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Assessment of the investigative value of pus swab collection after drainage of an odontogenic abscess. Does it effect management?
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Abstracts / British Journal of Oral and Maxillofacial Surgery 53 (2015) e37–e110
The American College of Rheumatology suggest a 5 point criteria by which meeting three or more points, scored on clinical findings, suggests a diagnosis of TA. As biopsy is 1 point, it is theoretically possible to diagnose TA without a positive biopsy by these criteria. This study aimed to evaluate the unit’s volume and quality of biopsies, the relevance of the biopsy result on patient management and to correlate this with the American criteria. Methods: Patients who underwent a temporal artery biopsy during a ten year period were identified via the hospital’s pathology database and a retrospective review of the notes was undertaken. Results: 207 specimens were identified. 25 were obtained by the maxillofacial department. The mean length of specimen obtained by the department was the highest compared to other specialities and was above the desired 20 mm. 21/207 biopsies positive. 161 patients scored 3–4 points on the American criteria without including biopsy. Over 50% of these patients were ultimately not treated for temporal arteritis. Conclusions: The maxillofacial unit is reliable in obtaining high quality specimens. Positive biopsy result yield was low throughout all specialities. A negative biopsy result was valuable to patient management suggesting biopsies still have a place in the diagnosis of this often subtle and elusive disease. http://dx.doi.org/10.1016/j.bjoms.2015.08.016 P9 Audit of diagnostic accuracy of parotid fine needle aspiration (FNA) S. Farook ∗ , A. Mistry, M. Hussain, A. Ahmed, M. Gilhooly, B. Visavadia Northwick Park Hospital, United Kingdom Fine needle aspiration (FNA) permits high accuracy in identifying the nature of salivary gland lesions. FNA of the salivary glands is an easy, safe and cost effective technique used in the primary diagnosis. It allows for assessment of both benign and malignant salivary gland lesions. Although rare, salivary gland tumours account for 2%–6.5% of all head and neck tumours; 80% of which occur in the parotid gland. Major salivary glands in its superficial location are readily accessible for this technique to be utilised effectively. An audit was carried out to examine the diagnostic accuracy of parotid FNA in Northwick Park Hospital. The gold standard was established after carrying out a literature review from 1966 to 2014. Patient data was collected over a period of 12 months, analysing all patients that underwent parotid surgery; 49 cases were recorded, of which 39 had undergone FNA Cytology. The average age was 54 years (16–84), Male to female ratio 47% of which were male and 53% female. A comparison of the results to the previous audit conducted in 2010 was carried out. The results from the 2010
audit showed 100% sensitivity, specificity, negative and positive predictive value of fine needle cytology for malignant parotid tumours. 2014 results showed 87.5% sensitivity and 97% negative predictive value; a decrease to the previous audit. 92% FNA correctly predicted exact histological diagnosis, illustrating an improvement from 70% accuracy noted in 2010. Overall, FNA cytology has an established role in the preoperative assessment and diagnosis of patients. http://dx.doi.org/10.1016/j.bjoms.2015.08.017 P 10 Assessment of the investigative value of pus swab collection after drainage of an odontogenic abscess. Does it effect management? S. Farzadi ∗ , K. Kassam, C. Bridle Royal London Hospital, United Kingdom Introduction: For the majority of patients admitted to the RLH for the incision and drainage of a dental abscess under GA, pus swabs and wound swabs are taken in order to carry out culture and sensitivity tests. We aimed to assess whether this investigation had any effect on the overall treatment plan. Method: MC&S results of patients who had undergone I&D under GA was compared to their discharge antibiotic medication. We analysed the results of patients admitted over a period of 6 months retrospectively. Results: Wound swabs, although carried out routinely, were deemed poorly predictive of the underlying aetiology and therefore no microbial analysis was carried out on them, thus being of no diagnostic value. The majority of pus swab MC&S results either had no significant bacterial growth or the antibiotics showed sensitivity to broad spectrum antibiotics used in dealing with odontogenic infections. Conclusion: Wound swabs have no diagnostic value in the treatment of odontogenic I&D and therefore we advise that this practice has to stop. On the other hand pus swab MC&S results do not alter the routine treatment plan of patients admitted and treated. The goal and value of this practice requires to be reconsidered unless in patients requiring I&D for the second time or patients with complex medical conditions. http://dx.doi.org/10.1016/j.bjoms.2015.08.018 P 11 An audit of venous thromboembolism prophylaxis in orthognathic surgery P. Fee ∗ , A. Siddiqui, R. Morrison, M. Ryan Aberdeen Royal Infirmary, United Kingdom Introduction and aims: Venous thromboembolism (VTE) is a preventable cause of significant morbidity and mortality in hospitalised patients. Pulmonary embolism
Abstracts / British Journal of Oral and Maxillofacial Surgery 53 (2015) e37–e110
The American College of Rheumatology suggest a 5 point criteria by which meeting three or more points, scored on clinical findings, suggests a diagnosis of TA. As biopsy is 1 point, it is theoretically possible to diagnose TA without a positive biopsy by these criteria. This study aimed to evaluate the unit’s volume and quality of biopsies, the relevance of the biopsy result on patient management and to correlate this with the American criteria. Methods: Patients who underwent a temporal artery biopsy during a ten year period were identified via the hospital’s pathology database and a retrospective review of the notes was undertaken. Results: 207 specimens were identified. 25 were obtained by the maxillofacial department. The mean length of specimen obtained by the department was the highest compared to other specialities and was above the desired 20 mm. 21/207 biopsies positive. 161 patients scored 3–4 points on the American criteria without including biopsy. Over 50% of these patients were ultimately not treated for temporal arteritis. Conclusions: The maxillofacial unit is reliable in obtaining high quality specimens. Positive biopsy result yield was low throughout all specialities. A negative biopsy result was valuable to patient management suggesting biopsies still have a place in the diagnosis of this often subtle and elusive disease. http://dx.doi.org/10.1016/j.bjoms.2015.08.016 P9 Audit of diagnostic accuracy of parotid fine needle aspiration (FNA) S. Farook ∗ , A. Mistry, M. Hussain, A. Ahmed, M. Gilhooly, B. Visavadia Northwick Park Hospital, United Kingdom Fine needle aspiration (FNA) permits high accuracy in identifying the nature of salivary gland lesions. FNA of the salivary glands is an easy, safe and cost effective technique used in the primary diagnosis. It allows for assessment of both benign and malignant salivary gland lesions. Although rare, salivary gland tumours account for 2%–6.5% of all head and neck tumours; 80% of which occur in the parotid gland. Major salivary glands in its superficial location are readily accessible for this technique to be utilised effectively. An audit was carried out to examine the diagnostic accuracy of parotid FNA in Northwick Park Hospital. The gold standard was established after carrying out a literature review from 1966 to 2014. Patient data was collected over a period of 12 months, analysing all patients that underwent parotid surgery; 49 cases were recorded, of which 39 had undergone FNA Cytology. The average age was 54 years (16–84), Male to female ratio 47% of which were male and 53% female. A comparison of the results to the previous audit conducted in 2010 was carried out. The results from the 2010
audit showed 100% sensitivity, specificity, negative and positive predictive value of fine needle cytology for malignant parotid tumours. 2014 results showed 87.5% sensitivity and 97% negative predictive value; a decrease to the previous audit. 92% FNA correctly predicted exact histological diagnosis, illustrating an improvement from 70% accuracy noted in 2010. Overall, FNA cytology has an established role in the preoperative assessment and diagnosis of patients. http://dx.doi.org/10.1016/j.bjoms.2015.08.017 P 10 Assessment of the investigative value of pus swab collection after drainage of an odontogenic abscess. Does it effect management? S. Farzadi ∗ , K. Kassam, C. Bridle Royal London Hospital, United Kingdom Introduction: For the majority of patients admitted to the RLH for the incision and drainage of a dental abscess under GA, pus swabs and wound swabs are taken in order to carry out culture and sensitivity tests. We aimed to assess whether this investigation had any effect on the overall treatment plan. Method: MC&S results of patients who had undergone I&D under GA was compared to their discharge antibiotic medication. We analysed the results of patients admitted over a period of 6 months retrospectively. Results: Wound swabs, although carried out routinely, were deemed poorly predictive of the underlying aetiology and therefore no microbial analysis was carried out on them, thus being of no diagnostic value. The majority of pus swab MC&S results either had no significant bacterial growth or the antibiotics showed sensitivity to broad spectrum antibiotics used in dealing with odontogenic infections. Conclusion: Wound swabs have no diagnostic value in the treatment of odontogenic I&D and therefore we advise that this practice has to stop. On the other hand pus swab MC&S results do not alter the routine treatment plan of patients admitted and treated. The goal and value of this practice requires to be reconsidered unless in patients requiring I&D for the second time or patients with complex medical conditions. http://dx.doi.org/10.1016/j.bjoms.2015.08.018 P 11 An audit of venous thromboembolism prophylaxis in orthognathic surgery P. Fee ∗ , A. Siddiqui, R. Morrison, M. Ryan Aberdeen Royal Infirmary, United Kingdom Introduction and aims: Venous thromboembolism (VTE) is a preventable cause of significant morbidity and mortality in hospitalised patients. Pulmonary embolism