Background Intermaxillary fixation (IMF) with upper and lower arch bars is commonly used for the management of maxillofacial fractures. However, prolonged fixation may alter the oral microbial environment, resulting in dysbiosis and increased antimicrobial resistance. Aim To evaluate changes in oral microbiota and antimicrobial susceptibility patterns in maxillofacial trauma patients following IMF with arch bars. Methods A prospective randomized observational study was conducted in the Department of Oral and Maxillofacial Surgery, H.P. Government Dental College and Hospital, Shimla, Himachal Pradesh, from November 2023 to October 2025. A total of 102 patients undergoing IMF were included. Oral samples were collected before IMF placement and after 4–6 weeks from the tongue, palate, gingival margins, dental plaque, and throat. Bacterial and fungal cultures were performed using blood and MacConkey agar, followed by Gram staining, biochemical identification, and antimicrobial susceptibility testing. Results The majority of participants were male (90.2%), with falls being the most common cause of trauma (56.9%). Significant weight loss was observed after IMF (p < 0.001), and poor oral hygiene was significantly associated with wound infection (?² = 8.92, p = 0.0028). Pre-IMF samples were predominantly characterized by Gram-positive commensals, particularly Streptococcus, whereas post-IMF samples showed a significant increase in Gram-negative and opportunistic organisms. Gram-negative isolates increased from 27.5% to 60.8% (?² = 36.5, p < 0.001). Although several organisms retained good antimicrobial susceptibility, increased resistance was observed in Acinetobacter spp., Klebsiella pneumoniae, Streptococcus mitis, and Lactobacillus spp. Post-IMF isolates demonstrated a greater overall resistance burden. Conclusion Prolonged IMF is associated with significant alterations in oral microbiota and increased antimicrobial resistance. Regular oral hygiene, microbiological surveillance, and appropriate antimicrobial selection are therefore important during IMF treatment.
Intermaxillary fixation; Oral microbiota; Maxillofacial trauma; Antimicrobial resistance; Oral dysbiosis.
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