11.50
CURRENT LITERATURE
ments owing to the lack of tactile feedback and speed of cutting. Serious complications from cosmetic facial laser surgery include perforated globes, cicatricial eyelid retraction, injury to extraocular muscles, and cornea1 bums. In conclusion, the authors agree that only in experienced hands lasers may be preferable and offer some advantages over conventional approaches to facial cosmetic surgery.-H. PATINO Reprint requests to Dr Anderson: Suite 308, 1002 Salt Lake City, UT 84109.
E South
Simultaneous Face Lifting and Skin Resurfacing. JE. Plast Reconstr Surg 102:2480, 1998
Temple,
Fulton
It has become standard practice in the plastic surgery community that skin cannot be resurfaced and a face flap lifted simultaneously. This study examines the safety and efficacy of a combined face-lift and skin-resurfacing procedure. The skin procedure in all cases was completed using a “short-pulse” carbon dioxide laser in 3 passes and then lifted after liposuction and superficial musculoaponeurotic system tightening. A dramatic aesthetic result was obtained in 50 cases followed at 6-week, 6-month, and l-year intervals. No incidents of persistent erythema, burning, hyper- or hypopigmentation or flap necrosis were seen. Moderate edema and ecchymosis of short duration were seen in all cases but to no greater extent than in simple face-lift procedures. Other procedures such as blepharoplasty can also be added to the procedures without sequelae. Conclusions drawn by the authors that it is safe and effective to combine skin-resurfacing procedures with face-lifting procedures.-J BROKLOFF Reprint requests to Dr F&on: Newport
Beach,
1617 Westcliff Dr, Suite
100,
CA 92660.
Non-NSAID Pharmacologic Management of Chronic 105:458, 1998 (suppl1B)
Treatment Options for the Pain. Schnitzer TJ. Am J Med
Arthritis is the second most chronic condition in the United States and the most common cause of chronic pain. Of the 75 million US citizens who suffer chronic (persistent or recurring) pain, 66 million have arthritis. The most common type of arthritis is osteoarthritis (OA), a degenerative joint disease that affects predominately the elderlyapproximately 80% of the population older than 65 years of age have OA, and with increasing age the figure approaches 100%. The etiology of OA is primarily biomechanical, possibly involving trauma and repetitive injury. Thus, although inflammatory episodes do occur, the primary physiological mechanism of OA pain is largely noninflammatory and may therefore be treated with non-nonsteroidal antiinllammary drug analgesics. Acetaminophen is an effective analgesic with antipyretic but not anti-inflammatory activity. It is rapidly absorbed, metabolized in the liver, and provides signiticant analgesic relief while increasing functional ability. Acetaminophen has been associated with liver toxicity when administered in massive doses or in chronic alcohol abuse. Tramadol is a centrally active analgesic that binds to the p-opiod receptor site, and inhibits inhibition of norepinephrine and serotonin re-uptake by nerve cells. It is rapidly absorbed, metabolized in the liver, and has shown efficacy for the treatment of chronic pain. Side effects involve nausea, vomiting, and dizziness. Propoxyphene is a centrally acting nonopiate narcotic that produces analgesic, but not
anti-inflammatory or antipyretic effects. It may be accompanied by nausea, vomiting, constipation, and skin rashes, and includes the risk of central nervous system (dizziness, sedation) and cardiac toxicity.-R.H. HAUG Reprint requests to Dr Schnitzer: Office of Clinical Research and Northwestern University, Abbott Hall, 5th Floor, 710 N Lakeshore Dr, Chicago, IL 60611. Training,
Caries Prevention.
Stookey GK. J Dent Educ 62:803, 1998
Although the prevalence of dental caries is much less than it was 50 years ago because of a variety of measures including communal water fluoridation, professional fluoride treatments, and fluoride dent&ices, this disease remains the most common dental disease afflicting children and adults in the United States. The author of this paper reviewed information on the prevalence of dental caries in the United States and described the measures being taken by clinicians to prevent dental caries. Data from national surveys conducted in the early 1980s by the National Institute of Dental Research coupled with the author’s own investigations supported the following conclusions. The average US teenager older than 12 years of age develops at least 1 new carious lesion per year. During the period between the approximate ages of 20 to 40 years of age, the average young adult develops about 20 new carious surfaces (0.8 to 1 .O new carious surfaces per year). The average adult older than 65 years of age develops 0.87 new carious coronal surfaces and 0.57 new carious root surfaces each year. Approximately half of the restorations placed in dental practice are replacements of previous restorations and about half of these are being replaced because of secondary caries. Measures used for the prevention of dental caries including communal water fluoridation, professional fluoride treatments in the dental offlice, and the home use of fluoridated denttices, rinses, and gels were described.A.J. LIBUNAO Reprint requests to Dr Stookey: Indiana University School of Dentistry, 1121 W Michigan St, Indianapolis, IN 46202. Airway Management in Children With Major Craniofacial Anomalies. Sculerati N, Gottlieb MD, Zimbler MS. Laryngoscope lOS:lSOb, 1998 Children with craniofacial anomalies have upper-airway obstruction, ranging from nasal obstruction, increased work of breathing and severe obstructive sleep apnea syndrome (OSAS), to frank respiratory distress. Known sequela of obstruction include failure to thrive, suboptimal neurological development, and developmental delay. Although tracheotomy can help avert these sequelae, indwelling tracheotomies in infants and children carry the risk of mortality from plugging. Even without complication, tracheotomy further distorts the child’s appearance and voice. The authors of this study attempt to delineate the clinical characteristics affecting the airway in a group of craniofacially deformed children and differentiate between patients requiring and those not requiring surgical intervention. This study also indicates which factors predispose to the need for tracheotomy. A 5-year retrospective study of 250 patients enrolled in the New York Institute of Reconstructive and Plastic Surgery’s Craniofacial Surgery Clinic and admission to the Tisch Hospital in Manhattan for surgery from 1990 to 1994. Nearly 20% of all children required tracheotomy (47 of 25 1). Cranial synostosis patients (Crouzon, Pfeiffer, or Apert