The Effect of Antibiotic Prophylaxis on Palatal Wound Healing Following Cleft Palate Closure: A Systematic Literature Review.

IntroductionImpaired palatal wound healing following cleft palate surgery can compromise functional outcomes, including speech, making their prevention essential. This literature review aims to evaluate the evidence regarding the use of prophylactic antibiotics in cleft palate surgery and to assess whether antibiotic prophylaxis affects palatal wound healing.MethodsA systematic search was carried out according to the PRISMA guidelines. Studies regarding the use of prophylactic antibiotics following cleft palate surgery were screened. Impaired palatal wound healing, that is, wound infection, dehiscence, and oronasal fistula, were used as outcome measures. A modified New-Ottawa Scale (NOS) was used for quality appraisal.ResultsA total of 382 studies were identified, of which 8 met inclusion criteria; none were excluded based on NOS quality appraisal. In 4 studies comparing antibiotic prophylaxis to no antibiotics, no preventive effect on wound healing problems was demonstrated. Comparisons of prolonged versus shorter antibiotic regimens showed no benefits of prolonged therapy, and the choice of antibiotic agent did not significantly influence outcomes. Notably, one study reported a significant reduction in fistula rates with the use of a local antibiotic soaked palatal pack as an adjunct to standard systemic prophylaxis (2% vs 21%; P < .05).ConclusionsCurrent evidence does not demonstrate that systemic antibiotic prophylaxis affects palatal wound healing following cleft palate surgery. However, evidence-based protocols could only be supported by large clinical prospective trials.