Antibiotic Prophylaxis in Maxillofacial Surgery and Evidence-Based Practice: A Systematic Review.

Abstract

Antibiotic prophylaxis is defined as the intentional administration of antibiotics with the goal of preventing infection prior to the occurrence of contamination by surgical incision. So, it can either be given before the procedure or after the surgery to prevent infection. The aim of this study was to review the current literature and evaluate whether the use of preoperative, perioperative, or postoperative antibiotic prophylaxis influences outcomes in patients undergoing oral and maxillofacial surgeries. This systematic review was conducted in line with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines and was registered in the International Prospective Register of Systematic Reviews (PROSPERO). A comprehensive search of PubMed, Scopus, and Web of Science was conducted for studies published up to May 2025, utilizing Medical Subject Headings (MeSH) terms based on the Population, Intervention, Comparison, and Outcome (PICO) framework. Eligible studies included randomized controlled trials (RCTs) and cohort studies involving patients undergoing maxillofacial procedures such as orthognathic surgery, trauma surgery, dental implant placement, tumor resection, and temporomandibular joint surgery. The outcomes assessed were surgical site infections (SSIs), wound infections, abscess formation, antibiotic-related side effects, antimicrobial resistance, length of hospital stay, and cost-effectiveness. Thirteen studies met the inclusion criteria and were categorized under five clinical domains: dental implants, surgical tooth extraction, maxillofacial trauma, orthognathic surgery, and drug allergy. The Newcastle-Ottawa Scale (NOS) was applied to evaluate potential sources of bias across the included studies. Overall, the included studies were of fair quality, supporting a moderate level of confidence in the conclusions drawn. Prophylactic antibiotics in maxillofacial surgery show limited overall benefit, with selective advantages in complex or high-risk cases. Routine use is not consistently justified, highlighting the need for judicious application and further high-quality research to guide practice.