Do Post-injury Prophylactic Antibiotics Reduce Infection for Isolated Midface Fractures: A Cohort Study.

PURPOSE: Fractures of the midface are a core component to the practice of contemporary oral and maxillofacial trainees and surgeons. As such, in an era where antibiotic resistance is increasing it is important to investigate if antibiotics are required after midface fractures to prevent infections before follow-up in an outpatient setting. The purpose of this study is to determine whether postinjury prophylactic preoperative antibiotics reduce rates of infection after midface fracture. METHODS: A retrospective multicenter cohort study was conducted in Queensland, Australia. Patients who presented to Royal Brisbane Hospital and Townsville Hospital with isolated midface fractures between January 2017 and January 2019 were included. Clinical and demographic data of patients who received postinjury prophylactic antibiotics were compared to those who did not using the χ2 test. Logistic regression was used to determine factors associated with increased odds of postinjury prophylactic antibiotic prescription. RESULTS: In total, 1,353 patients with midfacial fractures over the 2-year period were included. In addition, 724 (53.5%) patients received postinjury antibiotics and 629 (46.5%) patients did not. The overall rate of infection was very low: 1 patient who received postinjury prophylactic antibiotics (0.1%) developed infection compared to 2 patients (0.3%) who did not receive postinjury prophylactic antibiotics, and this difference was not significant (χ2 = 0.49; P = .48). Male sex (odds ratio 1.4; 95% confidence interval, 1.1 to 1.7; P = .02) and tobacco use (odds ratio 1.4; 95% confidence interval, 1.1 to 1.7; P = .008) were associated with an increased odds of postinjury prophylactic antibiotic prescription in the univariate analyses, but were no longer significant once site, age, and fracture type were adjusted for in the multivariate model. CONCLUSIONS: The rate of infection after midface fracture was low and there was no significant difference in infection rates for patients who received postinjury prophylactic antibiotics compared to those who did not. Use of postinjury prophylactic preoperative antibiotics for midfacial fractures should be reconsidered.

Passive versus active drainage following neck dissection: a non-randomised prospective study.

Drainage is used following neck dissection to prevent the collection of fluid and aid healing. Active drains are thought to be more effective due to their ability to assist adherence of skin flaps and the minimisation of bacterial migration. There is controversy regarding the type of drain (active or passive) which should be used due to concerns about the potential for compromise of free flap pedicles with active drains. A prospective non-randomised study was undertaken to determine if there were any differences in neck healing following neck dissection between active and passive drains. A consecutive series of patients (the majority of whom had free flap reconstruction) were included over an 8 month period and were examined for delayed healing of the neck wound, flap loss, infection, haematoma and fistula. A total of 60 patients underwent 72 neck dissections during the study period (passive: 13, active: 47). The delayed healing rate in patients with passive drains was 54% compared with 6% for active drains (P < 0.001). This difference remained significant irrespective of surgeon grade, nodal status and whether or not a free flap was performed. There was no patient in whom the drain was thought to contribute to free flap loss. This non-randomised study has shown a significant difference in neck healing depending on the type of drain used following neck dissection. Despite the numerical differences between the groups the patients were relatively well matched for the parameters described. This difference in neck healing, combined with the lack of evidence for a contribution to flap loss, suggests active drains should be used following neck dissection in both free flap and non-free flap cases.

The patterns of facial injury suffered by patients in road traffic accidents: a case controlled study.

Road traffic accidents cause severe facial injuries and are frequently associated with injuries to other organ systems. The aims of this study were to define the facial injuries suffered by victims of road trauma and assess the need for a multidisciplinary approach to their management. A retrospective study of all patients over 14years of age suffering facial injuries over a five year period was conducted. Data was collected on the nature of their facial and other injuries and the impact of interspeciality management on their treatment. Four hundred and nine patients were identified. The midface was injured more frequently than the mandible and the majority of patients had multiple facial injuries. Neurologic, orthopaedic, thoracic and abdominal injuries were common and impacted on the management of the patients' facial trauma. Road traffic accidents cause more severe facial trauma than other mechanisms of injury. Other organ systems are more likely to be injured and the management of these injuries often impacts on their facial injury treatment demanding high levels of interspeciality cooperation.