Symptomatic Plate Removal in Maxillofacial Trauma

Abstract

This study reviewed the fate of titanium plates used to correct maxillofacial trauma in 76 patients to define risk factors for plate removal. Medical records of 76 consecutive patients at a single institution, over a 10-year period, were retrospectively reviewed. Variables included age, sex, trauma type, diagnosis, fracture type, fracture diagnosis, plate location, surgical approach, and reasons for plate removal. Fracture diagnosis was described as panfacial (42%), blowout (3%), midface (28%), zygoma (26%), mandible angle (6%), ramus (7%), and symphysis (9%). All plate removals according to fracture diagnosis were in the mandible angle (30%) and symphysis (20%). When plate location was reviewed, 68% of the plates were placed in the upper and midface and 32% were placed in the mandible. Specifically, plates were placed in the frontozygomatic suture (18%), zygomaticomaxillary suture (19%), infraorbital rim (14%) and mandible symphysis (15%), mandible angle (9%), piriform (6%), nasal (5%), mandible ramus (4%) and body (4%), zygoma (2%), and frontal (2%). Of 163 plates that were placed, 6 plates (3.7%) were removed. Three (12%) of the symphysis plates and 3 (20%) of the angle plates were removed. Among all variables, only fracture diagnosis (P = 0.01) and plate location (P = 0.01) were statistically significant in plate removal. Five plates were removed for abscess/infection; 1 plate was removed for osteomyelitis. Further review revealed that 4 out of 6 plates removed involved synchronous mandible fractures. Most infections after maxillofacial trauma occur in the mandible, and often these infections are the main reason for plate removal. More vigilance is needed in the treatment of mandible angle and symphyseal fractures, especially if there are synchronous fractures, to prevent infection, plate removal and subsequent malunion.

Symptomatic plate removal after treatment of facial fractures

“…This was based on findings of a study from Canada which revealed that subjective (Nagase et al, 2005), and which mentioned the possible influence of the cold climate on this finding. The rate of patients undergoing PR for subjective reasons was notably lower in the present study (29.2%); however, it was clearly higher than the rates of 0% and 17.9% presented in studies conducted in Washington DC, USA (Murthy and Lehman, 2005) and Oman (Bakathir et al, 2008). We also observed that 14.6% of the patients who underwent PR stipulated that it was specifically because of cold intolerance, implying that the climate does have an influence on PR.…”

“…The great majority of the patients in the present study who had PR for unknown reason (81.3%) had plates removed from the mandible, possibly reflecting the surgeons' concern over future infection-related complications. Indeed, previous studies have shown that whenever osteosynthesis material needs to be removed from the mandible, the reason is most often related to infections (Islamoglu et al, 2002;Murthy and Lehman, 2005;Bakathir et al, 2008). In addition, as observed in the present study, the lower jaw is particularly susceptible to complications and to a subsequent need for PR.…”

“…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).…”

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

“…14 Es motivo de controversia y criterio de cada cirujano craneomaxilofacial cuándo, cómo y bajo qué circunstancias se retira un sistema de fijación de osteosíntesis funcionalmente estable, con excepción de los casos en que la presencia de infecciones, sintomatología álgica, exposición intra y extraoral, malunión, pseudoartrosis y fractura de la placa e interferencia con el crecimiento facial, lo requieran. 15 El objetivo de este artículo es presentar el caso de un paciente con exposición de una placa de reconstrucción mandibular, postratamiento oncológico quien fue tratado de forma no convencional mediante el retiro del material de osteosíntesis y sin tratamiento posterior reconstructivo, mostrando adecuada función sin necesidad de otro tiempo quirúrgico, siendo un tratamiento diferente y un caso inusual en nuestro medio.…”