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

Laryngoscope. 2010 Oct;120(10):1940-5. doi: 10.1002/lary.21081.


Objectives/hypothesis: 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.

Study design: Retrospective chart review and cohort analysis.

Methods: 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.

Results: 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.

Conclusions: 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.

MeSH terms

  • Adolescent
  • Adult
  • Aged
  • Aged, 80 and over
  • Antibiotic Prophylaxis*
  • Chi-Square Distribution
  • Child
  • Facial Injuries / surgery*
  • Female
  • Frontal Sinus / injuries*
  • Frontal Sinus / surgery*
  • Humans
  • Male
  • Middle Aged
  • Multiple Trauma / surgery*
  • Retrospective Studies
  • Skull Fractures / surgery*
  • Surgical Wound Infection / prevention & control*
  • Trauma Severity Indices
  • Treatment Outcome