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Systemic Preoperative Antibiotics with Mandible Fractures: Are They Indicated at the Time of Injury?

Linkugel, Andrew (Division of Plastic and Reconstructive Surgery, Washington University in Saint Louis School of Medicine, Saint Louis, Missouri ) ; Odom, Elizabeth (Division of Plastic and Reconstructive Surgery, Washington University in Saint Louis School of Medicine, Saint Louis, Missouri ) ; Bavolek, Rebecca (Division of Emergency Medicine, Washington University in Saint Louis School of Medicine, Saint Louis, Missouri ) ; Snyder-Warwick, Alison (Division of Plastic and Reconstructive Surgery, Washington University in Saint Louis School of Medicine, Saint Louis, Missouri ) ; Patel, Kamlesh (Division of Plastic and Reconstructive Surgery, Washington University in Saint Louis School of Medicine, Saint Louis, Missouri ) ;
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    Abstract Mandible fractures are the most common result of facial trauma. The proximity of oral flora to the site of both the injury and resulting surgical instrumentation makes managing infection a unique challenge. The benefit of antibiotic prophylaxis at the time of surgical treatment of mandible fractures is well established. However, the routine use of antibiotics between the time of injury and surgery is of unclear benefit. We aim to define the role of antibiotics in the preoperative period: from the time of injury to surgical intervention. Demographic and clinical data were collected retrospectively on all patients who were treated for mandible fracture by the Division of Plastic and Reconstructive Surgery at our institution between 2003 and 2013. The use of both preoperative (between injury and surgery) and perioperative (at the time of surgery) systemic antibiotics was recorded along with the incidence of postoperative infections and other complications. Complete data were available for 269 patients. Of the 216 patients who received preoperative antibiotics, 22 (10%) developed an infection postoperatively. Of the 53 patients who did not receive preoperative antibiotics, 2 (4%) developed infection (p = 0.184). Likewise, preoperative antibiotics were not significantly associated with hardware complication rates. In our retrospective review, the use of antibiotics between injury and surgical repair had no impact on postoperative infection rates. These data suggest that preoperative antibiotic use may actually be associated with an increased incidence of postoperative infection. Our results do not support the routine use of antibiotics between injury and surgical repair in patients with mandible fractures.


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