ABSTRACT Background Objectives: To evaluate the clinical effectiveness and safety of adjunctive corticosteroid versus standard treatment alone in facial infections. Methods Eligibility criteria: Included clinical comparative studies (randomized or non‐randomized) evaluating adjunctive corticosteroids versus standard care in patients with bacterial facial infections such as odontogenic/facial space infections, dental abscesses, orbital cellulitis, periorbital cellulitis, and Ludwig's angina. Information sources: An unrestricted literature search of five databases was conducted up to December 15, 2025. Risk of bias: The quality assessment of the studies was conducted using the Cochrane Risk of Bias Tool (ROBINS‐I) for non‐randomized and a new risk of bias tool (RoB‐2) for randomized studies. Synthesis of results: Random effects meta‐analyses using mean difference (MD) or standardized mean differences (SMDs) were performed, followed by sensitivity analyses, and assessment of the quality of evidence using GRADE. Results Included studies: Fifteen comparative studies (three randomized and 12 non‐randomized) including 13,905 patients with bacterial facial infections (61.5% male) were included. Synthesis of results: Low‐certainty evidence showed that the use of adjunctive steroids significantly reduced hospital stay compared with standard treatment alone (10 studies; MD = −1.61 −3.17, −0.05 days; p = 0.04; I 2 = 99.3%). Low‐certainty evidence also showed that pre‐treatment CRP was higher in the steroid groups (3 studies; SMD = 0.33 0.09, 0.58; p = 0.03; I 2 = 0%). Low‐certainty evidence indicated no significant difference in the number of surgeries ( p = 0.13), while very low‐certainty evidence showed no significant differences in intensive care unit admissions ( p = 0.07) or airway compromise ( p = 0.18). Sensitivity and subgroup analyses showed no significant differences by study design, infection type, or risk of bias, confirming robust results; only ethnicity had a significant effect on hospital stay ( p = 0.0027). Discussion Limitations of evidence: Certainty of evidence was low to very low for all outcomes, with hospital stay rated low due to methodological limitations, high risk of bias, and the predominance of non‐randomized studies. Interpretation : The low level of evidence suggests that adjunctive corticosteroids may provide a reduction in hospital length of stay for patients with bacterial facial infections. Further well‐designed, randomized, and prospective comparative studies are needed to confirm these findings. PROPSERO Registration Number: (CRD420261329331).
Hussain et al. (2026) studied this question.