study period, VSP also arose as a prevalent and lasting tool in the orthognathic surgery landscape, with the first publications on VSP in orthognathic surgery emerging in 2011 and multiplying since then 34 .…”

“…Obstructive sleep apnea has also been consistently shown to elevate the risk of ROH and other complications in orthognathic surgery patients 28 . In a 20-year retrospective analysis, Dunlop et al 4 found that patients who underwent ROH had much higher rates of sleep apnea, compared to the general orthognathic surgery population (9.3% versus 4.5%). We similarly observed higher rates of sleep apnea in our ROH cohort (22% versus 11%; P <0.001), and in multivariable analysis, sleep apnea independently increased odds of ROH (OR: 1.615; P =0.018).…”

“…Although hardware is typically intended to be implanted permanently, the removal of hardware (ROH) is occasionally required. Common indications for ROH usually emerge within the first postoperative year and include infection, pain, exposed hardware, loose hardware, thermal sensitivity, and patient preference 1–7 . Reported rates of ROH in orthognathic surgery range broadly (between 0.4% and 27%) with female patients, older patients, patients who smoke, and patients with sleep apnea being more likely to undergo ROH 3–5,8 …”

“…First, titanium plates have overtaken stainless steel plates as the standard of care for facial fracture fixation. Proponents of this transition have cited several advantages of titanium plates over stainless steel: enhanced biocompatibility, durability, ductility, and lack of interference with medical imaging modalities 4,5,15 . Prior investigations have posited that these characteristics of titanium plates might also reduce rates of ROH relative to stainless steel plates 8 .…”

“…Common indications for ROH usually emerge within the first postoperative year and include infection, pain, exposed hardware, loose hardware, thermal sensitivity, and patient preference. [1][2][3][4][5][6][7] Reported rates of ROH in orthognathic surgery range broadly (between 0.4% and 27%) with female patients, older patients, patients who smoke, and patients with sleep apnea being more likely to undergo ROH. [3][4][5]8 It is widely accepted that the risks of removing asymptomatic hardware outweigh any perceived benefits as ROH is decisively associated with morbidity.…”