Pre-Operative Antibiotic Agents for Facial Fractures: Is More than One Day Necessary?

Surgical site infections in maxillofacial trauma surgery - Single-dose versus prolonged antibiotic prophylaxis

Open reduction with internal fixation (ORIF) for facial fractures has frequently been associated with the occurrence of surgical site infections (SSIs). Perioperative antibiotic prophylaxis is customarily recommended for ORIF. Thus, the comparison of two different antibiotic regimens (i.e., single-dose and prolonged antibiotic prophylaxis) concerning the rate and severity of SSIs in facial fracture patients undergoing ORIF was the main purpose of this study. This retrospective analysis included patients who underwent ORIF for facial fractures. They were distributed into two groups. The single-dose antibiotic prophylaxis group (SDAP) received single-dose perioperative antibiotic prophylaxis, whereas the prolonged antibiotic prophylaxis group (PAP) were administered prophylactic antibiosis over a course of 5 days. 122 patients were included in the study. Nine patients in the SDAP group and 15 patients in the PAP group were affected by SSIs; no significant difference in the incidence of SSIs was found (p = 0.218). Moreover, the severity of SSIs did not significantly differ between the two groups (p = 0.982).

Isolated facial fractures transferred for higher level of care

BACKGROUND

Isolated facial fractures (IFF) have been identified as overtriaged injuries in multiple single-center studies. We sought to describe IFF in a national database.

METHODS

The 2019 Trauma Quality Improvement Program database was queried for all patients with facial fractures and Abbreviated Injury Score<1 for other body regions. Descriptive statistics were performed.

RESULTS

Of 1,097,190 trauma patients, 36,077 (3.3%) had IFF. Median age was 39 [26-89], 92% had blunt mechanism, median Glasgow Coma Scale 15 [15-15], and vital signs were normal (ED systolic blood pressure 137 [125-153], ED pulse 86 [73-99]). 0.3% required unplanned intubation. 25.7% underwent operation after a median interval 26.4 [14.4-47.9] hours. IFF patients represented 4.4% of interfacility transfers and were more likely to have been transferred (34.4% vs 25%, p < 0.001). Hospital stay was 3 [2-4] days.

CONCLUSIONS

IFF are rarely surgical emergencies and frequently nonoperative, yet are disproportionately represented among transfers. IFFs may represent an opportunity for outpatient follow-up or telehealth consultation to decrease resource utilization.

Factors associated with delays in medical and surgical open facial fracture management

Objectives

Open fractures are at risk of infection because of exposure of bone and tissue to the environment. Facial fractures are often accompanied by other severe injuries, and therefore fracture management may be delayed until after stabilization. Previous studies in this area have examined timing of multiple facets of care but have tended to report on each in isolation (eg, antibiotic initiation).

Methods

This was a retrospective study of adult patients admitted to five trauma centers from January 1, 2017 to March 31, 2021 with open facial fractures. Variables collected included demographics, injury mechanism, details on facial and non-facial injuries, facial fracture management (irrigation and debridement (I&D), irrigation without debridement, open reduction internal fixation (ORIF), antibiotics), and other hospital events. The study hypothesized that the presence of serious non-facial injuries would be associated with delays in facial fracture management. The primary aims were to describe open facial fracture management practices and examine factors associated with early versus delayed fracture management. A secondary aim was to describe infection rates. Early treatment was defined as within 24 hours of arrival for I&D, irrigation without debridement, and ORIF and within 1 hour for antibiotics.

Results

A total of 256 patients were included. Twenty-seven percent had major trauma (Injury Severity Score ≥16). The presence of serious head injury/traumatic brain injury was associated with delayed I&D (OR_early=0.04, p<0.01), irrigation without debridement (OR_early=0.09, p<0.01), and ORIF (OR_early=0.10, p<0.01). Going to the OR within 24 hours was associated with early I&D (OR_early=377.26, p<0.01), irrigation without debridement (OR_early=13.54, p<0.01), and ORIF (OR_early=154.92, p<0.01). The infection rate was 4%.

Conclusions

In this examination of multiple aspects of open facial fracture management, serious injuries to non-facial regions led to delays in surgical fracture management, consistent with the study hypothesis.

Level of evidence

Level III, prognostic/epidemiological.

Systemic Antibiotic Prophylaxis in Maxillofacial Trauma: A Scoping Review and Critical Appraisal

Infection after maxillofacial trauma remains an important complication, with a significant socio-economic impact. While consensus exists that systemic antibiotic prophylaxis reduces the risk of infection in the management of maxillofacial fractures, the type, and duration remain controversial. Therefore, the purpose of this scoping review was to provide an overview of the current evidence that supports the use of prophylactic antibiotics in the treatment of maxillofacial fractures. A comprehensive literature search on 1 January 2022, in PubMed, Web of Science, Embase, and Cochrane, revealed 16 articles. Most studies focused on the duration of systemic antibiotic prophylaxis and compared a one-day to a five-day regimen. Included studies showed considerable variability in design and research aims, which rendered them difficult to compare. Furthermore, a variety of antibiotic regimens were used, and most studies had a short follow-up period and unclear outcome parameters. This scoping review demonstrates the lack of well-constructed studies investigating the type and duration of systemic antibiotic prophylaxis in the treatment of maxillofacial trauma. Based on the included articles, prolonging antibiotic prophylaxis over 24 h for surgically treated fractures does not appear to be beneficial. Furthermore, there is no evidence for its use in conservatively treated fractures. These results should be interpreted with caution since all included studies had limitations.

Mandibular Fractures: Diagnosis and Management

Accurate evaluation, diagnosis, and management of mandibular fractures is essential to effectively restore an individual's facial esthetics and function. Understanding of surgical anatomy, fracture fixation principles, and the nuances of specific fractures with respect to various patient populations can aid in adequately avoiding complications such as malocclusion, non-union, paresthesia, and revision procedures. This article reviews comprehensive mandibular fracture assessment, mandibular surgical anatomy, fracture fixation principles, management considerations, and commonly encountered complications. In addition, this article reviews emerging literature examining 3-dimensional printing and intraoperative imaging.