Department of Maxillo-Facial & Oral Surgery

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A study to determine the forensic quality of records and record keeping by dentists in the greater Cape Town area
(University of the Western Cape, 2018) Opperman, Johan Frank; Phillips, Vincent
South African dentists have a legal and ethical obligation to maintain complete and comprehensive dental records. In addition to the legal and ethical requirements, dental records are also important in the case of medico-legal issues, quality assurance processes and forensic purposes. Valuable forensic evidence contained in dental records are used in the identification of victims of mass disasters, personal victim identification e.g. in severely decomposed or skeletonized remains where DNA or other biometric data are not available. The victim identification process is highly dependent on complete, legible and accurate dental records. A review of the literature however shows that dental record keeping practices are sub-optimal worldwide. There is a paucity of studies in South Africa regards to dental record keeping practices. The aim of this study was to assess the record keeping practices of a sample of private practicing dentists in Cape Town and surrounding towns, for forensic dental purposes. Knowledge and awareness regards to forensic odontology as well as adherence to the guidelines prescribed by the Health Professional Council of South Africa were also assessed. This was a cross-sectional descriptive study, employing a researcher-administered questionnaire and a dental checklist for forensic valuable items in the dental file. The results were entered in a MS Excel spreadsheet and statistically analysed using IMB SPSS Statistics. This study concluded that most of the dental records kept by Cape Town dentists are near to optimal and would be helpful during forensic odontology investigations. However, shortcomings in record keeping practices exists which may compromise the forensic accuracy of their dental records. The study also shows a significant difference in dental record keeping practices by dentists practicing in lower income areas in Cape Town, compared to those practicing in economic affluent areas. The dentists in this study adhered to most of the guidelines prescribed by the Health Professional Council of South Africa however, important medico-legal information was missing from most dental records. This study hopes to contribute to future comprehensive studies in the broader South Africa to determine the validity of dental records for forensic odontology purposes.
Advanced tumour-induced osteomalacia secondary to sinonasal phosphaturic mesenchymal tumour
(AOSIS (pty) Ltd, 2024) van Wijk, Monica; Opperman, Johan F.; Afrogheh, Amir H.
Phosphaturic mesenchymal tumours (PMT) are rare, benign lesions and the most common tumour to cause tumour-induced osteomalacia (TIO), a paraneoplastic syndrome. Patients frequently exhibit severe osteomalacia, accompanied by multiple fractures, which significantly impair their quality of life. Complete surgical resection is curative. Contribution: A rare case of sinonasal PMT is presented, with a focus on the imaging findings and role of the radiologist and nuclear physician.
Aesthetic outcomes using trans-conjunctival vs transcutaneous approaches for orbital trauma
(University of the Western Cape, 2021) Mhlanga, Gugulethu; Morkel, J.A
Introduction: Maxillofacial and oral surgeons often encounter challenges when choos-ing an appropriate surgical access for patients who sustained periorbital and orbital trauma. There are various surgical approaches/incisions (transcutaneous and transcon-junctival) used to access the periorbital skeletal framework. However, there is no consen-sus in the literature regarding the aesthetical outcome of these approaches/incisions. Complications of the lower lid such as entropion, ectropion, retraction of lower lid, scar-ring, oedema of lid, canthal mal-position and chemosis are associated with these ap-proaches. Surgeons are posed with these challenges and aim for best aesthetic outcomes and low post-operative complications. Aim: The aim of this study was to compare aesthetic outcome of the transcutaneous ap-proach (subtarsal) to that of the transconjunctival approach when managing orbital trauma. Objectives: The objectives were to compare the aesthetic outcomes between the trans-conjunctival and transcutaneous (subtarsal) approach; to assess unwanted clinical out-comes, such as scaring, lid malposition (ectropion, entropion, scleral show), lid oedema, chemosis, haematoma, ecchymosis, wound dehiscence, infection and canthal malposition for the two approaches. Methodology: Twenty-two patients were enrolled in this study, 11 of which underwent “transconjunctival incision”, and 11 underwent "subtarsal incision". A high quality dig-ital photograph of each patient’s face was taken at specified time periods up to nine months after surgery. Ten Maxillofacial and Plastic surgeons were instructed to rank or-der the 22 photographs applying Q-sort scaling. Results: Eleven patients underwent the transconjunctival (retroseptal) incision. Ten of which had pure blowout fractures and one had a zygomatic complex fracture. Of the 11, seven were black Africans, two were Caucasians and two mixed race. There were four males and seven females in the transconjunctival incision group. The remainder of the 22 underwent the transcutaneous (subtarsal) incision. Six of the 11 were black Africans and five mixed race. There were nine males and two females in the tranconjunctival group. In this group, two patients had pure blowout fractures and nine had zygomatic complex fractures. Scars were visible in the subtarsal group after six months in seven out of the 11 cases (63.6%), but all the scars were rated as mild on the modified Vancouver Scar Scale. Scle-ral show was noted after six months in four of the 11 cases with the subtarsal approach and in two of the 11 cases with the transconjunctival approach. Only one case of ectropion was seen with both approaches and only one case of entropion was noted in the transcon-junctival group. According to the findings of the study, both approaches were found to have good aesthetic outcomes. Results from the expert rating showed a high-quality rank of 96.8% for the transconjunctival incision versus 90.5% for the subtarsal incision. Conclusion: Both approaches demonstrated good aesthetic results. The transconjunctival incision was associated with scleral show and entropion, while the subtarsal incision was more associated with scar formation. However, when performed meticulously, both inci-sions can provide aesthetically pleasing results.
Ameloblastoma of the mandible: A radiological and clinical study at the University of the Western Cape Oral Health Centre
(University of the Western Cape, 2019) Ranchod, Sanjay; Morkel, Jean
Ameloblastoma is the most common benign tumour of odontogenic origin and presents five times more in the mandible than in the maxilla (Reichardt et al. 1995). Although benign, it exhibits an invasive behavioural growth pattern with a high rate of recurrence if not managed appropriately. Ameloblastoma occurs in all age groups, but is most common in patients between the ages of 20 and 40 years. Males and females are equally affected. Clinically, ameloblastoma presents as a slow-growing, painless tumour, which if left untreated, can grow to enormous proportions. Radiographically, the lesion presents as either multilocular or unilocular radiolucency. The internal appearance of multilocular lesions may resemble a soap-bubble, honeycomb or spider-like pattern. Combinations of these patterns are not unusual.
Analysis of the occurrence of taurodontism in patients attending the Tygerberg Oral Health Centre
(University of the Western Cape, 2015) Benzahya, Mohamed; Parker, Mohamed Ebrahim
Aim: Analysis of the occurrence of taurodont molars among patients attending the Tygerberg Oral Health Centre. Methodology: A retrospective descriptive study comprising 1608 panoramic radiographs of patient records, 815 females and 793 males, ranging in ages from 18 to 68 years old. The panoramic radiographs were evaluated for presence of taurodontism. Gender predilection and location of taurodont molars were analysed using a chi-square test. Results: Taurodontism was found in 52 (3.23%) radiographs distributed according to gender (30 females and 22 males [P > 0.05]). The overall prevalence of taurodont molars was (0.73%) from a total of 17148 molars that were examined. The mandibular molar teeth were more affected than the maxillary molar teeth and the second mandibular tooth was the most affected. Conclusion: Taurodontism was not uncommon in a group of patients that attended the Tygerberg Oral Health Centre, UWC. Further larger scale studies are required to assess its distribution in the general population of South Africa to compare it with other ethnic groups and to establish any associations. However, taurodontism in mandibular teeth is a condition that should be taken into consideration, especially the second mandibular tooth, to avoid complications.
Antibiotic prophylaxis in third molar surgery
(University of Western Cape, 2007) Siddiqi, Allauddin; Morkel, Jean
The purpose of this study is to evaluate the need for prophylactic antibiotic treatment in third molar surgery and to establish specific guidelines for antibiotic prophylaxis in the department of Maxillo-Facial and Oral Surgery (MFOS) at Tygerberg Academic, Groote Schuur and Mitchells Plain Hospitals.
The assessment of osseous changes in the temporomandibular joint using cone beam computed tomography
(University of the Western Cape, 2013) Shaik, Shoayeb; Parker, M.E.
Aim: To compare osseous changes in the mandibular condyles in patients presenting to the Oral Health Center, Tygerburg Campus, with and without clicking of the temporomandibular joint. Background: Clicking of the temporomandibular joint (TMJ) is not a normal occurrence in its form or function. A chronic click may lead to the development of osteoarthritis. A clinical finding of clicking of the joint can reflect osseous changes of the bony structures and form part of the early signs of degenerative joint diseases. These osseous changes can be detected on Cone Beam Computed Tomography (CBCT) images. The purpose of this study is to confirm the presence osseous changes of the joint and institute the early management of these patients. Failure to intervene in the early stages could result in disease progression to possible osteoarthritis. CBCT imaging will be used to assess osseous changes in the temporomandibular joints with reference to erosions, flattening, lipping, sclerosis and osteophyte formation. Materials and methods: 25 patient records were selected for a control group and 25 patients that attended the Oral Health center were screened for asymptomatic clicking of the temporomandibular joints. Osseous changes of the 100 condyles were examined by the author and a senior member of the department. Changes were recorded when consensus was reached on the presence of any changes. Cone Beam Computed Tomography was used to assess the joints in both groups. Results: Age and gender showed no statistical significance between the 2 groups. The proportion of ‘yes’ for the variables showed that sclerosis (right) was statistically significant when comparing case versus control groups (P = 0.002). A chi-squared test applied to the data resulted in observed chi-square = 15.68, df = 1, p-value = 7.501e-05, (<0.0001) confirming that the discrimination is statistically significant. Conclusion: Osseous changes were found in both the control and case group. The case group exhibited equal or greater prevalence of osseous changes. Patients with asymptomatic click of the temporomandibular joints demonstrate osseous changes.
The association between baby bottle-feeding habits and early childhood caries in young children in Khartoum, Sudan
(University of Western Cape, 2021) Garelnabi, Liyla Abdelrahman; Smit, Dirk
Early childhood caries (ECC) is one of the most common chronic infectious diseases affecting early childhood. It has a multifactorial aetiology and is difficult to control on a population scale. Feeding habits, throughout the first year of life, involve several simultaneous and consistent behaviours, such as breastfeeding, bottle-feeding and the introduction of complementary foods. Particular feeding behaviours recognized at this age may be maintained in later years, potentially impacting health over the life course. The following study was done to interrogate bottle-feeding practices among caregivers in Khartoum and to determine if there was an association with the prevalence of dental caries among young children.
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.
A comparative immunohistochemical study of Ki-67 expression in adenomatoid odontogenic tumour, unicystic ameloblastoma and dentigerous cyst
(University of the Western Cape, 2014) Fakir, E; Hille, J; Morkel, J
The aim of this study was to investigate the biological profile oftheAOT by comparing the Ki-67 proliferative indices of the AOT, Unicystic Ameloblastoma (UA) and Dentigerous Cyst (DC) using ImmunoRatio® software. Adenomatoid Odontogenic Tumours (AOTs) are classified as benign epithelial odontogenic neoplasms with mature fibrous stroma, without odontogenic mesenchyme. However these lesions, like odontomes, occur almost exclusively during the final period of odontogenesis, and clinically behave like self-limiting hamartomatous lesions. Histologically they seem to arise from the lining of dental follicles
Comparison of a piezoelectric and a standard surgical handpeice in third molar surgery
(University of the Western Cape, 2010) Gopal, Ishmael; Faculty of Dentistry
To compare the use of a piezoelectric with a standard surgical handpiece in third molar surgery. Thirty patients requiring removal of third molars were included in the study. Panoramic radiographs were used to assess the third molars. The patients were randomly subdivided and the split-mouth technique applied. In split-mouth design, divisions of the mouth, such as right (upper and lower) and left (upper and lower) quadrants constitute the experimental units, which are randomly assigned to two treatment groups. Each patient serves as his or her own control, which increases statistical efficiency (Siddiqi et al. 2010). Each side was operated with either a piezoelectric or a conventional handpiece. All aspects of preoperative care, general anaesthesia, surgery and postoperative care were standardized for the groups.
Comparison of an intra-oral approach using a contra-angle hand piece with the transbuccal technique for mandibular angle fracture repair
(University of the Western Cape, 2010) De Waal, Andre Stephanus; NULL; Faculty of Dentistry
Purpose: To compare the intra-oral approach using a contra-angled hand piece with the standard transbuccal approach in the treatment of mandibular angle fractures. Patients and Methods: Thirty patients with isolated fractures of the mandibular angle were treated by open reduction and internal fixation using one three-dimensional “strut” or “geometric” Synthes® angle plate. Patients were selected randomly for placement of two-millimeter self-threading screws, either through the standard transbuccal technique or with an intra-oral approach using a contra-angle hand piece. None of the patients were placed into post-surgical maxillomandibular fixation (MMF). Swelling and pain were measured pre-operatively and again twenty-four hours after surgery. The actual cutting time from first incision to placement of last suture was documented, as well as the perception of difficulty of the specific case by a single operating surgeon. Results: No statistically significant difference in perception of pain was experienced between the two groups of patients during the first twenty-four hours after surgery. There was also no statistically relevant difference in cutting time between the two placement techniques. A small statistically relevant difference (p-value = 0.089) was found in the amount of swelling post-operatively between the two groups, with more swelling in the control group. Conclusion: The use of a contra-angle hand piece to place screws in the compression band area in a mandible angle fracture is an acceptable alternative to the transbuccal approach.
Comparison of the accuracy of direct versus indirect bracket placement in orthodontics: An in vitro study
(University of the Western Cape, 2020) Streit, Günther Arthur; Harris, Angela
The purpose of this study was to compare the accuracy of direct versus indirect bracket placement in orthodontics in a controlled setting. The more accurate the initial bracket placement is the less time will be required in terms of treatment. Accurate bracket placement can reduce the envelope of error in the three dimensions of vertical (incisal height, height of tooth), horizontal (mesial-distal) and angular (degrees incisal to root apex causing rotational irregularities) based on Andrews’ six keys to normal occlusion (Andrews, 1979). In this comparative experimental study, 10 Class I molar relation study models were selected from the researcher’s practice archives. Only the MBT pre-adjusted or angulated orthodontic brackets were used on manikins, followed by the use of 3D CAD CAM technology to evaluate the results against a pre-determined golden standard.
A comparison of the treating mandibular fractures at the department of maxillofacial and oral surgery, Groote Schuur hospital
(1995) Rughubar, Vivesh; Kariem, G
Mandibular fractures are common facial injuries, occurring twice as frequently as fractures of the bones of the midface. Only the nasal bones are fractured more often as the result of trauma to the face (Olson eta/ 1982; Theriorletal 1987; Shepherd et al 1988; Dodson et al 1990; Lownie et al 1996). In many oral and maxillofacial units, the treatment of fractures of the mandible form the major proportion of the services rendered. Internationally it is accepted that there are two methods of treatment for fractures of the mandible, namely, closed and open reduction. Closed reductions are performed in dentate patients either under local or general anaesthesia. This method entails the placement of eyelet wires between or around teeth in both arches and then placing the patient into intermaxillary fixation. This is the method of choice when treating an undisplaced fracture of the mandible.
Correlating the intra-operative position of the inferior alveolar nerve with pre-operative cone- beam computer tomography in bilateral sagittal split osteotomies
(University of the Western Cape, 2015) Meyer, Mark Keith; Morkel, A
Aim: The aim of the study was to investigate whether a correlation exists between the intra- operative position of the Inferior Alveolar Nerve (IAN) and the nerve position as noted on a pre-operative Cone Beam Computer Tomography (CBCT) scan in patients requiring Bilateral Sagittal Split Osteotomy (BSSO) of the mandible. Introduction: The BSSO of the mandible is of fundamental importance in the correction of dental facial deformities. The main post-operative complication of a BSSO of the mandible is Neurosensory Impairment (NSI). To avoid possible NSI it is important to have as much pre- operative information as possible. In this regard, pre-operative CBCT scans can provide the surgeon with an important assessment of the mandibular canal. This information on the buccolingual, superior and inferior position of the canal, especially in the region of the planned osteotomy, could help the surgical team to avoid IAN injury. Materials and Methods: This study correlates the pre-operative position of the IAN as indicated on a CBCT scan with the intra-operative IAN position in patients requiring BSSO of the mandible. Ten standardised cases were included in a prospective case series where twenty mandibular sides were assessed. Results: The variables assessed in this study were location of the nerve, age, sex, type of movement and side of mandible operated on. It was found that only the distance between the Inferior Alveolar Canal (IAC) and the lower border of the mandible are predictive of whether the IAN will be attached to - or free from - the proximal segment of the mandible. Conclusion: From the study it can be concluded that a CBCT scan is a useful and reliable modality in the pre-operative evaluation of patients undergoing BSSO especially with regard to the assessment and mapping of the mandibular canal.
Economics of the South African toothpaste industry
(University of Western Cape, 2019) Vorster, Lesley Ross; Naidoo, Sudeshni
Introduction: Untreated caries of the permanent dentition is the most prevalent condition worldwide. Ongoing globalisation and the heightened exposure to a refined, westernised diet against a backdrop of deficient health services and inadequate implementation of preventive public health measures, means that dental caries remains pervasive, especially in emerging economies. In South Africa, an estimated 90% of caries remains untreated, disproportionately affecting the poor and detrimentally impacting on the economy. The use of an effective fluoridated toothpaste is regarded as the best clinical practice available today in caries management. Aim: The aim of the present study was to evaluate the availability, pricing and affordability of fluoridated toothpastes marketed to South African households and to identify mechanisms to improve financial access among low-income households. Methods: A cross-sectional survey of fluoridated toothpastes, retail price and unit weight/volume was undertaken. Following calculation of a median reference price for each paste, affordability relative to household income brackets was assessed using a modification of the WHO/HAI’s essential medicines pricing protocol. Affordability was expressed in terms of the number of days of disposable household income required to purchase the annual, household therapeutic dosage of a fluoridated toothpaste. Results: Despite the wide availability (n=142) of fluoridated toothpastes, of those assessed for affordability (n=130), none and 49% were affordable to households located in the first and second lowest income brackets, collectively termed low-income earners. Accessibility (±96%) increased sharply for low emerging middle income households and upwards. In general, as household income declined, the proportion of daily, disposable income required to purchase the annual, household therapeutic dosage increased. Households located in the lowest income bracket spent 104.3% of daily income on the annual dosage of the lowest priced toothpaste in contrast to 0.23% spent by the wealthiest households. Horizontal disparity in terms of affordability between household income brackets differed significantly (p<0.00001). Conclusion: Stark inequity in affordability of fluoridated toothpastes exists between low income and affluent households with dire implications in terms of oral health and economic hardship suffered by the poor. To redress this social injustice, a number of price regulatory policies and funding mechanisms are suggested to stimulate dialogue and urge all relevant entities (clinical, legal, industrial, and governmental) to take action urgently.
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
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, Nashreen
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) b
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.
An evaluation of Shandon Papspin liquid based oral test utilizing a novel cytologic scoring system
(University of the Western Cape, 2010) Afrogheh, Amir; Dept. of Maxillo-Facial/Oral Surgery; Faculty of Dentistry
Background and Aims: While a single “high quality” oral liquid based cytology (LBC) study has shown a high sensitivity and specificity for the technique in detection of oral dysplasia and malignancy, the high unit cost of this technology cannot be borne by the developing African countries. This study aims to evaluate the efficiency of an alternative cost-effective technique, Shandon PapSpin (PS) LBC in diagnosis of oral and oropharyngeal dysplasia and malignancy. Materials and Methods.We compared the diagnostic accuracy of Shandon PS LBC with that of scalpel biopsy in 69 patients. Transepithelial cytology specimens were obtained using a cervical Cytobrush. The cytology specimens were graded and scored using a novel oral cytologic grading and scoring system respectively. Results: Histological diagnosis of dysplasia or invasive squamous cell carcinoma was made in 51 of the 69 cases. Histology confirmed the cytological diagnosis of dysplasia or malignancy in 49 of the 51 cases. There were two false negative and no false positive cases. The sensitivity was 96% and the specificity 100%. The cytologic grade correlated positively with histologic grade. The best cut off value for distinguishing reactive/mildly dysplastic lesions from high 9 grade/invasive squamous cell carcinoma was determined as a cytologic score of 3, representing a sensitivity of 95% and a specificity of 96%. Conclusion: The Shandon PS LBC in association with transepithelial brush biopsy technique (TBBT) is a highly sensitive, specific and economical screening test in detection of oral and oropharyngeal dysplasia and malignancy. The proposed oral cytologic grading system correlates well with histology. The novel oral cytologic scoring system shows promise as a simple, reliable and reproducible scoring system. In addition, the liquid residual allows for immunocytochemical (Podoplanin) testing.

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