Browsing by Author "Morkel, J.A."

Now showing 1 - 5 of 5
  • Thumbnail Image
    Item
    Colorado microdissection needle versus cold steel scalpel for incisions in third molar surgery
    (University of the Western Cape, 2014) Mohamed, Allie; Morkel, J.A.
    This study compares the CMN to the steel scalpel by assessing incision time, incisional blood loss, postoperative pain, wound healing, and the incidence of lingual and long buccal nerve injury. Twenty standardised cases were included in an analytical prospective case series. Each case had one side cut with CMN and the other side with steel scalpel. Third molar surgery is the most commonly performed procedure by maxillo-facial and oral surgeons, and is associated with expected but transient sequelae such as pain, swelling and trismus. Modalities to reduce the severity of these sequelae are desirable. Several studies report that the use of conventional electrosurgical instruments and the Colorado Microdissection Needle (CMN) resulted in significant reductions in cutting time, incisional blood loss, postoperative pain, with no evidence of increased incidence of wound complications such as dehiscence and infection.
  • Thumbnail Image
    Item
    Efficacy of two different types of throat packs
    (University of the Western Cape, 2009) Parker, Ebrahim; Morkel, J.A.; Dept. of Oral Medicine and Periodontics; Faculty of Dentistry
    Post-operative sore throat is a common minor complication following general anaesthesia via endotracheal intubation. Pharyngeal packing has often been implicated in this minor anaesthetic complication. In maxillo-facial and oral surgery, two types of throat packs are commonly used namely ribbon gauze and tampons. In order to establish the efficacy of these two types of throat packs a prospective, randomised, clinical study was conducted. The objectives of the study were threefold: to investigate the effect of the two different types of throat packs on the incidence of post-operative sore throat, to determine the quality of seal provided by the two different types of throat packs and finally, to formulate a faculty protocol. The study consisted of 70 patients undergoing third molar surgery. All the patients were intubated via endotracheal intubation and had a throat pack placed. Patients were also randomly selected and allocated to two groups. One group had ribbon gauze while the other group had a tampon as a throat pack. The study reflected no statistically significant difference in the incidence of postoperative sore throat between the two groups. It was interesting to note that the symptoms of sore throat resolved quicker with the use of tampons. On the other hand, the ribbon gauze provided a better pharyngeal seal.
  • Thumbnail Image
    Item
    Orofacial sepsis and HIV at maxillo-facial surgery units in the Western Cape: a prospesctive study
    (2009) Sarvan, Imraan; Morkel, J.A.; Bütow, K.W.
    The World Health Organisation estimated that in 2002 more than 13,772 000 deaths in developing countries were caused by infections. This accounted for more than 45% of all deaths, making up 7 of the top 10 causes of death (World Health Organisation, 2004). Sub-Saharan Africa is the epicentre of the devastating HIV pandemic. The country leading with the highest HIV rate in the world is South Africa, with approximately 5.5 million people infected(UNAIDS, 2008; South Africa Country Progress Report, 2008).The development from HIV to AIDS progressively weakens the immune system, making the individual more susceptible to numerous infections, e.g.various forms of orofacial sepsis (Mindel, and Tenant-Flowers, 2001). HIVpositive individuals are eighteen times more likely to become infected with community-acquired methicillin-resistant Staphylococcus aureus than the general population. (Crum-Cianflone et al., 2006). The management of sepsis is of great concern with regard to human morbidity and mortality, as well as its financial implications, especially in cases of antibiotic resistance (Kimleck et al., 1976; Panlilo et al., 1992; Kirkland et al., 1999). Currently, there is no published peer-reviewed literature assessing the impact of HIV on orofacial sepsis. This study aimed to assess the impact of HIV on orofacial sepsis, investigating the clinical and microbiological profiles of the population. These results were used as a guide in the adaptation of current treatment protocols.The study population consisted of patients with orofacial sepsis (requiring incision and drainage or admission) who were referred to the Maxillo-Facial and Oral Surgery Units at either Groote Schuur or Tygerberg Hospitals. These patients were examined, diagnosed and treated as per standard protocol. The empiric antibiotic treatment was tailored according to microscopy and sensitivity results when it became available. The exclusion criteria of the study were refusal of HIV testing or unwillingness of patients to participate in the study.The ratio of HIV positive patients treated was much higher than the population prevalence (2.4:1.1). Odontogenic infections (71.11%), followed by septic jaw fractures (15.56%) were the most common causes of sepsis. The most common causative teeth were the mandibular posterior teeth (43.75%)(excluding the mandibular 3rd molars). The most common fascial spaces involved in the HIV positive group were the submandibular spaces (36%),followed by the submasseteric and canine spaces (27% each). In the HIV negative group, the buccal (41%) and submandibular spaces (33%) were the most common fascial spaces infected.The HIV negative group had the most multi-fascial space involvement, with 35% having more than one fascial space involved. In comparison, the HIV positive group had only 18% involvement of more than one fascial space. This was also reflected by the HIV negative group, which included five cases of Ludwig’s Angina as compared to one case in the HIV positive group. The Gram Stain showed a predominance of Gram positive cocci for both the HIV positive and negative groups. Gram positive bacilli were significantly more prevalent in the HIV negative group (p = 0.0409). Pre-treatment antibiotics were associated with sterile abscesses in 20% of the cases. No growth on culture occurred only in the HIV negative group (statistically significant with p = 0.00488).A statistically significant increased length of admission was found for the cases with penicillin-resistant bacteria (Wicoxin Rank Sum Test p =0.0072). Penicillin resistance was found in 17.78% (8 cases) with ten strains of five types of bacteria (S. aureus, K. pneumonia, Enterobacter, E. coli,Alpha-haemolytic Streptococcus). Eight percent (5) of these cases were also resistant to co-amoxiclav®.In the HIV positive group the following trends (p>0.005) were found:• The average platelet counts of this group was 112.34 x108/L (lower than the HIV negative group);• The length of admission for the HIV positive group was slightly longer by 0.25 days even though this group had fewer fascial spaces infected;• A larger number of bacteria with penicillin-resistance was more prevalent in the HIV positive group (six resistant bacteria in four cases compared to four resistant bacteria in four cases).Greater numbers of orofacial infections were seen in HIV positive subjects relative to their population prevalence rates. Added to this, was the higher rate of antibiotic resistance and longer hospital admissions.These findings may warrant further investigation of the relationship between HIV positive and negative groups with regard to orofacial sepsis.
  • Thumbnail Image
    Item
    Ossifying fibroma : a clinical and radiological study at the University of the Western Cape Oral Health Centre
    (University of the Western Cape, 2016) Titinchi, Fadi; Morkel, J.A.
    Ossifying fibroma (OF) is the most frequent of the three fibro-osseous lesions of the jaws. It occurs mostly in patients between the age of 20 and 40 years. Females are more commonly affected than males. Clinically, OF usually presents as a painless expansive intra-bony mass. Swelling and pain may be present in some cases while some lesions are discovered incidentally. Radiographically, OF is usually well-defined and unilocular or multilocular. Early lesions present as well-defined radiolucency that are small in size. Over time, the lesions tend to enlarge in size and become mixed radiolucent-radiopaque and finally become completely radiopaque. The aim of this study was to determine the clinical and radiological features of ossifying fibroma presenting at the Departments of Maxillo-Facial and Oral Surgery and Diagnostics and Radiology, University of the Western Cape Oral Health Centre as well as to assess its management and recurrence patterns. A retrospective case series analysis was performed of all histopathologically diagnosed ossifying fibroma cases available at the Departments of Maxillo-Facial and Oral Surgery and Diagnostics and Radiology at the Faculty of Dentistry, University of the Western Cape from 1976-2014. Patient's age, gender and ethnicity were recorded. The clinical presentation of the lesion as well as the history was analyzed. Radiographic features including density, size, shape, location, locularity and its effect on adjacent structures was noted. Management of each case and follow-up was also documented. A total 61 cases were included in the study. The majority of patients were females (63.9%) and below 40 years of age (73.9%). Few cases were symptomatic (29.5%) with an average period 22 months from first symptoms to presentation. The mandibular posterior region was most affected (55.5%) while larger lesions occurred more frequently in younger patients. Majority of lesions were radiopaque (49.2%) and had well-defined margins (93.6%). Most cases were managed by surgical curettage (68.2%). Following an average follow-up period of 20 months only one case recurred (recurrence rate =6.7%). In conclusion, the majority of the clinical and radiographic findings of ossifying fibroma were similar in South African patients as those of other populations. Differences include that the lesions in this population were more radio-opaque and larger in size than in the reported literature. Surgical curettage is an acceptable management protocol with low rate of recurrence.
  • Thumbnail Image
    Item
    Radiographic profile of symptomatic impacted mandibular third molars in the Western Cape, South Africa
    (University of the Western Cape, 2005) Qirreish, Emad Eddin Yacob Juma; Parker, M.E.; Morkel, J.A.; Norval, E.J.G; Dept. of Diagnostics and Radiology; Faculty of Dentistry
    It is common practice to remove impacted mandibular third molars due to pathology associated with these impactions. Alternatively, impactions can be treated conservatively through a closely guarded follow-up regiment. However, many symptoms associated with impacted third molars may be prevented by elective removal of potentially problematic teeth. To determine the risk of developing pathology associated with impacted mandibular third molars, a ransom sample of 200 pantomographs were analyzed displaying 324 impactions from patients who presented for treatment at the Maxillo-Facial and Oral Surgery Department, Faculty of Dentistry, University of the Western Cape.