# Early versus delayed fixation of maxillofacial fractures in polytrauma: a systematic review

## TL;DR

This review compares early and delayed surgery for facial fractures in severely injured patients and finds no clear benefit to delaying surgery.

## Contribution

The study provides a systematic review of timing for facial fracture fixation in polytrauma patients, highlighting the lack of strong evidence for delayed surgery.

## Key findings

- No significant differences in infection rates, complications, or outcomes between early and delayed surgery.
- Hospital stays, ICU stays, and mortality were similar regardless of surgery timing.
- Current evidence is low quality and does not clearly support delayed fixation as better practice.

## Abstract

Maxillofacial fractures are common in polytrauma, and these patients often require intensive care unit (ICU) admission until delayed definitive surgical management. This review aims to evaluate the scientific evidence on timing of definitive internal fracture fixation of maxillofacial fractures in polytrauma. We hypothesise that delayed definitive surgery is associated with better outcomes.

This systematic review was conducted in accordance with the PRISMA protocol. MEDLINE, EMBASE, Scopus, CINAHL and PubMed were searched from inception to July 2025 for articles in English reporting timing of facial fracture fixation in polytrauma cohorts. Two reviewers independently screened studies and extracted data on patient characteristics, injury severity, fixation timing, and patient outcomes. Risk of bias was assessed using the Newcastle-Ottawa Scale.

359 studies were initially identified. After applying inclusion and exclusion criteria, three retrospective studies (total 365 patients) were included. Timing definitions of fixation varied, with early fixation intervals ranging from ≤ 24 h to ≤ 72 h. Surgical-site infection rates ranged from 0 to 12.7% (early) and 4.8–14.4% (delayed). No significant differences emerged in anatomical reduction, reoperation rates, or complications between groups. Hospital and ICU length of stay, ventilator days and mortality rates were comparable. Studies were heterogeneous and subject to high risk of bias.

The available low-quality evidence does not support a clear advantage of the current practice of delayed fixation of facial fractures in polytrauma patients. Quality prospective studies with predefined inclusion criteria, clear consensus about the cut-off for early timing of surgery and standardised outcome measures are required.

The online version contains supplementary material available at 10.1007/s00068-026-03127-2.