Removal of symptomatic craniofacial titanium hardware following craniotomy: Case series and review

•Titanium hardware complications include palpability, infection, exposure, and pain.•Symptomatic plates were found near the frontozygomatic suture, MacCarty keyhole.•Proximity to the supraorbital nerve was a risk factor for hardware removal.•Surgeons should be aware of plate locations that are high risk for causing symptoms.

Titanium craniofacial hardware has become commonplace for reconstruction and bone flap fixation following craniotomy. Complications of titanium hardware include palpability, visibility, infection, exposure, pain, and hardware malfunction, which can necessitate hardware removal. We describe three patients who underwent craniofacial reconstruction following craniotomies for trauma with post-operative courses complicated by medically intractable facial pain. All three patients subsequently underwent removal of the symptomatic craniofacial titanium hardware and experienced rapid resolution of their painful parasthesias. Symptomatic plates were found in the region of the frontozygomatic suture or MacCarty keyhole, or in close proximity with the supraorbital nerve. Titanium plates, though relatively safe and low profile, can cause local nerve irritation or neuropathy. Surgeons should be cognizant of the potential complications of titanium craniofacial hardware and locations that are at higher risk for becoming symptomatic necessitating a second surgery for removal.

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