Antibiotic prophylaxis for mandibular advancement with bilateral sagittal split osteotomy: a comparison of three versus four doses penicillin V

Aim Compare two regimens of antibiotic prophylaxis on the development of surgical site infection (SSI) following mandibular advancement with bilateral sagittal split osteotomy (BSSO). Materials and methods In total, 176 patients were included. Two antibiotic regimens were administered intravenously. The first 114 patients were given penicillin V (PcV) in three doses every 8 h (PcV3-group), and the next 62 patients were given PcV in four doses every 6 h (PcV4-group). The same surgical protocol was followed for all patients. Development of SSI was registered at follow-up 2 months and 1 year after surgery. Results A significant reduction in the rate of SSI was found in the PcV4 group compared to the PcV3-group (P = 0.012). The infection rates were 4.8% and 19.3% respectively. A higher prevalence of SSI was found when mandibular wisdom teeth were present, but this was not statistically significant. There were no correlations between gender, age, intraoperative bleeding and operation time and the development of SSI. None of the patients developed severe infection. Conclusion The infection rate was significantly reduced when PcV was administered in four doses, suggesting that an extended regimen of antibiotic prophylaxis is beneficial when performing mandibular advancement with BSSO

Strength of titanium intramedullary implant versus miniplate fixation of mandibular condyle fractures

Objective. To test the strength of internal fixation of mandibular condyle fractures repaired with titanium miniplates versus titanium intramedullary implants. Study Design. Prospective laboratory experimentation in urethane mandible models and human cadaveric mandibles. Setting. Materials testing laboratory at an academic medical center. Methods. Osteotomies of the mandibular condyle were created in 40 urethane hemimandible models and 24 human cadaveric specimens. Half of the samples in each group were repaired with traditional miniplates, and the other half were repaired with intramedullary titanium implants. Anteroposterior and mediolateral loads were applied to the samples, and the displacement was measured with reference to the applied force. Results. Titanium intramedullary implants demonstrated statistically significant improved strength and stiffness versus miniplates in the urethane model experimental groups. Despite frequent plastic deformation and mechanical failures of the miniplates, a 1.6-mm-diameter titanium intramedullary pin did not mechanically fail in any of the cases. Intramedullary implantation failures were due to secondary fracture of the adjacent cortical bone or experimental design limitations including rotation of the smooth pin implant. Conclusion. Mechanical implant failures that were encountered with miniplate fixation were not seen with titanium intramedullary implants. These intramedullary implants provide stronger and more rigid fixation of mandibular condyle fractures than miniplates in this in vitro model. © 2012 American Academy of Otolaryngology - Head and Neck Surgery Foundation