To Örebro University

INTRODUCTION: The free fibula flap is a workhorse flap for bony reconstruction of the craniofacial skeleton. The aim of the study was to conduct a systematic review to investigate the postoperative donor site complications and functional outcomes, specifically ankle instability (AI) and gait disturbances (GD), for patients who have received a free fibula flap (FFF) for head and neck cancer reconstruction.

METHODS: We designed a PRISMA-compliant systematic review, which was registered prospectively in PROSPERO. Searches were designed with a health science librarian and included MEDLINE, EMBASE, CINAHL and PEDro. Risk of bias assessment was conducted for each included study, with an assessment of quality using GRADE.

RESULTS: Following exclusion of duplicate entries, a total of 1940 abstracts were identified. After parallel blinded eligibility assessment, 32 studies were included in the analysis. The total number of included participants was 1163, with the total number of FFF being 955. The mean time for functional assessment was 35 months postoperatively (range 8-81 months). The subjective and objective assessment modalities varied considerably. The primary result for AI were 3.3 % and 5.5 % for GD. The results demonstrate heterogeneity in the literature regarding the reporting of AI and GD following FFF.

CONCLUSION: According to this review, the risk of developing these complications appears to be limited but underreporting may be a limitation. Consensus on methods for standardized outcomes assessment of FFF-reconstruction is needed to establish the impact of free fibula flap on AS and GD.

There is ongoing debate about the necessity of antibiotic prophylaxis regarding temporomandibular joint (TMJ) surgery. With antibiotic resistance being a major concern and challenge, developing solid recommendations on antibiotic use is essential to prevent overuse, misuse, and to enhance patient safety. The aim of this systematic review (SR) was to evaluate the scientific evidence regarding the effectiveness of antibiotics in preventing postoperative infections following TMJ surgery. Comprehensive literature searches were conducted using The Cochrane Library, Medline, EMBASE, and Web of Science. The selection process was based on predefined criteria, followed by a quality assessment of the retrieved SRs and primary studies using ROBIS and GRADE, respectively. Out of 8976 studies identified, 20 were reviewed in full text, and two were included in this SR for a risk of bias assessment. The quality assessment revealed a generally high risk of bias. In conclusion, no evidence-based recommendation can currently be made regarding antibiotic usage in relation to TMJ surgery. There is a knowledge gap concerning the impact of antibiotics on postoperative infection in TMJ surgeries, underscoring the need for further research in this field.

The primary aim of this study was to investigate whether patients with end-stage temporomandibular joint (TMJ) disease treated with gap arthroplasty with temporalis interpositional flap (GAT) had improved maximal interincisal opening (MIO) and TMJ pain in a long-term perspective. All patients with severe osteoarthritis, or fibrous or bony ankyloses, and subjected to GAT between 2008 and 2015 were included. The criteria of treatment success were TMJ pain VAS score ≤4 and MIO ≥30 mm. Reoperation was considered as a failure. Forty-four patients (mean age 47 years) were included in this retrospective descriptive case series and followed up for up to 7 years (mean 4.5). Comorbidities were frequent (n = 34) and most commonly rheumatic disease (n = 17). The indications for surgery were ankylosis (n = 32) or severe osteoarthritis (n = 12). Of the 44 included patients, 84% (n = 37) had a history of earlier TMJ surgery. The preoperative mean values for TMJ pain and MIO (VAS 7 and 23 mm, respectively) changed significantly (p < 0.001) to postoperative means of VAS 3 and 34 mm, respecitvely. The success rate was 59% (n = 26). When compared with a previous 2-year follow-up, the success rate was found to have decreased over time (p = 0.0097). The rate of successful treatment outcome in terms of MIO alone was 82% (n = 36). The most common reason for treatment failure was residual pain. In conclusion, the success-rate after GAT did not show long-term stability and continued to drop over time in this patient cohort. TMJ pain seems to be the main reason for failure.

BACKGROUND: Adherence to antibiotic recommendations and safety aspects of restrictive use are important components when combating antibiotic resistance. The primary aim of this study was to assess the impact of national guidelines on antibiotic prescriptions for bone augmentation procedures among dentists working at three specialized clinics. The secondary aim was to assess the occurrence of postoperative infections.

METHODS: Medical charts of 400 patients treated with bone augmentation were reviewed: 200 in the years 2010-2011 and 200 in 2014-2015. The Swedish national recommendations for antibiotic prophylaxis were published in 2012.

RESULTS: There was a wide variation in antibiotic regiments prescribed throughout the study. The number of patients treated with antibiotic prophylaxis in a single dose of 2 g amoxicillin, and treated as advocated in the national recommendations, was low and decreasing between the two time periods from 25% (n = 50/200) in 2010-2011 to 18.5% (n = 37/200) in 2014-2015. The number of patients not given any antibiotics either as a prophylactic single dose or during the postoperative phase increased (P < 0.001). The administration of a 3-7-days antibiotic prescription increased significantly from 25.5% in 2010-2011 to 35% in 2014-2015. The postoperative infection rates (4.5% and 6.5%) were without difference between the studied periods. Smoking and omitted antibiotic prophylaxis significantly increased the risk of postoperative infection. Logistic regression analyses showed that patient male gender and suffering from a disease were predictive factors for the clinician to adhere to the guidelines.

CONCLUSIONS: After introduction of national recommendations for antibiotic prophylaxis before bone augmentation procedures, the patient group receiving a single preoperative dose decreased while the group not given antibiotic prophylaxis increased. There was no difference in occurrence of postoperative infections between the two time periods. The results indicate a need for educational efforts and strategies for implementation of antibiotic prudence and awareness among surgeons performing bone augmentation procedures.