Antibiotics in the Management of Non-Operative Midface Fractures
Objectives: Comparison of the infection rates of patients with non-operative midface fractures who received antibiotics in the post-trauma period with patients who did not receive antibiotics as well as identification of CT scan findings of increased risk of infection following trauma.
Study Design: Retrospective chart review and cohort analysis.
Methods: 116 patients with nonoperative midface fractures were included in the study and divided into two groups: those treated with broad spectrum antibiotics and those treated without antibiotics. Antibiotics were most commonly used for at least seven days and consisted of amoxicillin/clavulanate or clindamycin. Patients were followed within two weeks and evaluated for sinusitis. CT scan was used to compare the fracture site and degree of opacification of the paranasal sinuses. Those groups were further compared amongst multiple outcome variables including past medical history, comorbidities, and use of saline and oxymetazoline nasal sprays.
Results: 65 patients did not receive antibiotics and 51 patients did receive antibiotics in the post-trauma period. Infection rates were 6% versus 4%, respectively. This difference was not significant. Only 5% of the patients received saline and oxymetazoline nasal sprays and none had an infection at follow up. Paranasal sinus opacification involving multiple sinuses significantly increased the risk of infection.
Conclusions: The incidence of sinusitis in patients with nonoperative midface fractures is not related to the use of antibiotics. We observed an increased infection rate with involvement of multiple sinuses or history of chronic sinusitis. The use of antibiotics should be considered for those patients. Our data also shows a tendency of decreased infection rates with saline nasal irrigation and oxymetazoline nasal sprays.
Level of Evidence: 2b
Midface - fracture - antibiotics - lamina papyracea - orbit - paranasal sinus.