Lancashire Teaching Hospitals NHS Foundation Trust, UK.
University of Manchester Medical School, UK.
Br J Oral Maxillofac Surg. 2024 Jun;62(5):504-509. doi: 10.1016/j.bjoms.2024.03.003. Epub 2024 Mar 24.
Temporomandibular disorders include a wide spectrum of extra-articular and intra-articular conditions affecting the temporomandibular joint (TMJ). In salvage cases involving intra-articular end-stage disease, alloplastic temporomandibular joint replacement (TMJR) is a management option which can be utilised to rehabilitate a disabled joint's function and form. Whilst post-TMJR infection is rare, it is one of the most serious complications. The principles governing TMJR surgery antibiotic prophylaxis have been based on those established in orthopaedic surgery literature. Antibiotic resistance due to antibiotic over-use is a significant concern, therefore antibiotic stewardship has been developed to deal with this world-wide public health concern. The TMJ's anatomical proximity to the external auditory canal and oral cavity creates the potential for bacterial contamination. The aim of this study was to explore the views of 39 sub-specialist TMJ surgeons across nine nations usual approach to antibiotic prophylaxis and their management of TMJR infection. To accomplish this, an international survey was developed and conducted using Google Forms. The results demonstrated that 97.4% of the respondents employ prophylactic antibiotics at TMJR surgery, 83.8% on discharge. Variability in antibiotic choice with additional antimicrobial perioperative practices were also reported. Opinions on the management of a TMJR infection also varied. This survey establishes there is an agreement on the use of antibiotic prophylaxis, However the variability in choice, timing, course, duration of antibiotic use as well as the management of a postoperative TMJR infection demonstrates the need for further study leading to development of standardised antibiotic prophylaxis and infection management protocols for TMJR surgery.
颞下颌关节紊乱包括广泛的关节外和关节内疾病，影响颞下颌关节（TMJ）。在涉及关节内终末期疾病的挽救性病例中，全关节置换术（TMJR）是一种可以用来恢复残疾关节功能和形态的治疗选择。虽然 TMJR 术后感染很少见，但它是最严重的并发症之一。指导 TMJR 手术抗生素预防的原则基于骨科手术文献中确立的原则。由于抗生素过度使用而导致的抗生素耐药性是一个重大问题，因此抗生素管理策略已经发展起来以应对这一全球性的公共卫生问题。TMJ 与外耳道和口腔的解剖位置接近，为细菌污染创造了潜在条件。本研究的目的是探讨来自九个国家的 39 名颞下颌关节亚专科医生对 TMJR 手术抗生素预防的常规方法及其 TMJR 感染管理的看法。为此，使用 Google Forms 开发并进行了一项国际调查。结果表明，97.4%的受访者在 TMJR 手术时使用预防性抗生素，83.8%在出院时使用。还报告了抗生素选择的变异性以及额外的抗菌围手术期实践。对于 TMJR 感染的管理意见也存在差异。这项调查表明，在使用抗生素预防方面存在共识。然而，抗生素选择、时机、疗程、使用时间以及术后 TMJR 感染的管理方面存在变异性，这表明需要进一步研究，以制定 TMJR 手术的标准化抗生素预防和感染管理方案。
