A retrospective study to ascertain the need for hardware removal following orthognathic surgery

Background: The concept of rigid fixation following surgical interventions in the maxillofacial region is in use since the 1970s. The presence of oral native bacteria in addition to the occlusal forces acting on the plates during mastication results in few complications following rigid fixation which would eventually lead to their retrieval. Objective: The purpose of this study was to evaluate the need for hardware removal in the postoperative phase following orthognathic surgery. Methods: This retrospective study encompassed 86 patients who underwent orthognathic surgery for the correction of their dentofacial deformities in a single hospital unit between July 2009 and October 2019. A total of 314 stainless steel miniplates were used for achieving osteosynthesis in 86 patients. The primary outcome variable in this study was hardware removal. Secondary outcome variables included the reason for hardware removal and the duration between the time of placement of the hardware and its removal. The verdict on whether to postoperatively retrieve plates was based on plate exposure, infection, and patient discomfort caused by the palpability of the plate. Results: Out of the 86 patients (314 plates), 36 patients underwent Le Fort I osteotomy, harboring 144 plates; eight patients underwent anterior maxillary osteotomy, harboring 16 plates; 47 patients underwent bilateral sagittal split osteotomy, harboring 94 plates; and 30 patients underwent genioplasty, harboring 60 plates. It was observed that hardware was retrieved from 24 patients (27.90%) only due to palpability. Among the patients from whom the hardware was removed as a result of complications, 41 patients (47.67%) developed an infection in the postoperative phase, 15 patients (17.44%) had exposed hardware, and six patients (6.97%) developed an inflammatory reaction as a result of a loose screw that necessitated the removal of the hardware. Conclusion: Based on the results of this study, it can be concluded that hardware removal is essential following orthognathic surgery in the late postoperative phase. Hence, following confirmation of optimal postoperative osseous healing, patients should be educated about the need for hardware retrieval and the significance of postoperative follow-up.