Clinical complications following surgical interventions for adult maxillofacial trauma: a systematic review of cohort studies

Abstract

Background. Maxillofacial trauma represents a significant public health concern, with road traffic accidents (RTAs) among the leading causes in adults, although other mechanisms are also common. Despite advances in surgical techniques, postoperative complications may include infection, impaired wound healing, malocclusion, and sensory deficits. Objective. To evaluate postoperative complications after surgical management of adult maxillofacial trauma in cohort studies, with particular attention to studies in which RTAs were an important injury mechanism. Methods. This PRISMA-guided systematic review searched PubMed/MEDLINE and Google Scholar for prospective or retrospective cohort studies published between 2000 and February 2026. Eligible studies reported postoperative outcomes after surgical treatment in adult or predominantly adult populations. Two reviewers independently extracted data. Methodological quality was assessed using the Newcastle-Ottawa Scale and evidence certainty using GRADE. Findings were synthesized qualitatively because of clinical and methodological heterogeneity. Results. Four retrospective cohort studies were included. Where separately reported, surgical-site infection rates ranged from 4.4% to 5.7%, malocclusion from 2.6% to 5.1%, and sensory deficits from 3.5% to 6.7%. Other studies included these events in overall complication rates or did not report them separately. Severe adverse events and the need for reintervention were inconsistently reported, limiting conclusions about rare serious complications. Evidence certainty was generally low to very low owing to retrospective designs, heterogeneity, indirectness, and inconsistent outcome reporting. Conclusion. Available cohort studies identified postoperative infection, malocclusion, sensory deficits, and implant-related complications. However, the limited number of studies, methodological heterogeneity, and inconsistent reporting substantially restrict the certainty and generalizability of the findings. Because several cohorts included mixed trauma populations without RTA-specific postoperative outcomes, the reported complication rates cannot be attributed specifically to RTAs.