Prescribing antibiotic prophylaxis in orthognathic surgery: a systematic review.

There is no consensus on the use of antibiotic prophylaxis in orthognathic surgery to prevent infections. A systematic review of randomized controlled trials investigating the efficacy of antibiotic prophylaxis was performed to make evidence-based recommendations. A search of Embase, Ovid Medline, and Cochrane databases (1966-November 2012) was conducted and the reference lists of articles identified were checked for relevant studies. Eleven studies were eligible and were reviewed independently by the authors using two validated quality assessment scales. Three studies were identified to have a low risk of bias and eight studies a high risk of bias. Most studies compared preoperative and perioperative antibiotic prophylaxis with or without continuous postoperative administration. Methodological flaws in the included studies were no description of inclusion and exclusion criteria and incorrect handling of dropouts and withdrawals. Studies investigating the efficacy of antibiotic prophylaxis are not placebo-controlled and mainly of poor quality. Based on the available evidence, preoperative antibiotic prophylaxis appears to be effective in reducing the postoperative infection rate in orthognathic surgery. However, there is no evidence for the effectiveness of prescribing additional continuous postoperative antibiotics. More trials with a low risk of bias are needed to produce evidence-based recommendations and establish guidelines.

Postoperative radiographs after maxillofacial trauma: Sense or nonsense?

The purpose of the present study was to investigate the necessity of routine postoperative radiographic analysis in patients with maxillofacial trauma. Between January 2000 and January 2010, 579 patients were treated surgically for 646 maxillofacial fractures including complex maxillofacial trauma. The incidence of surgical retreatments based on postoperative radiographs after maxillofacial trauma were investigated. 16 patients needed surgical retreatment. The decision to revise was based on postoperative imaging alone in one patient (0.2%). The available data in the literature concerning postoperative radiography in maxillofacial trauma was reviewed. Six useful studies concerning postoperative radiography in maxillofacial trauma were available for review. When combining these studies a total of 1377 patients underwent surgery for correction of a maxillofacial fracture. Nine patients returned to the operating theatre for correction of the initial procedure after trauma (0.7%). The present results are in line with the available literature. Routine postoperative radiography is not necessary after surgical treatment of maxillofacial trauma. Avoiding routine postoperative radiography will lead to a reduction in exposure of patients to ionizing radiation, a reduction of costs and probably a more efficient discharge.