Do the Benefits of Systemic Corticosteroids Outweigh Adverse Effects During Maxillofacial Trauma Surgery? A Systematic Review and Meta-Analysis.

Abstract

PURPOSE\nPerioperative systemic corticosteroids are widely used in maxillofacial trauma surgery to prevent postoperative complications, but potentially perceived benefits are speculative rather than evidence-based. The purpose of our systematic review and meta-analysis was to assess the effects of perioperative systemic corticosteroids on clinically significant outcomes in patients undergoing maxillofacial trauma surgery.\n\n\nMETHODS\nWe searched Medline, Embase, CENTRAL, Clinical trial registry, and grey literature as well as references of included trials. Our primary outcomes were facial edema and pain after the surgery. Our secondary outcomes were postoperative nausea and vomiting, neurosensory disturbance, functional recovery, wound infections, and other adverse events.\n\n\nRESULTS\nOf the 94 trials retrieved, 13 were included (n\xa0=\xa0652). Perioperative steroid use was associated with reduced pain and facial edema. We observed a decreased in postoperative nausea and vomiting with the use of systemic corticosteroids (n\xa0=\xa0184, OR\xa0=\xa00.53, [0.28, 1.02], I2\xa0=\xa00%). Four trials reported infections and impaired wound healing associated with steroids (n\xa0=\xa0160. OR\xa0=\xa03.37, [1.43. 7.94], I2\xa0=\xa02%). The thirteen trials had an unclear risk of bias.\n\n\nCONCLUSIONS\nSystemic corticosteroids reduced facial edema and postoperative pain, but impaired wound healing was also reported. The use of systemic steroids in maxillofacial trauma surgery is thus supported only by weak evidence and further research is advocated.