Background: Open reduction and internal fixation (ORIF) is widely used in the management of maxillofacial fractures because it provides stable fixation and allows early functional recovery. However, the presence of fixation hardware is not always free of complications. It can be observed in daily clinical practice that a proportion of patients later require hardware removal due to infection, exposure, pain, or other related complaints. The factors influencing this decision, particularly surgical technique and trauma etiology, remain a subject of ongoing discussion.

Objective: To evaluate the clinical and radiographic factors associated with hardware removal following ORIF in patients with maxillofacial trauma, with specific emphasis on the influence of surgical technique and trauma etiology.

Materials and Methods: A retrospective descriptive study was conducted at the Department of Oral and Maxillofacial Surgery, Military Hospital, Sana’a, Yemen, between January 2021 and December 2025. Medical records of patients who underwent hardware removal after previous ORIF were reviewed. Demographic data, trauma etiology, fracture site, type of fixation hardware, surgical approach, duration of hardware retention, and indications for removal were collected. Radiographic evaluation was performed using archived panoramic radiographs and computed tomography images. Statistical analysis was used to assess associations between infection-related hardware removal and relevant clinical variables.

Results: Out of 110 patients with a history of ORIF who were screened, 77 met the inclusion criteria and underwent hardware removal. Most patients were male, with the highest frequency observed in the 21–30-year age group. Gunshot and explosive injuries were the most common causes of trauma. Infection represented the most frequent indication for hardware removal, followed by pain and hardware exposure. Through analysis of the collected data, clear patterns emerged in relation to hardware type, surgical approach, and duration of retention.

Conclusion: Based on the above findings, surgical technique, trauma etiology, and prolonged hardware retention appear to play an important role in the need for hardware removal following maxillofacial fracture management. These results underline the importance of careful surgical planning and structured postoperative follow-up, particularly in settings with complex trauma patterns.