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Delaplain PT, Phillips JL, Lundeberg M, Nahmias J, Kuza CM, Sheehan BM, Murphy LS, Pejcinovska M, Grigorian A, Gabriel V, Barie PS, Schubl SD. No Reduction in Surgical Site Infection Obtained with Post-Operative Antibiotics in Facial Fractures, Regardless of Duration or Anatomic Location: A Systematic Review and Meta-Analysis. Surg Infect (Larchmt) 2019; 21:112-121. [PMID: 31526317 DOI: 10.1089/sur.2019.149] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
Background: We performed a systematic review of the literature on antibiotic prophylaxis practices in open reduction, and internal fixation of, facial fracture(s) (ORIFfx). We hypothesized that prolonged antibiotic prophylaxis (PAP) would not decrease the rate of surgical site infections (SSIs). Methods: We performed a systematic review of four databases: PubMed, CENTRAL, EMBase, and Web of Science, from inception through January 15, 2017. Three independent reviewers extracted fracture location (orbital, mid-face, mandible), antibiotic use, SSI incidence, and time from injury to surgery. Mantel-Haenszel and generalized estimating equations were carried out independently for each fracture zone. Results: Of the 587 articles identified, 54 underwent full-text review, yielding 27 studies that met our inclusion criteria. Of these, 16 studies (n = 2,316 patients) provided data for mandible fractures, four studies (n = 439) for mid-face fractures, and six studies (n = 377) for orbital fractures. Pooled analysis of each fracture type's SSI rate showed no statistically significant association with the odds ratio (OR) of developing an SSI. For mandible fractures treated with ORIFfx, the OR for an SSI after 24-72 hours of prophylaxis relative to <24 hours was 0.85 (95% confidence interval [CI] 0.62-1.17), whereas for >72 hours compared with <24 hours, the OR was 1.42 (95% CI) 0.96-2.11). For mid-face fractures, there was no improvement in SSI rate from PAP (OR 1.05; 95% CI 0.20-5.63). Conclusions: We did not demonstrate a lower rate of SSI associated with PAP for any ORIFfx repair. Post-operative antibiotics for >72 hours paradoxically may increase the SSI risk after mandible fracture repairs.
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Affiliation(s)
- Patrick T Delaplain
- Department of Surgery, University of California, Irvine Medical Center, Orange, California
| | - Jacquelyn L Phillips
- Department of Surgery, University of California, San Francisco East Bay, San Francisco, California
| | | | - Jeffry Nahmias
- Department of Surgery, University of California, Irvine Medical Center, Orange, California
| | - Catherine M Kuza
- Department of Anesthesiology, University of Southern California, Los Angeles, California
| | - Brian M Sheehan
- Department of Surgery, University of California, Irvine Medical Center, Orange, California
| | - Linda S Murphy
- Reference Department, University of California-Irvine Libraries, NS, University of California, Irvine, Irvine, California
| | - Marija Pejcinovska
- Center for Statistical Consulting, University of California, Irvine, Irvine, California
| | - Areg Grigorian
- Department of Surgery, University of California, Irvine Medical Center, Orange, California
| | - Viktor Gabriel
- Department of Surgery, University of California, Irvine Medical Center, Orange, California
| | - Philip S Barie
- Department of Surgery, Weill Cornell Medical College at New York/Presbyterian Hospital, New York, New York
| | - Sebastian D Schubl
- Department of Surgery, University of California, Irvine Medical Center, Orange, California
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Oya R, Shikina T, Takenaka Y, Uno A, Horii A, Inohara H. Endoscopic repair through the medial wall of maxillary sinus for blowout fracture of the inferior orbital wall: a case report. ACTA OTO-LARYNGOLOGICA CASE REPORTS 2017. [DOI: 10.1080/23772484.2017.1303605] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
Affiliation(s)
- Ryohei Oya
- Department of Otorhinolaryngology Head and Neck Surgery, Osaka General Medical Center, Osaka, Japan
| | - Takashi Shikina
- Department of Otorhinolaryngology Head and Neck Surgery, Ikeda Municipal Hospital, Osaka, Japan
| | - Yukinori Takenaka
- Department of Otorhinolaryngology Head and Neck Surgery, Osaka General Medical Center, Osaka, Japan
| | - Atsuhiko Uno
- Department of Otorhinolaryngology Head and Neck Surgery, Osaka General Medical Center, Osaka, Japan
| | - Arata Horii
- Department of Otorhinolaryngology Head and Neck Surgery, Niigata University Graduate School of Medicine and Dentistry, Niigata, Japan
| | - Hidenori Inohara
- Department of Otorhinolaryngology Head and Neck Surgery, Osaka University Graduate School of Medicine, Osaka, Japan
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Abstract
OBJECTIVES: Transconjunctival and subciliary approaches to orbital floor blowout fractures (OBF) have known risks of postoperative eyelid malposition. This study evaluates the endoscopic transmaxillary repair of OBFs in a cadaveric model and clinical setting. METHODS: Sixteen cadaveric and 10 clinical OBFs were repaired endoscopically. A Caldwell-Luc approach and modified sinus surgery instrumentation were used to repair each fracture. Variations in fracture pattern, instrumentation, and surgical technique were evaluated. RESULTS: Endoscopic repair was achieved in all 16 cadaveric orbits and in 9 of 10 patients. Fracture patterns were classified as either medial or lateral to the infraorbital nerve. Average clinical operating time was 1:38. Of 9 postoperative CT scans, 5 were rated as excellent, 3 as good, and 1 as poor. CONCLUSIONS: The endoscopic transmaxillary approach is a safe, viable technique for OBF repair. It offers improved visualization, anatomic fracture repair, no risk of postoperative eyelid complications, and good clinical results. EBM rating: C.
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Affiliation(s)
- E Bradley Strong
- Department of Otolaryngology, University of California Davis School of Medicine, Sacramento, CA 95817, USA
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Transantral Orbital Floor Fracture Repair Using a Folded Silastic Tube. Clin Exp Otorhinolaryngol 2015; 8:250-5. [PMID: 26330920 PMCID: PMC4553356 DOI: 10.3342/ceo.2015.8.3.250] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2014] [Revised: 09/19/2014] [Accepted: 09/21/2014] [Indexed: 11/08/2022] Open
Abstract
OBJECTIVES The purpose of this study was to evaluate the advantages and limitations of using a silicon tube to support the fractured orbital floor by a transantral approach. METHODS A retrospective study was conducted from January 2000 to December. 2011 in 51 patients with pure orbital floor fractures. The patients underwent reduction surgery via a transantral approach for inserting a folded silastic tube to support the fractured orbital floor in the maxillary sinus. A chart review of preoperative and postoperative ocular symptoms, operation records, and complications was maintained. RESULTS In 18 out of 25 patients with diplopia, postoperative improvement was seen. In 13 out of 15 patients with extraocular muscle limitation, postoperative improvement was seen. Enophthalmos resolved postoperatively in four of five patients. Postsurgical complications occurred in three patients: an overcorrection, an infection in the maxillary sinus, and an implant extrusion, all of which were resolved by revision surgeries. CONCLUSION During the course of the study, we sensed reduction using a folded silastic tube via a transantral approach as an easy and effective technique with good postoperative results, and minimal implant related complications. This novel procedure is recommended as a surgical option for the reduction of orbital floor fractures.
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Open reduction versus endoscopically controlled reconstruction of orbital floor fractures: a retrospective analysis. Int J Oral Maxillofac Surg 2012; 41:489-93. [DOI: 10.1016/j.ijom.2012.01.006] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2010] [Revised: 12/29/2011] [Accepted: 01/13/2012] [Indexed: 11/22/2022]
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6
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Broad Application of the Endoscope for Orbital Floor Reconstruction: Long-Term Follow-Up Results. Plast Reconstr Surg 2010; 125:969-78. [DOI: 10.1097/prs.0b013e3181cb64b2] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Farwell DG, Sires BS, Kriet JD, Stanley RB. Endoscopic Repair of Orbital Blowout Fractures. ACTA ACUST UNITED AC 2007; 9:427-33. [DOI: 10.1001/archfaci.9.6.427] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- D. Gregory Farwell
- Department of Otolaryngology–Head and Neck Surgery, University of California, Davis Medical Center, Sacramento
| | | | - J. David Kriet
- Department of Otolaryngology–Head and Neck Surgery, University of Kansas Medical Center, Kansas City
| | - Robert B. Stanley
- Department of Otolaryngology–Head and Neck Surgery, University of Washington School of Medicine, Seattle
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9
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Ploder O, Oeckher M, Klug C, Voracek M, Wagner A, Burggasser G, Baumann A, Czerny C. Follow-up study of treatment of orbital floor fractures: relation of clinical data and software-based CT-analysis. Int J Oral Maxillofac Surg 2003; 32:257-62. [PMID: 12767871 DOI: 10.1054/ijom.2003.0366] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
This retrospective study quantifies isolated orbital floor fractures using software-based CT-analysis and compares the clinical outcome across surgical and non-surgical treatment groups. Depending on the surgeon's interpretation of the clinical and radiological appearance, 10 fractures were treated non-surgically and 20 fractures surgically, either with antral balloon catheter alone or in combination with an orbital implant. Ophthalmologic findings were evaluated until 12 weeks after injury. Fracture area, and volume of displaced tissue (VDT) were assessed by software-based CT-analysis. VDT was marginally significantly smaller in non-surgically than in surgically-treated patients (P=0.08). Ophthalmologic findings improved in all groups during follow-up and no statistical difference was found between the groups. Diplopia remained moderate in three patients with balloon catheter alone, and minimal in four patients in both surgical groups. In one patient with non-surgical treatment, diplopia remained minimal after 12 weeks. Although CT-analysis revealed no significant difference between both surgical groups, patients treated with balloon catheter alone presented more diplopia after 12 weeks. Using balloon catheters for fracture repair a combined approach should be performed when large fractures involve the orbital floor to achieve sufficient reduction of orbital content and placement of an orbital implant. Software-based CT-analysis is helpful for objective interpretation in managing of orbital fractures.
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Affiliation(s)
- O Ploder
- Department of Cranio-Maxillofacial and Oral Surgery, University of Vienna Medical School, Austria.
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Persons BL, Wong GB. Transantral endoscopic orbital floor repair using resorbable plate. J Craniofac Surg 2002; 13:483-8; discussion 488-9. [PMID: 12040223 DOI: 10.1097/00001665-200205000-00022] [Citation(s) in RCA: 49] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
The transantral endoscopic orbital floor approach can be used to repair pure orbital floor blowout fractures, avoiding the risks of lower lid incisions. A transoral incision is made to expose the anterior maxillary wall. A 1-cm2 antral bone flap gives access to the maxillary sinus and infraorbital floor. The size and fracture configuration are defined using a 30-degree, 4-mm endoscope. Stable bony shelves are identified adjacent to the fracture. Resorbable bone plating material is cut slightly larger than the defect. The material is introduced through defect, rotated, and allowed to rest on the stable medial, lateral, and anterior orbital shelves. Fixation is not required if there is adequate stability of the bony shelves. If not, direct screw fixation can be done from below.
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Affiliation(s)
- Barbara L Persons
- Division of Plastic Surgery, University of California, Davis Medical Center, Sacramento 95817, USA
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11
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Abstract
Traditionally, orbital floor fractures are repaired with standard transcutaneous or transconjunctival approaches. Complications such as external scarring, eyelid edema, ectropion, entropion, and granuloma formation have been associated with these open lid techniques. The endoscope has been used to assist in orbital floor exploration, to reduce entrapped orbital tissue, and to identify the posterior shelf for implant placement. However, an open lid incision is inevitable when implant placement is necessary. We present our experiences in repairing orbital floor fractures using transantral endoscopy without open lid incision.A 0-degree, 4-mm endoscope was placed through a 2 x 1.5-cm2 maxillary antrostomy to dissect the sinus roof. The endoscope was used to assist in the reduction of the floor fractures and prolapsed orbital tissue into the orbital cavity, if present. The orbital floor defect was reconstructed with titanium mesh or Medpor through the antrostomy under endoscopic control. This technique was applied to nine patients who had orbital floor fractures. Two of the patients had zygomatico-orbital fractures, whereas the rest had isolated orbital floor fractures. Three patients received Medpor reconstruction and the remaining six underwent titanium mesh reconstruction. The patients were followed up for 10 months on average. The enophthalmos was corrected in all patients but one, who suffered from mild enophthalmos because of uncorrected orbital medial wall fractures. Diplopia occurred in three patients preoperatively, which was resolved in two of them and improved in the other postoperatively. There have been no complications apart from transient anesthesia in the dermatome of the infraorbital nerve. The technique successfully reconstructed the orbital floor defects, minimized ocular globe manipulation, and eliminated a lower eyelid incision.
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Affiliation(s)
- C T Chen
- Division of Trauma and Emergency Surgery, Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital, College of Medicine, Chang Gung University, Taipei, Taiwan, Republic of China.
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Rosbe KW, Meredith SD, Holmes DK. Complication of maxillary sinus Foley balloon placement for orbital floor support. Otolaryngol Head Neck Surg 1997; 117:S148-50. [PMID: 9419131 DOI: 10.1016/s0194-59989770085-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- K W Rosbe
- Department of Surgery, University of North Carolina School of Medicine, Chapel Hill 27599-7070, USA
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13
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Catone GA, Morrissette MP, Carlson ER. A retrospective study of untreated orbital blow-out fractures. J Oral Maxillofac Surg 1988; 46:1033-8. [PMID: 3193279 DOI: 10.1016/0278-2391(88)90446-6] [Citation(s) in RCA: 30] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
A retrospective study of 27 cases of untreated orbital blow-out fractures is presented. These patients were managed non-surgically because they presented with minimal ophthalmologic symptoms, or they sustained other injuries that prevented early repair. Twelve patients returned for follow-up examination and eight were contacted by telephone. In evaluating patients for diplopia, enophthalmos, hypesthesia, and restricted ocular movement, 85% showed complete resolution of symptoms. Based on these findings, surgical intervention is recommended only in those patients who demonstrate residual diplopia in primary gaze and restricted ocular motility that persist after 10 to 14 days, the presence of enophthalmos greater than 2 mm, and gross disruption of the orbital floor as confirmed by CT or tomography.
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Affiliation(s)
- G A Catone
- Division of Oral and Maxillofacial Surgery, Allegheny General Hospital, Pittsburgh, PA 15212
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