Effects of Antibiotic Rinses on Maxillomandibular Advancement Surgical Site Complications

Introduction: The use of intraoperative antibiotics remains a divisive issue. We examined the utility of impregnation of sterile saline irrigation with antibiotics on maxillomandibular advancement surgical site complications.

Methods: We conducted a single center retrospective case series of patients who had undergone maxillomandibular advancement, during which either antibiotic-impregnated or non-antibiotic irrigation was used intraoperatively. We gathered demographic and sleep-related clinical data. Surgical site complication data within a 30-day post-operative period was also collected, including surgical site infections, non-infectious surgical site complications (e.g. hematoma, fistula, wound dehiscence), and readmissions.

Results: A total of 38 subjects were studied, 10 were female and 28 were male, with a mean age of 48.8 (standard deviation (SD)=10.3). Twenty-four (63%) received antibiotic irrigation intraoperatively, while 14 (37%) did not. Twenty-one (88%) subjects receiving antibiotic irrigation received Ancef irrigation, followed by 3 (12%) receiving clindamycin irrigation. There was a statistically significant difference in surgical site infections between the antibiotic irrigation and non-antibiotic irrigation groups (Chi-square=5.584, p-value=0.018), but no significant difference in all non-infectious surgical site complications (Chi-square=0.611, p-value=0.435) or readmissions (Chi-square=3.619, p-value=0.057) between the groups.

Conclusions: Perioperative antibiotic use is often controversial. Irrigation alone is extremely beneficial in reducing surgical complications, particularly infection risk. Antibiotic-impregnation of intraoperative irrigation may have a role in preventing at least surgical site infections post-operatively, but further study is needed.