Comparative Evaluation of Gentamicin Solution Versus Normal Saline Irrigation in the Surgical Management of Maxillofacial Space Infections: A Prospective Randomized Pilot Study

Abstract

Background: Intraoperative wound irrigation is a standard adjunct in the surgical management of maxillofacial space infections. While normal saline is commonly used, antimicrobial irrigants such as gentamicin may confer additional benefits.

Objective: To compare the effectiveness of gentamicin solution irrigation versus normal saline in reducing postoperative inflammatory and microbiological burden.

Methods: Thirty patients with maxillofacial space infections were prospectively randomized into two groups: gentamicin irrigation (n = 15) and normal saline irrigation (n = 15). In the gentamicin group, the surgical cavity was irrigated with 80 mg gentamicin diluted in 500 mL of 0.9% saline, while the control group received 500 mL 0.9% saline irrigation. All patients underwent surgical drainage and systemic antibiotics. Outcomes assessed at 72 hours included WBC count, clinical swelling resolution, pain (VAS), microbiological load, and hospital stay.

Results: The gentamicin group showed a greater reduction in WBC count at 72 hours (10,200 ± 1,350 → 8,400 ± 1,180 cells/µL) compared with the saline group (10,000 ± 1,420 → 9,100 ± 1,310 cells/µL); mean between-group difference −700 cells/µL (95% CI −1,580 to 180; p = 0.11). Median swelling scores improved from 3 to 1 in the gentamicin group and from 3 to 2 in the saline group (p = 0.09). Mean VAS pain scores at 72 hours were 3.1 ± 0.9 (gentamicin) versus 3.6 ± 1.0 (saline), p = 0.18. Microbiological load decreased by 1.8 log CFU in the gentamicin group versus 1.2 log CFU in the saline group (p = 0.12). Median hospital stay was 5 days in the gentamicin group versus 6 days in the saline group (p = 0.15).

Conclusion: Gentamicin irrigation was associated with numerically greater improvements in WBC count, swelling, pain, and microbiological reduction at 72 hours compared with saline irrigation; however, these differences were not statistically significant. Larger studies are required to confirm clinical utility.