In mandibular open fractures, delaying repair may increase bacterial load and osseous devascularization, so early immobilization is recommended. Airway compromise and hemorrhage are also indications for acute reduction. Īcute reconstruction is indicated in orbital fractures with muscle entrapment to prevent muscle atrophy. The timing for repair relies mostly on surgeon’s preference, hospital resources, and the clinical presentation. Immediate reconstruction is done within 2 weeks and delayed reconstruction is considered at any time after 2 weeks. Sinus precautions such as no nose blowing, sneezing with an open mouth, and avoidance of straws may prove to be most important.Īcute treatment is done within 72 h after trauma. To date, no proven benefits exist in the literature. įor midface fractures, as the sinuses are thought to be a source of contamination, some surgeons prescribe prophylactic antibiotics to prevent orbital cellulitis and wound infection. Longer postoperative antibiotic therapy has not been proven beneficial and may lead to drug complications. A systematic review conducted by Andreasen showed a lower infection rate for mandibular fractures that were put on a short-term antibiotic regimen (less than 48 h peri- and postoperatively). These fractures may benefit from antibiotic coverage to prevent postoperative infection. Open jaw (maxilla and mandible) fractures are contaminated by saliva through the sulcus of the teeth or mucosal lacerations. Ī distinction to be made is “open” versus “closed” fracture. The midface as well as the condylar head of the mandible are at low risk of postoperative infection as compared to the angle, body, and symphysis of the mandible (tooth-bearing segments). In general, facial fractures are at low risk of postoperative infection. Cephazolin and clindamycin are the two antibiotics more frequently used in the perioperative period.
This practice should be rethought given the increase in antibiotic resistance and antibiotic-associated complications such as Clostridium difficile colitis. The practice of protracted courses of pre- and postoperative antibiotics despite the lack of supporting evidence persists. There are no questions about the necessity of antibiotics during the perioperative time and in the presence of an infected wound. When considering antibiotic therapy, the risks factors for infection need to be assessed. The use of antibiotics in maxillofacial fractures remains controversial. Clinical examination and computed tomography imaging are the gold standards in the diagnosis, planning, and management of maxillofacial fractures.
Securing the airway needs to be addressed prior to any other evaluation/treatment as per ATLS guidelines. Upper airway obstruction can be secondary to hemorrhage, edema, displaced or comminuted fractures, and foreign bodies such as dentures. In maxillofacial trauma, airway assessment represents a key part of the clinical examination. Patients with multiple facial fractures are more likely to have a concomitant head injury (66 to 89 %) compared to patients with a single facial fracture.
Depending on the population, orthopedic injuries represent about 50−64 % of these associated injuries with head injuries representing about 16−54 % of them next come after the cutaneous, the cervical spine, and the pulmonary injuries. Ĭoncomitant injuries occur in about 16−35 % of cases with maxillofacial injuries. Nasal fractures are the most frequent, followed by dentoalveolar and mandibular fractures, midface and orbital floor fractures, and then frontal sinus. More recently, in North America and Europe, an increase in IPV is noted. MVCs are the most important mechanism worldwide. Their respective prevalence is geographically dependent. The most frequent causes of facial fractures are motor vehicle collision (MVC), interpersonal violence (IPV), falls, and sports-related accidents. Facial fractures occur most commonly in males in the third decade of life.
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