Citation Information :
Hosmani SB, Sankaranarayanan AI, Oberoi NH, Singh PK, Singh N. Comparing the Efficacy of Postoperative Antibiotic Regimens in the Treatment of Maxillofacial Fractures: A Prospective Study. J Contemp Dent Pract 2023; 24 (7):454-458.
Aim: The present study was designed to investigate the difference in the effectiveness of a 3 day postoperative course and a single perioperative dose of antibiotics on the incidence of postoperative infection in the management of maxillofacial trauma patients.
Materials and methods: About 183 maxillofacial trauma patients requiring open reduction and internal fixation (ORIF) under general anesthesia were divided based on the type of fracture sustained, i.e., mandibular fractures, Le Fort fractures, and zygomaticomaxillary complex fractures. Patients from each fracture type were randomized into two groups, A and B. All patients were administered amoxicillin/clavulanate 1.2 grams intravenously 8 hours from the time of admission till the patient was taken up for surgery. Once the patients were taken up for surgery, a perioperative dose was administered. No antibiotics beyond this point were given to patients in Group A. Patients in Group B were administered the same antibiotic for 3 postoperative days additionally. Outcomes in terms of purulent discharge from the surgical site, an abscess or any other sign of infection, and wound dehiscence requiring reopening of the surgical site were considered. Patients were reviewed at 1 week, 2 weeks, 1 month, 2 months, and 3 months.
Results: No statistically significant difference was found between the two groups across all three fracture types in terms of postoperative outcomes. However, increased numbers of complications were noted in the patients treated with an intra-oral approach in each fracture type irrespective of group. All complications were managed with local measures.
Conclusion: A single perioperative dose of antibiotics is effective in minimizing postoperative complications following ORIF of maxillofacial fractures and there is no significant benefit in prolonging the course of antibiotics postoperatively with the need for further studies to be conducted considering comminuted, complex fractures and old fractures.
Clinical significance: In maxillofacial trauma, fractures frequently communicate with contaminated indigenous flora on the skin surface, oral cavities, or sinus cavities. Surgery is frequently performed using an approach across a contaminated area, even in closed fractures. Postoperative infections can be significantly decreased by using antibiotics in surgical procedures to treat facial fractures.
Schaefer EH, Caterson IV EJ. Antibiotic selection for open reductioninternal fixation of mandible fractures. J Craniofac Surg 2013;24(1):85–88. DOI: 10.1097/SCS.0b013e318275ef21.
Mangram AJ, Horan TC, Pearson ML, et al. Guideline for prevention of surgical site infection, 1999. Hospital infection control practices advisory committee. Infect Control Hosp Epidemiol 1999;20(4): 250–278. DOI: 10.1086/501620.
Owens CD Stoessel K. Surgical site infections: Epidemiology, microbiology and prevention. J Hosp Infect 2008;70(Suppl 2):3–10. DOI: 10.1016/S0195-6701(08)60017-1.
Gaal A, Bailey B, Patel Y, et al. Limiting antibiotics when managing mandible fractures may not increase infection risk. J Oral Maxillofac Surg 2008;74(10):2008–2018. DOI: 10.1016/j.joms.2016.05.019.
Schaller B, Soong PL, Zix J, et al. The role of postoperative prophylactic antibiotics in the treatment of facial fractures: A randomized, double-blind, placebo-controlled pilot clinical study. Part 2: Mandibular fractures in 59 patients. Br J Oral Maxillofac Surg 2013;51(8):803–807. DOI: 10.1016/j.bjoms.2013.08.008.
Larson EL, et al. Guideline for prevention of surgical site table of contents, infect. Control hosp. Epidemiol 1999;20(4):247–280. https://pubmed.ncbi.nlm.nih.gov/10196487/.
Salmerón-Escobar JI, del Amo-Fernández de Velasco A. Antibiotic prophylaxis in oral and maxillofacial surgery. Med Oral Patol Oral Cir Bucal 2006;11(3):E292–E296. PMID: 16648771.
Lamphier J, Ziccardi V, Ruvo A, et al. Complications of mandibular fractures in an Urban Teaching Center. J Oral Maxillofac Surg 2003;61(7):745–750. DOI: 10.1016/s0278-2391(03)00147-2.
Chole RA, Yee J. Antibiotic prophylaxis for facial fractures. A prospective, randomized clinical trial. Arch Otolaryngol Head Neck Surg 1987;113(10):1055–1057. DOI: 10.1001/archotol.1987.01860100033016.
Ellis III E. Outcomes of patients with teeth in the line of mandibularangle fractures treated with stable internal fixation. J Oral MaxillofacSurg 2002;60(8):863–866. DOI: 10.1053/joms.2002.33852.
Stone IE, Dodson TB, Bays RA. Risk factors for infection following operative treatment of mandibular fractures: A multivariate analysis. Plast Reconstr Surg 1993;91(1):64–68. DOI: 10.1097/00006534-199301000-00008.
Abubaker AO Rollert MK. “Postoperative antibiotic prophylaxis in mandibular fractures: A preliminary randomized, double-blind, and placebo-controlled clinical study”. J Oral Maxillofac Surg 2001;59(12):1415–1419. DOI: 10.1053/joms.2001.28272.
Miles BA, Potter JK, Ellis E 3rd. The efficacy of postoperative antibiotic regimens in the open treatment of mandibular fractures: A prospective randomized trial. J Oral Maxillofac Surg 2006;64(4): 576–582. DOI: 10.1016/j.joms.2006.01.003.
Lauder A, Jalisi S, Spiegel J, et al. Antibiotic prophylaxis in the management of complex midface and frontal sinus trauma. Laryngoscope 2010;120(10):1940–1945. DOI: 10.1002/lary.21081.
Soong PL, Schaller B, Zix J, et al. “The role of postoperative prophylactic antibiotics in the treatment of facial fractures: A randomised, double-blind, placebo-controlled pilot clinical study. Part 3: Le Fort and Zygomatic fractures in 94 patients”. Br J Oral Maxillofac Surg 2014;52(4):329–333. DOI: 10.1016/j.bjoms.2014.01.010.
Zix J, Schaller B, Iizuka T, et al. “The role of postoperative prophylactic antibiotics in the treatment of facial fractures: A randomised, double-blind, placebo-controlled pilot clinical study. Part 1: Orbital fractures in 62 patients”. Br J Oral Maxillofac Surg 2013;51(4):332–336. DOI: 10.1016/j.bjoms.2012.08.008.
Sethi A, Van Huekelom E, Mehra P. Outcomes following use of a standard antibiotic protocol in the management of maxillofacial trauma patients”. J Oral Biol Craniofacial Res 2020;10(4):519–522. DOI: 10.1016/j.jobcr.2020.08.009.
Blatt S, Al-Nawas B. A systematic review of latest evidence for antibiotic prophylaxis and therapy in oral and maxillofacial surgery. Infection 2019;47(4):519–555. DOI: 10.1007/s15010-019-01303-8.
Habib AM, Wong AD, Schreiner GC, et al. Postoperative prophylactic antibiotics for facial fractures: A systematic review and meta-analysis. Laryngoscope 2019;129(1):82–95. DOI: 10.1002/lary.27210.