Effect of early or delayed treatment upon healing of mandibular fractures: a systematic literature review

The possible relation between treatment delay and healing complications in mandibular fracture treatment (excluding condylar fractures) was reviewed systematically. Twenty-two studies were identified. No randomized studies focused on the effect of immediate or delayed treatment. The main focus of most studies was surgical repositioning and internal skeletal fixation. The healing complications analyzed in this study were infection in the fracture line and malocclusion. Statistical analysis of the influence of treatment delay upon healing complications was possible in six studies. Four studies showed no significant difference between immediate and delayed treatment. One study showed a preference for healing for cases treated within 3 days, whereas another study indicated that treatment time between 3 and 5 days were optimal with the lowest rate of complications. Finally, a few studies identified confounding factors such as alcohol, drug abuse and/or non-compliance, factors which have been shown strongly to influence the likelihood of complications. A significant problem in this analysis was that rather few patients were actually treated on an acute basis (i.e. within 12 or 24 hours after injury), a fact which together with the lack of control of confounding factors made this analysis problematic. In conclusion, there is presently no strong evidence for either acute or delayed treatment of mandibular fractures in order to minimize healing complications; new studies including a substantial number of cases treated on an acute basis are very much needed.