YIJOM-4289; No of Pages 13 Please cite this article in press as: ElKhashab MA, et al. Implant prognosis in irradiated versus non-irradiated nasal, orbital and auricular sites, Int J Oral Maxillofac Surg (2019), https://doi.org/10.1016/j.ijom.2019.09.010 Meta-Analysis Pre-Implant Surgery Implant prognosis in irradiated versus non-irradiated nasal, orbital and auricular sites M. A. ElKhashab, I. A. W. Radi, A. H. Elkhadem: Implant prognosis in irradiated versus non-irradiated nasal, orbital and auricular sites. Int. J. Oral Maxillofac. Surg. 2019; xxx: xxx–xxx. ã 2019 International Association of Oral and Maxillofacial Surgeons. Published by Elsevier Ltd. All rights reserved. M. A. ElKhashab, I. A. W. Radi, A. H. Elkhadem 11, El Saraya Street, ElManial, Cairo, Egypt Abstract. The purpose of this systematic review was to evaluate implant survival in irradiated nasal, auricular, orbital sites and to compare them with non-irradiated respective sites. Four electronic databases and seven related journals were searched until December and March 2018, respectively. A total of 7892 articles were identified, 18 of which were included in this review; one non-randomized clinical trial, two prospective cohort, eight retrospective cohort and seven cross-sectional studies. Using the ROBIN-I Cochrane tool for risk assessment, 13 studies were judged at serious, one at moderate and four at critical risk of bias. Thirteen were included in 18 meta-analyses, the results of which showed a significant difference between irradiated and non-irradiated sites, favouring non-irradiated with risk ratio (RR) = 0.93, 95% confidence interval (CI) 0.89–0.97, P=0.001. Comparisons among nasal, auricular and orbital sites revealed no significant differences, whether in irradiated or non-irradiated patients at P<0.05. Hence, it was concluded that, within the limitations of this review, survival of craniofacial implants is negatively affected by radiotherapy, especially in orbital sites. Level of evidence is moderate. Therefore, further prospective cohort studies with calculated sample sizes, restricted or properly managed confounders and no deviations from intended interventions might produce different results. Key words: craniofacial implants; radiotherapy; nasal; orbital; auricular; extra-oral maxillofacial prosthesis. Accepted for publication The introduction of new treatment mo- dalities and techniques, when combining surgery with radio- and/or chemotherapy, has improved the survival rate of patients with craniofacial defects remarkably dur- ing recent years 1 . This increased the demands for better maxillofacial pros- thetic services for these patients and challenged prosthodontists to provide a retentive, properly aligned and esthetical- ly pleasing prosthesis 2 . For many years maxillofacial prosthetic retention has been dependent on skin adhesives, dou- ble-sided tapes, engaging undercuts and other retentive means such as eye- glasses 3 . These means result in inferior aesthetics, distortion of edges and skin reactions 4 . The integration of osseointegrated implants with new materials for the fabri- cation of maxillofacial prosthesis man- aged to provide patients with durable, stable, easily aligned and highly retained as well as natural-looking prostheses 5–7 . Int. J. Oral Maxillofac. Surg. 2019; xxx: xxx–xxx https://doi.org/10.1016/j.ijom.2019.09.010, available online at https://www.sciencedirect.com 0901-5027/000001+013 ã 2019 International Association of Oral and Maxillofacial Surgeons. Published by Elsevier Ltd. All rights reserved.