Evaluation of the use of different prophylactic antibiotic protocols in surgically assisted rapid maxillary expansion: A controlled, double-blind, randomized clinical study

Maykel Sullyvan Marinho De Souza,Fábio Wildson Gurgel Costa,Tácio Pinheiro Bezerra,Fabrício De Lamare Ramos,Soraia Rodrigues De Gois,Marcelo Leite Machado Da Silveira ,Francisco Samuel Rodrigues Carvalho ,João Octávio Pompeu Hyppolito ,Rafel Linard Avelar ,Eduardo Costa Studart Soares

doi:10.33448/rsd-v10i5.14717

Abstract

Data related to postoperative infection in surgically-assisted rapid maxillary expansion (SARME) are scarce. Our goal was to compare the effects of two different prophylactic antibiotic regimens on infection rates in patients undergoing SARME. A randomized, double-blind clinical trial was carried out with 23 patients (06 men and 17 women) who received 1g cefazolin one hour before the procedure (Group 1 – G1) or 1g cefazolin one hour before the procedure and again in the first 24 postoperative hours (Group 2 – G2). Patients were followed up for one month after surgery. Pain was greater in G1 with a statistically significant difference in the follow-ups of 1, 2, 7 and 21 postoperative days (p<0.05). Variable such as edema, erythema, fever, abscess and drainage did not differ between groups. Despite the similarities between the groups, the total sum of inflammatory events was 17 times higher in G1 (p<0,001). A single dose of cefazolin 1g one hour before the procedure is sufficient to prevent infection in patients undergoing SARME. These findings may help to decrease the indiscriminate use of antibiotics in in these situations, thus preventing the emergence of bacterial resistance and complications associated with the use of antibiotics.

Highlights

Patients may have an ogival palate, crowding and nasal breathing difficulties. (Barbosa et al, 2020; de Gijt et al, 2017; Iodice et al, 2013; Koudstaal et al, 2005) there is little data in the literature regarding the incidence of Maxillary transverse deficiency (MTD) in adults, (Suri & Taneja, 2008) between 8 to 18% of patients seeking orthodontic treatment have this deformity, which may reach 24%. (Filho et al, 1991; Sato et al, 2014) The most common treatment modalities for MTD include orthopedic maxillary expansion (OME), compensatory orthodontics, surgically-assisted rapid maxillary expansion (SARME) and segmental maxillary osteotomy during orthognathic surgery. (Suri & Taneja, 2008; Bays & Greco, 1992; Betts, 2016; Northway & Meade, 1997)
Considered a surgical modality inserted in the orthognathic surgery universe, the incisions and osteotomies used in SARME are more conservative
Considering the scarcity of studies in the literature which have evaluated the use of prophylactic antibiotic therapy in patients undergoing SARME and the scarcity of guidelines regarding prophylactic regimens to be instituted, the objective of the present study is to evaluate two prophylactic antibiotic therapy protocols and their effects on the infection rates in patients undergoing SARME

Summary

Introduction

Maxillary transverse deficiency (MTD) is a deformity characterized by unilateral or bilateral posterior crossbite.Patients may have an ogival palate, crowding and nasal breathing difficulties. (Barbosa et al, 2020; de Gijt et al, 2017; Iodice et al, 2013; Koudstaal et al, 2005) there is little data in the literature regarding the incidence of MTD in adults, (Suri& Taneja, 2008) between 8 to 18% of patients seeking orthodontic treatment have this deformity, which may reach 24%.(Filho et al, 1991; Sato et al, 2014) The most common treatment modalities for MTD include orthopedic maxillary expansion (OME), compensatory orthodontics, surgically-assisted rapid maxillary expansion (SARME) and segmental maxillary osteotomy during orthognathic surgery. (Suri & Taneja, 2008; Bays & Greco, 1992; Betts, 2016; Northway & Meade, 1997) considered a surgical modality inserted in the orthognathic surgery universe, the incisions and osteotomies used in SARME are more conservative. & Taneja, 2008) between 8 to 18% of patients seeking orthodontic treatment have this deformity, which may reach 24%. (Filho et al, 1991; Sato et al, 2014) The most common treatment modalities for MTD include orthopedic maxillary expansion (OME), compensatory orthodontics, surgically-assisted rapid maxillary expansion (SARME) and segmental maxillary osteotomy during orthognathic surgery. (Suri & Taneja, 2008; Betts, 2016) it is possible to perform maxillary expansion with segmentation concomitant with Le Fort I osteotomy, there are advantages to performing SARME as a previous procedure. The performance of multiple osteotomies, especially on patients with major deformities, can result in greater instability and relapse after removing orthodontic devices. Class IV surgeries, or dirty-contaminated surgeries, occur when there is an established clinical infection or a traumatic wound which occurred more than eight hours ago. (Peterson, 1990)

Objectives

Methods

Results

Conclusion