- Email: [email protected]
Paranasal sinus endoscopy and orbital fracture repair
1361
CURRENT LITERATURE tooth. A total of 32 extracted teeth (molars and premolars) were included in the study. One half of the sample were sterilized with steam autoclave (260” F at 20 psi for 20 minutes). All of the teeth were randomly distributed in groups of four, and each group contained both autoclaved and non-autoclaved teeth. Fourteen teeth were prepared with two surface cavities by four faculty members and hardness and brittleness were subjectively evaluated. Physical properties such as hardness were tested with the Vickers’ microhardness measurements and the structural changes were assessed by differential thermal analysis. Among the physical analysis, the only remarkable difference founded between the two groups was the reduction of the dentin hardness within the autoclaved teeth, maybe as a result of alteration of the dentinal collagen (20% to 25% of the organic material). Because the relative low organic content of the enamel structure no modification in hardness was seen due to exposure to the high temperature and pressure of the autoclave. However, no significant chemical bond breakdown had occurred during autoclaving because exothermic characteristics were unchanged for the two groups. The conclusions of this paper showed that the autoclaving of extracted teeth affects the dentin structure, but not so much that it will always be detected by the clinician. Besides the preclinical usage, the extracted teeth are used during the preliminary phases of dental material development. The effect of the autoclave sterilization on the chemical and physical relationship between the dental material and the dentin structure is unknown. Because of the high mineral content of the peritubular dentin, it is thought that the effect of autoclaving on bonding performance should be minimal.-A.F. HERRERA Reprint request to Dr Parsell: Department of Restorative Dentistry, School of Dentistry, University of Mississippi Medical Center, Jackson, MS 392164505.
Ultrasound-Guided Interstitial Nd:YAG Laser Treatment of Voluminous Hemangiomas and Vascular Malformations in 92 Patients. Werner JA, Lippert BM, Gottslich S, et al. Laryngoscope 108:463, 1998 Hemangiomas and vascular malformations are common in the head and neck region. Conventional surgery, embolization, and interferon and steroid therapy are standard treatment options for these lesions. Over the last 15 years, laser therapy has also become an accepted treatment protocol. This study is a review of 92 patients with voluminous hemangiomas and vascular malformations treated with interstitial Nd:Yag laser therapy. The vascular tumors all had a diameter of more than 3 cm in at least two dimensions. Treatment was carried out under ultrasound guidance. Five patients required only one application of laser, 36 patients needed two applications, and 51 patients needed three or more treatments. Nearly 60% of the patients showed complete clinical regression. Thirty-three patients (35.8%) had a partial regression and were satisfied with the outcome. Four patients were treated unsuccessfully and required conventional surgery. None of the patients had significant intraoperative bleeding and three patients had mild postoperative bleeding. No blood transfusions were necessary and no infections occurred. Conclusions drawn by the authors were that laser treatment of large vascular lesions is safe, effective, and cosmetically satisfying.-J. BROKLOFF Reprint requests Christian-AIbrechts Germany.
to Dr Werner: Department of Otolaryngology, University, Arnold Heller-Str. 14, D-24105, Kiel,
Dose-Related Effects of Oral Acetaminophen on ColdInduced Pain: A Double-Blind, Randomized, PlaceboControlled Trial. Yuan CS, Karrison T, Wu JA, et al. Clin Pharmacol Ther 63:379, 1998 Acetaminophen, a non-NSAID, nonopioid analgesic, is one of the most widely used medications for the treatment of mild and moderate pain. Immersion of a limb in ice-cold water has long been known to induce pain in humans and this cold-induced tonic pain model has been shown to be a sensitive and reliable technique. It is a widely used paininduction method in clinical trials. This study was a doubleblind, randomized, placebo-controlled design that was used to evaluate the dose response effects of oral acetaminophen on cold pressor-induced pain in 18 normal, healthy human subjects. Each subject underwent four sessions in which they were given one of three doses of oral acetaminophen (325 mg, 650 mg, or 1,000 mg) or placebo. A cold-pressor test was performed 110 minutes after the administration of the study drug. Each subject was asked to verbally rate the pain on a scale (0 to 10) at 30, 70, 110, and 170 second intervals during the immersion. A dose-related analgesic effect was observed. There were statistically significant main effects of both dose and time. This study concluded that it is possible that acetaminophen may be particularly effective for treatment of certain kinds of pain and the results suggest that the cold-pressor method may have clinical value in evaluation of non-opioid analgesic agents--T. ZUCK Reprint requests to Dr Yuan: Department of Anesthesia Care, The Pritzker School of Medicine, The University 5841 S Maryland, MC 4028, Chicago, IL 60637.
and Critical of Chicago,
Intralesional Bare Fiber Laser Treatment of Hemangioma of Infancy. Achauer B, Celikoz B, Vanderkam V. Plast Reconstr Surg 101:1212,1998 The purpose of this study is to examine effects of intralesional fiber with the potassium-titanyl-phosphate laser for treatment of hemangioma of infancy. Twelve patients were treated. Results showed 92% had 50% reduction in size at 3 months, 8% had greater than 50% reduction in 6 months. Fifty percent required two treatments and 8% required three treatments. The authors concluded that intralesional fiber therapy is effective.-R. HOLLOWAY Reprint requests sity of California,
to Dr Achauer: Division 101 City Dr, Building
of Plastic Surgery, Univer53, Route 81, Orange, CA
92868.
Paranasal Sinus Endoscopy and Orbital Fracture Repair. Woog JJ, Harstein ME, Gliklich R. Arch Ophthalmol 116:688, 1998 Although excellent results may be achieved in the management of orbital floor injuries with standard transconjunctival or transcutaneous approaches, visualization of the posterior orbital floor or medial wall defect may be challenging. The authors describe the use maxillary sinus endoscopy and examination of the orbital floor during the repair of selected orbital floor fractures. An important goal of orbital fracture repair is the complete removal of herniated orbital soft tissues from the fracture site. The orbital floor has a posterosuperior angulation relative to the anterior orbital rim, which makes it difticult to visualize when orbital exploration is performed solely through a transconjunctival subperiosteal approach. This paper reported a concurrent
1362
CURRENT LITERATURE
antrostomy/endoscopy to allow better visualization, and therefore, allow complete removal of soft tissues from the fracture site. Initially, the patient’s mucosa is decongested with oxymetazoline hydrochloride or 4% cocaine hydrochloride. Local anesthesia is inftltrated into the lateral nasal wall and the uncinate process of the affected side is removed for proper visualization of the ostium. Enlargement and antrostomy is followed by placement of the endoscope into the maxillary sinus. In the event of medial rectus entrapment, a limited ethmoidectomy is recomended, leaving the lamina papyracea intact. The authors then described the use of a standard transconjuctival approach for identification of the fracture and removal of bony fragments. A custom-made titanium mesh orbital implant was then placed to space the defect in the floor and medial wall. The endoscope was used to guide the implant into proper position away from the optic nerve and to ensure clearance of posterior orbital soft tissues. Subsequently, the implant was secured with screws and the incision was closed in a standard fashion. The authors’ suggest that endoscopic visualization of orbital floor fractures may facilitate safe and secure placement of orbital implants while ensuring no residual soft tissue incarceration, minimal extention of orbital incision, and decreased postoperative enophthalmos.-H. PATINO Reprints requests MO 63124.
to Dr Hartstein:
8729 Delmar,
Surgery.
Dermabrasion is a time-tested modality for facial skin resurfacing and should continue to be an important tool for every plastic surgeon. Dermabrasion is safe, efficacious, inexpensive, portable, and widely available. It does not require special safety equipment, does not pose a fire hazard, has a shorter erythema phase than for laser resurfacing, and minimal training is required for its use. Dermabrasion is simply the controlled mechanical abrasion of the epidermis and a variable segment of the upper dermis. It is indicated for perioral rhytids, acne scarring, traumatic facial scarring, and rhinophyma. Dermabrasion is performed in the operating room with anesthesia of the appropriate magnitude. Diamond-impregnated cylindrical fraises are most commonly used. They rotate at 12,000 to 15,000 rpm via an electrically powered hand-held motor driver unit. The operating room staff should be protected from airborne and aerosolized particles. The wound is created gradually by region, to the appropriate depth. A saline-moistened sponge is placed over the wound postoperatively to aid in hemostasis. A petrolatum-based ointment is then placed in a thin layer over the abraded surface. After 7 to 10 days, a moisturizer is substituted for the petrolatum dressing. Complications include hypertrophic scarring; infection by bacterial, viral, or fungal agents; hypopigmentation, and hyperpigmentation. Despite the continued demand for space-age laser technology, dermabrasion remains a safe and efficaciousmodality for the treatment of rhytids and scars.-R.H. HAUG
The Preoperative Benefit. Peterson 133:134, 1998
Plastic Surgery
Bleeding P, Hayes
Time TE,
Arkin
Associates,
PA, 1501 S
Test Lacks Clinical CF,
epidurai
anesthesia
given
to patients
receiving
oral anticoag-
ulants, they were anecdotal cases of spinal subdural bleeding; however, the preoperative bleeding time has not been uniformly prolonged in these cases. The authors concluded that the bleeding time test is not a useful predictor of the risk of hemorrhage associated with surgical procedure. The best preoperative screen to predict bleeding complications is comprehensive clinical history, which includes family and previous dental, obstetric, surgical, traumatic injury, transfusion, and drug histories. A patient with a history suggesting a possible bleeding disorder may require further evaluation.I.E. SHAMI Reprint request to: College of American Rd, NorthReId, IL 60093-2750.
Pathologists,
325 Waukegan
Suite 2W, St Louis,
Dermabrasion: As a Complement to Aesthetic Baker TM. Clin Plast Surg 25:81, 1998
Reprint requests to Dr Baker: MIamIAve, Miami, FL 33129.
tests of hemostasis. The authors reviewed the data concerning the of preoperative use of the bleeding time test and its prediction for hemorrhagic complications. In one study of 101 patients, only 2 out of 17 patients who experienced excessive bleeding were prospectively classified as high risk according to the result of bleeding time test. Another study by Amrein et al found no correlation between increased bleeding and a bleeding time greater than 10 minutes or an aspirin-induced prolongation of 4 minutes over baseline. Odom and Sih reported their experience with 1,000 cases of
et al. Arch
Surg
One to two million bleeding time procedures are formed each year in the US, making it one of the most widely used
Identikation of Obstructive Sleep Apnea in Patients who Snore. Tami TA, Duncan HJ, PBeger M, et al. Iaryngoscope 108:508,1998 This study examines a series of snoring patients who underwent home overnight sleep studies and completed extensive sleep related questionaires. The objectives of the study were to determine the incidence of obstructive sleep apnea (OSA) in patients presenting with socially unacceptable snoring and to develop a protocol to identify patients with OSA as a subset of patients who snore. Ninety-four snoring patients were recruited to determine the incidence of OSA in this highly selected population. The patients answered an extensive sleep questionaire to determine factors that might suggest a diagnosis of OSA and a home sleep study was performed on each participant. The overall incidence of OSA in this group was 72%. Severe sleep apnea with greater than 25 apneic events per hour was found in 42% of the patients. Moderate sleep apnea with 10 to 20 apneic events per hour was found in 30% of the patients. Twenty of the subjects with severe sleep apnea also underwent inpatient polysomnogmphy and the diagnosis was con6rmed in all cases. Conclusions drawn by the authors were that home sleep studies are an accurate and costeffective alternative to inpatient polysomnography.-J. BROKLOFF Reprint Center, 670528,
requests to Dr TamI: University of Cincinnati Medical Department of Otolaryugology, 231 Bethesda Ave, PO Box Cincinnati, OH 45267.
Minimal Head Trauma in Children Revisited: Is Routine Hospitalization Required? Roddy SP, Cohn SM, Moller BA, et al. Pediatrics 101:575,1998 Treatment of pediatric head injuries with a history of loss of consciousness or amnesia has been debated for years. More than 100,000 children per year sustain head injuries that warrant hospital admission, and 90% of them have Glasgow Coma Scales (GCS) of 13 or greater. Early diagnosis of intracranial hemorrhage has been shown to substantially
CURRENT LITERATURE tooth. A total of 32 extracted teeth (molars and premolars) were included in the study. One half of the sample were sterilized with steam autoclave (260” F at 20 psi for 20 minutes). All of the teeth were randomly distributed in groups of four, and each group contained both autoclaved and non-autoclaved teeth. Fourteen teeth were prepared with two surface cavities by four faculty members and hardness and brittleness were subjectively evaluated. Physical properties such as hardness were tested with the Vickers’ microhardness measurements and the structural changes were assessed by differential thermal analysis. Among the physical analysis, the only remarkable difference founded between the two groups was the reduction of the dentin hardness within the autoclaved teeth, maybe as a result of alteration of the dentinal collagen (20% to 25% of the organic material). Because the relative low organic content of the enamel structure no modification in hardness was seen due to exposure to the high temperature and pressure of the autoclave. However, no significant chemical bond breakdown had occurred during autoclaving because exothermic characteristics were unchanged for the two groups. The conclusions of this paper showed that the autoclaving of extracted teeth affects the dentin structure, but not so much that it will always be detected by the clinician. Besides the preclinical usage, the extracted teeth are used during the preliminary phases of dental material development. The effect of the autoclave sterilization on the chemical and physical relationship between the dental material and the dentin structure is unknown. Because of the high mineral content of the peritubular dentin, it is thought that the effect of autoclaving on bonding performance should be minimal.-A.F. HERRERA Reprint request to Dr Parsell: Department of Restorative Dentistry, School of Dentistry, University of Mississippi Medical Center, Jackson, MS 392164505.
Ultrasound-Guided Interstitial Nd:YAG Laser Treatment of Voluminous Hemangiomas and Vascular Malformations in 92 Patients. Werner JA, Lippert BM, Gottslich S, et al. Laryngoscope 108:463, 1998 Hemangiomas and vascular malformations are common in the head and neck region. Conventional surgery, embolization, and interferon and steroid therapy are standard treatment options for these lesions. Over the last 15 years, laser therapy has also become an accepted treatment protocol. This study is a review of 92 patients with voluminous hemangiomas and vascular malformations treated with interstitial Nd:Yag laser therapy. The vascular tumors all had a diameter of more than 3 cm in at least two dimensions. Treatment was carried out under ultrasound guidance. Five patients required only one application of laser, 36 patients needed two applications, and 51 patients needed three or more treatments. Nearly 60% of the patients showed complete clinical regression. Thirty-three patients (35.8%) had a partial regression and were satisfied with the outcome. Four patients were treated unsuccessfully and required conventional surgery. None of the patients had significant intraoperative bleeding and three patients had mild postoperative bleeding. No blood transfusions were necessary and no infections occurred. Conclusions drawn by the authors were that laser treatment of large vascular lesions is safe, effective, and cosmetically satisfying.-J. BROKLOFF Reprint requests Christian-AIbrechts Germany.
to Dr Werner: Department of Otolaryngology, University, Arnold Heller-Str. 14, D-24105, Kiel,
Dose-Related Effects of Oral Acetaminophen on ColdInduced Pain: A Double-Blind, Randomized, PlaceboControlled Trial. Yuan CS, Karrison T, Wu JA, et al. Clin Pharmacol Ther 63:379, 1998 Acetaminophen, a non-NSAID, nonopioid analgesic, is one of the most widely used medications for the treatment of mild and moderate pain. Immersion of a limb in ice-cold water has long been known to induce pain in humans and this cold-induced tonic pain model has been shown to be a sensitive and reliable technique. It is a widely used paininduction method in clinical trials. This study was a doubleblind, randomized, placebo-controlled design that was used to evaluate the dose response effects of oral acetaminophen on cold pressor-induced pain in 18 normal, healthy human subjects. Each subject underwent four sessions in which they were given one of three doses of oral acetaminophen (325 mg, 650 mg, or 1,000 mg) or placebo. A cold-pressor test was performed 110 minutes after the administration of the study drug. Each subject was asked to verbally rate the pain on a scale (0 to 10) at 30, 70, 110, and 170 second intervals during the immersion. A dose-related analgesic effect was observed. There were statistically significant main effects of both dose and time. This study concluded that it is possible that acetaminophen may be particularly effective for treatment of certain kinds of pain and the results suggest that the cold-pressor method may have clinical value in evaluation of non-opioid analgesic agents--T. ZUCK Reprint requests to Dr Yuan: Department of Anesthesia Care, The Pritzker School of Medicine, The University 5841 S Maryland, MC 4028, Chicago, IL 60637.
and Critical of Chicago,
Intralesional Bare Fiber Laser Treatment of Hemangioma of Infancy. Achauer B, Celikoz B, Vanderkam V. Plast Reconstr Surg 101:1212,1998 The purpose of this study is to examine effects of intralesional fiber with the potassium-titanyl-phosphate laser for treatment of hemangioma of infancy. Twelve patients were treated. Results showed 92% had 50% reduction in size at 3 months, 8% had greater than 50% reduction in 6 months. Fifty percent required two treatments and 8% required three treatments. The authors concluded that intralesional fiber therapy is effective.-R. HOLLOWAY Reprint requests sity of California,
to Dr Achauer: Division 101 City Dr, Building
of Plastic Surgery, Univer53, Route 81, Orange, CA
92868.
Paranasal Sinus Endoscopy and Orbital Fracture Repair. Woog JJ, Harstein ME, Gliklich R. Arch Ophthalmol 116:688, 1998 Although excellent results may be achieved in the management of orbital floor injuries with standard transconjunctival or transcutaneous approaches, visualization of the posterior orbital floor or medial wall defect may be challenging. The authors describe the use maxillary sinus endoscopy and examination of the orbital floor during the repair of selected orbital floor fractures. An important goal of orbital fracture repair is the complete removal of herniated orbital soft tissues from the fracture site. The orbital floor has a posterosuperior angulation relative to the anterior orbital rim, which makes it difticult to visualize when orbital exploration is performed solely through a transconjunctival subperiosteal approach. This paper reported a concurrent
1362
CURRENT LITERATURE
antrostomy/endoscopy to allow better visualization, and therefore, allow complete removal of soft tissues from the fracture site. Initially, the patient’s mucosa is decongested with oxymetazoline hydrochloride or 4% cocaine hydrochloride. Local anesthesia is inftltrated into the lateral nasal wall and the uncinate process of the affected side is removed for proper visualization of the ostium. Enlargement and antrostomy is followed by placement of the endoscope into the maxillary sinus. In the event of medial rectus entrapment, a limited ethmoidectomy is recomended, leaving the lamina papyracea intact. The authors then described the use of a standard transconjuctival approach for identification of the fracture and removal of bony fragments. A custom-made titanium mesh orbital implant was then placed to space the defect in the floor and medial wall. The endoscope was used to guide the implant into proper position away from the optic nerve and to ensure clearance of posterior orbital soft tissues. Subsequently, the implant was secured with screws and the incision was closed in a standard fashion. The authors’ suggest that endoscopic visualization of orbital floor fractures may facilitate safe and secure placement of orbital implants while ensuring no residual soft tissue incarceration, minimal extention of orbital incision, and decreased postoperative enophthalmos.-H. PATINO Reprints requests MO 63124.
to Dr Hartstein:
8729 Delmar,
Surgery.
Dermabrasion is a time-tested modality for facial skin resurfacing and should continue to be an important tool for every plastic surgeon. Dermabrasion is safe, efficacious, inexpensive, portable, and widely available. It does not require special safety equipment, does not pose a fire hazard, has a shorter erythema phase than for laser resurfacing, and minimal training is required for its use. Dermabrasion is simply the controlled mechanical abrasion of the epidermis and a variable segment of the upper dermis. It is indicated for perioral rhytids, acne scarring, traumatic facial scarring, and rhinophyma. Dermabrasion is performed in the operating room with anesthesia of the appropriate magnitude. Diamond-impregnated cylindrical fraises are most commonly used. They rotate at 12,000 to 15,000 rpm via an electrically powered hand-held motor driver unit. The operating room staff should be protected from airborne and aerosolized particles. The wound is created gradually by region, to the appropriate depth. A saline-moistened sponge is placed over the wound postoperatively to aid in hemostasis. A petrolatum-based ointment is then placed in a thin layer over the abraded surface. After 7 to 10 days, a moisturizer is substituted for the petrolatum dressing. Complications include hypertrophic scarring; infection by bacterial, viral, or fungal agents; hypopigmentation, and hyperpigmentation. Despite the continued demand for space-age laser technology, dermabrasion remains a safe and efficaciousmodality for the treatment of rhytids and scars.-R.H. HAUG
The Preoperative Benefit. Peterson 133:134, 1998
Plastic Surgery
Bleeding P, Hayes
Time TE,
Arkin
Associates,
PA, 1501 S
Test Lacks Clinical CF,
epidurai
anesthesia
given
to patients
receiving
oral anticoag-
ulants, they were anecdotal cases of spinal subdural bleeding; however, the preoperative bleeding time has not been uniformly prolonged in these cases. The authors concluded that the bleeding time test is not a useful predictor of the risk of hemorrhage associated with surgical procedure. The best preoperative screen to predict bleeding complications is comprehensive clinical history, which includes family and previous dental, obstetric, surgical, traumatic injury, transfusion, and drug histories. A patient with a history suggesting a possible bleeding disorder may require further evaluation.I.E. SHAMI Reprint request to: College of American Rd, NorthReId, IL 60093-2750.
Pathologists,
325 Waukegan
Suite 2W, St Louis,
Dermabrasion: As a Complement to Aesthetic Baker TM. Clin Plast Surg 25:81, 1998
Reprint requests to Dr Baker: MIamIAve, Miami, FL 33129.
tests of hemostasis. The authors reviewed the data concerning the of preoperative use of the bleeding time test and its prediction for hemorrhagic complications. In one study of 101 patients, only 2 out of 17 patients who experienced excessive bleeding were prospectively classified as high risk according to the result of bleeding time test. Another study by Amrein et al found no correlation between increased bleeding and a bleeding time greater than 10 minutes or an aspirin-induced prolongation of 4 minutes over baseline. Odom and Sih reported their experience with 1,000 cases of
et al. Arch
Surg
One to two million bleeding time procedures are formed each year in the US, making it one of the most widely used
Identikation of Obstructive Sleep Apnea in Patients who Snore. Tami TA, Duncan HJ, PBeger M, et al. Iaryngoscope 108:508,1998 This study examines a series of snoring patients who underwent home overnight sleep studies and completed extensive sleep related questionaires. The objectives of the study were to determine the incidence of obstructive sleep apnea (OSA) in patients presenting with socially unacceptable snoring and to develop a protocol to identify patients with OSA as a subset of patients who snore. Ninety-four snoring patients were recruited to determine the incidence of OSA in this highly selected population. The patients answered an extensive sleep questionaire to determine factors that might suggest a diagnosis of OSA and a home sleep study was performed on each participant. The overall incidence of OSA in this group was 72%. Severe sleep apnea with greater than 25 apneic events per hour was found in 42% of the patients. Moderate sleep apnea with 10 to 20 apneic events per hour was found in 30% of the patients. Twenty of the subjects with severe sleep apnea also underwent inpatient polysomnogmphy and the diagnosis was con6rmed in all cases. Conclusions drawn by the authors were that home sleep studies are an accurate and costeffective alternative to inpatient polysomnography.-J. BROKLOFF Reprint Center, 670528,
requests to Dr TamI: University of Cincinnati Medical Department of Otolaryugology, 231 Bethesda Ave, PO Box Cincinnati, OH 45267.
Minimal Head Trauma in Children Revisited: Is Routine Hospitalization Required? Roddy SP, Cohn SM, Moller BA, et al. Pediatrics 101:575,1998 Treatment of pediatric head injuries with a history of loss of consciousness or amnesia has been debated for years. More than 100,000 children per year sustain head injuries that warrant hospital admission, and 90% of them have Glasgow Coma Scales (GCS) of 13 or greater. Early diagnosis of intracranial hemorrhage has been shown to substantially