## 4 Discussion
In our study, 4.8% of miniplate removals were attributed to pain. Other reasons for removal encompassed patient requests, growth limitations in pediatric cases, prosthetic rehabilitation requirements, deformities stemming from malunion or non-union, tooth extraction, wound reopening, palpability, nerve impairment, and cold intolerance. [PERSON] et al. [26] reported a 14% incidence of post-surgery pain around the fixation site, while [PERSON] et al. [27] identified pain in 24% of cases. For pediatric patients, miniplates should ideally be removed within two to three months after fracture surgery to prevent growth restrictions. Nevertheless, [PERSON] et al. [28] suggest that removal should only be conducted in symptomatic cases. In our investigation, the removal rate was higher among patients under 40 years old, diverging from [PERSON] et al. 's [29] findings that indicated higher removal rates among patients under 30 years old. Nonetheless, the previous study discovered elevated miniplate removal rates in patients aged 30 years or older. Hardware failure represents another reason for miniplate removal. Over time, miniplates, composed of metal, can corrode, become brittle, or fracture. Hardware failure can lead to pain, discomfort, or even bone displacement. The incidence of hardware failure ranges from 1% to 23%, with most cases occurring within the first year of fixation [30]. Retained miniplates might cause discomfort or pain, especially when located near facial muscles, nerves, or tendons. Such discomfort can impede the patient's quality of life, especially if the miniplate is situated in a visible region, such as the cheek or jawbone. Miniplates may also become visible through the skin or lead to scarring, which can be a cosmetic concern for some patients, prompting them to consider removal. Although the benefits of using titanium-based alloy miniplates for osteosynthesis are well-established, questions persist regarding their long-term effects. Recent research has concentrated on assessing the tissue surrounding removed titanium materials, to investigate potential consequences. While the removal of titanium devices has typically been limited to cases of infection or exposure [17], there are concerns about the local cellular impact of metallic particles that can infiltrate nearby tissues [8; 31; 32] and potentially migrate through the lymphatic system to other organs [33]. Studies have pointed to local reactions and immune-inflammatory responses in fibrous connective tissue deposits, with titanium being implicated in the induction of oxidative stress [34]. Although allergic reactions to titanium-based alloys are rare, there have been reported cases of facial eczema [35; 36]. Tooth extraction constitutes another rationale for miniplate removal. During orthodontic treatment, teeth may need to be extracted to facilitate proper alignment. This can result in the removal of miniplates used for fracture stabilization. [PERSON] et al. [17] noted that out of 800 miniplates, 2 were removed due to tooth extraction. Plate exposure arises when the miniplate becomes visible through the skin or mucosa. This can occur due to inadequate wound closure, insufficient soft tissue coverage, or suboptimal plate placement. [PERSON] et al. [13] documented 3 out of 296 miniplates being removed due to plate exposure, while [PERSON] et al. [20] reported no cases of plate exposure among 437 miniplates. Prosthetic rehabilitation serves as another cause for miniplate removal. Prosthetic rehabilitation involves dental implants, and in some instances, miniplates must be removed to facilitate this procedure. [PERSON] et al. [13] reported 4 out of 296 miniplates being removed due to prosthetic rehabilitation. Pain emerges as another impetus for the removal of miniplates employed in treating maxillofacial fractures. Pain can stem from various sources, such as nerve damage or impingement, plate migration, or cold intolerance. [PERSON] et al.