Perioperative Considerations

Skin

A Cochrane Database Review provided no clear evidence of benefit of preoperative showering or bathing with chlorhexidine over other wash products to reduce surgical infections. However, a benefit of day-of-surgery showering or bathing in an effort to reduce the incidence of nosocomial infections was demonstrated [26].

Pre-incision Antibiotic Prophylaxis

Systemic intravenous antibiotic prophylaxis reduces the risk of postoperative infection. Cephalosporins are widely used, based on their good efficacy against staphylococcal species and uropathogens. Vancomycin is indicated in high-risk patients carrying methicillin-resistant Staphylococcus aureus (MRSA). If the patient has an allergy to p-lactam antibiotics, clindamycin or vancomycin can be used [27]. Rosenberg [28] and Levant [29] demonstrated the importance of the administration of antibiotic prophylaxis 1 h before initiation of the skin incision in orthopedic joint replacement. Therefore, it is recommended that antibiotic administration be part of the “time-out” protocol to ensure compliance with the proper timing of prophylactic antibiotic administration in TMJ TJR cases.