ANALYSIS OF HARDWARE REMOVAL IN MAXILLOFACIAL TRAUMA: A RETROSPECTIVE STUDY IN A MILITARY HOSPITAL IN SANA'A, YEMEN
Authors: Aldeen Haifa Mohammed Abdulmaged Sharaf , Al-Rahbi Lutf  Mohammed , Al-Ashwal Ahmed Abdulah , Abbas Al-Kasem Mohammed A , Al-Kibsi Taghreed Ahmed M , Al-Shamahy Hassan Abdulwahab 
Published: January 2024

Background and objective: Dental trauma is a significant problem for total dental health in terms of expenses, frequency, and age (young patients). Collaboration between various professionals, including oral surgeons, maxillofacial surgeons, dentists, orthodontists, and periodontists, frequently results in the treatment process. Surgical treatment may entail placing plates for fractures and shattered bones for long or permanent periods, and may require their removal for many reasons. Therefore, this study sought to ascertain the reasons for plate removal in individuals referred to the Department of Oral and Maxillofacial Surgery at Military Hospital in Sana'a, Yemen during a period of 3 years.
Method: The study included 57 Yemeni patients who visited the Department of Oral and Maxillofacial Surgery at the Military Hospital in Sana’a during the period 2021-2023. Cases of hardware removal were extracted from the medical records to include sex, age, medical history, accident history, type of fracture, primary complaint, period from the date of the first operation, approach to the operation, tooth in the fracture line, and extracted tooth.
Results: Gunshot injuries (40.4%) and explosive injuries (31.6%) were the most common causes of maxillofacial fractures. Mandibular fractures (68.4%) were the most frequent, followed by orbital and zygomatic fractures (12.3% each). The main reason for hardware removal was infections (29.8%), followed by patient preference (22.8%) and visible exposed hardware (15.8%). Mini-plates (68.4%) were the most commonly removed hardware, and the extra-oral approach (56.1%) was the most frequently used for removal. There was a significant association between orbital fractures and the incidence of positive discharge, as well as between reconstructive plates and the incidence of positive discharge. Longer plate usage, exceeding 24 months, increased the probability of positive discharge. Tooth involvement and extraction were minimal.
Conclusion: Gunshot and explosive injuries were the main causes of maxillofacial fractures, while infections, patient preferences, visible exposed devices, and pain and discomfort were the main reasons for removal of devices. Mandibular fractures were the most common and orbital fractures carry a higher risk of infection, while small plates have shown lower rates of infection. Prolonged panel use beyond 24 months increased the probability of positive discharge.
                   
Peer Review History:
Received: 25 October 2023; Revised: 18 November; Accepted: 24 December, Available online: 15 January 2024
Academic Editor: Dr. Gehan Fawzy Abdel Raoof Kandeel, Pharmacognosy Department, National Research Centre, Dokki, 12622,  Giza, Egypt, gehankandeel9@yahoo.com 
Received file:                             Reviewer's Comments:
Average Peer review marks at initial stage: 6.0/10
Average Peer review marks at publication stage: 7.0/10
Reviewers:
Dr. George Zhu, Tehran University of Medical Sciences, Tehran, Iran, sansan4240732@163.com
Dr.  Hasniza Zaman Huri, University of Malaya Medical Centre, Kuala Lumpur, hasnizazh@ummc.edu.my