Risk of complications in panfacial bone fracture according to surgeons: A meta-analysis

Abstract

Background: Panfacial bone fractures pose intricate challenges because of severe fragmentation and the loss of landmarks. Surgeons use a variety of reduction techniques, including bottom-up and top-down approaches. This single proportional meta-analysis explores sequencing differences and complications between oral and maxillofacial surgery surgeons (OMSs) and plastic and reconstructive surgeons (PRSs) in treating panfacial bone fractures.

Methods: The PubMed and Scopus databases were searched systematically, and we compiled 14 studies published between 2007 and 2023 involving 1238 patients. A systematic review of the included studies was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines, and data on the reduction techniques; total complication rates; and rates of malocclusion, enophthalmos, infection, asymmetry, and esthetic complications were collected.

Results: The bottom-up technique was the most prevalent for both types of surgeons (57.1%, 8 out of 14). Malocclusion rates (I2 = 0% for OMSs and 41% for PRSs) were similar between the groups (p = 0.72), but PRSs tended to have a lower enophthalmos rate (I2 = 0% for OMSs and 32% for PRSs) than OMSs (p < 0.01). Infection rates remained consistent across all studies. However, high heterogeneity was observed for the total complication rate (I2 = 94% for OMSs and 85% for PRSs) and asymmetry and esthetic complications (I2 = 88% for OMSs and 92% for PRSs), making direct comparison between the two groups inconclusive.

Conclusions: In this study, the differences in surgical techniques and levels of interest have a greater impact on the outcomes of the panfacial bone fracture than the surgeon's specialty. However, more in-depth studies are needed to accurately pinpoint panfacial bone fracture reduction trends and differences in postoperative complications in the two expert groups.