Chart for outcome prediction in severe head injury

CURRENT LITERATURE J Oral Maxillofac 42:273-274.

Surg

1904

Abstracts Osseointegration and Its Experimental Background. Branemark P-I: J Prosth Dent 50:399, 1983

mary deviation in one system tends to be compensated by the other. The author reviews the homeostatic mechanism of acid-base balance, which includes 1) the body buffers; 2) pulmonary regulation; and 3) renal reabsorption and excretion of bicarbonate and excretion of fixed acids. He reviews the “anion gap,” emphasizing that this index should always be calculated in the evaluation of acid-base disorders. An elevated anion gap indicates metabolic acidosis. A stepwise approach to the evaluation of acid-base disturbances is presented in tabular form.-

In this article the author reviews his experimental and clinical work that lead to the development of the concept of osseointegration and its application in dental implants. Osseointegration refers to the placement of an alloplastic implant (titanium) in such a way as to allow bone formation immediately adjacent to the implant without an intervening layer of fibrous tissue. Experiments by the author using both dogs and humans are cited to show the possibility of such intimate adaptation of bone to an alloplast. According to the author the advantage of osseointegrated implants is that they can be maintained indefinitely and used as abutments for prosthetic rehabilitation. Reportedly, masticatory stresses on osseointegrated implants result in physiologic remodeling and strengthening of the bone-implant interface instead of increased

mobility

and eventual

loss.-R.

ROBERT CHUONC Reprint requests to Dr. DuBose, Jr: Renal/Electrolyte Physiology Laboratory, Division of Nephrology H-78, University of Texas Medical Branch, Galveston. Texas 77550.

Improvement in the Augmentation Genioplasty via Suprahyoid Muscle Repositioning. Collins PC, Epker BN. J Maxillofac Surg 11: 116, 1983

L. FIESE

Reprint requests to Dr. Zarb: University of Toronto, Faculty of Dentistry, 124 Edward Street, Toronto, Ontario MSGlG6, Canada.

When considering the augmentation genioplasty, analysis of the submental region is necessary. The normal cervicomental angle is between 100-140”. The combination of a deficient chin and an obtuse cervicomental angle in the absence of lipohyperplasia (excess submental fat), should lead one to consider the position of the hyoid bone and suprahyoid muscles. Analysis of the hyoid position can be done on the lateral cephalogram, checking the relation it has to the mandibular symphysis and the third cervical vertebra. Normally this position is 32 mm anterior to the body of C,, 37 mm posterior to the symphysis, and 5 mm below a line drawn from C, to the symphysis. The technique for the repositioning of the suprahyoid muscles is described. It involves completing the downfracture of the chin segment prior to the detachment of the geniohyoid and anterior digastric muscles to posteriorly reposition them. The muscles are held in their new position by sutures passed through the floor of the mouth and secured to the second molars. Profile changes can be evaluated at the time of surgery.-ROGER P. HITCHCOCK

A Twenty-year Evaluation of Subperiosteal Implants. Young Jr L, Michael JD, Moor DJ. J Prosthet Dent 49:690, 1983 Twenty five patients received subperiosteal mandibular vitalium implants between 1955 and 1975 at the University of Missouri-Kansas City, This article evaluated the implants from four different aspects; longevity, clinical quality of implant survival, patient’s description of success, and overall implant success. Only 17 of the original 25 patients were available and only eight of these were examined. Three of the 17 implants had been removed at two, eight, and 12 years, respectively. The greatest cause of removal was deterioration from chronic inflammation leading to bone loss. Ninety percent of the implants had been in service for more than five years and 75% for over ten years. Two had not yet been in place for ten years. Of those patients with implants still in place, the implant of one had lateral mobility, all but two had had bone loss, and two had infections present, while 70% had had previous infections. Two patients had had transient paresthesia for approximately one year, and three patients still had anesthesia on one side. However, even when complications were considered, all patients seemed satisfied with their implant, and those who had had to have the implant removed are seeking another implant. Patients reported being able to wear dentures much more satisfactorily and to eat more acceptably.-DOUGLAS W.

Reprint requests to Dr. Epker: Oral and Maxillofacial Surgery, John Peter Smith Hoseital. 1500 South Main Street. Fort Worth. Texas 76104. .

Chart for Outcome Prediction in Severe Head Injury. Choi SC, Ward JD, Becker DP. J Neurosurg 59:294, 1983 Several of the techniques proposed for evaluation of the prognosis of head injury involve relatively complex statistical formulas. The authors evaluated 264 patients with severe head trauma using a combination of results from the Glasgow Coma Scale (GCS), oculocephalic responses, and age as predictors of the outcome. The criterion for admission to the study was the inability to obey commands or to utter recognizable words following head injury after successful cardiopulmonary resuscitation had been accomplished. A method was devised to approximate verbal response to the GCS for intubated patients. The authors developed a simple chart, which combines the GCS results, oculocephalic reflexes, and ages, with which the accuracy of prognosis is expected to be 80% or above.-STEVEN B. ARAGON

WALLACE Reprint requests to Dr. Young, Jr: University School of Dentistry, Kansas City, MO 64108.

of Missouri,

Clinical Approach to Patients with Acid-Base Disorders. DuBose Jr JD. Med Clin North Am 67:799, 1983

Deviations from normal systemic arterial pH may be secondary to respiratory or metabolic causes (“simple disturbances”) or may result from a combination of the two. the so-called “mixed” acid-base disturbances. Pri273

CURRENT LITERATURE

274

Reprint requests to: Dr. Choi, Department of Biostatistics, Medical College of Virginia, Virginia Commonwealth University, Box 32, MCV Station, Richmond, Virginia 23298.

Surgical Treatment of Angular Cheilosis. Palmer B: Int J Oral Surg 12:137, 1983

Bjorlin

G,

The authors describe a surgical approach to angular cheilosis that has been unresponsive to conservative measures, including correction of both inadequate vertical dimension of occlusion and vitamin deficiencies. Using local anesthesia, angular skin excisions are made over the nasolabial regions, followed by undermining of the inferior skin flap and primary closure. Four of 13 operated patients required reoperation, with severe psoriasis complicating healing in two cases. All patients experienced a subjective improvement in appearance and decrease in symptoms related to the angular cheilosis. Candidal growth cleared in all Cases.-ROBERT CHUONG Reprint requests to Dr. Bjorlin: Department General Hospital, Malmo 2 14 01, Sweden.

Complications After Treatment Sinus Disease with Caldwell-Luc Laryngoscope 93:3, 1983

of Oral Surgery,

of Chronic Maxillary Procedure. Murray JP

The radical antrostomy, or Caldwell-Luc procedure, has long been used in the treatment of maxillary sinusitis. More recently, it has also been used in the treatment of sinus neoplasms and polyps and as a route of access to the pterygomaxillary fossa, the ethmoid sinus, and the orbital floor. Sixty Caldwell-Lucs were performed on 45 patients using uniform surgical techniques (including a nasoantral window in all but one of the cases). No intraoperative or perioperative complications were noted. Postoperatively, all patients were studied for a minimum of six months. Postoperative complications in this series included recurrent sinusitis (lo), protracted numbness (8), nasal synechia (3), persistent swelling (2), and dental complication (1). Other complications that have been reported with the procedure but were not seen in this series have included osteomyelitis, oro-antral fistulas, facial asymmetry, and bleeding.-ROBERT STRAUSS Reprint requests to

Dr. Murray: P.O. Box 4956, Jackson, Mis-

sissippi 39216.

Mast Cells and Their Mediators. Ann Allergy 50:367, 1983

Marom Z, Casale TB.

This article is a review of the role of mast cells in immunologic functions. The effects of various mediators on mast cells and thus on allergic reactions is also discussed. The mast cell is described as a large, perilymphatic and perivascular cell found in abundance in human tissue. IgE is the trigger responsible for the degranulation of mast cells. This reaction is termed sequential exocytosis, and its biochemical pathway is described. Three types of mediators are derived from or are released along this pathway. These mediators are responsible for the course and nature of a particular allergic reaction. The mediators are either 1) preformed (histamine), 2) secondarily formed (slow-reacting substances), or 3) granule-derived (heparin). The sequential release or delayed activity of certain

mediators is responsible for the delayed onset and protracted course of certain allergic phenomena. A list of over 20 known mediators in humans or animals is included. A review of recent research in this field is also presented.-DALBERT

W. FEAR

Reprint requests to Dr. Casale: National Institutes of Health, Building 10, Room llC207, Bethesda, Maryland 20205.

Granular Cell Myoblastoma. Curr Surg 40:202, 1983

Silva-Lopez

E, Wood DK.

Granular cell myoblastoma is a neoplasm which is slow growing and rarely diagnosed but which has the potential of being malignant. Areas of interest for this lesion exist due to its uncertain histogenetic origin and the fact that histologically there is no difference between the malignant and benign versions of the lesion. Invariably the benign or malignant nature of the tumors has been established by the clinical outcomes of their surgical management. Patients who present with this lesion should receive the treatment of choice, wide surgical excision, and be followed at yearly intervals. Granular cell myoblastoma should be considered in the differential diagnosis of slowly growing, space-occupying lesions presenting with subcutaneous and visceral manifestations.-DoucLAs D. RICHARDSON

Reprint requests to Dr. Silva-Lopez: Department of Surgery, Loyola University Medical Center, Maywood, Illinois.

Mohs Surgery. Techniques, Indications, Applications, and the Future. Swanson NA. Arch Dermatol 119:761, 1983 Mohs surgery is a technique of microscopically guided resection of various neoplasms, primarily of the skin but also of paracutaneous sites such as the oral cavity or paranasal sinuses. This article reviews the technique developed by Dr. Frederic Mohs and its refinements, particularly the transition from fixed-tissue “chemosurgery” to the fresh-tissue modification. The goal of Mohs surgery is to resect a neoplasm while maximally preserving normal tissue resulting, therefore, in the minimal functional and cosmetic deformity. The technique is described and the indications are reviewed for its application to the treatment of primary and recurrent basal cell carcinoma and squamous cell and verrucous carcinoma, as well as other cutaneous lesions, including adenoid cystic carcinoma. The tendency of the latter lesion to infiltrate along the adentitia of nerves is particularly suited to the Mohs technique. The author also briefly describes the use of Mohs technique in the treatment of squamous cell carcinomas of the floor of mouth, tongue, pharynx, and paranasal sinuses, emphasizing the contrast between conventional extirpative procedures that often result in tongue or mandibular resection with resulting severe functional deficit, and the microscopically controlled excision of a primary tumor that maximizes the preservation Of

COntigUOUS SttIKtUreS.-ROBERT

CHUONG

Reprint requests to Dr. Swanson: Department of Dermatology, University of Michigan, C2065 Outpatient Building, Ann Arbor, Michigan 48109.