Risk Factors of Titanium Removal in Orthognathic Surgery

Objectives: The use of titanium miniplates has changed the conventional treatment and outcome of orthognathic surgery. However, the use of titanium plates to achieve semi-rigid fixation can develop complications, which often warrants the need for hardware removal after the bony consolidation period. The goal of the study was to determine the rate of plate removal, potential risk factors, and etiological factors that may contribute to this outcome

Methods: Retrospective analysis was performed on the medical and dental records of 112 subjects who underwent orthognathic surgery using semi-rigid fixation technique at Tufts University School of Dental Medicine within a 5 year period (2003-2008). Chi-square tests were used to evaluate the potential association between the risk factors (age, gender, site of plate insertion, type of movement performed, intra-operative estimated blood loss, and placement of final splint, plate position in the mandible) and the outcome (plate removal). 

Results: : The 112 subjects underwent 192 surgeries (103 in mandible, and 89 in maxilla). The average age of the group was 25.2 years old.  76 (67.9%) of the subjects were female. There were 24 total plates removed, 15 from the mandible and 9 from the maxilla. Plate position in the mandible is the only factor found to be statistically significant to predict plate removal. For the subjects with plate removal, the most commonly etiology factor for removal is pain/discomfort. 

Conclusions: In this study, surgical plate removal after orthognathic surgery is found to be a potential complication with a rate as high as 18.8%, comparable with existing literature (9%-16%). However, in the literature, some risk factors (such as age and duration of operation) were considered to be significant to this outcome. This study found the only factor that is statistically significant to predict plate removal is the position of plate placement in the mandible.