Background: Surgical site infections are a complication of oral and maxillofacial procedures, with the potential for significant morbidity and mortality. Use of pre-, peri- and post-operative antibiotic prophylaxis to reduce the incidence of surgical site infections must be balanced with considerations of a patients’ risk of antibiotic-related adverse events. This review aims to provide evidence-based recommendations for antibiotic prophylaxis.
Methods: Searches were conducted using MEDLINE, the Cochrane Library, EMBASE and PUBMED for maxillofacial procedures including: treatment of dental abscesses, extractions, implants, trauma, temporomandibular joints, orthognathics, malignant and benign tumour removal, and bone grafting, limited to articles published since 2000.
Results: 98 out of 280 retrieved papers were included in the final analysis. Systematic reviews were assessed using AMSTAR criteria. Randomised controlled trials were assessed for bias using Cochrane Collaborative tools. The overall quality of evidence was assessed using GRADE.
Conclusions: Prophylactic antibiotic use is recommended in surgical extractions of third molars, comminuted mandibular fractures, temporomandibular joint replacements, clean-contaminated tumour removal, and complex implants. Prophylactic antibiotic use is not routinely recommended in upper or midface fracture facial thirds. Further research is required to provide recommendations in orthognathic, cleft lip, palate, temporomandibular joint surgery, and maxillofacial surgical procedures in medically compromised patients.


Dr Priyanka Raidoo graduated with a Bachelor of Medicine Bachelor of Surgery from James Cook University in 2015. She is currently undertaking a Masters of Tropical Medicine and Public Health at James Cook University. Priyanka is also completing her Doctor of Dental Medicine at the University of Western Australia and is a maxillofacial service registrar in Perth, Australia.