Biomaterial-Based Drainage Strategies for Maxillofacial and Deep Neck Space Infections: A Narrative Review of Clinical Outcomes and Mechanistic Considerations

(1)

Background

Maxillofacial and deep neck space infections require timely source control and exudate evacuation amid growing interest in minimally invasive, biomaterial-based drainage systems. (2)

Methods

This narrative review synthesized clinical evidence (2001–2026) on four drainage strategies: incision and drainage (I&D), ultrasound-guided drainage (USD), closed-suction drainage (CSD), and vacuum-sealing/negative-pressure wound therapy (VSD/NPWT), across 44 studies (13,795 patients), emphasizing clinical outcomes and material properties. (3)

Results

The studies differed in infection extent, patient selection, and device configuration, which limits comparison between modalities. Weighted mean length-of-stay values were 6.0 (I&D), 5.8 (USD), 19.8 (CSD), and 13.4 days (VSD); these are descriptive and do not represent treatment effects. Within comparative studies, stays were shorter than in the comparator arm in all five USD studies and in four of the six VSD studies. I&D, the most extensively studied approach, was usually combined with extraction of the causative tooth (80% of patients in the studies that reported it). The USD studies mostly involved localized collections and reported the shortest stays; repeat procedures were reported in 7.1% of patients in the studies that recorded them. CSD was described in three studies (two of which were deep neck series), with conflicting comparative findings; none of them reported drain material or measured blockage. VSD/NPWT studies ranged from single-space abscesses to necrotizing infection, and its pooled stay probably reflects a case mix: in four of the six comparative studies, the stay was noted as shorter with VSD than with conventional drainage, and was longer in two studies. (4)