Excluding Antibiotics in the Management of Nonoperative Orbital and Zygomatic Fractures.

INTRODUCTION: Indications for prophylactic antibiotic therapy in nonoperative, closed fractures of the orbit and zygoma remain controversial and are based on anecdotal data. The purpose of this study was to report the incidence of infectious sequelae among patients who presented to our institution with stated fractures and who were not administered prophylactic antibiotic therapy. The authors hypothesized that an increase in infectious complications would not be seen in these patients. METHODS: The authors conducted a prospective single site study from October 2015 to December 2019. Patients with closed, nonoperative fractures involving the orbit and/or zygoma were included. These patients did not receive prophylactic antibiotic therapy for their fracture patterns, and infectious complications including orbital cellulitis, meningitis, and bacterial sinusitis were noted if present during follow-up. RESULTS: Of 301 patients with closed, nonoperative orbital and/or zygomatic fractures, 268 were included in the study and 33 were excluded because of administration of antibiotics. The average age was 60 years, and the most common mechanism of injury was a traumatic fall. Fracture types included 100 orbital wall, 133 orbital floor, 15 orbital rim, 23 orbital roof, 48 zygoma, and 44 zygomaticomaxillary compound fractures. Infectious sequelae were not identified in any patient. CONCLUSIONS: Of the 268 patients included in the study, no infectious complications were identified during the follow-up period. This outcome further supports that the use of prophylactic antibiotics is not indicated for closed, nonoperative fractures involving the orbital and/or zygoma. Prospective randomized control studies would be useful to support this outcome and better guide clinical antibiotic prescribing practices.

The role of postoperative prophylactic antibiotics in the treatment of facial fractures: a randomised, double-blind, placebo-controlled pilot clinical study. Part 3: Le Fort and zygomatic fractures in 94 patients.

The aim of this study was to evaluate the difference between the effect of a 5-day and a 1-day postoperative course of antibiotics on the incidence of infection after midfacial fractures. A total of 98 patients with displaced Le Fort or zygomatic fractures that required operation were randomly assigned into 2 groups, both of which were given amoxicillin/clavulanic acid 1.2g intravenously every 8h from the time of admission until 24h postoperatively. The 5-day group was then given amoxicillin/clavulanic acid 625 mg orally 8-hourly for another 4 days. The 1-day group was given placebo orally at the same time points. Patients were followed up 1, 2, 4, 6, and 12 weeks, and 6 months, postoperatively. The development of an infection of the wound was the primary end point. Ninety-four of the 98 patients completed the study. Two of the 45 patients in the 5-day group (4%) and 2/49 in the 1-day group (4%) developed postoperative wound infections. One in each group had a purulent infection, while the others had only wound breakdown. Two patients of the 5-day group and one in the 1-day group developed rashes on the trunk. There were no significant differences in the incidence of infection or side effects between the groups. In midfacial fractures a 1-day course of antibiotics postoperatively is as effective in preventing infective complications as a 5-day regimen.

[Osteosynthesis with 2-octylcyanoacrylate and sodium bicarbonate in zygomatic arch fractures: animal model results]. / 2-octilcianoacrilato y bicarbonato de sodio para osteosíntesis de arco cigomático. Un modelo animal.

BACKGROUND: 2-octylcyanoacrylate (2OCA) is a liquid monomer that polymerizes on contact with a surface by an exothermic reaction creating a strong and flexible film. The addition of sodium bicarbonate accelerates the polymerization. The aim was to use the combination of 2OCA and sodium bicarbonate in the treatment of zygomatic arch fractures in an animal model and to evaluate the biocompatibility and bone healing. METHODS: twenty animals were subjected to bilateral zygomatic arch fracture under surgical sedation, and using 2OCA fixation and sodium bicarbonate for the experimental side and without fixation for the control side. Observation was over a period from two to four weeks, assessing biocompatibility, stability and consolidation. RESULTS: at the end of two and four weeks the twenty animals showed the presence of osseous callus and continuity of marrow channel measured by macroscopic and radiography examinations. CONCLUSIONS: the use of 2-octylcyanoacrylate and sodium bicarbonate led to the stabilization and reduction of bilateral zygomatic arch fractures in an animal model without adverse reactions.

Epidemiología del trauma maxilofacial por accidente ciclístico / Epidemiology of the maxillofacial trauma caused by bicycle accident

Se realizó un estudio descriptivo y transversal sobre aspectos epidemiológicos del trauma maxilofacial por accidentes ciclísticos en 194 pacientes con diagnóstico clínico, radiográfico o ambos, de lesiones en esta región, que fueron recibidos y atendidos en el Servicio de Urgencia de Cirugía Maxilofacial del Hospital Clinicoquirúrgico "Saturnino Lora" de Santiago de Cuba, durante el período comprendido desde el 1 de octubre de 1998 hasta el 31 de diciembre de 1999. Entre los resultados más sobresalientes figuraron el predominio de los adultos jóvenes de 20 a 39 años de edad, sobre todo de los varones, la caída como modalidad de accidente, la colisión como la causante del mayor número de lesionados graves y defunciones. La imprudencia e ingestión de alcohol en conductores laboralmente activos resultaron ser las causas y víctimas que prevalecieron en este tipo de accidente, particularmente en el horario de 4 p.m. a 12 a.m. y en la calle, esta última la vía donde más accidentes y lesionados se produjeron. Las contusiones y laceraciones dentro de los tejidos blandos y las fracturas zigomáticas, nasales y palatoalveolares dentro del tejido duro, resultaron los patrones de lesiones predominantes(AU)

A descriptive cross-sectional study on epidemiological aspects of the maxillofacial trauma caused by bicycle accidents was conducted among 194 patients with clinical or radiographic diagnosis, or both, of injuries in this region. They received attention at the Emergency Service of Maxillofacial Surgery of "Saturnino Lora" Clinical and Surgical Hospital, in Santiago de Cuba, from October 1st, 1998 to December 31st, 1999. Some of the most significant results were: the predominance of young adults aged 20-39, mainly males, among the victims, the fall as an accident modality, the collision as the cause of the highest number of severe injures and deaths, and imprudence and alcohol ingestion in working drivers. These were some of the prevailing causes in this type of accident, ocurring particularly from 4 pm to 12 am, in the street, where most of the accidents and injuries are reported. The contusions and lacerations within the soft tissues and the zygomatic, nasal and palatoalveolar fractures in the hard tissue were the predominating injury patterns(AU)