Titanium plates used in skull reconstruction or fracture repair are generally well-tolerated, but like any surgical implant, they can lead to certain side effects or complications. The most common issues experienced by patients include the plate being palpable, infection at the surgical site, exposure of the plate through the skin, and pain.
Common Complications of Titanium Skull Plates
While titanium is biocompatible, complications can arise, often necessitating medical intervention or even removal of the hardware.
Here's a breakdown of the primary side effects:
| Side Effect | Description |
|---|---|
| Palpability | The plate or screws can be felt under the skin, often as a noticeable bump or ridge. While not always painful, it can be a cosmetic concern or cause discomfort when touched. |
| Infection | Bacterial contamination around the implant can lead to localized infection, manifesting as redness, swelling, warmth, tenderness, or pus discharge. Infections can range from superficial to deep-seated, potentially affecting bone. |
| Exposure | In some cases, the overlying skin and soft tissues may thin or break down, causing the titanium plate to become visible or protrude through the skin. This significantly increases the risk of infection. |
| Pain | Persistent pain can occur at the implant site. This discomfort might be due to nerve irritation, pressure on surrounding tissues, inflammation, or an underlying infection. |
Factors Influencing Side Effects
The likelihood and nature of complications can be influenced by several factors:
- Location of the Plate: Some areas of the skull are more prone to issues. For instance, plates placed near the frontozygomatic suture (the area where the frontal bone meets the cheekbone) or the MacCarty keyhole (a common entry point for neurosurgical procedures) have been found to be symptomatic more often. These areas may have thinner tissue coverage or be subject to more movement.
- Proximity to Nerves: The presence of the plate or screws near sensitive nerves can lead to specific symptoms. For example, proximity to the supraorbital nerve (which supplies sensation to the forehead and upper eyelid) is a known risk factor for pain and other symptoms, often leading to the need for hardware removal.
- Patient-Specific Factors: Individual healing capabilities, overall health, and immune response can also play a role in the development of complications.
When is Hardware Removal Considered?
While many patients live without issues with their titanium skull plates, removal of the hardware may be necessary if complications become symptomatic or pose a significant health risk. Hardware removal is often considered for:
- Persistent pain that is unresponsive to conservative treatments.
- Recurrent or intractable infections that cannot be cleared with antibiotics while the hardware is in place.
- Plate exposure through the skin, which carries a high risk of infection.
- Significant cosmetic deformity or discomfort due to palpability.
