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.

Rigid versus non-rigid fixation for bilateral mandibular angle fractures: a retrospective multicentre review.

BACKGROUND: Fractures involving the bilateral mandibular angle are an uncommon occurrence with limited evidence to inform the ideal fixation requirements for adequate treatment. The aim of this study was to evaluate the outcomes of managing bilateral mandibular angle fractures and determine if rigid fixation on one side improves outcomes compared to bilateral non-rigid fixation. METHODS: Patients with isolated bilateral mandibular angle fractures surgically treated at the Royal Brisbane and Women's Hospital, Princess Alexandra Hospital, Gold Coast University Hospital and Townsville University Hospital between January 1, 2010 and December 31, 2022 were retrospectively identified. Data collected included patient demographics, mechanism of injury, fixation scheme, postoperative occlusion and the occurrence of postoperative complications and subsequent management. RESULTS: Eighty-four patients met the inclusion criteria. Fifty-two patients had non-rigid fixation applied to both fractures, and thirty-two had rigid fixation placed on at least one side. All cases proceeded to union. There was no statistically significant difference between the groups for occlusal outcomes, wound dehiscence, infection or plate or screw loosening. CONCLUSION: Our results suggest that bilateral non-rigid fixation can be used to treat bilateral mandibular angle fractures in the appropriate clinical context.

Maxillofacial trauma.

BACKGROUND: Maxillofacial injuries are a common presentation to general practice and hospital emergency departments in Australia; surprisingly they can be easily overlooked at initial assessment. OBJECTIVE: This article describes the common typical clinical and radiographic findings in maxillofacial injuries that require further specialist treatment. Signs and symptoms requiring immediate treatment are highlighted and discussed individually. DISCUSSION: The full extent of functional disturbances might not be detectable in the first instance. Overlooked injuries may result in severe and enduring impairment of the patient and can have medicolegal ramifications.

Impact of extent of parotid resection on postoperative wound complications: a prospective study.

BACKGROUND: Sialocele and salivary fistula are common complications after parotidectomy. The purpose of the present study was to investigate whether extent of parotidectomy influences the incidence of these complications. METHODS: We conducted a prospective study of 66 consecutive parotidectomies. Cases undergoing skin or bone resection or flap reconstruction were excluded. Patients were divided into 2 groups based on extent of surgery: group 1 (extracapsular dissection or partial superficial parotidectomy); and group 2 (superficial parotidectomy or more extensive resection). The incidence of postoperative sialocele, salivary fistula, and facial weakness was studied. RESULTS: Eleven patients (16.7%) developed a sialocele, and 4 (6.1%) developed a salivary fistula. Group 1 had a significantly higher incidence of wound complications (p = .008), but a significantly lower incidence of facial weakness (p = .004). CONCLUSION: Less extensive parotid resection seems to be associated with a higher incidence of postoperative sialocele and salivary fistula, but is also associated with less postoperative facial nerve dysfunction.

Impact of current smoking and alcohol consumption on gastrostomy duration in patients with head and neck cancer undergoing definitive chemoradiotherapy.

IMPORTANCE: Prophylactic gastrostomy tube (GT) insertion prior to chemoradiotherapy is a valuable nutritional adjunct in patients with head and neck cancer undergoing nonsurgical treatment. However, concerns have been expressed regarding high rates of GT dependence. There is little information in the literature regarding the impact of modifiable risk factors such as smoking and alcohol consumption on duration of GT use and dependence rates. OBJECTIVE: To study the duration of GT use in patients with head and neck cancer at our institution and to investigate risk factors for prolonged GT duration and dependence, including the impact of smoking and alcohol consumption. DESIGN, SETTING, AND PARTICIPANTS: This retrospective study at an academic teaching hospital included 104 patients with squamous cell carcinoma of the head and neck undergoing definitive treatment with either chemoradiotherapy (n = 84) or radiotherapy alone (n = 20). INTERVENTIONS: Prophylactic GT insertion prior to commencement of treatment. MAIN OUTCOMES AND MEASURES: Duration of GT use after completion of chemoradiotherapy or radiotherapy and the impact of risk factors on same. Duration of GT use was analyzed using Kaplan-Meier survival curves, with censoring of patients who developed cancer recurrence or died. RESULTS: The median duration of GT use was 9 months. The actuarial GT persistence rate at 1 year was 35%. Current smoking (hazard ratio [HR], 0.47; 95% CI, 0.27-0.81; P = .01) and current heavy alcohol consumption (HR, 0.55; 95% CI, 0.32-0.97; P = .04) were significant predictors of GT persistence. On multivariate analysis, only current smoking remained significant (HR, 0.53; 95% CI, 0.30-0.94; P = .03). Age 65 years or older, advanced T classification, larynx and/or hypopharynx primary site, and posttreatment neck dissection were not significant risk factors. CONCLUSIONS AND RELEVANCE: Current smoking and current heavy alcohol consumption are predictive of prolonged GT requirement in patients with head and neck cancer undergoing prophylactic GT insertion before definitive radiotherapy or chemoradiotherapy. Further study is required to investigate whether smoking or drinking cessation can reduce GT dependence rates in this population.