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This paper from the Netherlands looked at 137 patients over a one-year period, 18 of whom had Le Fort I procedures, 68 bilateral sagittal split surgery, and 51 bi-maxillary surgery. A further 54 surgical procedures were undertaken, including 15 having a genioplasty and 39 having one or more third molar teeth removed. The surgery never exceeded an operating time of three hours and blood loss never greater than 1.5 litres. Twenty patients had a postoperative infection as defined by purulent discharge with isolated organisms, and a clinical diagnosis of infection with pain, swelling, redness or heat. All patients had Cephalosporin and Metronidazole before induction or Clindamycin if there was a Penicillin allergy. No postoperative antibiotics were prescribed. The overall infection rate was 14.6% noting that the literature suggests clean contaminated oral and maxillofacial surgery has an infection range of 1.4-21.4%. All the infections were located in the mandible, were low grade, and only required minor treatment. There was no association with patients age, sex, ASA classification, removal of third molar teeth or genioplasty. They advocate that whilst this infection rate is slightly on the high side within the quoted range, postoperative antibiotics after orthognathic surgery is questionable.

Antibiotics and orthognathic surgery, a retrospective analysis and identification of risk factors for post-operative infection.
Van Camp P, Verstraete L, Van Loon B, et al.
2020;S0901-5027(20):30376-3. Epub ahead of print.
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Stuart Clark

Manchester Royal Infirmary, Manchester, UK.

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