Reasons for Removal of Miniplates Used in Fixation of Maxillofacial Bone Fractures: Systematic Review and Meta-Analysis

Abstract

Maxillofacial fractures are a prevalent occurrence, and the widespread use of miniplates to stabilize and secure these fractures during surgery is common. However, the post-surgical fate of these miniplates remains a subject of contention among surgeons. Some advocate for their removal, while others suggest leaving them in place. This study aims to perform an extensive meta-analysis of pertinent studies to ascertain the destiny of miniplates employed in maxillofacial surgery and discuss the consequences of either their extraction or retention. To execute this meta-analysis, a search was conducted across number of databases, including PubMed, Google Scholar, ResearchGate, Embase, and Scopus. Keywords such as “titanium miniplates”, “screws”, “maxillofacial surgery”, “complications”, and “removal” were utilized to identify pertinent studies. The search was constrained to studies published between 1989 and 2022. The analysis encompassed only studies reporting outcomes related to miniplates in maxillofacial surgery, including complication rates and removal frequencies. Eleven studies conformed to the inclusion criteria and were incorporated into the meta-analysis, encompassing a total of 2240 patients, ten of which were retrospectives and one prospective, with the largest study involving 434 patients. The overall complication rate was determined to be 13.3%. The most prevalent reasons for miniplate removal included patient preference, tooth extraction, and infections. The average time span for miniplate removal was 10.7 months, with the most prolonged reported duration being 24 years. These findings imply that immediate removal might not be imperative in the majority of instances. In conclusion, our meta-analysis underscores the necessity of removing miniplates in cases where hardware leads to a variety of complications and physical discomfort. Principal factors driving plate removal included patient requests, tooth extractions, and infections. Ordinarily, plate removal took place within the span of 6 to 12 months, with the mandible being the most frequent site for removal. These findings accentuate the significance of extended monitoring to assess the trajectory of miniplates in maxillofacial surgery and provide valuable insights for future clinical decisions. To validate these conclusions and gain deeper insights into the factors influencing plate removal in maxillofacial surgery, further research with larger participant cohorts and standardized outcome reporting is imperative.

Risk Factors Contributing to Symptomatic Miniplate Removal following Orthognathic Surgery: Systematic Review and Meta-Analysis

“…The use of miniplates to stabilize bones has gained popularity due to their efficacy in achieving stability and promoting rapid recovery, but these methods present several challenges, which include growth inhibition, palpable presence of plates and screws, difficulties with imaging and radiation therapy, temperature sensitivity, dispersion of titanium particles in lymph nodes, bone stress due to rigidity of the system, and the potential risk of genetic mutations. Consequently, approximately one-third of these systems are removed, leading to increased costs and additional burdens [ 1 , 2 , 3 , 4 , 5 , 6 , 7 , 8 ].…”

“…The opinions of surgeons on removal varied, with some recommending routine removal and others suggesting it only when necessary. However, the use of titanium, known for its biocompatibility and inertness, has weakened the argument for its routine removal as a foreign body [ 3 , 7 , 8 , 9 ].…”

“…Commonly reported reasons for the removal of miniplates include infection, exposure of the miniplate, and patient-reported irritation or discomfort [ 3 , 8 , 10 , 11 , 12 ]. The decision to remove miniplates after orthognathic surgery lacks consensus due to associated risks such as infection, morbidity, and cost [ 3 , 7 , 10 , 12 ]. This controversy reflects the complexity of balancing potential risks and benefits.…”