Browsing by Author "Morkel, JA"

Now showing 1 - 4 of 4
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    The efficacy of platelet-rich fibrin (PRF) on healing following surgical removal of third molar teeth
    (University of the Western Cape, 2021) Pedro-Beech, Kim; Behardien, N; Morkel, JA
    Aim: A clinical trial to determine the post-operative outcomes of a PRF-treated socket versus a conventionally treated socket following surgical removal of third molar teeth. Introduction: Third molar surgery is a procedure many have to endure and which often results in prolonged healing time with consequential absence from work and school. This has motivated clinicians to seek methods to enhance the healing process and in effect, reduce the healing time. Research on the use of PRF in enhancing wound healing in maxillofacial and oral surgery have shown varying results. Therefore, this study was conceived to ascertain the effect PRF has on the post-operative sequelae of third molar teeth. Materials and Methods: This was a split mouth, prospective, single blinded, randomized control trial. The study sample was made up of 26 patients (N=26) who met the inclusion criteria. Four of the patients experienced neurosensory fallout of an associated nerve and were subsequently excluded from the sample. This resulted in the total sample size of twenty-two patients (n=22). Symmetrically impacted maxillary and mandibular third molars were removed under general anaesthesia. Patients were treated in a within subject design: when one side of a patient was treated with PRF, the other side was conventionally treated and acted as a control. The allocation of the side treated with PRF was 'random'. Patients were followed-up on Day 2 and Day 7, respectively. Pain scores were recorded on a visual analogue scale (VAS) using 0 to 10 pain score. Swelling, wound dehiscence, development of alveolar osteitis, wound infection and post-operative bleeding were compared between the intervention and control side. Results: Twenty-two patients (females = 13 and males = nine) between the age of 16 and 31 years met the inclusion criteria. Pain experienced between the PRF and control side on Day 2 and Day 7 were not shown to be statistically significant. The reduction in pain was significant. between Day 2 and Day 7 but not between the treatment modalities. Swelling was lower on the PRF side but this was not significant compared to the control side. There was a significant reduction in swelling over time (between Day 2 and Day 7) but not between the treatment modalities. No impact was shown of PRF on wound dehiscence, infection, alveolar osteitis and bleeding. Conclusion: Overall, this study showed no reduction in post-operative pain and swelling following placement of PRF in the sockets of third molar teeth. It also showed no effect on the incidence of wound dehiscence, infection, alveolar osteitis and bleeding, following PRF treated third molar sockets. The small sample size could be the limiting factor to reflect the true value of PRF as an intervention. However, further investigation with larger sample sizes, more meticulous measuring tools as well as longer follow-up periods are needed to assess the true effect PRF has on enhancing post-operative healing in third molar surgery
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    Post-operative computed tomography scans in severe cervicofacial infections
    (University of the Western Cape, 2015) Ngcwama, Yanga; Morkel, JA
    Purpose: To assess the value of postoperative CT scans in the management of severe cervicofacial infections or deep neck abscesses. Patients and Methods: Thirteen patients underwent post-operative contrast enhanced CT scans after initial incision and drainage followed by a tracheostomy. As per surgical protocol, the CT scans were taken with radiopaque surgical drains in situ from the brain down to the mediastinum and chest/lungs. Data were collected on the presence of abscesses, their location, the location of surgical drains and presence of other pathology. Results: The most common initially affected space was the submandibular space (69%), followed by the submental space (62%). Almost half of the cases studied had two spaces affected and slightly less than a third had three spaces affected. Slightly more than half (54%) of the patients were in good health generally. More than a third (38.5%) of the patients were HIV positive, and thus immuno-compromised. The mean time lapse between the CT and surgery was 2.61 days (SD = 1.56). In the majority (69.23%) of post-operative scans a residual pus collection was found. In just over a quarter (30.8 %) of the patients no residual pus collection was detected on the postoperative CT scan, while in seven patients (53.8%) affected fascial spaces were missed by the surgeon. These spaces included the submasseteric, anteriormediastinum and parotid spaces. Almost half (44.15%) of the patients required a repeatincision and drainage. Conclusion: This study demonstrates clinical value of post-operative CT scans in severe cervicofacial infections. This study also advances the argument for acquisition of preoperative CECT scans for all patients with severe cervicofacial infection.
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    Quality of life assessment after fibula free flap reconstruction for mandibular defects post benign tumour ablative surgery
    (University of the Western Cape, 2021) Jonsson, Philip; Morkel, JA
    Introduction: Defects in the mandible and maxilla have various etiological factors. These include trauma, inflammatory diseases or pathology such as benign and malignant tumours. Patients that are exposed to these factors are often left with compromised function and aesthetics which could have a deleterious effects on the patients’ quality of life if not adequately restored with reconstructive surgery (Goh et al. 2008). Reconstruction should aim to allow rehabilitation of normal stomatognathic function, facial contour and aesthetics, obliteration of dead space left after ablation, and the need to examine the area for recurrence (Kim and Ghali 2011). The fibula free flap has become the gold standard for maxillofacial reconstruction. This flap offers various advantages that makes it suitable, especially for reconstructing defects of the mandible (Anne-Gaelle et al. 2011). The success of rehabilitation of these patients should however also take into consideration the patient’s ability to use a dental prosthesis (conventional or implant retained) post-operatively. This remains challenging (Kramer and Dempf 2005). The effective placement of a dental prosthesis relies on the basic principles of retention, stability and support. With the altered anatomy caused by the graft, placement of dental implants is used to enhance retention and stability. Quality of life (QoL) is a measure of a patient’s satisfaction with their current situation in regards to function and other factors compared to a perceived or expected ideal. The subjective component linked to quality of life means that it could vary from one locality to another, and therefore gathering data that will establish a baseline for these patients that have undergone tumour ablative surgeries. This could be invaluable to healthcare practitioners that operate in this specific field.
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    Quality of life change in patients on the third molar surgery waiting list at Tygerberg Oral Health Centre
    (University of the Western Cape, 2016) Mahomed, Naeem Ahmed; Morkel, JA
    Aim: To assess the change in the quality of life of patients while on the third molar surgery waiting list. Introduction: A large number of patients routinely present at the Tygerberg Oral Health Centre for removal of symptomatic impacted third molars. This results in many patients being placed on a surgical waiting list. In addition, many patients who have been placed on this waiting list return for adjunctive interventions, indicating a possible decrease in Quality of Life (QoL) over the waiting period. Numerous studies document post-surgery changes in QoL in patients that have had third molars removed. Many other studies detail QoL changes in patients awaiting orthopaedic and general surgery procedures. However, no study could be found that dealt with changes in QoL while awaiting third molar surgery. Materials and Methods: This is a prospective questionnaire-based study. It compares QoL at the beginning and the end of the waiting period for the removal of impacted third molars in order to determine whether a change in QoL occurs during the waiting period. The study sample was made up of 48 patients who met the inclusion criteria. Results: The present study shows that patients presenting with symptomatic impacted third molars have a decreased QoL at baseline, which further deteriorates over the waiting period. Although the overall change is negative, it is not statistically significant. This suggests that the null hypothesis cannot be excluded, and that it is therefore acceptable for patients to be managed on a waiting list. Conclusion: Third molar surgery results in a greater decrease in mental than physical wellbeing. The results in this study regarding a negative change in QoL was found not to be statistically significant. Only three out of 48 patients required emergency intervention. It can thus be concluded that placing patients on a waiting list for third molar surgery is acceptable.