How should we describe complications and stratify error in the treatment of facial fractures? A systematic review of the literature.

Oral and maxillofacial (OMFS) facial fractures account for approximately 5%-10% of presentations to emergency departments in the UK. Although most trauma is treated operatively, different methods of surgery exist for the same clinical presentation and non- surgical management is in some cases appropriate. Analysis of patient morbidity is an essential component of clinical governance in surgery. OMFS units in the UK should hold regular morbidity and mortality (M&M) meetings, but no consensus exists for which cases should be discussed. For example, most units focus only on cases treated surgically, primarily unexpected returns to theatre. Finally, there is no agreed structure for describing how complications occur and a focus on terms such as error. The aim of this review is to help inform which patients should be discussed in M&M meetings based on existing scoring systems. A systematic review of the literature has been undertaken using the Preferred Reporting in Systematic Reviews and Meta-Analysis methodology. Databases searched were PubMed and Science Direct. Eleven unique papers and a companion article met the criteria and were analysed. Many M&M classification systems exist, but these systems are unsuited for maxillofacial purposes. There is a need for a novel system which is tailored to the specialty.