title: Removal of bicortical screws and other osteosynthesis material that caused symptoms after bilateral sagittal split osteotomy: a retrospective study of 251 patients, and review of published papers.
abstract: Rigid fixation with either bicortical screws or miniplates is the current standard way to stabilise the mandibular segments after bilateral sagittal split osteotomy (BSSO). Both techniques are widely used and the superiority of one or other method is still debatable. One complication of rigid fixation is the need to remove the osteosynthesis material because of associated complaints. The main aim of this retrospective study was to analyse how often we needed to remove bicortical screws because they caused symptoms after BSSO in our clinic. Review of other published papers also enabled us to investigate the reported rates of removal of screws and miniplates at other centres. The mean (SD) duration of follow-up of 251 patients (502 sites) was 432 (172) days, and the number of bicortical screws removed in our clinic was 14/486 sites (3%). Other methods of fixation were used at 16 sites. We found no significant association between removal of bicortical screws and age, sex, presence of third molars, or bad splits. Published rates of removal of bicortical screws and miniplates are 3.1%-7.2% and 6.6%-22.2% per site, respectively. These findings show that fixation with bicortical screws after BSSO is associated with a low rate of removal of osteosynthesis material. Reported incidences imply a lower rate of removal for screws than for miniplates.
authors: Department of Oral and Maxillofacial Surgery, Leiden University Medical Centre, Leiden, The Netherlands.
authors: Jop P
authors: JP
authors: Verweij
authors: Department of Oral and Maxillofacial Surgery, Leiden University Medical Centre, Leiden, The Netherlands.
authors: Pascal N W J
authors: PN
authors: Houppermans
authors: Department of Oral and Maxillofacial Surgery, Leiden University Medical Centre, Leiden, The Netherlands; Department of Oral and Maxillofacial Surgery, Amphia Hospital, Breda, The Netherlands.
authors: Gertjan
authors: G
authors: Mensink
authors: Department of Oral and Maxillofacial Surgery, Leiden University Medical Centre, Leiden, The Netherlands. Electronic address: J.P.R.van_Merkesteyn@lumc.nl.
authors: J P Richard
authors: JP
authors: van Merkesteyn
mesh_terms: D000293:Adolescent; D000328:Adult; D001860:Bone Plates / Q000706:statistics & numerical data*; D001862:Bone Resorption / Q000209:etiology; D001863:Bone Screws / Q000706:statistics & numerical data*; D020878:Device Removal / Q000706:statistics & numerical data*; D004867:Equipment Design; D005260:Female; D005500:Follow-Up Studies; D005593:Fracture Fixation, Internal / Q000295:instrumentation; D006097:Granulation Tissue / Q000473:pathology; D006801:Humans; D019248:Jaw Fixation Techniques / Q000295:instrumentation; D008297:Male; D008875:Middle Aged; D008904:Miniaturization; D016155:Oral Fistula / Q000209:etiology; D059229:Osteotomy, Sagittal Split Ramus / Q000295:instrumentation*; D057240:Patient Preference; D011183:Postoperative Complications; D012189:Retrospective Studies; D013529:Surgical Wound Dehiscence / Q000209:etiology; D013530:Surgical Wound Infection / Q000209:etiology; D055815:Young Adult
keywords: Fixation; Mandibular osteotomy; Osteosynthesis; Plates; Post-operative complication; Screws