What is the evidence for use of antibiotic prophylaxis in clean-contaminated head and neck surgery?

BACKGROUND Antibiotic prophylaxis is commonly used in head and neck surgery. Prophylactic use of antibiotics in clean surgical cases is not clearly indicated, but evidence exists for use in cases of clean-contaminated surgery, such as major head and neck oncologic procedures. Despite evidence specifically outlining the indications for antibiotic prophylaxis, there continues to be widespread variability in the use (and overuse) of prophylactic antibiotics in head and neck oncologic surgery. In an era of increasing resistance to antimicrobial therapy, it is worthwhile to revisit the evidence for the use of antibiotic prophylaxis in head and neck surgery.