Skip to main content
SpringerLink
Log in

Should Osteosynthesis Material in Cranio-Maxillofacial Trauma be Removed or Left In Situ? A Complication-associated Consideration

  • Chapter
  • First Online:
Complications in Cranio-Maxillofacial and Oral Surgery

Abstract

For many years, the vast majority of cranio-maxillofacial fractures require rigid osteosynthesis by the use of titanium plates and screws. Because titanium is biologically inert, most surgeons around the world do not remove osteosynthesis material (OM) routinely as long as it is not symptomatic. However, its continued presence in the body can be associated with side effects like infection with plate exposure, pain, plate palpability over sensitive facial areas, cold intolerance, soft tissue erosion, sinusitis, and nerve and tooth damage. Once those complications are present, removal of titanium hardware is mostly required. Apart from those case-specific indications, there are a few strong indications for elective hardware removal.

When considering the present literature still today, there is no consensus among treating surgeons in terms of long-term management of titanium hardware used for the osteosynthesis of craniofacial trauma.

Therefore, this chapter discusses and explains the pros versus cons of elective metal OM removal and gives an overview about potential long-term systemic side effects of titanium like corrosion if left in situ for ever.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution
eBook
USD 16.99
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 99.00
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info
Hardcover Book
USD 139.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

Similar content being viewed by others

References

  1. Thoma KH, Holland DJ Jr, et al. Fracture cases treated by means of internal fixation. Oral Surg Oral Med Oral Pathol. 1948;1:90–7.

    Article  CAS  Google Scholar 

  2. Luhr HG. On the stable osteosynthesis in mandibular fractures. Dtsch Zahnarztl Z. 1968;23:754.

    CAS  PubMed  Google Scholar 

  3. Becker R, Machtens E, Lenz J. Possibilities and limitations of compression osteosynthesis. Fortschr Kiefer Gesichtschir. 1975;19:87–91.

    CAS  PubMed  Google Scholar 

  4. Alpert B, Seligson D. Removal of asymptomatic bone plates used for orthognathic surgery and facial fractures. J Oral Maxillofac Surg. 1996;54:618–21.

    Article  CAS  Google Scholar 

  5. Trevisan F, Calignano F, Aversa A, et al. Additive manufacturing of titanium alloys in the biomedical field: processes, properties and applications. J Appl Biomater Funct Mater. 2018;16:57–67.

    CAS  PubMed  Google Scholar 

  6. Ottria L, Lauritano D, Andreasi Bassi M, et al. Mechanical, chemical and biological aspects of titanium and titanium alloys in implant dentistry. J Biol Regul Homeost Agents. 2018;32:81–90.

    CAS  PubMed  Google Scholar 

  7. Haug RH. Retention of asymptomatic bone plates used for orthognathic surgery and facial fractures. J Oral Maxillofac Surg. 1996;54:611–7.

    Article  CAS  Google Scholar 

  8. Munuera C, Matzelle TR, Kruse N, et al. Surface elastic properties of Ti alloys modified for medical implants: a force spectroscopy study. Acta Biomater. 2007;3:113–9.

    Article  CAS  Google Scholar 

  9. Bozkus I, Germec-Cakan D, Arun T. Evaluation of metal concentrations in hair and nail after orthognathic surgery. J Craniofac Surg. 2011;22:68–72.

    Article  Google Scholar 

  10. Cahill TJ III, Gandhi R, Allori AC, et al. Hardware removal in craniomaxillofacial trauma: a systematic review of the literature and management algorithm. Ann Plast Surg. 2015;75:572–8.

    Article  CAS  Google Scholar 

  11. Kim YK, Yeo HH, Lim SC. Tissue response to titanium plates: a transmitted electron microscopic study. J Oral Maxillofac Surg. 1997;55:322–6.

    Article  CAS  Google Scholar 

  12. Thoren H, Snall J, Kormi E, Lindqvist C, Suominen-Taipale L, Tornwall J. Symptomatic plate removal after treatment of facial fractures. J Craniomaxillofac Surg. 2010;38:505–10.

    Article  Google Scholar 

  13. Nagase DY, Courtemanche DJ, Peters DA. Plate removal in traumatic facial fractures: 13-year practice review. Ann Plast Surg. 2005;55:608–11.

    Article  CAS  Google Scholar 

  14. Anderson JM, Rodriguez A, Chang DT. Foreign body reaction to biomaterials. Semin Immunol. 2008;20:86–100.

    Article  CAS  Google Scholar 

  15. Galante JO, Lemons J, Spector M, Wilson PD Jr, Wright TM. The biologic effects of implant materials. J Orthop Res. 1991;9:760–75.

    Article  CAS  Google Scholar 

  16. Kitaura H, Kimura K, Ishida M, Kohara H, Yoshimatsu M, Takano-Yamamoto T. Immunological reaction in TNF-alpha-mediated osteoclast formation and bone resorption in vitro and in vivo. Clin Dev Immunol. 2013;2013:181849.

    Article  Google Scholar 

  17. Fox SW, Fuller K, Bayley KE, Lean JM, Chambers TJ. TGF-beta 1 and IFN-gamma direct macrophage activation by TNF-alpha to osteoclastic or cytocidal phenotype. J Immunol. 2000;165:4957–63.

    Article  CAS  Google Scholar 

  18. Katou F, Andoh N, Motegi K, Nagura H. Immuno-inflammatory responses in the tissue adjacent to titanium miniplates used in the treatment of mandibular fractures. J Craniomaxillofac Surg. 1996;24:155–62.

    Article  CAS  Google Scholar 

  19. Nautiyal VP, Mittal A, Agarwal A, Pandey A. Tissue response to titanium implant using scanning electron microscope. Natl J Maxillofac Surg. 2013;4:7–12.

    Article  Google Scholar 

  20. Souza PP, Lerner UH. The role of cytokines in inflammatory bone loss. Immunol Invest. 2013;42:555–622.

    Article  CAS  Google Scholar 

  21. Sunderman FW Jr. Carcinogenicity of metal alloys in orthopedic prostheses: clinical and experimental studies. Fundam Appl Toxicol. 1989;13:205–16.

    Article  CAS  Google Scholar 

  22. Vahey JW, Simonian PT, Conrad EU 3rd. Carcinogenicity and metallic implants. Am J Orthop (Belle Mead NJ). 1995;24:319–24.

    CAS  Google Scholar 

  23. Brewster DH, Stockton DL, Reekie A, et al. Risk of cancer following primary total hip replacement or primary resurfacing arthroplasty of the hip: a retrospective cohort study in Scotland. Br J Cancer. 2013;108:1883–90.

    Article  CAS  Google Scholar 

  24. Makela KT, Visuri T, Pulkkinen P, et al. Risk of cancer with metal-on-metal hip replacements: population based study. BMJ. 2012;e4646:345.

    Google Scholar 

  25. Smith AJ, Dieppe P, Porter M, Blom AW, National Joint Registry of England and Wales. Risk of cancer in first seven years after metal-on-metal hip replacement compared with other bearings and general population: linkage study between the National Joint Registry of England and Wales and hospital episode statistics. BMJ. 2012;344:e2383.

    Article  Google Scholar 

  26. Makela KT, Visuri T, Pulkkinen P, et al. Cancer incidence and cause-specific mortality in patients with metal-on-metal hip replacements in Finland. Acta Orthop. 2014;85:32–8.

    Article  Google Scholar 

  27. Mathew CA, Maller S, Maheshwaran. Interactions between magnetic resonance imaging and dental material. J Pharm Bioallied Sci. 2013;5:S113–6.

    Article  Google Scholar 

  28. Hung SC, Wu CC, Lin CJ, et al. Artifact reduction of different metallic implants in flat detector C-arm CT. Am J Neuroradiol. 2014;35:1288–92.

    Article  Google Scholar 

  29. Hargreaves BA, Worters PW, Pauly KB, Pauly JM, Koch KM, Gold GE. Metal-induced artifacts in MRI. Am J Roentgenol. 2011;197:547–55.

    Article  Google Scholar 

  30. Eppley BL, Sparks C, Herman E, Edwards M, McCarty M, Sadove AM. Effects of skeletal fixation on craniofacial imaging. J Craniofac Surg. 1993;4:67–73.

    Article  CAS  Google Scholar 

  31. De Crop A, Casselman J, Van Hoof T, et al. Analysis of metal artifact reduction tools for dental hardware in CT scans of the oral cavity: kVp, iterative reconstruction, dual-energy CT, metal artifact reduction software: does it make a difference? Neuroradiology. 2015;57:841–9.

    Article  Google Scholar 

  32. Shimamoto H, Sumida I, Kakimoto N, et al. Evaluation of the scatter doses in the direction of the buccal mucosa from dental metals. J Appl Clin Med Phys. 2015;16:5374.

    Article  Google Scholar 

  33. Eppley BL, Platis JM, Sadove AM. Experimental effects of bone plating in infancy on craniomaxillofacial skeletal growth. Cleft Palate Craniofac J. 1993;30:164–9.

    Article  CAS  Google Scholar 

  34. Kolk A, Kohnke R, Saely CH, Ploder O. Are biodegradable osteosyntheses still an option for midface trauma? Longitudinal evaluation of three different PLA-based materials. Biomed Res Int. 2015;2015:621481.

    Article  Google Scholar 

  35. Kolk A, Neff A. Long-term results of ORIF of condylar head fractures of the mandible: a prospective 5-year follow-up study of small-fragment positional-screw osteosynthesis (SFPSO). J Craniomaxillofac Surg. 2015;43:452–61.

    Article  Google Scholar 

  36. Jhass AK, Johnston DA, Gulati A, Anand R, Stoodley P, Sharma S. A scanning electron microscope characterisation of biofilm on failed craniofacial osteosynthesis miniplates. J Craniomaxillofac Surg. 2014;42:e372–8.

    Article  Google Scholar 

  37. Bhatt V, Chhabra P, Dover MS. Removal of miniplates in maxillofacial surgery: a follow-up study. J Oral Maxillofac Surg. 2005;63:756–60.

    Article  Google Scholar 

  38. Rallis G, Mourouzis C, Papakosta V, Papanastasiou G, Zachariades N. Reasons for miniplate removal following maxillofacial trauma: a 4-year study. J Craniomaxillofac Surg. 2006;34:435–9.

    Article  Google Scholar 

  39. Yamamoto K, Matsusue Y, Horita S, Murakami K, Sugiura T, Kirita T. Routine removal of the plate after surgical treatment for mandibular angle fracture with a third molar in relation to the fracture line. Ann Maxillofac Surg. 2015;5:77–81.

    Article  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. University Clinic of Oral and Maxillofacial Surgery, Medical University of Innsbruck, Innsbruck, Austria

    Andreas Kolk

Authors
  1. Andreas Kolk
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Andreas Kolk .

Editor information

Editors and Affiliations

  1. Department of CMF and Oral Surgery, Medical University of Innsbruck, Innsbruck, Austria

    Robert Gassner

Rights and permissions

Reprints and permissions

Copyright information

© 2020 Springer Nature Switzerland AG

About this chapter

Check for updates. Verify currency and authenticity via CrossMark

Cite this chapter

Kolk, A. (2020). Should Osteosynthesis Material in Cranio-Maxillofacial Trauma be Removed or Left In Situ? A Complication-associated Consideration. In: Gassner, R. (eds) Complications in Cranio-Maxillofacial and Oral Surgery. Springer, Cham. https://doi.org/10.1007/978-3-030-40150-4_10

Download citation

  • DOI: https://doi.org/10.1007/978-3-030-40150-4_10

  • Published:

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-030-40149-8

  • Online ISBN: 978-3-030-40150-4

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics

Search

Navigation