Purpose The purpose of this retrospective study was to determine the prevalence of surgical site infection (SSI) after orthognathic surgery at the Department of Oral and Maxillofacial Surgery of ...Capital Health and Dalhousie University (Halifax, NS, Canada). Patients and Methods A retrospective chart review of all patients undergoing orthognathic surgery from October 2005 through April 2013 was performed. The outcome variable was SSI. The primary predictor variable was the antibiotic used for prophylaxis. The secondary predictor variables were patient demographics, such as age, gender, medical comorbidities, and smoking status; duration of surgery; wisdom teeth extractions; single-jaw or bimaxillary surgery; and type of surgery. Data also were gathered on the diagnosis of SSIs and the treatment to resolve these infections. Results In total, 2,521 patients underwent surgery, and 253 patients did not meet the inclusion criteria; therefore, the charts of 2,268 patients were reviewed (mean ± standard deviation, 26.9 ± 11.7 yr of age). Eight percent of patients developed an SSI. None of the patient demographics was associated with an increased risk for infection. Most initial infections (62%) and most recurrent infections (78%) occurred in the mandible. Twenty-six percent of patients who developed SSIs had recurrent infections after antibiotic treatment. SSIs necessitated hardware removal for 14% of patients. Adverse effects from the antibiotics were seen in 4.2% of patients. Infection was most frequently diagnosed 11 to 15 days postoperatively. The average length of surgery for patients who did not have an SSI was 136 minutes compared with an average of 157 minutes for patients who had an SSI (odds ratio = 1.0051; 95% confidence interval, 1.0026 to 1.0076; P < .001). Wisdom teeth were extracted in 49.6% of the 2,268 cases. The mean SSI prevalence for multiple jaw procedures (9.2%) was significantly higher than that for single surgical procedures (5.3%; P = .0013). Isolated Le Fort surgeries had a significantly lower prevalence of infection compared with the mean prevalence (3.9%; P = .02), whether they were single piece or segmented (3.5 and 4.3%, respectively; P = .98). The prevalence of infection was significantly lower in the cefazolin group (6.2%) compared with the penicillin (14.3%; P < .0001) and clindamycin (10.4%; P < .02) groups. Conclusions The prophylactic use of first-generation cephalosporins, such as cefazolin, appears to be more effective than penicillin and clindamycin for preventing SSIs in orthognathic surgery. In addition, bimaxillary surgery, mandibular procedures, and duration of surgery might demand antibiotic prophylaxis that is more effective. The presence of third molars and patient demographics are not risk factors for SSIs. A prospective randomized controlled study is underway to investigate the findings of this study.
The purpose of this study was to determine the effect of a 3- versus 1-day antibiotic regimen on the rate of surgical site infection (SSI) in patients undergoing orthognathic surgery at a department ...of oral and maxillofacial surgery in Halifax, Nova Scotia, Canada.
A prospective, randomized controlled trial was conducted. All patients received 1 day of intravenous antibiotics after surgery. Then, patients were randomly distributed into groups that received 2 days of additional antibiotics (group A) or placebo (group B). The primary outcome measured was the presence of SSI. The operating surgeon, concomitant extraction of teeth, surgical procedures performed, duration of intermaxillary fixation, and length of hospital stay were analyzed for an effect on SSI. Patients were followed for 1 year after surgery to identify SSIs that might have been diagnosed outside the hospital.
The trial started with 288 patients, and 117 patients were lost to follow-up. Statistical analyses were ultimately performed on those 171 patients who were adherent to the study medication regimen. Group A (n = 86) and B (n = 85) SSI rates were 7.0 and 17.6% (number needed to treat = 10; P = .04), respectively. Mandibular bilateral sagittal split osteotomy (BSSO) was involved in 71% of SSIs. Intra- and postoperative surgical variables did not have a relevant effect on the SSI rate. Patients were followed for 1 year after surgery, and group A (n = 46) and group B (n = 44) had SSI rates of 4 and 25% (P < .05), respectively.
Three days of postoperative cefazolin and cephalexin markedly decreases SSI rates compared with 1 day. However, the number needed to treat of 10 suggests that the benefits of the extended regimen might not outweigh the risks. The high prevalence of SSIs at the mandibular BSSO incisions might have been caused by contamination, with more saliva and reception of a lower blood supply, than maxillary Le Fort I incisions. Mandibular osteotomies could benefit from an extended antibiotic regimen to minimize SSIs and associated complications. Other surgical variables might not require special consideration for antibiotic therapy.
Purpose The purpose of this study was to investigate prospectively the effects of the presence or absence of third molars during sagittal split osteotomies (SSOs) on the frequency of unfavorable ...fractures, degree of entrapment and manipulation of the inferior alveolar nerve (IAN), and procedural time. Materials and Methods The investigators designed and implemented a prospective cohort study and enrolled a sample composed of patients who underwent SSOs to correct mandibular deformities. The primary predictor variable was the status of the mandibular third molar at the time of SSO, and it was divided into 2 levels, present at the time of SSO (group I) or absent at the time of SSO (group II). The primary outcome variable was unfavorable splits. The secondary outcome variables were the degree of entrapment/manipulation of the IAN and the procedural time. Appropriate bivariate and multivariate statistics were computed, and the level of statistical significance was set at P < .05. Results Six hundred seventy-seven SSOs were performed in 339 patients: group I consisted of 331 SSOs (mean age ± SD: 19.6 ± 7.4 yrs), and group II consisted of 346 SSOs (30.4 ± 12.1 yrs). The overall rate of unfavorable fractures was 3.1% (21 of 677), with frequencies of 2.4% (8 of 331) in group I, compared with 3.8% (13 of 346) in group II ( P = .3). The rate of IAN entrapment in the proximal segment was significantly lower in group I (37.2%) than in group II (46.5%; P = .01). The degree of entrapment was also significantly more severe for group II ( P < .001). Third molars increased procedural time by 1.7 minutes ( P < .001). Conclusions The presence of third molars during SSOs is not associated with an increased frequency of unfavorable fractures. Concomitant third molar removal in SSOs also decreases proximal segment IAN entrapment but only slightly increases operating time.
Purpose The purpose of this study was to assess the predictability of sentinel lymph node biopsy (SNB) for oral squamous cell carcinoma (OSCC) when pathologic processing is performed without serial ...step sectioning. Materials and Methods We prospectively enrolled 36 patients with T1 or T2 cN0 OSCC into this institutional review board–approved prospective cohort study, and they underwent gamma probe–guided SNB in addition to selective neck dissection. The rate of patients with negative SNB results whose neck dissection was also negative for metastasis (negative predictive value) was the primary endpoint. Results Of the 28 patients whose sentinel lymph nodes were found to be pathologically and clinically node negative by routine hematoxylin-eosin stain and immunohistochemistry, 27 were found to have no other pathologically positive nodes, corresponding to a negative predictive value of 96%. Conclusion The results of this study suggest that SNB performed without the use of thin serial step sectioning may accurately predict neck stage in OSCC.
Repair of fractures involving the nasofrontal region remains a mainstay of contemporary oral and maxillofacial surgery. This article discusses the epidemiology of these injuries, anatomy of the area, ...and management of these fractures with insight into potential complications. These include fractures of the frontal sinus, naso-orbital-ethmoidal region, root of the nose, and associated adjacent structures.
Purpose The purpose of this study is to determine the effect of a 3- vs. 1-day antibiotic regimen on the rate of surgical site infection (SSI) in patients undergoing orthognathic surgery at the ...Department of Oral and Maxillofacial Surgery in Halifax, Nova Scotia, Canada. Patients and Methods A prospective, randomized controlled trial (RCT) was conducted. All patients received 1 day of intravenous (IV) antibiotics following surgery. The patients were then randomly distributed into groups that received 2 days of additional antibiotics (Group A) or placebo (Group B). The primary outcome measured was the presence of SSI. The operating surgeon; concomitant extraction of teeth; surgical procedures performed; duration of intermaxillary fixation (IMF) and length of hospital stay were analyzed for an effect on SSI. Patients were followed for 1 year following surgery to identify SSIs that may have been diagnosed outside of our hospital. Results The trial started with 288 patients, and 117 patients were lost to follow-up. Statistical analyses were ultimately performed on those 171 patients who were adherent to the study medication regimen. Group A (n=86) and B (n=85) SSI rates were 7.0 and 17.6% (p=0.04; NNT=10), respectively. The mandible/bilateral sagittal split osteotomy (BSSO) was involved in 71% of SSIs. Intra- and post-operative surgical variables did not have a significant effect on the SSI rate. Patients were followed for 1 year following surgery, where Group A (n=46) and Group B (n=44) had an SSI rate of 4 and 25% (p<0.05), respectively. Conclusions Three days of post-operative cefazolin/cephalexin significantly reduces SSI rates compared with 1 day. However, the NNT of 10 suggests that the benefits of the extended regimen may not outweigh the risks. The high prevalence of SSIs at the mandibular/BSSO incisions may be caused by contamination with more saliva and reception of a lower blood supply than maxillary/Le Fort I incisions. Mandibular osteotomies may benefit from an extended antibiotic regimen to minimize SSI and associated complications. Other surgical variables may not require special consideration for antibiotic therapy.
The demonstration that angiogenic growth factors can stimulate new blood vessel growth and restore perfusion in animal models of myocardial ischemia has led to the development of strategies designed ...for the local production of angiogenic growth factors in patients who are not candidates for conventional revascularization. The results of recent clinical trials of proangiogenesis gene therapy have been disappointing; however, significant limitations in experimental design, in particular in gene transfer strategies, preclude drawing definitive conclusions. In the REVASC study cardiac gene transfer was optimized by direct intramyocardial delivery of a replication-deficient adenovirus-containing vascular endothelial growth factor (AdVEGF121, 4 x 10(10) particle units (p.u.)). Sixty-seven patients with severe angina due to coronary artery disease and no conventional options for revascularization were randomized to AdVEGF121 gene transfer via mini-thoracotomy or continuation of maximal medical treatment. Exercise time to 1 mm ST-segment depression, the predefined primary end-point analysis, was significantly increased in the AdVEGF121 group compared to control at 26 weeks (P=0.026), but not at 12 weeks. As well, total exercise duration and time to moderate angina at weeks 12 and 26, and in angina symptoms as measured by the Canadian Cardiovascular Society Angina Class and Seattle Angina Questionnaire were all improved by VEGF gene transfer (all P-values at 12 and 26 weeks < or =0.001). However, if anything the results of nuclear perfusion imaging favored the control group, although the AdVEGF121 group achieved higher workloads. Overall there was no significant difference in adverse events between the two groups, despite the fact that procedure-related events were seen only in the thoracotomy group. Therefore, administration of AdVEGF121 by direct intramyocardial injections resulted in objective improvement in exercise-induced ischemia in patients with refractory ischemic heart disease.
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