3. Electronic Theses and Dissertations (ETDs) - All submissions
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Item A comparative study of 3 treatment modalities for mandibular angle fractures(2017) Dulabh, ShailenIntroduction: The mandibular angle fracture remains one of the most common mandibular fractures with a reported incidence of ~20 – 40%. Its treatment is rife with controversy with a reported global complication rate of ~30%. Aim: The purpose of the study is to determine the optimum management of the compound, isolated mandibular angle fracture. Methods and materials: A prospective, randomised, study was carried out within the department where all cases of isolated, compound, mandibular angle fractures were allocated to 1 of the three treatment groups: Group1: Superior border wire; Group2: Single miniplate; Group3: Double miniplate. The patients were assessed for the presence of post-operative infection, malocclusion and fixation failure and the outcomes were correlated. The data was analysed statistically and reported upon using STATA. Results: 75 patients were included in the study with 25 patients per group. Complication rates were equal between the miniplate groups (16%), with the Superior border wire having the best outcomes. The average ―days to surgical fracture repair post-injury‖ (p = 0.08) and the category of ―severely displaced fractures‖ (>5mm) are the factors shown to increase the incidence of complications, p = 0.02. Overall a 13.3% complication rate was noted. Conclusion: The use of 2 miniplates seems to offer no benefit over a single miniplate. In stark contrast to previous global findings, fixation using a superior border wire with intermaxillary fixation (IMF) showed the best outcomes with a 92% success rate and its usage should be reaffirmed as a cost-effective alternative in a resource-constrained environment.Item A clinico-pathological study of HIV-associated cystic lymphoid hyperplasia(2011-11-23) Dulabh, ShailenIntroduction: Cystic lymphoid hyperplasia (CLH) is a common yet under recognised entity affecting the parotid gland in HIV infected patients. This is the largest global clinicopathological study of CLH to date consisting of 167 cases (85M, 82F). Aim: To define the clinical parameters, histology and immunopathological features of CLH with a view to elucidating the aetio-pathogenesis. Material and Methods: This retrospective study on archival cases of CLH included patient’s age, race, gender, nature of CLH, HIV status, CD4 counts and viral loads where available. Of the 167 confirmed cases of CLH, 109 cases were histologically reviewed and 25 cases were immunohistochemically analysed with CD3, CD20, CD4, CD8 and p24 using standard procedures. Ethics clearance (M080927 and M080850) was obtained. Results: CLH mainly affects the parotid gland with a male predominance. Submandibular gland (p = 0.27) and bilateral parotid involvement favours females (2:1). CLH affects females at a younger mean age in both the parotid and submandibular glands (36.5, 31 years) respectively compared to males (40.9, 42.4 years) (p = 0.0032). Intra-lymph nodal origin is favoured with 76.1% of cases occurring within entrapped salivary gland remnants. P24 staining reveals ~90% specificity in HIV associated CLH. Immunostaining showed a CD8:CD4 of ~1:1 except in selected cases where CD4 was decreased in the interfollicular areas. Conclusion: CLH is the preferred term to describe bilateral parotid enlargement in HIV infected patients. This study strongly supports origin of CLH following ductal ectasia of entrapped salivary gland inclusions within atypical lymphoid hyperplasia arising within lymph nodes in the context of an HIV setting. CLH should be classified as an orofacial lesion strongly associated with HIV and AIDS.