Antibiotic prophylaxis in the management of complex midface and frontal sinus trauma

Although mandible trauma has been studied extensively, there is no standard for use of pre- and postoperative antibiotics in other facial trauma. We sought to determine whether antibiotic strategies have an effect on infection rates.

Retrospective chart review and cohort analysis.

Patients seen by the otolaryngology service for traumatic facial injuries between January 1, 2003 and January 1, 2009, were included in a retrospective cohort analysis (N = 223). All patients received perioperative antibiotic coverage. Isolated mandible fractures were excluded.

Patient demographics were 73% male and 27% female, with an average age of 35 years (range, 8-81 years). The most common causes of trauma were assault (39%), motor vehicle accidents (28%), and falls (11%). The overall infection rate was 9%. There was no significant difference (P = .248) between infection rates for patients in each antibiotic group (preoperative, postoperative, pre- and postoperative, only perioperative). Infection rate was independently correlated with both number of fractures (P < .0001) and open fracture wounds (P = .034). There was no significant difference in infection rate between patients who received only perioperative antibiotics and those who received additional antibiotics (P = .997). However, the cohort with the most antibiotic use (pre-, peri-, and postoperative) had more severe facial injuries than the cohort that received only perioperative antibiotics.

The use of additional antibiotics outside the perioperative timeframe does not reduce the rate of postoperative infections; however, such antibiotic use may be warranted in cases of severe facial trauma with multiple open fracture wounds. Laryngoscope, 2010.