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Prophylactic Antibiotics Should Be Used Conservatively in Setting Mandibular Fractures

by Christopher Harryman, MD, Stephen Park, MD, and Samuel Oyer, MD •

TRIO Best PracticeTRIO Best Practice articles are brief, structured reviews designed to provide the busy clinician with a handy outline and reference for day-to-day clinical decision making. The ENTtoday summary below includes the Background and Best Practice sections of the original article. To view the complete Laryngoscope articles free of charge, visit Laryngoscope.com.

BACKGROUND

Mandible fractures are a common clinical problem encountered by otolaryngologists. While all injuries with signs of active infection warrant antimicrobial therapy, there is variability regarding when and how to use prophylactic antibiotics. To enable better evidence-based management of patients, the current literature on this topic was reviewed.

BEST PRACTICE

The current literature, including meta-analyses and systematic reviews incorporating data from 54 separate studies, suggests that prophylactic antibiotics be used conservatively in the setting of mandibular trauma. Current consensus and evidence support the use of perioperative antibiotics, though the articles included in this review did not assess this treatment in the same level of detail as preoperative and postoperative prophylaxis. There is some weak evidence that preoperative antibiotics are beneficial in the setting of comminuted or compound fractures of the mandible, as defined by fracture involving a tooth-bearing mandibular segment or gingival laceration with exposed bone. Further studies of higher quality are needed to better delineate this benefit. There is no evidence to suggest that postoperative antibiotics provide a benefit. These recommendations relate to prophylactic use, with signs of infection warranting treatment.

Unfortunately, many of the studies included lack specific inclusion/exclusion criteria regarding fracture location, complexity, time from fracture to repair, and involvement of diseased teeth. These factors should also be considered in patient care. Additional well-designed prospective cohort studies or randomized control trials would be beneficial in further elucidating the role of antimicrobials in the setting of mandibular trauma.