Kanatas A N, Rogers S N, Martin M V
Liverpool University Dental Hospital.
Br Dent J. 2002 Feb 9;192(3):157-60. doi: 10.1038/sj.bdj.4801322.
To analyse the antibiotic prescribing trends for exodontia and minor oral surgery in patients with a history of radiotherapy. Also, to evaluate the use of hyperbaric oxygen as a separate modality in the prevention of osteoradionecrosis.
A survey of antibiotic prescribing involving the analysis of a questionnaire which included the management of three patients with a history of head and neck malignancy.
The heads of the departments in each unit in the UK were sent a closed-response questionnaire. Antibiotic prescribing was assessed in three case scenarios. Case one referred to a patient that had surgery alone as part of the management of head and neck cancer, who needed the surgical removal of second molar roots. Case two referred to a patient that had surgery and adjuvant radiotherapy as part of the management of head and neck cancer, and needed the same procedure as in case one. Case three included a patient with a history of surgery and adjuvant radiotherapy, who required the extraction of three mobile and periodontally-involved lower incisors. Consultants were also asked about the use of hyperbaric oxygen in the patients who had radiotherapy as part of their treatment strategy.
A total of 109 questionnaires were sent to all the Maxillofacial Units in the UK. The response rate was 73%. In patients with a history of radical surgery alone for the management of head and neck cancer, 20% of the surgeons advocated pre-operative antibiotics for the surgical removal of lower posterior teeth. In contrast, in the patient with a history of adjuvant radiotherapy 86% supported pre-operative antimicrobial use for the surgical removal of the same teeth. In the extraction of mobile and periodontally involved lower incisors in the previously irradiated patient, 63% of the clinicians supported pre-extraction antibiotics. Postoperative antibiotics were advocated in 52% in the first case, 89% in the second case and 71% in the third case. 34% of the clinicians advocated hyperbaric oxygen for surgical removal of posterior teeth and 15% for the extraction of mobile anterior teeth.
The use of peri-extraction antibiotics was favoured among oral and maxillofacial surgeons. There was little enthusiasm towards the use of hyperbaric oxygen as a prophylactic measure, alone or in conjunction with an antimicrobial regime. Control randomised trials that will measure the effectiveness of hyperbaric oxygen and the appropriate use of antibiotics for prophylaxis in pre- and post-operative regimes are necessary to evaluate the use of these modalities.
分析有放疗史患者拔牙及小型口腔外科手术的抗生素处方趋势。同时，评估高压氧作为预防放射性骨坏死的单一治疗手段的应用情况。
一项抗生素处方调查，涉及对一份问卷的分析，该问卷包含三名有头颈部恶性肿瘤病史患者的治疗情况。
向英国各单位的科室主任发送封闭式问卷。在三种病例场景中评估抗生素处方情况。病例一为仅接受手术治疗的头颈部癌症患者，需手术拔除下颌第二磨牙牙根。病例二为接受手术及辅助放疗的头颈部癌症患者，所需手术与病例一相同。病例三为有手术及辅助放疗史的患者，需拔除三颗松动且牙周受累的下颌切牙。还向会诊医生询问了在放疗作为治疗策略一部分的患者中高压氧的使用情况。
共向英国所有颌面外科单位发送了109份问卷。回复率为73%。在仅接受根治性手术治疗头颈部癌症的患者中，20%的外科医生主张在手术拔除下颌后牙前使用抗生素。相比之下，在有辅助放疗史的患者中，86%的医生支持在手术拔除相同牙齿前使用抗菌药物。在对先前接受过放疗的患者拔除松动且牙周受累的下颌切牙时，63%的临床医生支持拔牙前使用抗生素。在第一种病例中，52%的医生主张术后使用抗生素，第二种病例中为89%，第三种病例中为71%。34%的临床医生主张在手术拔除后牙时使用高压氧，15%的医生主张在拔除松动前牙时使用。
口腔颌面外科医生倾向于在拔牙前后使用抗生素。对于单独或与抗菌方案联合使用高压氧作为预防措施，积极性不高。有必要进行对照随机试验，以衡量高压氧的有效性以及在术前和术后方案中适当使用抗生素进行预防的效果，从而评估这些治疗手段的应用情况。
