Postoperative stability of conventional bimaxillary surgery compared with maxillary impaction surgery with mandibular autorotation for patients with skeletal class II retrognathia

We aimed to compare the postoperative stability of conventional bimaxillary surgery (with bilateral sagittal split osteotomy) with that of maxillary impaction surgery (with mandibular autorotation without bilateral sagittal split osteotomy) in patients with skeletal class II retrognathia. Patients were assigned to have conventional bimaxillary surgery (conventional group, n = 6) or mandibular autorotation (experimental group, n = 7). Measurements were made using serial lateral cephalometric radiographs taken immediately preoperatively (T0), immediately postoperatively (T1), and one year later (T2) to assess the variation in operative change (T1-T0) and relapse (T2-T1). There was no significant difference in median (range) surgical change in the anterior movement at point B (conventional group, 4.5 (3.0–11.0) mm; experimental group 4.1 (2.1–6.4) mm). However, there was a significant difference in median (range) surgical posterior movement relapse at point B (conventional group −1.7 (−2.3 to −0.5) mm; experimental group −0.6 (−1.0 to 1.0) mm; p = 0.032). Mandibular advancement with mandibular autorotation is therefore a more stable procedure than mandibular advancement with bilateral sagittal split osteotomy in patients with skeletal class II retrognathia.     

Surgical morbidities of sagittal split ramus osteotomy versus intraoral vertical ramus osteotomy for the correction of mandibular prognathism: a randomized clinical trial

The sagittal split ramus osteotomy (SSRO) and intraoral vertical ramus osteotomy (IVRO) are two common orthognathic procedures for the treatment of mandibular prognathism. This randomized clinical trial compared the surgical morbidities between SSRO and IVRO for patients with mandibular prognathism over the first 2 years postoperative. Ninety-eight patients (40 male, 58 female) with a mean age of 24.4 ± 3.5 years underwent bilateral SSRO (98 sides) or IVRO (98 sides) as part or all of their orthognathic surgery. IVRO presented less short-term and long-term surgical morbidity in general. The SSRO group had a greater incidence of inferior alveolar nerve deficit at all follow-up time points (P <  0.01). There was more TMJ pain at 6 weeks (P =  0.047) and 3 months (P =  0.001) postoperative in the SSRO group. The SSRO group also presented more minor complications, which were related to titanium plate exposure and infection. There were no major complications for either technique in this study. Despite the need for intermaxillary fixation, IVRO appears to be associated with less surgical morbidity than SSRO when performed as a mandibular setback procedure to treat mandibular prognathism.     

Posterior calvarial distraction in craniosynostosis – An evolving technique

BackgroundPosterior advancement of the occiput is an established surgical option for the treatment of raised intracranial pressure (ICP) secondary to craniocerebral disproportion in syndromic craniosynostoses. Distraction osteogenesis has gained popularity in a variety of craniofacial procedures to achieve greater advancement in the anterior craniofacial skeleton, but has only relatively recently been used in the posterior calvarium. We report the Oxford Craniofacial Unit’s experience of using distraction techniques to expand the occiput.MethodsWe preformed a retrospective casenote review of all patients with syndromic craniosynostoses who underwent posterior distraction at our centre from 2007 to 2010, as identified by the Oxford Craniofacial Database.ResultsTen syndromic patients underwent posterior distraction (mean age of 18.1 months). Successful calvarial expansion (mean advancement of 19.7 mm) was achieved in all patients clinically and radiologically. There were 6 minor and 1 major complications.ConclusionsPosterior distraction was successfully performed in 10 patients including babies as young as 3 months of age. It achieved a reduction in turricephaly, an improvement in the cephalic index, and a resolution of raised ICP. We have customised our surgical technique to address individual patient needs. The use of distraction techniques in the occiput appears to increase the reliability of expansion in this region.     

Transverse maxillary stability assisted by a transpalatal device: A retrospective pilot study of 9 cases

This retrospective pilot study assessed the transverse stability of an original surgical approach in nine patients with moderate transverse maxillary deficiency associated with a sagittal and/or vertical skeletal anomaly. During the one-stage surgical procedure, bi- or three-dimensional anomalies were corrected. Maxillary expansion was guided by a transpalatal bone-anchored device (TPD?). Expansion measurements were made 1-2 months before surgery, 6 and at least 12 months after surgery. The transverse occlusion was corrected in all cases. After 12 months the gingival landmarks revealed an expansion range from ?0.83 to +2.92 mm for the cuspids, +1.66 to +6.23 mm for the bicuspids and from +2.68 to +4.80 mm for the molars. For the occlusal landmarks, expansion ranged from -2.01 to +3.15 mm (cuspids), from +1.11 to +7.13 mm (bicuspids) and from +2.70 to +6.26 mm (molars). Cuspid expansion was significantly smaller than that of bicuspids and molars. This more posterior expansion was achieved through the surgical procedure. The transverse stability obtained with the aid of the bone-anchored TPD? was satisfying. This preliminary study supports the principle of an original surgical approach, called ‘Le Fort I – TPD’, which combines a Le Fort I osteotomy with a controlled maxillary expansion.     

Benign temporomandibular joint tumours with extension to infratemporal fossa and skull base: condyle preserving approach

This article introduces a modified surgical approach combining condylotomy with posterior disc attachment release for the resection of large non-malignant masses located in the infratemporal fossa and involving the skull base. This retrospective study included 14 patients treated at Shanghai Ninth People’s Hospital, Shanghai Jiao Tong University between January 2010 and December 2016. Clinical evaluations (visual analogue scale (VAS) for pain, maximum inter-incisal opening (MIO), and complications) and radiological findings (magnetic resonance imaging (MRI) and computed tomography (CT)) were collected pre- and postoperatively. All patients had satisfactory surgical exposure and complete resection of the neoplasms. During an average follow-up of 54.8 months, no clinical or radiographic signs of recurrence were reported. MIO increased from 28 mm preoperatively to 35.4 mm postoperatively (P < 0.001). The pain VAS score changed from 5.4 preoperatively to 0.7 postoperatively (P < 0.001). Neural function was normal for all patients. Postoperative MRI and CT scans showed a satisfactory disc position and condyle morphology, with no resorption. Three-dimensional reconstruction of the postoperative CT scan also demonstrated healing of the skull base defects. The modified surgical approach combining condylotomy with posterior disc attachment release is suitable for the removal of large non-malignant masses involving the infratemporal fossa and skull base.     

Long-term neurosensory disturbances after modified sagittal split osteotomy

We have investigated the long-term incidence of neurosensory disturbances after modified bilateral sagittal split osteotomy, and identified associated risk factors. We prospectively studied 376 patients, and their self-reported neurosensory disturbances were evaluated six months, and one, two, and three years postoperatively. The correlations between the following risk factors and neurosensory disturbances were investigated using univariate analysis and stepwise multivariate analysis: age at operation, sex, type of movement (advancement, setback, or rotation), concurrent genioplasty, type of detachment, iliac crest bone graft, and use of dicalcium phosphate synthetic bone graft. Probabilities of less than 0.05 were accepted as significant. Three years postoperatively, 57 patients (15%) reported altered sensation of the lower lip or chin. Older age correlated significantly with neurosensory disturbances (p < 0.0001). Greater mandibular advancement correlated with postoperative “positive” neurosensory phenomena (right side p = 0.08; left side p = 0.03). Intraoperative surgical manipulation of the left inferior alveolar nerve was significantly associated with postoperative hypoaesthesia (p = 0.014). Older age at surgery, extensive mandibular advancement, and surgical manipulation of the left inferior alveolar nerve, were associated with long-term neurosensory disturbances after modified bilateral sagittal split osteotomy. The modified operation seems to safeguard the inferior alveolar nerve from transection, without causing damage to other nerves.     

Endoscope-assisted hairline approach for resecting maxillofacial masses

The endoscope-assisted hairline approach is becoming a preferred technique in several surgical disciplines because of its advantage of good cosmetic outcomes. However, such operations are not yet standard for benign lesions in the maxillofacial area due to the anatomical complexity of this region. This study describes an endoscope-assisted technique for resecting benign lesions in the maxillofacial area via a hairline approach. The clinical outcomes with this approach were compared to those obtained with the conventional transcutaneous approach. Benign maxillofacial lesions were excised via endoscope-assisted hairline approach in 27 patients and via transcutaneous approach in 28 patients. Clinical outcomes and complications related to the procedures were evaluated; the primary outcome was the efficacy of the procedure and the secondary outcome was cosmetic satisfaction. There were no significant differences with respect to overall demographic characteristics between the groups, although the operation time was longer for the hairline approach (P = 0.001). Cosmetic satisfaction showed much better results for the hairline approach (P = 0.001). Endoscope-assisted excision of benign maxillofacial lesions via the hairline approach is a feasible method with excellent cosmetic results.     

Variables associated with stability after Le Fort I osteotomy for skeletal class III malocclusion

The purpose of this study was to assess skeletal stability and predictors of relapse in patients undergoing an isolated Le Fort I osteotomy. A retrospective cohort study of 92 subjects undergoing Le Fort I osteotomy for Class III malocclusion was implemented. Predictor variables were demographic and perioperative factors. The primary outcome variable was postoperative skeletal position with relapse defined as >2 mm sagittal and/or vertical change at A-point on serial lateral cephalograms at immediate postoperative, 1 year, and latest follow-up time points. Mean advancement at A-point was 6.28 ± 2.63 mm and mean lengthening was 0.92 ± 1.76 mm. Eight subjects (8.70%) had relapse (>2 mm) in the sagittal plane, and two subjects (2.17%) in the vertical plane. No subjects required reoperation for relapse as overbite and overjet remained in an acceptable range due to dental compensation. In regression analysis, magnitude of maxillary advancement was an independent predictor of relapse in the sagittal plane (P = 0.008). There were no significant predictors of relapse in the vertical plane. This study suggests that isolated Le Fort I osteotomy for correction of skeletal Class III malocclusion is a stable procedure and that greater advancement is an independent risk factor for sagittal relapse.     

Polyglactin 910 suture compared with polyglactin 910 coated with triclosan in dental implant surgery: randomized clinical trial

Antibacterial coating of surgical sutures is a suggested approach to prevent surgical site infections. The aim of this study was to compare the incidence of surgical site infection following the use of polyglactin 910 (Vicryl) and polyglactin 910 coated with triclosan (Vicryl Plus) sutures in dental implant surgery. This single-blind, randomized clinical trial evaluated patients who received three implants in the posterior mandible. Patients were randomly divided into two groups to receive either Vicryl Plus sutures (group 1) or Vicryl sutures (group 2). A total of 320 patients were included in the study (n = 160 in each group). Twelve patients (7.5%) in group 1 and 11 patients (6.9%) in group 2 had a surgical site infection. Analysis of the data did not demonstrate any significant difference in the incidence of surgical site infection between the two groups (P = 0.5). The incidence of surgical site infection in fresh socket implant placement was higher than that in delayed implant placement, irrespective of the type of suture used (P = 0.001). Triclosan-coated Vicryl sutures did not decrease the incidence of surgical site infection in dental implant surgery.     

Surgical complications related to temporomandibular joint arthroscopy: a prospective analysis of 39 single-portal versus 43 double-portal procedures

Temporomandibular joint (TMJ) arthroscopy is a minimally invasive surgical procedure proposed for diverse TMJ intra-articular disorders. A prospective study was designed with the aim of investigating intraoperative and postoperative surgical complications for single and double-portal TMJ arthroscopy. All interventions were performed by one surgeon with the same surgical protocol. A total of 55 patients were enrolled, resulting in 82 TMJ arthroscopies (28 unilateral and 27 bilateral). A total of 39 single portal (47.57%) and 43 double-portal (52.43%) arthroscopies were performed. No severe and irreversible complications were observed. Most complications were resolved after 4 weeks. Double-portal was associated with more complications (n = 23) compared with single-portal TMJ arthroscopy (n = 14), with a statistically significant difference found between single and double-portal TMJ arthroscopy in two intraoperative complications: intra-articular bleeding (P = 0.044) and oedema of the preauricular area (P = 0.042). This study confirms the safety of TMJ arthroscopy for single and double-portal procedures, with the authors suggesting a multicentre study, in an effort to minimize any possible bias.     

Robotic sialoadenectomy of the submandibular gland via a modified face-lift approach

The purpose of this study was to describe and analyse the advantages and disadvantages of submandibular gland (SMG) resection using a robotic surgical system through a modified face-lift approach. The authors performed robotic sialoadenectomy of the SMG on 5 patients using the daVinci robot system through a modified face-lift approach. Three robotic arms were inserted through a modified face-lift incision; a face-down 30-degree endoscopic arm and two operative arms. The right arm was equipped with a harmonic scalpel and the left arm with a Maryland forceps. In all patients, robotic sialoadenectomy of the SMG was completed successfully. Diagnoses were sialolithiasis in two patients, pleomophic adenoma in two patients, and ranula in one patient. The mean robotic operative time was 90.2 min (range 62–185 min) and that for setting the robotic system was 8.2 min (range 5–15 min). No significant intra-operative or postoperative complications were observed. All patients were satisfied with the outcome and especially the cosmetic results at their last follow-up visit. In the authors opinion robotic sialoadenectomy of the SMG is technically feasible and secures a better cosmetic outcome than endoscopic submandibular resection.     

Comparison between the classical and a modified trans-septal technique of alar cinching for Le Fort I osteotomies: a prospective randomized controlled trial

The aim of this prospective randomized control trial was to analyse the efficacy of a new trans-septal alar base cinch suture in controlling alar width in patients undergoing maxillary intrusion and setback by comparing it with the traditional cinch suture. Statistical evaluation was carried out in 62 of 76 patients. Group I (31 patients) received the traditional alar base cinch suture, and group II (31 patients) received the alar base cinch suture with an anchoring bite taken through the nasal septum 10 mm behind its anterior edge. In both groups the accurate identification of alar fibroareolar tissue was facilitated by an 18 gauge green needle passed extra orally. Alar base width was measured before and 6 months after surgery using Vernier callipers. Preoperative alar base width for group I was 29.76 mm (1.901 SD) and for group II 29.79 mm (3.141 SD); the postoperative values were 32.42 mm (1.858 SD) and 29.94 mm (2.568 SD), respectively. Mean alar base widening was 2.661 mm (0.800 SD) in group I and 0.145 mm (2.050) in group II. The difference in alar widening was statistically significant (p < 0.001). In conclusion, the trans-septal modified alar cinch suture offers better control of alar base architecture in maxillary intrusion and setback.     

Three-dimensional evaluation of distal and proximal segment skeletal relapse following isolated mandibular advancement surgery in 100 consecutive patients: A one-year follow-up study

The aim of this study was to perform a three-dimensional evaluation of the skeletal relapse of the proximal and distal mandibular segments following isolated bilateral sagittal split osteotomy advancement surgery. One hundred consecutive patients (mean age 25.8 ± 11.7 years), comprising 65 female patients (mean age 26.4 ± 12.1 years) and 35 male patients (mean age 24.6 ± 11.0 years) requiring mandibular advancement without genioplasty, were enrolled prospectively in the study. Cone beam computed tomography scans were acquired for each patient at three time-points: preoperatively, immediately (1–6 weeks) after surgery, and 1 year after surgery. A validated tool was utilized to assess the surgical movement and relapse. Based on percentage, the majority of the distal and proximal translational and rotational movements relapsed within the range of ≤2 mm and ≤2°. The distal segment revealed a significant relapse in a posterior, inferior, and clockwise pitch direction. Both left and right proximal segments showed a significant translational relapse in the medial, posterior, and superior direction. Amongst the rotational parameters, proximal segments relapsed significantly in clockwise pitch, clockwise roll, and counterclockwise yaw direction. Overall, both distal and proximal bone segments showed a clinically acceptable translational and rotational stability. The proximal segments torqued towards their original position with a reduction of flaring.     

Short-term use of an exposed polypropylene barrier in the preservation of alveolar bone after extraction: randomized clinical trial

This study was performed to evaluate the short-term preservation of alveolar bone volume with or without a polypropylene barrier and exposure of the area after extractions. Thirty posterior tooth extraction sockets were distributed randomly to a control group (n = 15; extraction and suture) and a barrier group (n = 15; extraction, barrier, and suture). All sutures and barriers were removed 10 days postoperatively. Cone beam computed tomography scans taken with the aid of a tomographic guide were obtained preoperatively, immediately postoperative, and at 120 days postoperative. A visual analysis of the coronal sections of the alveolus was performed, and vertical loss in the mesial, distal, buccal, and lingual bone ridges and horizontal thickness were evaluated. The mean vertical loss after extraction did not differ significantly between the control and barrier groups (Student t-test: mesial P =  0.989, buccal P =  0.997, lingual/palatal P =  0.070, distal P =  0.107). The mean vertical loss at 120 days postoperative did not differ significantly between the control (0.65 mm) and barrier (0.52 mm) groups (P >  0.05), with an effect size of 0.13 mm. At 120 days, the barrier group presented a mean resorption in thickness (0.45 mm) that was significantly lower than that in the control group (0.76 mm) (P =  0.021), with an effect size of 0.31 mm. The polypropylene barrier reduced the horizontal resorption in sockets of posterior teeth after extraction.     

Inlay–onlay grafting for three-dimensional reconstruction of the posterior atrophic maxilla with mandibular bone

This prospective study describes and evaluates a surgical approach for 3D reconstruction of the posterior maxilla with autogenous mandibular bone in 16 patients (mean age 51 years). Bone blocks were harvested from the mandible and used as lateral or vertical block grafts (onlay); they were also partially milled and used for sinus elevation (inlay). In 4 cases, anorganic bovine bone was added at the periphery of the blocks. 4 months after grafting, implants were placed in a second operation and loaded after 12 weeks. Lateral and vertical augmentations were measured immediately after grafting and at re-entry for implant placement. Mean lateral augmentation performed was 5.5 mm, reduced to 4.3 mm (p < 0.01) after 4 months’ healing. Mean vertical augmentation was 3.2 mm, reduced to 2.1 mm (p < 0.01) after healing. The amounts of lateral and vertical graft resorption were similar (1.2 mm vs. 1.1 mm) but were different when compared with the original graft (22% vs. 34%). 49 implants were placed 4 months after grafting. Implant parameters were evaluated after 32–48 months follow up and demonstrated 100% survival rates. The use of mandibular bone grafts for 3D augmentation of the posterior maxilla has shown good results and minor complications.     

Chimeric posterior tibial artery flap: clinical application in oral and maxillofacial reconstruction

The objective was to describe the utility of the chimeric posterior tibial artery flap (CPTAF) in the restoration of compound defects in the oral and maxillofacial region. Patients who underwent head and neck reconstruction using a CPTAF between February 2018 and February 2019 were included. Special consideration was given to the distribution of septocutaneous perforators (SPs), indications, flap survival, and complications. Nine patients were included. All flaps survived. One patient developed a surgical site infection, which was managed conservatively. The CPTAF was raised as a bipaddle skin flap without muscle (n = 1), with the gastrocnemius muscle (n = 6), or with the soleus muscle (n = 2). The number of SPs ranged from three to five (mean 4 ± 0.8). The SPs were mostly located between 4 cm and 20 cm proximal to the medial malleolus (mean 9.5 ± 3.8 cm). The skin paddle was used to reconstruct skin or mucosal defects, whereas the muscle part was used to fill the dead space (n = 7) or to support the orbital contents (n = 1). The donor site healed with no associated functional complications. The CPTAF is a good option for the restoration of composite tissue defects in the head and neck region. It offers flexibility during flap inset and provides the appropriate bulk to repair defects in multiple planes.     

Comparison of three different types of splints and templates for maxilla repositioning in bimaxillary orthognathic surgery: a randomized controlled trial

The selection and implementation of a plan for maxillary surgery is of the utmost importance in achieving the desired outcome for the patient undergoing two-jaw orthognathic surgery. Some splint-based and splintless methods, accompanied by computer-assisted techniques, are helpful in improving surgical plan implementation. However, randomized controlled trials focused on this procedure are lacking. This study included 61 patients who underwent bimaxillary surgeries. The patients were randomly assigned to a conventional resin occlusal splint (CROS) group, a digital occlusal splint (DOS) group, or a digital templates (DT) group, in a 1:1:1 ratio. The mean linear distance between the planned and actual postoperative positions of eight selected points on the surfaces of the maxillary teeth was selected as the outcome measure. The distance was significantly smaller in the DT group (1.17 ± 0.66 mm) when compared to both the CROS group (2.55 ± 0.95 mm, P < 0.05) and DOS group (2.15 ± 1.12 mm, P < 0.05). However, the difference between the CROS group and DOS group was not statistically significant. These findings indicate that using digital templates results in the best performance in transferring the surgical plan to the operation environment as compared to the other two types of splints. This suggests that the application of digital templates could provide a reliable treatment option.     

Comparison of procedures for immediate reconstruction of large osseous defects resulting from removal of a single tooth to prepare for insertion of an endosseous implant after healing

This study evaluated the treatment outcome of immediate reconstruction of 45 large osseous defects resulting from removal of a single tooth with a 1:2 mixture of Bio-Oss^® and autologous tuberosity bone, and three different procedures for soft tissue closing (Bio-Gide^® membrane, connective tissue graft, full-thickness palatal mucosa graft; n = 15 per group). All defects had an unfavourable osseous–gingival relationship and vertical bone loss of >5 mm. The hard and soft tissues were immediately reconstructed after removal of the tooth. Implants were inserted after 3 months. Patients’ acceptance, complications and postoperative morbidity were prospectively evaluated by standardized clinical and radiographic examinations up to 12 months after the augmentation procedure. The patients completed a questionnaire on subjective complaints related to the procedure. All hard–soft tissue procedures resulted in sufficient bone volume for the insertion of implants and a favourable aesthetic outcome. The gingival mid-buccal aesthetics before, and 1 year after, treatment significantly favoured the full-thickness palatal mucosa graft, showing a gain in gingival contour of 0.5 ± 0.8 mm; the other procedures resulted in a 1.2 ± 1.6 mm decrease. Of the procedures evaluated, a full-thickness palatal mucosa graft was the most predictable for immediate reconstruction of the socket after tooth removal.     

The impact of smoking on surgical complications after head and neck reconstructive surgery with a free vascularised tissue flap: a systematic review and meta-analysis

Reconstructive surgery with a free vascularised tissue flap is indicated in large defects in the head and neck region, which arise mostly because of head and neck cancer. Tobacco smoking is a major risk factor for head and neck cancer, and many patients undergoing reconstructive surgery in the head and neck have a history of smoking. The objective of this meta-analysis was to determine the impact of smoking on surgical complications after head and neck reconstructive surgery with a free vascularised tissue flap. A systematic review was undertaken for articles reporting and comparing the incidence of overall surgical complications after reconstructive surgery with a free vascularised tissue flap between smokers and nonsmokers. Relevant articles were searched using PubMed, Cochrane, and Embase databases, and screened for eligibility according to the PRISMA guidelines. The risk of bias analysis was conducted using the Newcastle-Ottawa quality assessment scale. A meta-analysis was performed to quantitatively compare the incidence rate of overall surgical complications, flap failure, surgical site infection, fistula, and haematoma between smokers and nonsmokers using OpenMetaAnalyst (open source) software. Only qualitative analysis was performed for wound dehiscence, bleeding, nerve injury, and impaired wound healing. Forty-six articles were screened for eligibility; 30 full texts were reviewed, and 19 studies were included in the quantitative meta-analysis. From the 19 studies, 18 were retrospective and 1 was a prospective study. In total, 2155 smokers and 3124 nonsmokers were included in the meta-analysis. Smoking was associated with a significantly increased risk of 19.12% for haematoma (95% Confidence Interval (CI): 4.75–33.49; p < 0.01), and of 4.57% for overall surgical complications (95% CI: 1.97–7.15; p < 0.01). No significant difference in risk was found for flap failure (95% CI: ?4.33–9.90; p = 0.44), surgical site infection (95% CI: ?0.88–2.60; p = 0.33) and fistula formation (95% CI: ?3.81–3.71; p = 0.98) between smokers and nonsmokers. Only for flap failure was a significant heterogeneity found (I² = 63.02%; p = 0.03). Smoking tobacco was significantly associated with an increased risk of overall surgical complications and haematoma, but did not seem to affect other postoperative complications. Encouraging smoking cessation in patients who need reconstructive head and neck surgery remains important, but delaying surgery to create a non-smoking interval is not needed to prevent the investigated complications. More high-quality retrospective or prospective studies with a standardised protocol are needed to allow for definitive conclusions.     

Systematic review and meta-analysis of tracheostomy outcomes in COVID-19 patients

A systematic review and meta-analysis of the entire COVID-19 Tracheostomy cohort was conducted to determine the cumulative incidence of complications, mortality, time to decannulation and ventilatory weaning. Outcomes of surgical versus percutaneous and outcomes relative to tracheostomy timing were also analysed. Studies reporting outcome data on patients with COVID-19 undergoing tracheostomy were identified and screened by 2 independent reviewers. Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines were followed. Outcome data were analysed using a random-effects model. From 1016 unique studies, 39 articles reporting outcomes for a total of 3929 patients were included for meta-analysis. Weighted mean follow-up time was 42.03 ± 26 days post-tracheostomy. Meta-analysis showed that 61.2% of patients were weaned from mechanical ventilation [95%CI 52.6%–69.5%], 44.2% of patients were decannulated [95%CI 33.96%–54.67%], and cumulative mortality was found to be 19.23% [95%CI 15.2%–23.6%] across the entire tracheostomy cohort. The cumulative incidence of complications was 14.24% [95%CI 9.6%–19.6%], with bleeding accounting for 52% of all complications. No difference was found in incidence of mortality (RR1.96; p = 0.34), decannulation (RR1.35, p = 0.27), complications (RR0.75, p = 0.09) and time to decannulation (SMD 0.46, p = 0.68) between percutaneous and surgical tracheostomy. Moreover, no difference was found in mortality (RR1.57, p = 0.43) between early and late tracheostomy, and timing of tracheostomy did not predict time to decannulation. Ten confirmed nosocomial staff infections were reported from 1398 tracheostomies. This study provides an overview of outcomes of tracheostomy in COVID-19 patients, and contributes to our understanding of tracheostomy decisions in this patient cohort.