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2020 ePosters / British Journal of Oral and Maxillofacial Surgery 58 (2020) e139–e231 e189
tive antimicrobials, the success of major surgery can be
compromised, undermining many advances in healthcare. A
pilot study within our OMFS unit demonstrated periopera-
tive use of various antimicrobials for varied lengths of time
when surgically managing facial fractures. As per the World
Health Organisation (WHO) global action plan on antimicro-
bial resistance, with our microbiology team we developed and
implemented a shortened antimicrobial protocol for use in the
surgical management of mid 1/3rd facial fractures.
Methods: A prospective study investigated the effects a
shortened course of perioperative antimicrobial cover had on
infective post operative complications in patients who had
surgical management of mid 1/3rd facial fractures.
Results: Of 55 patients who underwent surgical man-
agement of mid 1/3rd facial fractures 28/55 (50.9%) were
prescribed a shortened course of perioperative antimicrobials
depending on whether an intra or extra oral surgical approach
was used, whilst 27/55 (49.1%) were prescribed a longer
course of antimicrobials. Of those given a shortened course of
antimicrobials 1/28 (3.6%) experienced infective post opera-
tive complications. Conversely 4/27 (14.8%) of those given a
longer course of antibiotics experienced infective post oper-
ative complications.
Discussion/conclusions: This data supports growing evi-
dence that shorter courses of antimicrobials are appropriate
in the surgical management of facial fractures. As OMFS
surgeons we can utilise evidence based medicine to provide
optimal surgical care whilst simultaneously contributing to
healthcare professionals obligations to tackle the increasing
challenge of antimicrobial resistance.
Prophylactic antibiotics in the surgical management
of mandibular fractures: an updated Clinical Practice
Alison Mace , Douglas Hammond, Zbys Fedorowicz,
Imon Pal, Sek Ping San
Newcastle University, United Kingdom
Introduction: Unnecessary use of antibiotics is driving
the global development and spread of antibiotic resistant
infections. Optimising antibiotic use is a global priority.
SIGN 104 (antibiotic prophylaxis in surgery), covering a
range of surgical procedures, is the only UK topic specific
guideline. Last searches were conducted 2007 and guideline
archived 2019.
Methods: An AGREE II compliant guideline devel-
opment process, building on SIGN 104, based on the
RAPADAPTE methodological approach to guideline adap-
tation, and including GRADE recommendations. Inclusion
criteria: RCTs evaluating prophylactic pre and post-operative
antibiotics for non-infected mandibular fractures including a
condylar subset. Five clinical questions/scenarios were pro-
vided by a multidisciplinary guideline development team.
Updated electronic searches (2005–January 2019, were con-
ducted using relevant search terms, in PubMed, CENTRAL
(the Cochrane Library) and Google Scholar. Screening of
studies against the inclusion criteria, risk of bias assessment
and data extraction were conducted independently by two
reviewers, with inconsistencies resolved through discussion.
Results: 98 references were identified and screened. Full
text assessments retrieved 6 RCTs and 3 Systematic Reviews.
AMSTAR evaluation of the SRs revealed moderate quality
and no further RCTs were identified. Finally, 6 RCTs were
included and assessed for risk of bias using the Cochrane
domain-based tool. Overall risk of bias was low for one RCT,
and the remainder were rated high to unclear risk.
Conclusions: 6 recent RCTs add substantially to the exist-
ing body of evidence. The updated version of this guideline
rates the certainty in the evidence and strength of recommen-
dations against each of the GRADE domains.
Evaluation of maxillofacial emergency admissions for
2018 in a busy regional maxillofacial unit: the East Grin-
stead experience
Afsha Musa , Raghuram Boyapati
William Harvey Hospital, Kent, United Kingdom
Surgical non-elective admissions vary from region to
region and are often dependent on the socioeconomic sit-
uations of a populace. The Queen Victoria Hospital (QVH),
East Grinstead, houses a maxillofacial regional referral centre
catering to almost 2.5 million people. Our study is aimed at
classifying non-elective admissions with a view to identifying
areas for improvement.
Materials and methods: There were 3229 patients seen
under trauma at the Queen Victoria Hospital in the year 2018.
The retrieved data from the operating theatre reporting sys-
tems as well as paediatric ward records showed that 548 adults
and 468 paediatric patients were admitted for treatment under
general anaesthetic.
Results: In the adult group, 235 cases involved dental
abscesses. There were 239 facial fractures, 35 lacerations and
46 other cases. Of the adult facial fractures, there were 153
fractured mandibles, 48 zygoma fractures, 16 nasal bones,
17 orbit fractures and 11 panfacial fractures. In the paediatric
group there were 391 lacerations, 44 cervico-facial abscesses,
20 facial bone fractures and 18 instances of dental injury.
There were 54 admitted cases of trauma due to dog bites and
47 of these were among the paediatric cohort.
Conclusion: Of the 1016 patients admitted for non-
elective treatment to QVH, 40% of the admissions were
paediatric lacerations, 30% were dental abscesses and 25%
were adult facial fractures. There is a dire need to improve the
primary dental services given the fact that 30% of admissions
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