Microbial contamination profile change over a 4-year period in nonoperated cleft soft palate

AIMS

Surgical site infection is a major concern in cleft soft palate. Knowledge of the type, number and antimicrobial resistance of pathogens present preoperatively contribute to treatment success. The aim of this study is to determine whether or not the microbial contamination (diversity) preoperatively has changed since 2015.

METHODS AND RESULTS

Swabs were taken from the surgical site in 103 consecutive patients who presented for primary repair of the soft palate cleft. These were sent for microscopy, culture and sensitivity testing. Swabs were taken before disinfecting the site. Results were tabled and compared with two previous studies from the same facility. Out of 103 patients, 100 patients showed positive cultures with 42 different pathogenic micro-organisms identified. Most dominant pathogen was Klebsiella pneumoniae, 45.6%, increased by 28% from the previous two studies, with 93.6% of these pathogens resistant to one or more antimicrobials. Most of the other identified pathogens showed an alarming increase in occurrence, with a wide resistance to antimicrobials.

CONCLUSIONS

The increase in number and diversity of microbial contamination as well as their resistance to antimicrobials is a real concern. Ways of preventing postoperative infection in a natural way need to be explored.

SIGNIFICANCE

Surgeons need to be aware of constant changes in micro-organisms.

A Descriptive Study of Chlorhexidine as a Disinfectant in Cleft Palate Surgery

OBJECTIVES

Chlorhexidine is seen as the golden standard of disinfectants. It is widely used to clean surgical sites; however, many studies indicate resistance of pathogens to chlorhexidine. One study indicated that pathogenic microorganisms were isolated from the soft palate cleft region in 57% of patients with facial clefts. The objectives of our study were to determine (1) if chlorhexidine application is effective in removing pathogens from the surgical site in these patients, and (2) if any pathogens are isolated, determine if they are resistant to other antimicrobials.

DESIGN

A descriptive observational study.

SETTINGS

A private practice that specializes in facial cleft surgery, with a country-wide patient base. All procedures were executed by one oral and maxillofacial surgeon.

PARTICIPANTS

All patients (N=50) who presented for primary repair of the soft palate cleft were included in the study.

INCLUSION CRITERIA

written consent from parent(s), and patient cleared as systemically healthy by a pediatric physician.

EXCLUSION CRITERIA

patient(s) with systemic infections (eg, flu) and/or any local infections (eg, tonsillitis). There were 25 males and 25 females with an average age of 7 months and 16 days included in the study.

METHODS

Swabs were taken from the surgical site of all 50 patients with cleft soft palate and were sent for culture, identification and antimicrobial sensitivity. The swabs were taken before disinfecting the site as well as after 2 minutes of disinfecting the surgical site with chlorhexidine. Results were compared against each other.

RESULTS

Positive cultures with 28 different pathogenic microorganisms that were identified in 47 patients before cleaning the surgical site with the chlorhexidine. The most dominant pathogens were K. pneumonia (n=22), H. influenza (n=18) and S. aureus (n=10). Of the pathogens found, 13 (46%) were still present on the swabs taken after disinfecting with chlorhexidine. K. pneumonia (n= 13), H. influenza (n=11) and S. aureus (n=9) were still the most prevalent pathogens.

CONCLUSIONS

This study demonstrated that 61 of the total of 113 pathogens isolated (54%), survived after 2 minutes of disinfecting the surgical and surrounding area with chlorhexidine, thus intensifying the chances of post-operative infection.

Pterygoid Hamulus syndrome--undiagnosed

Undiagnosed Pterygoid Hamulus syndrome can cause long-term suffering. We herewith report on a case with a 30-year history of discomfort and pain without being correctly diagnosed.

An alternative surgical flap design for impacted third molars: a comparison of two different surgical techniques

INTRODUCTION

A major concern of patients who need surgery for impacted third molars is the occurrence of pain and swelling. The damage done during the incision and retraction of soft tissue to expose the impacted teeth, contribute to the above-mentioned.

AIMS AND OBJECTIVES

The study was done to prove a hypothesis that an alternative surgical flap (ASF) is effective in limiting pain and swelling when compared to the standard reverse L-flap (RLF).

METHOD

A prospective randomized cross-over study was done, which included 33 healthy patients. Patients with mirror-image impacted mandibular third molars were selected. Evaluation of pain and swelling was done by Visual Analogue Scale (VAS), implemented for the first seven days after surgery.

RESULTS

The results indicated on average that patients experience less pain with the ASF, although this was not statistically significant. The patients also indicated that they experienced a significant reduction (p < 0.05) in swelling for days one through three, compared to the RLF.

CONCLUSIONS

The hypothesis that the ASF will result in less swelling, has been proven. It is therefore recommended that surgeons use this flap method for removal of impacted third molars to enhance post-operative patient comfort.

Mandibular fractures: an epidemiological survey at the Oral and Dental Hospital, Pretoria

OBJECTIVE

The objective of this retrospective analysis was to study the etiology, distribution, treatment modalities and complications of mandibular fractures of patients who attended the Maxillo-Facial and Oral Surgery (MFOS) unit at the School of Dentistry, University of Pretoria.

METHOD

The records of a representative sample of patients who presented at the MFOS unit with mandibular fractures between January 1999 and December 2003 were captured on a data form specifically designed for this purpose. The data were then analysed using the Statistix 8 programme.

RESULTS

Of the 501 patients who were included in the survey, 67.6% were in the age group 21 to 40 years. The majority of the patients (83.2%) were male. Assault (72.5%) was the most common cause of injury followed by road traffic accidents (14.2 %) and falls (8.8%). Of the 501 cases, 41.3% were bilateral, 32.7% on the left side and 26% on the right side. With regard to the location of the fractures, the majority occurred in the body of the mandible (411%), followed by those in the area of the symphysis/ parasymphysis (23.1%). In the majority of cases (51.7%) the treatment modality used was a closed reduction with intermaxillary fixation. Complications were reported in 14.6% of the 501 cases of which malunion (32%) was the most prevalent.

CONCLUSIONS

Mandibular fractures are more common in males in the age range 21 to 40 years. Interpersonal violence is the main cause of these fractures. The majority of mandibular fractures occur in the body region while malunion is the most common complication.