Effectiveness of Postoperative Antibiotics in Orthognathic Surgery: A Meta-Analysis
To conduct a systematic review of published clinical trials on the effectiveness of extended postoperative antibiotics in orthognathic surgery.
Electronic databases were searched for randomized clinical trials. Data from relevant articles were extracted and assessed. The primary outcome variable was surgical site infection. Extracted data were analyzed using a meta-analytical program with a random effects model.
In total 532 patients were assessed in 8 clinical trials. Wound infection occurred in 30 of 268 patients in the short-term prophylaxis group (frequency, 11.2%) and in 10 of 264 patients in the extended-term group (frequency, 3.8%). Extended antibiotic therapy was more effective in decreasing the risk of postoperative wound infection (odds ratio, 3.2; number needed to treat, 13.5).
Extended postoperative antibiotic treatment does have a place in decreasing the risk of postoperative wound infection in orthognathic surgery. More trials are needed to standardize a proper regimen.
Available from: Jochen Weitz
- "On average, 13.5 patients had to be treated with antibiotics to prevent one case of wound infection (NNT = 13.5) . Tan et al. compared intravenous versus oral application of postoperative antibiotics in a randomized clinical trial with 42 patients and found no statistically significant difference in the infection rate . "
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ABSTRACT: Antibiotic prophylaxis is commonly used to decrease the rate of infections in head and neck surgery. The aim of this paper is to present the available evidence regarding the application of antibiotic prophylaxis in surgical procedures of the head and neck region in healthy patients. A systemic literature review based on Medline and Embase databases was performed. All reviews and meta-analyses based on RCTs in English from 2000 to 2013 were included. Eight out of 532 studies fulfilled all requirements. Within those, only seven different operative procedures were analyzed. Evidence exists for the beneficial use of prophylactic antibiotics for tympanostomy, orthognathic surgery, and operative tooth extractions. Unfortunately, little high-level evidence exists regarding the use of prophylactic antibiotics in head and neck surgery. In numerous cases, no clear benefit of antibiotic prophylaxis has been shown, particularly considering their potential adverse side effects. Antibiotics are often given unnecessarily and are administered too late and for too long. Furthermore, little research has been performed on the large number of routine cases in the above-mentioned areas of specialization within the last few years, although questions arising with respect to the treatment of high-risk patients or of specific infections are discussed on a broad base.
BioMed Research International 07/2014; 2014:879437. DOI:10.1155/2014/879437 · 1.58 Impact Factor
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ABSTRACT: To investigate the penetration of cefuroxime into the parotid saliva after short-term intravenous administration in patients undergoing various maxillofacial surgical procedures.
A total of 12 patients, 10 males and 2 females, with a mean age of 41 ± 21.2 years, participated in the present study. Each patient received 1.5 g of intravenous cefuroxime every 8 hours. Blood and parotid saliva samples were collected concomitantly, on the third day of therapy, just before the infusion of the first morning dose, and 0.5 hour after its end. All samples were analyzed using high-performance liquid chromatography.
The cefuroxime concentration in plasma and saliva before infusion was 2.08 ± 1.05 mg/L and 0.46 ± 0.33 mg/L, respectively. At 30 minutes after the end of infusion, the corresponding concentrations were 55.54 ± 20.24 mg/L and 14.50 ± 7.85 mg/L. The saliva/plasma ratio was 0.25 ± 0.18 before and 0.26 ± 0.12 after the infusion.
Cefuroxime is excreted in saliva in high levels shortly after infusion but is detected in far lower levels 8 hours after infusion. Taking into consideration the minimum inhibitory concentration values of common pathogens, we have concluded that the saliva concentrations of the drug are sufficient against some, but not all, pathogens involved in the oral-maxillofacial area.
Journal of oral and maxillofacial surgery: official journal of the American Association of Oral and Maxillofacial Surgeons 03/2012; 70(6):1398-403. DOI:10.1016/j.joms.2012.01.007 · 1.43 Impact Factor
Available from: Thiago de Santana Santos
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ABSTRACT: Orthognathic surgery is performed to correct dentofacial and craniofacial deformities and improve facial aesthetics, occlusal relations, and the functionality of the stomatognathic apparatus. However, complications in orthognathic surgery may occur at any time during the course of treatment: in the preoperative judgment and planning, during perioperative orthodontic care, or intraoperatively. The aim of the current study was to survey oral and maxillofacial surgeons regarding the main complications of orthognathic surgery.
One hundred oral and maxillofacial surgeons with at least 5 years of experience in dentofacial management were interviewed during a Brazilian national oral and maxillofacial surgery meeting by 2 calibrated postgraduate students, using a questionnaire addressing complications of orthognathic surgery.
No significant differences were found regarding educational background or postgraduate degrees among the oral and maxillofacial surgeons (P > 0.05). A total of 28.0% had no experience with vertical osteotomy of the mandibular ramus, 35.0% had no experience with subapical osteotomy of the mandible, and 4.0% had no experience with genioplasty. All participants had experience with sagittal osteotomy of the mandibular ramus. Among mandible procedures, the most common complication was nerve damage, followed by unfavorable osteotomy. The most common Le Fort I complication was also nerve damage (40%), followed by hemorrhage (29%). Regarding osteosynthesis fixation, fractures of the material were more frequent in the mandible (23%) and maxilla (10%).
Most oral and maxillofacial surgeons experienced similar orthognathic surgery complications to those reported in retrospective studies.
The Journal of craniofacial surgery 09/2012; 23(5):e423-30. DOI:10.1097/SCS.0b013e31825e49c1 · 0.68 Impact Factor
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