Surgical prophylaxis for oral maxillofacial surgery
Consider the principles for appropriate prescribing of surgical antibiotic prophylaxis (see Principles for appropriate prescribing of surgical antibiotic prophylaxis). See Oral maxillofacial procedures and their requirement for surgical antibiotic prophylaxis for the recommendations for surgical prophylaxis for oral maxillofacial surgery.
For perioperative management of complex and potentially contaminated open facial fractures, see Open fractures.
Although there is a risk of bacterial infection following procedures of the skin or subcutaneous tissue (including procedures that breach the oral mucosa), surgical antibiotic prophylaxis is not routinely indicated for clean or clean–contaminated procedures (see Centers for Disease Control and Prevention stratification of surgical wounds) of the skin or subcutaneous tissue. However, for patients with specific cardiac conditions (see here) who are undergoing a procedure that involves manipulation of the gingival or periapical tissue or perforation of the oral mucosa, prophylaxis against streptococcal endocarditis is required—see Endocarditis prophylaxis for dental procedures.
For a printable summary table of the indications and regimens for surgical antibiotic prophylaxis, see here.
|
Procedures |
Is surgical antibiotic prophylaxis indicated? |
|---|---|
|
clean or clean–contaminated procedures (see Centers for Disease Control and Prevention stratification of surgical wounds) not listed below procedures involving insertion of dental implants |
NO |
|
procedures involving insertion of prosthetic material, with the exception of dental implants open reduction and internal fixation of mandibular fractures or midfacial (eg Le Fort or zygomatic) fractures intraoral bone grafting procedures orthognathic surgery (major jaw realignment surgery) cleft lip and palate repairs |
YES [NB1] |
Note:
NB1: Although a single preoperative dose of surgical antibiotic prophylaxis is expected to be sufficient to prevent postoperative infection following orthognathic surgery, there is insufficient evidence to show that a single dose of prophylaxis is as effective as 24 hours of prophylaxis. Postoperative doses can be considered but prophylaxis (intravenous or oral) should not continue beyond 24 hours. | |
For prophylaxis for procedures involving incision through the oral mucosa only (eg cleft lip and palate repairs), use:
benzylpenicillin 1.2 g (child: 30 mg/kg up to 1.2 g) intravenously, within the 60 minutes before surgical incision; intraoperative redosing may be required (see here). Do not give additional doses once the procedure is completed1. surgical prophylaxis, oral maxillofacial benzylpenicillin
For prophylaxis for procedures involving incision through the skin and oral mucosa (eg temporomandibular joint replacement), use:
cefazolin 2 g (child: 30 mg/kg up to 2 g) intravenously, within the 60 minutes before surgical incision; intraoperative redosing may be required (see here ). Do not give additional doses once the procedure is completed1 surgical prophylaxis, oral maxillofacial cefazolin
PLUS
metronidazole 500 mg (child: 12.5 mg/kg up to 500 mg) intravenously, within the 120 minutes before surgical incision; intraoperative redosing may be required (see here ). Do not give additional doses once the procedure is completed1. metronidazole
For patients with immediate nonsevere or delayed nonsevere hypersensitivity to penicillins, use cefazolin plus metronidazole (as above). See also Surgical antibiotic prophylaxis for patients with a penicillin or cephalosporin allergy.
For patients with immediate severe or delayed severe hypersensitivity to penicillins, as a single drug, use:
clindamycin 600 mg (child: 15 mg/kg up to 600 mg) intravenously, within the 120 minutes before surgical incision; intraoperative redosing may be required (see here ). Do not give additional doses once the procedure is completed1. surgical prophylaxis, oral maxillofacial clindamycin