Magister Chirurgiae Dentium - MChD (Maxillo-Facial & Oral Surgery)

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Evaluation of the muscle relaxant orphenadrine in third molar surgery
(Universty of the Western Cape, 2023) Van Niekerk, Brenden; Hein, Gregory
This clinical trial evaluates the efficacy of the muscle relaxant orphenadrine in reducing pain, swelling and trismus, and subsequent quality of life during the post-operative phase following third molar surgery. Forty patients requiring removal of impacted third molar teeth were included and randomly assigned to one of two treatment groups. One group received orphenadrine following surgery, while a control group received no muscle relaxant therapy. Surgical and anaesthetic techniques as well as post-operative pharmacological regimens were standardised. Wisdom teeth surgery has been shown to influence the quality of life of patients in the pre- and post-operative stages. In the post-operative stages, the quality of life may be influenced by the limitation in mouth opening that will directly influence daily functioning. The surgery is often performed in the operating room where intravenous drugs are administered and patients have all wisdom teeth removed at one visit; however, in certain circumstances it becomes challenging to take all wisdom teeth patients to the operating room, hence some will have to endure surgical removal under local anaesthesia. The aim of this study is to determine whether the use of muscle relaxants in the post-operative period will influence the quality of life of these patients. The literature reports on the use of corticosteroids perioperatively, but says little about the use of muscle relaxants.
Residual cysts of the jaws: a retrospective study of characteristic features and management at the university of the Western Cape oral health centre
(University of the Western Cape, 2023) Titinchi, Fadi; Morkel, Jean
Residual cysts are infrequent inflammatory cysts of the jaws which are of odontogenic origin. They are usually preceded by a radicular cyst which has developed apical or adjacent to a carious tooth. These cysts usually present with similar features as radicular cysts; however, due to absence of the causative tooth, they can mimic more aggressive cysts and tumours on radiographs. Moreover, they have the ability to destroy bone within the jaws without any symptoms. There is paucity of studies in the literature regarding these cysts as they are often overlooked due to their lack of symptoms and innocent radiographic appearance. Hence, the aim of this study was to describe the clinical, radiological and histopathological features of residual cysts in the jaws as well as analyse their surgical management and recurrence patterns.
Unicystic Ameloblastoma : A critical appraisal
(University of the Western Cape, 2000) Singh, S; Shear, M
Robinson and Martinez first introduced the entity of unicystic ameloblastoma n 1977. Since then numerous case reports and series have been published. The evidence suggests that a more conservative approach can be used successfully to treat the unicystic ameloblastoma. The term unicystic is derived from the rnacro- and microscopic appearance of the lesion, whereas the term unilocular is used in radiological interpretation to describe a radiolucency having one loculus or compartment. Much confusion stems from the fact that a unicystic ameloblastoma might appear not only as a unilocular lesion, but also as what is often interpreted as a multilocular bone defect.
A retrospective anal\'sis of gunshot injuries to the maxillofacial region (1980 to 1995)
(University of the Western Cape, 1997) Kassan, Ashwin Harkison; Kariem, Gilmie
There appears to be an increase in the use of handguns amongst the civilian population with a resultant increase in the firearm related mortalities in the Cape Town metropolitan area (Lerer et al., 1997). Therefore, the aim of the study was to analyse the demographic data, patterns, management and complications of gunshot injuries to the maxillofacial region. This is a retrospective study of gunshot injuries to the maxillofacial region treated at Groote Schuur Hospital, Cape Town over a 15 year period (1980- 1995). A total number of 301 cases were analysed.
The inter-canine distance in the maxilla and mandible for sex determination in a sample of adults from Khartoum Teaching Dental Hospital, Sudan
(University of the Western Cape, 2022) Elhag, Ahmed; Chandler, Susan
In forensic odontology, sex determination is one of the key parameters and is a crucial element in identification of a deceased individual by a forensic investigator. Canines are considered an excellent tool to distinguish gender. This study investigated sexual dimorphism using quantities of the inter-canine distance of the mandibular and maxillary permanent canines in a sample of the Sudanese population living in Khartoum.
Malignant tumours of the maxillofacial and oral region in children: A clinicopathologic study
(University of the Western Cape, 1994) Mohamed, Ashraf; Kariem, Gilmie
This is a retrospective study of malignant tumours of the maxillofacial and oral region in children that presented over a 20 year period (1973 to 1993) at the Red Cross War Memorial Children's Hospital and Groote Schuur Hospital, Cape Town. Of the 352 children that were treated for a malignant tumour arising from various anatomic sites in the head and neck region, 30 were found to have had maxillofacial and oral involvement. This represented an incidence of 8,5%. Histologically, the majority of the tumours were non-odontogenic and mesenchymal in origin. The rhabdomyosarcoma was found to be the most common neoplasm, followed by the Burkitt's lymphoma. The age range was 6 months to 13.8 years (mean age 5.7 years). Males were more commonly affected than females, with a ratio of 1.3:1. There were 26 (86,7%) black patients and 4 (13,3%) white patients, representing a ratio of 6.5:1. Fifty percent of the cases were from the Eastern Cape. The mandible and the maxilla were the most common sites to be involved, followed by the soft tissues of the face. The most common presenting symptom was a painless swelling (73,3%) of the face. Twenty percent of the patients had "floating" or loose teeth. Radiographic features in the jaws were poorly circumscribed destructive lytic lesions with displacement of teeth. Histologic type was found to be the most significant variable affecting the outcome, with the Burkitt's lymphomas having the best prognosis and the rhabdomysarcomas the worst. The most common cause of death was metastases to the lungs. It is concluded that although malignant tumours of the maxillofacial and oral region in children are rare, their prognosis is poor. Therefore, any child presenting with a facial swelling should be viewed with suspicion.
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
A retrospective analysis of gunshot injuries to the Maxillofacial region (1980 to 1995)
(University of the Western Cape, 1997) Kassan, Ashwin Harkison; Kariem, G.
There appears to be an increase in the use of handguns amongst the civilian population with a resultant increase in the firearm related mortalities in the Cape Town metropolitan area (Lerer et al., 1997). Therefore, the aim of the study was to analyse the demographic data, patterns, management and complications of gunshot injuries to the maxillofacial region. This is a retrospective study of gunshot injuries to the maxillofacial region treated at Groote Schuur Hospital, Cape Town over a 15 year period (1980-1995). A total number of 301 cases were analysed. Maxillofacial gunshot injuries are increasing exponentially over the years with most of these occurring post 1990. The majority of these injuries were due to civilian type low velocity handguns. A smaller percentage were due to intermediate type shotgun injuries which occurred predominantly during periods of political uprising during the early and mid 1980's. The majority of these injuries were purposefully and intentionally inflicted by others. Males within their third decade of life were most often the victims of these gunshot injuries. Most of these patients were of a lower socio-economic status and resided in the traditionally "Black" and "Coloured" residential areas. The wounding effects of these low velocity injuries were characteristic, producing small rounded entrance wounds, causing fragmentation of teeth and comminution of the underlying bone, usually without any exit wounds. Mandibular fractures were more common than the maxillary ones with fracture patterns varying from simple to comminuted type fractures. The comminuted displaced type of fracture pattern, however, were most frequently observed. The most common associated bodily injuries occurred to the head, neck and limb regions. Special investigations included plain film radiographs with more sophisticated investigations, e.g. CT-scans and angiograms being requested where indicated. Necessary airway management was constituted where required and included emergency cricothyroidotomies, oral and nasal endotracheal intubations and elective tracheostomies. The vast majority of the patients, however, required no airway management. The definitive surgical management was initiated by early soft tissue debridement (within 12-24 hrs). There was an equal distribution in both the early and delayed timing of the fracture management. Both the mandibular and maxillary fractures had more open than closed reductions done. Bone continuity defects as a result of the initial injury were usually reconstructed secondarily using free antogenous bone grafts. This, however, comprised only of a smaller number of patients. All the patients received anti-tetanus toxoid on admission and the majority received antibiotic treatment varying from one dose to a five to seven day course. This consisted of either penicillin alone or a combination of penicillin and metronidazole in most cases. The mean hospitalization stay totalled six days. Most recorded complications presented early (within one week) post-injury. The most frequent recorded complications were sepsis, ocular and neurological complications and limitation of mouth opening. The post-operative sepsis rate was high (19%). The common neurological complications consisted of varying degrees of damage to the facial and trigeminal nerves. Blindness was the most common ocular complication observed. Other complications included oro-antral, oro-nasal and parotid fistulae and bony and fibrous ankylosis. These, however, occurred less frequently.
Extraction and retention of teeth in the line of mandibular fracture: A study of a Western Cape sample
(University of the Western Cape, 1986) Hendricks, Mogamat Rushdi; Garach, Vinay
Anecdotal and controversial discussion has.always been prompted by the bias of the clinician in relation to whether teeth in the line of fracture should be extracted or retained. In recent years, it became evident to clinicians serving the Maxi 11ofaci aland Oral Surgery Clinic at Groote Schuur Hospital, Cape Town, that a tendency towards reta ining teeth in the 1ine of fractu re did not seem to increase the possi bility of infecti on, providing that circumspection was used. A retrospective analysis of these cases was conducted in order to determine the outcome of our treatment. An independent sample of the 151 patients were investigated in relation to age, sex predilection, the effect timing has on the outcome of treatment and the incidence of infection when teeth in the line of mandibular fracture were extracted or retained. The results of this study has shown that most of our patients were young (aged 20-29yrs) and therefore a tendency to retain teeth was found. In older patients, (aged 30-49yrs), the tendency was to extract teeth. Males presented more than females in a 3:1 ratio. Patients treated early « 24hrs) had most of their teeth retained while others treated after 7 days had their teeth extracted. The infecti on rate was 2 percent if teeth were retained and 5 percent if teeth were extracted. A1though the difference was not statistically significant, it appeared that the retenti on of teeth in the 1ine of fracture presented more advantages to both patient and clinician.
Maturation of the permanent teeth in a Western Cape sample
(1974) Singh, Surandar; Lucchessi, M V
The need for in-depth knowledge of dental emergence and calcification in orthodontic diagnosis and treatment planning cannot be disputed. Serial extractions, treatment timing, bite opening and closing, expansion and various other orthodontic procedures cannot be successfully executed without an in depth knowledge of the calcification and eruption of teeth. Besides its orthodontic implications, dental calcification and eruption plays a significant role in physical anthropology, forensic odontology, endocrinology and nutrition (Demirjian, 1978). Forensic scientists are agreed that teeth constitute the most important and reliable means for determining age from approximately 10 week in utero to old age (Altini, 1983). It is a generally accepted fact that there is no correlation between biological age and chronological age (Prahl-Andersen and Van der Linden, 1972; Demirjian, 1978), an aspect, which will be discussed in further detail later in the review of the literature. Biological age is seen to be a more accurate indicator of an individuals maturity than chronological age (Moorees et al, 1963; Prahl-Andersen and Van der Linden, 1973; Oemirjian et al, 1973). However, allocating a biological age to an individual is not an easy exercise as no definite consensus has, to date, been reached regarding the best method of determining biological age (Moorees et al, 1963; Garn et al, 1967; Demirjian, 1978). Today, many different methods are being used to establish this, for example bone age, height, menarche, circumpubertal growth and dental age.
Survey on the management of Alveolar Osteitis ( Dry Sockets) in South Africa
(University of the Western Cape, 2009) Nokaneng, Emmy Ngoakoana; Morkel, Morkel
Exodontia remains one of the most regularly done procedures in dentistry in South Africa (SA) and alveolar osteitis (AO) is considered one of the most common complications associated with exodontia. Despite the extensive research done on this clinical entity, the management of AO still remains controversial. Various management protocols have been suggested in the literature, varying from prophylactic to symptomatic management of AO (Blum,2002). However, none of these management protocols have to date shown any conclusive evidence on the effectiveness and benefit over another protocol. The author was of the opinion that general dental practitioners (GDPs) in South Africa generally use preventative and treatment protocols based on what they were taught at their alumni dental schools or use protocols modified from their own clinical experience in practice. The aim of this study was to assess which treatment protocols are routinely used by GDPs in South Africa for the management of AO and suggest a scientifically sound treatment protocol for AO. The study was done in the form of a questionnaire and the participants were randomly selected from the Health Professions Council's register. The results showed that most of the GDPs in South Africa continued to use the same treatment protocol as their alumni dental school. They were of the opinion that these protocols were still clinically the most effective. Despite the plethora of intra-alveolar medicaments available, Alvogyl®still remains the medicament of choice of GDPs. As there is no evidence in the scientific literature that suggests that one intra-alveolar medicament or antibiotic is more effective than the other, the author does not encourage the use of the medicaments or antibiotics in the treatment of AO. However, by following simple measures such as improving patients' oral hygiene and using a pre-operative 0.2% chlorhexidine mouth rinse, the incidence of AO can be reduced significantly.
An osteo-radiographic study of the mandibular canal
(1982) erman, Neill Julian S; Nortjé, C.J.
Even though the mandibular nerve is of great importance to the dentist, very little research on the course of the nerve and the relationship of the mandibular canal to the adjacent anatomical structures has been carried out. From the. literature, it appears that the lateral ramus prominence (L.R.P.),or antilingula, is found to be present in from 50% to 100% of cases and is situated anterior and superior to the mandibular foramen. Most authors are in agreement on the situation of the mandibular foramen. Only one mandibular foramen is described in each ramus. The mandibular canal is described as lying inferior to the teeth. There is no agreement on the possibility of the existence of a second mandibular canal per hemimandible. Concerning the mental foramen, it is accepted that one is found on each side, but a second foramen,as well as accessory foramina, namely, the major and the minor variety, are described. In the horizontal plane, the mental foramen is found at the apex of the second premolar tooth or between the premolar teeth. In the vertical plane, the mental foramen is situated from inferior to the apex of the premolar teeth to halfway between the apex and the crown of the premolar teeth. The mylohyoid groove is converted into a canal in 16% of cases but never commences from within the mandibular canal, according to available literature.
Unicystic ameloblastoma: A critical appraisal
(2000) Singh, Suvir; Shear, M
Robinson and Martinez first introduced the entity of unicystic ameloblastoma in 1977. Since then numerous case reports and series have been published. The evidence suggests that a more conservative approach can be used successfully to treat the unicystic ameloblastoma. The term unicystic is derived from the macro- and microscopic appearance of the lesion, whereas the term unilocular is used in radiological interpretation to describe a radiolucency having one loculus or compartment. Much confusion stems from the fact that a unicystic ameloblastoma might appear not only as a unilocular lesion, but also as what is often interpreted as a multilocular bone defect.
Mandibulo-facial dysostosis - An investigation of the cranio-facial and oral manifestations in South African bantu.
(University of Pretoria, 1975) Seeliger, Joachim Ernst; Knobel, D P
The subject, an adult bantu male with most of the features of the classical syndrome, is subjected to a physical investigation with the - emphasis on the cranio-facial and oral manifestations. The clinical appearance of the facies and head is discussed and the findings correlated with those of the accepted syndrome. Special attention is paid to the oral and dental manifestations and measurements are recorded and compared. A rontgenographic examination is .performed on the cranium, facial bones and the jaws. Utilising the lateral skull radiograph ·(cephalogram), a cephalometric analysis is done of the skull and jaws to determine the development that has occurred.
An in vitro study of the microleakage of a compomer (polyacid modified resin composite) bonded to enamel and dentine with different bonding systems and the effect of saliva contamination there of.
(Stellenbosch University, 2002) Saayman, Charlene Margaret; Grobler, SR
Restorative systems classified as polyacid modified composite resins, or compomers, have appeared on the market. An example of this is Dyract AP. Dyract AP must be used with the Prime & Bond NT bonding system. Prime & Bond NT can be applied without any form of prior etching, or it can be applied after application of Non Rinse Conditioner, or it can be applied after etching with 36% phosphoric acid. The purpose of the study was to determine the qualitative microleakage of Dyract AP and its bonding systems, as well as the influence of saliva contamination there of. Freshly extracted, non-carious, human premolars were randomly divided into 8 groups of 18 teeth each. Apiseetomies coated with Polivar varnish and restored with amalgam were performed on all teeth. Class V type cavities of 3 mm diameter and 1,5 mm depth were prepared on the CEJ junction on the buccal side of all teeth. Dyract AP restorations were placed using the bonding procedures indicated: Group 1: P&B NT (Prime & Bond NT); group 2: acid (36% phosphoric acid) + P&B NT; group 3: NRC (Non Rinse Conditioner) + P&B NT; group 4: P&B NT + Saliva; group 5: acid + Saliva + P&B NT; group 6: acid + P&B NT + Saliva; group 7: NRC + Saliva + P&B NT; group 8: NRC + P&B NT + Saliva. Restorations were finished with Sof-Lex discs. After 24 hours storage in distilled water the teeth were removed and coated with two layers of nail varnish, except for 1 mm around the restorations. The teeth were then thermocycled in a 0.5% basic fuchsin solution for 500 complete cycles between 8°C and 50°C, with a dwell time of 15 seconds.
A photometric soft-tissue profile assessment in a Western Cape sample
(Uiversity of the Western Cape, 1986) Samsodien, Mogamat Gilmee; Sing, S
Cephalometric norms for the soft-tissue profile presently utilized in this country, are based almost entirely on North American Caucasian and Negroid studies. Orthodontists use these standards as a guide in the treatment of all sections of the South African population. Various studies have conclusively shown that the soft-tissue profile differs both racially, and from country to country. In recent years the number of patients presenting for orthodontic treatment at the University of the Western Cape has increased significantly. The need has therefore arisen for the establishment of soft-tissue profile trends in the Western Cape area.
An investigation into the role of histological parameters in the prediction of the prognosis for tl and t2 oral squamous cell carcinomas
(University of Western Cape, 1998) Roberts, Tina Sharon; Hille, Josh
TI and T2 squamous cell carcinomas of the head and neck have an unpredictable prognosis that often pose therapeutic problems. Sophisticated methods such as cytometric DNA analysis, immunocytochemistry and detection of cellular growth factors, have been applied with varying success rates for predicting recurrences, metastatic rates and overall prognoses. However, with the general lack of resources in Africa, devising a simple, reliable, reproducible and cost-effective method of predicting tumour behaviour to aid optimal treatment planning is imperative. Surgical excision specimens of forty-eight primary Tl and T2 squamous cell carcinomas of the floor of the mouth and tongue were histologically evaluated by two individual pathologists (double-blinded study) who had no prior knowledge of clinical course or outcome.
The titanium staple implant : A classification of three-dimensional profiles, of the anterior implant-bearing area of human mandibles
(University of Western Cape, 2021) Potgieter, Johannes Theodorus; Jooste, C. H
The purpose of this study was to e8tablish standards (norms), based on three-dimensional stereomicroscopic surveys of the anterior implant-bearing area of severely-resorbed human edentulous mandibles. Such standards could possibly be applied towards the development of a series of transmandibular implants which would have wide applications in a broad spectrum of patients. The sample consisted of forty five severely-resorbed human edentulous mandibles eminating from people of various ages, both genders and several ethnic groups. Only 28 specimens were accompanied by pertinent details about the deceased. Measure~ents were made in the anterior mandibular area bounded by the mental foramina.
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.
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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