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

BACKGROUND: 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. METHODS: 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. RESULTS: 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. CONCLUSIONS: 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.