title: Surgical Site Infections Following Bimaxillary Orthognathic, Osseous Genioplasty, and Intranasal Surgery: A Retrospective Cohort Study.
abstract: OBJECTIVE
  Frequency estimates of surgical site infection (SSI) after orthognathic surgery vary considerably. The purpose of this study was to determine the incidence and site of SSIs and associated risk factors after bimaxillary orthognathic, osseous genioplasty, and intranasal surgery.
  
  
  METHODS
  The authors executed a retrospective cohort study of patients with a bimaxillary developmental dentofacial deformity (DFD) and symptomatic chronic obstructive nasal breathing. All patients underwent at a minimum Le Fort I osteotomy, bilateral sagittal ramus osteotomies (SROs), septoplasty, inferior turbinate reduction, and osseous genioplasty. The primary outcome variable studied was the incidence and site of SSI. Predictor variables were type and extent of prophylactic antibiotic used, demographic (age and gender), and anatomic (pattern of DFD, surgical site, and presence of third molar).
  
  
  RESULTS
  Two hundred sixty-two patients met the inclusion criteria. Their average age at surgery was 25 years (range, 13 to 63 yr) and there were 134 female patients (51%). The major presenting patterns of DFD included long face (30%) and maxillary deficiency (25%). Forty percent of patients undergoing an SRO and 47% of those undergoing a Le Fort I osteotomy underwent simultaneous removal of a third molar. Ninety percent of patients received cefazolin or cephalexin antibiotics. Overall, 5 of 1,048 (0.5%) osteotomy sites sustained an infection, including 1 chin and 4 ramus SSIs. There were no delays in bone healing. Fixation hardware removal was not required in any patient who developed an infection. Two of the 25 patients (8%) given clindamycin prophylaxis developed an SSI, whereas 3 of 237 patients (1%) receiving cefazolin did. Three of the 4 patients who developed an SRO SSI underwent simultaneous removal of an erupted or partially erupted mandibular third molar (P < .05).
  
  
  CONCLUSIONS
  In this study, the incidence of SSI was limited to 1% of patients who were given cefazolin or cephalexin extended for 5 days. The removal of an erupted or partially erupted mandibular third molar in conjunction with an SRO was associated with risk of SSI, but the incidence remains low.
authors.affiliation: Director, Posnick Center for Facial Plastic Surgery, Chevy Chase, MD; Clinical Professor, Department of Surgery and Pediatrics, Georgetown University, Washington, DC; Clinical Professor, Department of Orthodontics, University of Maryland School of Dentistry, Baltimore, MD; Adjunct Professor, Department of Oral and Maxillofacial Surgery, Howard University College of Dentistry, Washington, DC. Electronic address: jposnick@drposnick.com.
authors.forename: Jeffrey C
authors.initials: JC
authors.lastname: Posnick
authors.affiliation: California Oral Surgery and Implantology, Stockton, CA; Stanislaus Oral Surgery and Implantology, Modesto, CA; Former Chief Resident, Howard University Hospital, Washington, DC.
authors.forename: Elbert
authors.initials: E
authors.lastname: Choi
authors.affiliation: Chief Resident, Department of Oral and Maxillofacial Surgery, Howard University Hospital, Washington, DC.
authors.forename: Anish
authors.initials: A
authors.lastname: Chavda
mesh_terms: D000293:Adolescent; D000328:Adult; D019072:Antibiotic Prophylaxis; D063169:Dentofacial Deformities / Q000601:surgery*; D005260:Female; D063172:Genioplasty; D006801:Humans; D015994:Incidence; D008297:Male; D063166:Maxillary Osteotomy; D008875:Middle Aged; D009300:Nasal Septum / Q000601:surgery; D056948:Orthognathic Surgical Procedures; D019340:Osteotomy, Le Fort; D059229:Osteotomy, Sagittal Split Ramus; D012189:Retrospective Studies; D013530:Surgical Wound Infection / Q000453:epidemiology*; D014420:Turbinates / Q000601:surgery