Policy towards Removal of Mini Plates in Maxillofacial Trauma –A Follow up Study of 234 Patients

Aim: To analyze the incidence and factors associated with mini plates removal in maxillofacial trauma and also create a protocol for removal of miniplates in maxillofacial trauma. Material & Methods: Records of 234 patients attending the department of oral and maxillofacial surgery over a 8-year period were evaluated regarding the site of plating, the number of patients in whom plates were removed & the reasons for their removal. A total of 437 stainless steel mini plates were inserted among 234 patients, among which 245 plates were inserted in mandible, 140 in the maxilla and 52 plates in a zygomatic complex region. Results: A total of 234 patients with maxillofacial trauma were included in the study. Out of these, 172 were males and 62 were females with age range of 14 -59 yrs. A total of 437 stainless steel mini plates were inserted. A total of 48(10.98 %) mini plates were removed from 28 (11.96%) patients over a period of 8 years. Out of these 48 plates, 15 (31.25 %) plates were removed because of infection, 12 ( 25 %) plates were removed because of dehiscence, 8 ( 16.68 %) were removed because of loosened plates, 5 (10.41%) were removed because of palpable plates, 5 (10.41%) plates were removed upon patient request and 3 ( 6.25 %) plates were removed because of non-union. Conclusion: Although there are conflicting opinions about the routine removal of miniplates, we follow the principle of wait and see for reasons of plate removal. The result of the present study favors our policy that is “wait and see”.


Introduction
Plates and screws for fixation of the facial skeleton have been used for more than a century. Their use started in Europe in the late 1970s and in North America in the late 1980s. Most of the available data regarding the fate of mini plates used for bony fixation has been published in the orthopedic literature. However, thousands of mini plates are being used yearly by oral and maxillofacial surgeons all over the world. Surprisingly, a review of the literature showed much philosophy and minimal data regarding the success or failure of mini plates used in the maxillofacial area. Although there is agreement that symptomatic plates should be removed, removal of asymptomatic plates from the facial skeleton is still controversial, yet which plates will become symptomatic is completely unpredictable.

Strasbourg Osteosynthesis Research Group (SORG) [1]
held at the Netherlands in 1991 stated that -"A plate which is intended to assist the healing of bone becomes a non-functional implant once this role is completed. It may then be regarded as a foreign body. While there is no clear evidence to date that a plate causes actual harm, our knowledge remains incomplete. Therefore it is not possible to state with certainty that an otherwise symptomless plate left in situ is harmless. The removal of the non-functioning plate is desirable provided that the procedure does not cause undue risk to the patient".
The principal aim of this study was to establish a policy towards the removal of mini plates in maxillofacial trauma after the jaw fractures had healed. were condyle, and 32 were body fractures.

Materials & Methods
A total of 437 stainless steel mini plates were inserted among these 234 patients, of which 245 plates were inserted in the mandible, 140 in the maxilla and 52 plates in the zygomatic complex region [ Figure. 1]. A proforma was made for all the patients, data were tabulated and analyzed.

Results
A total of 234 patients with maxillofacial trauma were included in the study. Out of these, 172 were males and 62 were females with an age range of 14 -59 yrs. A total of 437 stainless steel mini plates were inserted, of which 48 (10.98 %) mini plates were removed from 28 (11.96%) patients over a period of  years & 3 (6.25 %) plates were removed due to non-union within 3 months. Patient's request was because of concern about the permanent implant and also plate being palpable. Factors contributing to non-union were a poor medical condition. None of the patients neither requested nor showed any concern for plate removal after 2 years of insertion.

Discussion
In our 7 years follow up study of 234 patients who underwent internal fixation with 437 stainless steel mini plates, around 48 (10.98 %) plates were removed from 28 (11.96 %) patients which correlate with the study of Rallis G et al [2]. Out held at the Netherlands in 1991 stated that -"A plate which is intended to assist the healing of bone becomes a non-functional implant once this role is completed. It may then be regarded as a foreign body. While there is no clear evidence to date that a plate causes actual harm, our knowledge still remains incomplete. Therefore it is not possible to state with certainty that an otherwise symptomless plate left in situ is harmless. The removal of the non-functioning plate is desirable provided that the procedure does not cause undue risk to the patient".
Considering the above findings, we prefer to follow the following protocol for the removal of Mini plates. Removal of Mini plates in our Maxillofacial unit is done only when there is 1.
Presence of Plate related symptoms

Patient request or concern
We prefer to wait and see for a cause for removal rather than routine removal of plates after a particular time period.

Conclusion
The present study concluded that the main reasons for mini plate removal after maxillofacial trauma in our unit were Submit your manuscript to a JScholar journal and benefit from: ¶ Convenient online submission ¶ Rigorous peer review ¶ Immediate publication on acceptance ¶ Open access: articles freely available online ¶ High visibility within the field ¶ Better discount for your subsequent articles our policy that is "wait and see". We also further conclude that it is wise to leave a non-functioning symptomless miniplates insitu.