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Biology of the periodontal connective tissues
633
CURRENT LITERATURE versely affect deglutition, speech, cosmetics, and ultimately, the QOL. The purpose of this study was to assess the QOL and functional status of patients who have undergone hemimandibulectomy. Twenty-one patients who had undergone hemimandibulectomy and had similar defects were divided into two groups based on the reconstructive technique used. Eleven patients were placed in the soft-tissue reconstruction group. Ten patients were placed in the mandible reconstruction group. All patients were assessed for function using the performance status scale and QOL, using a general cancer questionnaire (FACT-G) and a series of questions specific for head and neck cancer patients. The mandible reconstruction produced a perceived better physical appearance (P = .02), better eating (P = .04), and a better overall QOL (P = ,002). The mandible reconstruction cohort consistently outscored the soft tissue cohort on all questionnaires. Hemimandibulectomy is a procedure usually performed for the treatment of late-stage head and neck cancer. Although the intent is usually curative, the procedure often serves a palliative function. Therefore, issues of QOL should be strongly considered when devising the reconstructive method. This study supports mandible reconstruction over soft tissue reconstruction from QOL and function standpoints. However, further investigation incorporating many psychosocial and perioperative issues needs to be completed before a definitive recommendation can be made.-H. PATINO Reprint requests to Dr Wilson: University of Cincinnati, Department of Otolaryngology, 231 Bethesda Ave, Cincinnati, OH 45267-0528.
A Multidisciplinary Approach to Wound Care in the Hospitalized Patient. Long CD, Granick MS. Clin Plast Surg 25:425, 1998 At any given time, 14% to 20% of all hospitalized patients are at risk of developing pressure ulcers. The mean hospital and physician cost per patient with an admitting diagnosis of pressure ulcer is $230,575. Identification of patients at risk, and aggressive intervention in those cases before the establishment or progression of wounds, could lead to a significant decrease in patient morbidity and health care costs. A multidisciplinary team including plastic and vascular surgery, nursing, nutrition, enterostomal therapy, social service, rehabilitation, medicine, and materials management is the baseline wound-care team. Nurses provide the frontline assessment of the patient and serve a pivotal role in identifying those patients at risk, as well as those with a pre-existing ulcer. Nutritional screening as well as location, stage and size of wounds is documented. For stage I and II wounds, wound care is provided as per protocol. For stage III or greater, consultation is provided by the wound care specialist. Specialty sleep surfaces are allocated on a case-bycase basis. Using this protocol, the ulcer prevalence in one institution dropped from 22.6% to 8.7% with nosocomial ulcers reducing in incidence from 82.4% to 54.3%. The result of a wound-care team and protocol is improved patient care and cost savings to the hospital. Both factors are crucial to survival in an increasingly competitive health care market place.-R.H. HUG Reprint requests to Dr Granick: Allegheny University of the Health Sciences, Suite 8001, 3300 Henry Ave, Philadelphia, PA 19129.
New Book
Annotations
Biology of the Periodontal Connective Tissues. Bartold PM, Narayanan AS. Chicago, IL, Quintessence, 1998, 278 pages, illustrated. Although this book is aimed mainly at the periodontist, the extensive discussion of the fundamentals of the molecular and cellular biology of connective tissue and the basic information about the composition of extracellular matrices make it of interest to a broader audience. Likewise, the application of this material to the diseases of the periodontal connective tissues also provides a better understanding of the general effects in other regions of the head and neck. Understanding Impacted Wisdom Teeth. Berns JM. Chicago, IL, Quintessence, 1998, 31 pages, illustrated, paperback. This nicely illustrated booklet is designed to provide answers to many of the questions patients may ask about wisdom teeth. It explains such things as how such teeth become impacted, problems they may cause, and what to expect after their removal. The clear illustrations and simple language make it an easily understood way of providing useful patient information. Case Review: Head and Neck Imaging. Yousem DM. St Louis, MO, Mosby, 1998, 239 pages, 348 illustrations, paperback, $39.95. The author of this book uses a unique case-based approach to the interpretation of various plain radiographic, computed tomography, magnetic resonance imaging, and scintigraphic images of the head and neck region. Each of the images is presented as an unknown and is followed by a series of pertinent questions related to diagnosis and clinical interpretation, and the reverse side of the page provides the answers, the diagnosis, references, and a brief commentary. The book begins with simple cases, and then progresses to those that are more diRicult and challenging, thus, helping readers gain confidence as they progress. Atlas of Advanced Orthodontics: A Guide to Chid Efficiency. Viazis AD (ed) with 8 contributors. Philadelphia, PA, Saunders, 1998, 272 pages, 606 illustrations, $159.00. This atlas presents a step-by-step approach to the diagnosis and treatment of various malocclusions. It contains sections on diagnostic methods, principles and methods of treatment, and post-treatment considerations. Although it does not include material on the role of orthodontics in orthognathic surgery, it does give the oral and maxillofacial surgeon an understanding of the fundamentals of orthodontic therapy. Oral Pathology: Clinical Pathologic Correlations (ed 3). Regezi JA, Sciubba JJ (eds) with 6 contributors. Philadelphia, PA, Saunders, 1999, 664 pages, 783 illustrations, $63.95.
CURRENT LITERATURE versely affect deglutition, speech, cosmetics, and ultimately, the QOL. The purpose of this study was to assess the QOL and functional status of patients who have undergone hemimandibulectomy. Twenty-one patients who had undergone hemimandibulectomy and had similar defects were divided into two groups based on the reconstructive technique used. Eleven patients were placed in the soft-tissue reconstruction group. Ten patients were placed in the mandible reconstruction group. All patients were assessed for function using the performance status scale and QOL, using a general cancer questionnaire (FACT-G) and a series of questions specific for head and neck cancer patients. The mandible reconstruction produced a perceived better physical appearance (P = .02), better eating (P = .04), and a better overall QOL (P = ,002). The mandible reconstruction cohort consistently outscored the soft tissue cohort on all questionnaires. Hemimandibulectomy is a procedure usually performed for the treatment of late-stage head and neck cancer. Although the intent is usually curative, the procedure often serves a palliative function. Therefore, issues of QOL should be strongly considered when devising the reconstructive method. This study supports mandible reconstruction over soft tissue reconstruction from QOL and function standpoints. However, further investigation incorporating many psychosocial and perioperative issues needs to be completed before a definitive recommendation can be made.-H. PATINO Reprint requests to Dr Wilson: University of Cincinnati, Department of Otolaryngology, 231 Bethesda Ave, Cincinnati, OH 45267-0528.
A Multidisciplinary Approach to Wound Care in the Hospitalized Patient. Long CD, Granick MS. Clin Plast Surg 25:425, 1998 At any given time, 14% to 20% of all hospitalized patients are at risk of developing pressure ulcers. The mean hospital and physician cost per patient with an admitting diagnosis of pressure ulcer is $230,575. Identification of patients at risk, and aggressive intervention in those cases before the establishment or progression of wounds, could lead to a significant decrease in patient morbidity and health care costs. A multidisciplinary team including plastic and vascular surgery, nursing, nutrition, enterostomal therapy, social service, rehabilitation, medicine, and materials management is the baseline wound-care team. Nurses provide the frontline assessment of the patient and serve a pivotal role in identifying those patients at risk, as well as those with a pre-existing ulcer. Nutritional screening as well as location, stage and size of wounds is documented. For stage I and II wounds, wound care is provided as per protocol. For stage III or greater, consultation is provided by the wound care specialist. Specialty sleep surfaces are allocated on a case-bycase basis. Using this protocol, the ulcer prevalence in one institution dropped from 22.6% to 8.7% with nosocomial ulcers reducing in incidence from 82.4% to 54.3%. The result of a wound-care team and protocol is improved patient care and cost savings to the hospital. Both factors are crucial to survival in an increasingly competitive health care market place.-R.H. HUG Reprint requests to Dr Granick: Allegheny University of the Health Sciences, Suite 8001, 3300 Henry Ave, Philadelphia, PA 19129.
New Book
Annotations
Biology of the Periodontal Connective Tissues. Bartold PM, Narayanan AS. Chicago, IL, Quintessence, 1998, 278 pages, illustrated. Although this book is aimed mainly at the periodontist, the extensive discussion of the fundamentals of the molecular and cellular biology of connective tissue and the basic information about the composition of extracellular matrices make it of interest to a broader audience. Likewise, the application of this material to the diseases of the periodontal connective tissues also provides a better understanding of the general effects in other regions of the head and neck. Understanding Impacted Wisdom Teeth. Berns JM. Chicago, IL, Quintessence, 1998, 31 pages, illustrated, paperback. This nicely illustrated booklet is designed to provide answers to many of the questions patients may ask about wisdom teeth. It explains such things as how such teeth become impacted, problems they may cause, and what to expect after their removal. The clear illustrations and simple language make it an easily understood way of providing useful patient information. Case Review: Head and Neck Imaging. Yousem DM. St Louis, MO, Mosby, 1998, 239 pages, 348 illustrations, paperback, $39.95. The author of this book uses a unique case-based approach to the interpretation of various plain radiographic, computed tomography, magnetic resonance imaging, and scintigraphic images of the head and neck region. Each of the images is presented as an unknown and is followed by a series of pertinent questions related to diagnosis and clinical interpretation, and the reverse side of the page provides the answers, the diagnosis, references, and a brief commentary. The book begins with simple cases, and then progresses to those that are more diRicult and challenging, thus, helping readers gain confidence as they progress. Atlas of Advanced Orthodontics: A Guide to Chid Efficiency. Viazis AD (ed) with 8 contributors. Philadelphia, PA, Saunders, 1998, 272 pages, 606 illustrations, $159.00. This atlas presents a step-by-step approach to the diagnosis and treatment of various malocclusions. It contains sections on diagnostic methods, principles and methods of treatment, and post-treatment considerations. Although it does not include material on the role of orthodontics in orthognathic surgery, it does give the oral and maxillofacial surgeon an understanding of the fundamentals of orthodontic therapy. Oral Pathology: Clinical Pathologic Correlations (ed 3). Regezi JA, Sciubba JJ (eds) with 6 contributors. Philadelphia, PA, Saunders, 1999, 664 pages, 783 illustrations, $63.95.