The Laryngoscope V C 2010 The American Laryngological, Rhinological and Otological Society, Inc. Antibiotic Prophylaxis in the Management of Complex Midface and Frontal Sinus Trauma Alexander Lauder, BA; Scharukh Jalisi, MD; Jeffrey Spiegel, MD; John Stram, MD; Anand Devaiah, MD Objectives/Hypothesis: Although mandible trauma has been studied extensively, there is no standard for use of pre- and postoperative antibiotics in other facial trauma. We sought to determine whether antibiotic strategies have an effect on infec- tion rates. Study Design: Retrospective chart review and cohort analysis. Methods: Patients seen by the otolaryngology service for traumatic facial injuries between January 1, 2003 and January 1, 2009, were included in a ret- rospective cohort analysis (N ¼ 223). All patients received perioperative antibiotic coverage. Isolated mandible fractures were excluded. Results: Patient demographics were 73% male and 27% female, with an average age of 35 years (range, 8–81 years). The most common causes of trauma were assault (39%), motor vehicle accidents (28%), and falls (11%). The overall infection rate was 9%. There was no significant difference (P ¼ .248) between infection rates for patients in each antibiotic group (preoperative, postoperative, pre- and postoper- ative, only perioperative). Infection rate was inde- pendently correlated with both number of fractures (P < .0001) and open fracture wounds (P ¼ .034). There was no significant difference in infection rate between patients who received only perioperative antibiotics and those who received additional antibiot- ics (P ¼ .997). However, the cohort with the most an- tibiotic use (pre-, peri-, and postoperative) had more severe facial injuries than the cohort that received only perioperative antibiotics. Conclusions: The use of additional antibiotics outside the perioperative timeframe does not reduce the rate of postoperative infections; however, such an- tibiotic use may be warranted in cases of severe facial trauma with multiple open fracture wounds. Key Words: Facial trauma, surgical prophylaxis, antibiotics, zygoma, maxilla, orbit, nasal, alveolar, frontal sinus, palate, tripod, LeFort. Level of Evidence: 2b Laryngoscope, 120:1940–1945, 2010 INTRODUCTION Approximately 3 million individuals suffer from blunt or penetrating traumatic facial injuries each year in the United States. 1 Facial injuries pose a significant burden to public health in terms of high comorbidity, mortality, and cost. 2–6 Management of facial trauma of- ten results in surgical intervention. Use of antibiotic prophylaxis in cases of clean and clean-contaminated fa- cial surgery has been well established. Patients receiving antibiotic treatment within the 2 hours before surgery have lower rates of surgical-site infections (SSI) than patients who receive antibiotics outside of this timeframe. 7,8 The current standard of care, as stated in the 2006 guidelines from the Medical Letter and the National Surgical Infection Prevention Project, is periop- erative antimicrobial prophylaxis for otolaryngologic surgery involving incisions through the oral or pharyn- geal mucosa 9,10 ; an association with reduced infection has been seen previously with this method. 11 However, there is little data regarding the efficacy of additional antibiotic treatment outside of this timeframe in reduc- ing SSI rates. Specifically, there have been no previous analyses of infection outcomes in patients receiving varying combinations of pre-, peri-, and postoperative antibiotics. Furthermore, some studies suggest no signif- icant benefit of antibiotic prophylaxis in clean otolaryngologic operations. 11,12 It has become common practice for hospitals to closely monitor and even restrict antibiotics given to sur- gical patients owing to the associated risks of antibiotic treatment. 13–16 It is therefore important to understand the efficacy of antibiotic treatment and the ideal timing From the Boston University School of Medicine (A.L., S.J., J.SPIEGEL, J.STRAM, A.D.), Department of Otolaryngology–Head and Neck Surgery (S.J., J.SPIEGEL, J.STRAM, A.D.), Department of Neurological Surgery (S.J.), and Department of Neurological Surgery and Reconstructive Surgery (J.SPIEGEL, A.D.), Boston Medical Center, Boston, Massachusetts (S.J., J.SPIEGEL, J.STRAM, A.D.), U.S.A. Editor’s Note: This Manuscript was accepted for publication April 20, 2010. Presented as a poster at the Triological Society Combined Sections Meeting, Orlando, Florida, U.S.A., February 5, 2010. The Boston University School of Medicine Summer Research Fel- lowship was awarded to Alexander Lauder, BA, for a 3-month research program in the Department of Otolaryngology at Boston Medical Center. The authors have no other funding, financial relationships, or conflicts of interest to disclose. Send correspondence to Anand K. Devaiah, MD, Department of Otolaryngology–Head and Neck Surgery, Boston Medical Center, 820 Harrison Ave., FGH Building, 4th Floor, Boston, MA 02118. E-mail: anand.devaiah@bmc.org DOI: 10.1002/lary.21081 Laryngoscope 120: October 2010 Lauder et al.: Antibiotics in Facial Trauma Surgery 1940