No Need to Routinely Remove Titanium Implants for Maxillofacial Fractures

Abstract

Purpose: Titanium implants are typically used to fix maxillofacial fractures and their routine removal is a controversial topic in maxillofacial surgery. This study aimed to estimate the removal rate and risk factors associated with removal.

Materials and methods: The authors designed and implemented a retrospective study. Adult patients who underwent open reduction and internal fixation with titanium implants for maxillofacial fractures were included and those who returned for implant removal were identified from January 2007 to December 2016. The predictor variables were gender, age, preoperative infection, injury time, trauma cause, and fracture site. The primary outcome variable was removal of titanium implants. Descriptive and bivariate statistics were computed. Kaplan-Meier survival methods were used to estimate rate of removal. Univariate and multivariate Cox proportional hazards models were used to identify risk factors associated with removal.

Results: Of 2,325 patients (1,890 men and 435 women; average age, ∼35.49 yr) registered in this study, 163 (7.01%) had their titanium implants removed and 1-, 2-, and 10-year removal rates were 3, 7, and 8%, respectively. The risk factors most closely associated with removal were preoperative infection, injury by a blow from an object, obsolete fracture, and female gender.

Conclusions: Routinely removing titanium implants in patients with maxillofacial fracture is not necessary. When the risk factors listed earlier are present in these patients, follow-up should be scheduled more frequently.