- 期刊
Infection Following Orthognathic Surgery -Clinical Presentation, Management, and Outcomes
正顎手術之術後感染－臨床表現，處置及結果
摘要
Background: Infection following orthognathic surgery is not uncommon, but clinical information regarding optimal management, and outcomes is insufficient. Our study, a review of all infections occurring in a large series over a five-year period, adds significantly to the literature. Materials and methods: We identified a total of 2,499 patients who underwent orthognathic surgery at our center from June 2010 to February 2015. Patients underwent LeFort I procedures and bilateral sagittal-split osteotomies of mandible angle and ramus, and were followed in clinic postoperatively. All infections were detected in clinic. The infection was treated based on their symptoms and signs. The information such as age, gender, comorbidities, procedural specifics of their operation, whether tooth extraction was performed, estimated blood loss, postoperative use of antibiotics, presenting signs/symptoms, duration of infection, management, and outcomes, etc. were collected in this study. Results: Seventy-three (2.9% of those undergoing surgery) patients had infections after orthognathic surgery. Presenting signs/symptoms included pain, tenderness, numbness, edema, abscess formation, elevated skin temperature, fever, etc. The infection site was the mandible in 66 patients (90%). Wound culture was done in 22 patients. Eleven patients with infections had polymicrobial infections of both aerobic and anaerobic; six were aerobic only; three were anaerobic only; two were no growth. Treatment varied depending on presentation. In this series, common modalities included targeted antibiotic therapy, surgical exploration and drainage, and removal of hardware. Conclusion: Based on our experience, routine preoperative antibiotic prophylaxis should provide both aerobic and anaerobic coverage. The infections could be controlled by antibiotic therapy and drainage. Routine hardware removal is not required.
並列摘要
背 景：正顎手術之術後感染並非罕見，但缺乏討論其臨床表現、細菌學、最佳治療方式及結果之文獻。目的及目標：本研究回顧本院近五年正顎手術術後感染病患之臨床症狀，處置及結果，以期歸納出最佳治療方式。材料及方法：2010年一月至2015年二月，共2,499名病患於本院進行勒福一式截骨術併雙側下顎骨垂直支的矢狀面劈開術(LeFort I procedures with advanement and bilateral sagittal-split osteotomies of mandible angle and ramus with advancement)及頦成形術 (genioplasty)，所有病患皆進行術後追蹤。我們蒐集發生感染徵象病患之年齡、性別、併發症、細菌培養結果、拔牙有無、失血狀況、術前術後抗生素使用、感染徵象、時間、處置及結果進行研究。結 果：共73 (2.9%)名病患發生正顎手術之術後感染，臨床症狀包含疼痛、壓痛、麻感、腫脹、膿瘍、滲液、發燒，局部皮膚溫度升高、傷口裂開、骨釘骨板暴露。共66 (90%)名病患感染處為下顎。對於22名病患進行傷口細菌培養，其中11名病患顯示嗜氧菌併厭氧菌感染；6名顯示單獨嗜氧菌感染，3名顯示單獨厭氧菌感染，另外2名並未培養出菌叢。治療方式隨病患之臨床表現各異，包括抗生素使用，手術移除骨釘骨板、膿瘍引流等方式。結 論：本院正顎手術之術後感染發生率為2.9%，低於文獻報告平均。依據經驗及文獻，應使用涵蓋嗜氧菌及厭氧菌之預防性抗生素。雖本院常規於術後使用抗生素，但其效果無法評估，需近一步研究佐證。如遇感染徵象，須立即使用抗生素治療；如有膿瘍或滲液，需進行引流及清創。骨釘骨板除非已暴露或感染症狀難以控制，否則不建議常規性移除。