Antibiotics in orbital floor fractures
A short cut review was carried out to establish whether prophylactic antibiotics are indicated in patients with undisplaced maxillary or orbital floor fractures. Altogether 214 papers were found using the reported search, but none presented any evidence to answer the clinical question. More research is needed in this area and, in the mean time, local advice should be followed.
Report by Bruce Martin, Specialist Registrar Checked by Angaj Ghosh, Senior Clinical Fellow
A 28 year old man presents to the emergency department with a punch injury to the left side of his face after a fracas. Clinical examination reveals no wound, but tenderness, bruising and swelling over the left infraorbital area. Radiological examination confirms the presence of fluid within the maxillary sinus, suggesting an undisplaced fracture of the orbital floor. You wonder whether you should prescribe him oral antibiotics to reduce the incidence of infection.
Three part question
In [patients with undisplaced maxillary or orbital floor fractures] are [antibiotics better than no antibiotics] at [preventing infective complications]?
Medline 1966–10/02 using the OVID interface. [(exp facial bones OR exp facial injuries OR facial.mp) AND (exp fractures OR exp maxillary fractures OR exp orbital fractures OR exp zygomatic fractures OR fracture$.mp) AND (exp antibiotics OR antibiotic$.mp)] LIMIT to human AND English.
Altogether 214 papers were found of which all were of irrelevant or of insufficient quality.
The evidence in this field is clearly lacking. There are no trials of any kind looking at the incidence of infection in patients with undisplaced orbital floor fractures. There is clearly a need for further investigation into this area.
▸ CLINICAL BOTTOM LINE
Local advice should be followed.