Early versus delayed management of maxillofacial fractures: a systematic review and meta-analysis with context-based subgroup analysis

Clinical Snapshot

Key Findings

• P Value: p = 0.72

• Effect Size: RR 1.07

• Primary Outcome: Overall complication rates between delayed versus early maxillofacial fracture management

• Nnt Or Sensitivity: Non-significant relative risk suggests no clinically meaningful difference in complication rates

• Confidence Interval: 95% CI 0.72-1.60

Clinical Application

Findings support that delayed management may be acceptable when immediate surgical intervention is not feasible Highly relevant for rural and remote Australian communities where specialist maxillofacial services may be delayed due to distance and resource constraints. Supports current RACGP guidelines for appropriate referral timing. Patients with maxillofacial fractures in both urban and rural settings, particularly relevant for resource-limited environments

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.

References

1. 1.Wibowo, J. G., Guritno, T., & Halim, E. N. (2026). Early versus delayed management of maxillofacial fractures: a systematic review and meta-analysis with context-based subgroup analysis. Oral and Maxillofacial Surgery. https://doi.org/10.1007/978-3-030-82335-1