Do I need to remove the fixation plates after corrective jaw surgery?

Corrective jaw surgeryis a procedure whereby the jaw bone is cut, detached, moved to a different position and held there with some sort of fixation device. In the past, the fixation device comprised mainly stainless steel wires to tie the jaws in the new position. Today, this is achieved by using plates and screws placed internally to provide a rigid fixation. Some patients are concern about the possibility of setting off metal detectors at the airport while others wonder whether having the metal plates and screws in their body affects their health in the long run. Can these fixation plates and screws be removed? Should they be removed?

 Purpose of fixation plates

The purpose of having fixation plates is to keep the cut repositioned jaws in the newly planned position so that the bones can heal. Corrective jaw surgery is basically a surgically performed fracture. To allow the fractured bone to heal, the two ends need to be placed in contact with minimal movement for the first six weeks. When someone breaks a leg and a plaster of Paris cast is placed over the leg, the cast is basically immobilizing the to broken ends so that the fracture can heal. In corrective jaw surgery, the plates and screws serves that function of immobilizing the two fragments relative to each other.

What are they made of?

These fixation plates and screws are made of titanium. Titanium is a fairly soft metal that has the unique property of not eliciting a foreign body reaction from the bone. In fact the bone cells actually attach themselves onto titanium directly, without an intervening fibrous layer that is present in other metallic implants. The plates can be pre-fabricated in the factory or they can patient-specific custom-made by 3D printing.

Should they be removed?

Because the titanium is seamlessly integrated with bone, these fixation plates need not be removed. They also do not set off alarms at airports or other metal detectors. However, sometimes, they may become exposed through the gums due to thin gums or superficial placement of the plates during surgery. When exposed, the plates are susceptible to infection and should be removed. Otherwise, they can be left alone.

Can they be removed?

As most orthognathic patients are young, some parents are concern about the any unknown risks that may surface many years later and request for their removal. These plates can be removed once the bone has healed as they do not serve any purpose after that. The best time to remove these plates is about one year after orthognathic surgery. At that point, the healing is completed and the bone has remodeled and the surgical results would have reach stability. However beyond a year, removal progressively becomes difficult due to the integration of the bone with the implants and screws. Late removal of the plates often requires a fair bit of bone removal to expose the plates. Screws may not be retrievable at all without extensive drilling of the bone.

In general, fixation plates that do not become exposed do no require removal after orthognathic surgery. However, if removal is desired by the patient, it should be done after about one year. Late removal is usually not recommended due to increase morbidity without any benefit.