Rajat Mohanty, Naman Awasthi, Shrinivas Baburao Hosmani, Anju Innaran Sankaranarayanan, Nimish H Oberoi, Praveen Kumar Singh, Nikhil Singh, Dharati Patel
{"title":"Comparing the Efficacy of Postoperative Antibiotic Regimens in the Treatment of Maxillofacial Fractures: A Prospective Study.","authors":"Rajat Mohanty, Naman Awasthi, Shrinivas Baburao Hosmani, Anju Innaran Sankaranarayanan, Nimish H Oberoi, Praveen Kumar Singh, Nikhil Singh, Dharati Patel","doi":"10.5005/jp-journals-10024-3493","DOIUrl":null,"url":null,"abstract":"<p><strong>Aim: </strong>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.</p><p><strong>Materials and methods: </strong>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.</p><p><strong>Results: </strong>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.</p><p><strong>Conclusion: </strong>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.</p><p><strong>Clinical significance: </strong>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.</p>","PeriodicalId":35792,"journal":{"name":"Journal of Contemporary Dental Practice","volume":null,"pages":null},"PeriodicalIF":0.0000,"publicationDate":"2023-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Journal of Contemporary Dental Practice","FirstCategoryId":"1085","ListUrlMain":"https://doi.org/10.5005/jp-journals-10024-3493","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q3","JCRName":"Dentistry","Score":null,"Total":0}
引用次数: 0
Abstract
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.
期刊介绍:
The Journal of Contemporary Dental Practice (JCDP), is a peer-reviewed, open access MEDLINE indexed journal. The journal’s full text is available online at http://www.thejcdp.com. The journal allows free access (open access) to its contents. Articles with clinical relevance will be given preference for publication. The Journal publishes original research papers, review articles, rare and novel case reports, and clinical techniques. Manuscripts are invited from all specialties of dentistry i.e., conservative dentistry and endodontics, dentofacial orthopedics and orthodontics, oral medicine and radiology, oral pathology, oral surgery, orodental diseases, pediatric dentistry, implantology, periodontics, clinical aspects of public health dentistry, and prosthodontics.