Orthognathic surgery for the correction of dentofacial and craniofacial deformities has become a common a common procedure. Postoperative infection rates have been reported between 2-33%. The aim of this review was to provide evidence-based recommendations on the efficacy of different antibiotic regimens in preventing postoperative infections after orthognathic surgery

Searches were conducted in Embase, Ovid Medline, and the Cochrane databases and the reference lists of identified papers.  Only randomised controlled trials (RCTs) in English were included. Study selection and quality assessment for conducted by two reviewers. Data abstraction was performed by one reviewer and checked by a second.  A qualitative summary of the included studies was presented.

• 11 studies were included, 3 were considered at low risk of bias, 8 at high risk.
• Most studies compared preoperative and perioperative antibiotic prophylaxis with or without continuous postoperative administration.
• One of the high quality studies (n=54) found a preoperative dose of antibiotics was effective in reducing postoperative infection;
• The other two high quality studies (n=112) concluded that additional postoperative antibiotics have no significant effect on the postoperative infection rate.

The authors concluded: –

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.

Comment

As noted by the authors the methodological quality of the available studies was poor. There is also marked heterogeneity in the antibiotic regimens tested. There have also been two previous systematic reviews published in 2011 (Danda & Ravi; Tan et al) with Danda and Ravi concluding, that postoperative antibiotic prophylaxis reduces the postoperative infection rate and Tan et al suggesting no efficacy of continuous post- operative administration of antibiotics.  The Tan review only included 5 studies while the Danda review had 8.  While this review contains more studies the overall quality of the available studies is poor so more high quality studies are need to establish the more effective antibiotic regimens for this type of surgery.

Links

Oomens MA, Verlinden CR, Goey Y, Forouzanfar T. Prescribing antibiotic prophylaxis in orthognathic surgery: a systematic review. Int J Oral Maxillofac Surg. 2014 Mar 2. pii: S0901-5027(14)00054-X. doi: 10.1016/j.ijom.2014.01.012. [Epub ahead of print] Review. PubMed PMID: 24598429.

Tan SK, Lo J, Zwahlen RA. Perioperative antibiotic prophylaxis in orthognathic surgery: a systematic review and meta-analysis of clinical trials. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2011 Jul;112(1):19-27. doi: 10.1016/j.tripleo.2010.07.015. Epub 2010 Dec 17. Review. PubMed PMID: 21168350.

Danda AK, Ravi P. Effectiveness of postoperative antibiotics in orthognathic surgery: a meta-analysis. J Oral Maxillofac Surg. 2011 Oct;69(10):2650-6. doi: 10.1016/j.joms.2011.02.060. Epub 2011 May 6. Review. PubMed PMID: 21549486.