REASONS FOR REMOVING TITANIUM PLATES IN TREATED MAXILLOFACIAL TRAUMATIZED PATIENTS

Abstract

Background: Titanium plates are widely accepted as the reference standard for the internal fixation of maxillofacial fractures owing to their favourable biocompatibility and mechanical behaviour. Nevertheless, a meaningful share of patients ultimately undergo a second operation to have the hardware removed for one of several reasons. Clarifying how often, and for what reasons, titanium plates are taken out is important for refining postoperative care and improving outcomes. The present study set out to establish the frequency of the various indications for titanium plate removal in patients previously treated for maxillofacial trauma.

Methods: This cross-sectional study was carried out at the Department of Oral and Maxillofacial Surgery, Lady Reading Hospital, Peshawar, Pakistan, with data collected from January 2025 to May 2025. A total of 115 patients undergoing titanium plate removal after maxillofacial trauma were recruited by consecutive non-probability sampling. Information was gathered through structured patient interviews, clinical examination, and review of case records. The indications for removal were classified as patient-demanded removal, infection, pain (Visual Analogue Scale score greater than 3), and age factor. Every patient underwent preoperative radiographic evaluation comprising orthopantomography and a postero-anterior skull view. Analysis was performed in SPSS version 26; categorical data were summarised as frequencies and percentages, and continuous data as mean ± standard deviation or median with interquartile range. Stratification was undertaken for age, gender, diabetes, hypertension, hardware type, fracture site, and the interval between fixation and removal, with the post-stratification Chi-square or Fisher’s exact test applied at the 5% significance level.

Results: The cohort of 115 patients had a mean age of 32.6 ± 11.8 years (range 18–65 years). Men made up 82.6% (n = 95) and women 17.4% (n = 20). Patient-demanded removal was the leading indication at 38.3% (n = 44), followed by infection at 27.8% (n = 32), pain at 20.9% (n = 24), and age factor at 13.0% (n = 15). The mandible was the commonest site of removal (66.1%, n = 76), with the parasymphysis predominating (27.8%, n = 32). Mini-plates represented 73.0% (n = 84) of removed hardware and micro-plates 27.0% (n = 31). Removal occurred at two months in 27.8% (n = 32) and at four months in 72.2% (n = 83) of cases. Hypertension was recorded in 17.4% (n = 20) and diabetes mellitus in 9.6% (n = 11). Significant associations emerged between fracture site and indication (χ² = 18.64, p = 0.028), with infection clustering in zygomaticomaxillary complex fractures, and between the removal interval and indication (χ² = 12.84, p = 0.005), with infection and pain dominating early removals and patient demand dominating later ones. No significant relationship was found between indication and age group (p = 0.389), gender (p = 0.689), hardware type (p = 0.511), hypertension (p = 0.612), or diabetes (p = 0.418).

Conclusions: Patient demand was the most frequent reason for titanium plate removal in treated maxillofacial trauma patients, ahead of infection, pain, and age factor. Both the fracture site and the interval between fixation and removal were significantly associated with the indication for removal. These observations underline the value of thorough preoperative counselling, site-specific risk appraisal, and well-timed intervention in the care of patients carrying titanium hardware. Further work is needed to formulate evidence-based guidelines for removal and to improve patient outcomes.