The effect of treatment timing on the management of facial fractures: a systematic review

The ideal timing for treatment of facial fractures has not been well established. The objective of this systematic review was to examine the effects of treatment delay on outcome in the management of facial fractures. The PubMed database was used to search for relevant English-language articles published between 1979 and 2013. Cross-referencing identified additional studies. There were no selection restrictions for study type. The first author, using pre-defined data fields, extracted information independently. Studies were assessed by study type, evidence level, sample size, data collected, outcome variables, control of confounding variables, and findings. Thirty studies were identified. Inconsistency was identified with data collected, outcome variables, and findings. Of the 30 studies identified, 28 were case series, thereby providing a low level of evidence overall. The majority of case series were retrospective and sample sizes were predominantly small. Control of confounding variables was poor. Eighteen studies found no statistically significant relationship between treatment delay and treatment outcome. Nine studies found a statistically significant relationship between treatment delay and worse treatment outcomes. There were three studies with conflicting results. With the current body of evidence, definitive conclusions cannot be drawn on the timing of treatment for facial fractures.