The incidence of
infection after cervicofacial surgery for ENT
cancer varied between 38 and 60% as a function of the type of operation, and prophylactic
antibiotic therapy administered, in a series of 133 cases. Contamination was greatest after operations of longest duration and with the largest exposure of tissue. Previous
cobalt therapy was an aggravating factor. The highest risk of
infections complications resulted therefore from combined salvage operations and the use of a
musculocutaneous flap. Among these
infections, a purulent bronchorrhea was a frequent and potentially serious complication sometimes the cause of
septicemia. A review of 4 different
antibiotic therapy regimens showed the pre-operative administration failed to alter the outcome. Combined penicillin-5
imidazole treatment, effective in preventing local and regional anaerobic
infection, resulted in
secondary infection developing in about 56% of cases. It was not able, in fact, to cover under certain circumstances during prolonged surgery, the postoperative risk of inhalation of gram-negative anaerobic and aerobic bacteria form the buccal cavity. Short-term
antibiotic therapy was totally ineffective. It is suggested that combined penicillin-5
imidazole be reserved for operations provoking little contamination of the tracheobronchial region, such as total
laryngectomy and total pharyngo-
laryngectomy, and that prophylactic
therapy using an
antibiotic with a wide spectrum against gram negative germs be administered prior to major buccopharyngeal operations with
tracheotomy.