Oral Flora and Perioperative Antimicrobial Interventions in Cleft Palate Surgery: A Review of the Literature

Abstract

Background: The role of perioperative antibiotics in cleft palate remains a topic of debate. Advocates stress their importance in preventing local and systemic infections and decreasing the incidence of oronasal fistula formation. However, few studies to date have directly evaluated the role of antibiotics and other antimicrobial measures in cleft palate surgery. Objective: The aim of this review is to evaluate the evidence surrounding the use of perioperative antibiotics and other antimicrobial interventions in cleft palate surgery. Additionally, we review the literature on the oral flora unique to the cleft palate patient population. Methods: This was accomplished utilizing PubMed, Medline, and the Cochrane Library with MeSH and generic terms. Articles were selected based on predefined inclusion and exclusion criteria. Results: This review highlights the lack of higher level evidence on perioperative antibiotic use and other antimicrobial interventions in cleft palatoplasty and calls for further research on the matter. Conclusions: The literature appears to support the use of preoperative antibiotics for cleft palatoplasty, but the benefits of prolonged postoperative antibiotic use remain questionable.

Patient Safety and Quality Improvement Initiatives in Cleft Lip and Palate Surgery: A Systematic Review

“…Although roughly half of all included studies related to patient pain and analgesia, others focused on topics ranging from the utility of perioperative antibiotics, risk factor analysis, suture materials, inpatient versus outpatient surgical outcomes, and timing of the surgical procedure on complication rates. 6,41,50,56,63,64 Such a comprehensive approach to identifying PS and QI strategies allows for more impactful and contextual practice recommendations.…”

“…Although Aznar et al 40 and Jodeh et al 42 examined the utility of preoperative and postoperative antibiotics in reducing rates of fistula formation, neither study found a significant difference between treatment and control groups. Pfaff et al 41 concluded that evidence appeared unclear toward the benefit of postoperative antibiotics in cleft palate surgery. Similarly, Mamidi et al 43 found no benefit to single-dose intraoperative antibiotics in reducing fistulae.…”

“…[40][41][42][43] Aznar et al 40 found that postoperative antibiotics (5 d, 50 mg/kg/d) compared with placebo resulted in less complication rates (8.7% versus 13.8%; P = 0.175) and fistula rates (10.7% versus 17.1%; P = 0.085) in cleft palate surgery. Pfaff et al 41 on the other hand found unclear evidence through a systematic review to support the use of prolonged postoperative antibiotics in cleft palate surgery. Jodeh et al 42 found that cleft palate patients who received preoperative antibiotics experienced lower rates of fistula (2.7% versus 3.6%; P = 0.163).…”

“…38,39 Fistula Formation and Infection Of the 7 articles (Supplemental Table 6, Supplemental Digital Content 6, http://links.lww.com/SCS/E643) that investigated the topic of fistula formation and infection, 4 examined the effect of antibiotics on rates of surgical complications, including wound breakdown and fistula formation. [40][41][42][43] Aznar et al 40 found that postoperative antibiotics (5 d, 50 mg/kg/d) compared with placebo resulted in less complication rates (8.7% versus 13.8%; P = 0.175) and fistula rates (10.7% versus 17.1%; P = 0.085) in cleft palate surgery. Pfaff et al 41 on the other hand found unclear evidence through a systematic review to support the use of prolonged postoperative antibiotics in cleft palate surgery.…”

A Scoping Review of Adjuvant Perioperative Therapies for Primary Cleft Lip Repair

“…A variety of protocols exist to discuss management after surgical repair including feeding protocols, pain management, and prophylactic antibiotics. 2,[4][5][6] However, guidance regarding adjuvant therapies for primary surgical repair is limited. Independent studies have examined the use of botulinum toxin type A, revision fat grafting, silicone gel and sheeting, intense pulsed light, and carbon dioxide (CO 2 ) lasers to ameliorate contracture and hypertrophic scar formation.…”