Early versus delayed management of maxillofacial fractures: a systematic review and meta-analysis with context-based subgroup analysis
AI Summary
Pooled analysis found no statistically significant difference in overall complication rates between delayed and early management (RR 1.07, 95% CI 0.72-1.60; p=0.72).
Delayed management showed a tendency for higher rates of infection, malunion, and nonunion despite nonsignificant overall differences.
Systematic review of observational studies (2005-2025), PRISMA-registered, included 13 studies with nine studies in the meta-analysis.
Oral Maxillofac Surg. 2026 May 19;30(1):87. doi: 10.1007/s10006-026-01574-0.
ABSTRACT
PURPOSE: Maxillofacial fractures are common injuries caused by traffic accidents, interpersonal violence, and falls. In resource-limited or remote settings, definitive management is often delayed due to limited diagnostic facilities, lack of surgical expertise, and referral constraints, raising concerns about increased complication rates. The current literature reports conflicting results. Some studies suggest that delayed management does not significantly affect outcomes, whereas others show higher complication rates and functional impairment. Therefore, this review aims to identify the associations between delayed management and complications.
METHODS: This review followed PRISMA guidelines and was registered in PROSPERO. Observational studies published between 2005 and 2025 were systematically retrieved from PubMed, Europe PMC, ScienceDirect, and OpenAlex. Thirteen studies met the inclusion criteria, with nine included in the meta-analysis.
RESULTS: Pooled analysis demonstrated no statistically significant difference in overall complication rates between delayed and early management (RR 1.07; 95% CI 0.72-1.60; p = 0.72), with no evidence of substantial publication bias.
CONCLUSION: Although no significant difference in the occurrence of complications was found between delayed and early management of maxillofacial fractures, there was a tendency for complications such as infection, malunion, or nonunion to occur more frequently in the delayed management group.
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