Outcomes in Treatment Protocols in Odontogenic Space-Occupying Lesions in the Middle Face: A Systematic Review with Meta Analysis

Odontogenic space-occupying lesions of the middle face—including cysts, tumors, abscesses, and inflammatory masses—may disrupt facial symmetry and compromise functions such as mastication and respiration, leading to significant morbidity if untreated. Treatment protocols vary widely, and outcomes depend on lesion subtype, patient comorbidities, and therapeutic strategy. Despite the clinical importance of these conditions, evidence remains fragmented, and a synthesis of available data is urgently needed. This systematic review and meta-analysis evaluates treatment outcomes for odontogenic space-occupying lesions of the middle face, comparing surgical and pharmacological interventions and identifying factors influencing clinical success, consistent with a structured PICO framework: Population (patients with odontogenic middle-face lesions), Intervention (surgical and/or antibiotic management), Comparator (alternative or no active treatment), and Outcomes (clinical success, recurrence, microbiological clearance, and functional recovery). A comprehensive, reproducible search of PubMed, Cochrane Library, Embase, Scopus, and Google Scholar was conducted, following PRISMA 2020 guidelines. RCTs and observational studies reporting outcomes of surgical and adjunctive pharmacological treatments were included. Two independent reviewers performed screening, data extraction, and quality assessment. Outcomes included recurrence, complications, microbiological clearance, and functional recovery. Meta-analysis estimated pooled effect sizes using fixed- and random-effects models. Two RCTs (constituting a single patient cohort across a primary and microbiological sub-study) reported a directional benefit of moxifloxacin over clindamycin, with statistically significant superiority for inflammatory infiltrate patients but not for odontogenic abscesses. Observational studies reported a pooled clinical success rate of 91% (95% CI 87–94%). Sinus irrigation was more effective than the traditional Caldwell-Luc procedure for postoperative maxillary sinus recovery (RR = 1.48). Early intervention and individualized, risk-stratified treatment consistently improved outcomes. Early diagnosis, appropriate antibiotic selection, and minimally invasive surgery lead to optimal outcomes in odontogenic middle-face lesions. Standardized outcome reporting and long-term follow-up are essential to strengthen future evidence. Future directions include machine-learning-assisted diagnosis, biomarker-guided therapy, and multicentre randomised controlled surgical trials.