Prognostic Value of Initial CT Imaging for Surgical Planning and Outcomes in Panfacial Fractures: A Systematic Review and Meta-Analysis.

Abstract

Objective: To evaluate the reported prognostic value of initial computed tomography (CT) imaging for surgical planning and postoperative outcomes in panfacial fractures, and to determine whether CT-derived variables have been consistently linked to clinically relevant outcomes.

Data sources: PubMed, MEDLINE, Embase, Cochrane Library, CINAHL, ClinicalTrials.gov, and the World Health Organization International Clinical Trials Registry Platform were searched from database inception to January 1, 2026. Eligible studies were restricted to publications from January 2015 onward.

Methods: Studies were eligible if they included patients with panfacial fractures or separately extractable panfacial fracture subgroups, reported CT or imaging-based assessment for diagnosis or surgical planning, and provided extractable postoperative or surgical-management outcomes. Study characteristics, CT-related variables, surgical-planning data, and postoperative outcomes were extracted. Random-effects meta-analysis of single proportions was performed for infection, malocclusion, revision or secondary surgery, and enophthalmos. CT-derived prognostic evidence was synthesized narratively according to whether imaging variables were directly or indirectly linked to outcomes.

Results: Sixteen studies involving 1811 patients were included. Pooled postoperative complication prevalences were 11% for infection (95% CI, 0%-90%), 10% for malocclusion (95% CI, 5%-19%), 2% for revision or secondary surgery (95% CI, 2%-4%), and 5% for enophthalmos (95% CI, 1%-21%). CT, multiplanar imaging, or three-dimensional reconstruction was frequently reported for fracture characterization and operative planning. However, standardized CT-derived prognostic variables were inconsistently reported, and few studies directly linked initial imaging findings to postoperative outcomes.

Conclusion: Initial CT imaging is essential for assessment and surgical planning in panfacial fractures. Current evidence provides pooled postoperative benchmarks but remains insufficient to establish robust CT-based prognostic prediction. Standardized CT reporting, fracture-severity classification, and outcome assessment are needed to clarify whether initial imaging findings can predict surgical complexity and long-term outcomes.