Orthognathic Surgery and Peri Operative Antibiotic Use
Purpose : The purpose of this study was to determine the most effective duration of antibiotic prophylaxis following orthognathic surgery. Methods: A survey of Canadian Oral and Maxillofacial surgeons (OMFS), a retrospective chart analysis, and a prospective randomized controlled trial was conducted. All patients received 1 day of IV antibiotics and then were randomized into an active antibiotic or placebo group for 2 additional days. The primary outcome measured was the presence of surgical site infection (SSI). The surgical procedures performed, duration of surgery, duration of MMF and hospital stay, concomitant extraction of teeth, and operating surgeon were documented and analyzed for effect on SSI. Results: A survey of 115 OMFS in Canada showed varying regimens for post operative antibiotic use. The most common antibiotic was cefazolin for 24 hours post operatively. One week of antibiotics was prescribed by 43.7% of respondents. A retrospective analysis of 2268 patients found a statistically lower rate of SSI with cefazolin(6.2%) compared to penicillin(14.3%) and clindamycin(10.4%). The prospective trial consisted of 288 patients, of whom 171 were adherent to the study medication. The active antibiotic group SSI rate was 7.0% compared to the placebo group SSI rate of 17.6% (p=0.04). Patients that were followed for 1 year also showed statistically significant difference in rate of SSI, (active group 4%, placebo group 25%, p<0.05). When SSI occurred, the mandible was involved 71% of the time. Conclusion: Cefzolin is the most effective antibiotic to use following orthognathic surgery. Extending antibiotic coverage for a total of 3 days decreases the risk of SSI. The greatest effect is in patients undergoing bilateral sagittal split osteotomies.