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Oral and maxillofacial infections
CURRENT
439
LITERATURE
rates the advantages of rigid fixation avoiding the complications that may result with lag screws and wire osteosynthesis.-S. C. BRYAN Reprint requests to Dr. Niederdellman: UniversitSit Strasse 31. D-8400 Regensburg. Federal Republic of Germany.
Aesthetic Augmentation of the Malar-Midface Structures. Whitaker LA. Plast Reconstr Surg 80:337, 1987 The author presents his method of alloplastic augmentation of the midface, malar region, with proplast. The surgical technique described allows for precise implant placement without the need for suture fixation. Preoperative evaluation is essential. with specific attention paid to three areas in the malar-midface complex; these are the paranasal fullness. the malar prominence, and the zygomatic arch projection laterally and posteriorly. The implant thickness is individually tailored to accentuate the optimum fullness in each of these areas. The procedure is performed intraorally through a sulcular incision. A subperiosteal pocket is developed in the malar region, extending onto the zygomatic arch. The implant sits freely in the pocket, fixed in position by the soft tissue inferiorly and medially, and the tunnel over the zygomatic arch laterally. The author presents his experience with 106 patients. with 176 implants over a 6 year period. There were four unilateral infections and no permanent motor or sensory nerve problems. Three of the four implants were successfully reinserted. The other patient elected not to have the implant replaced. Six implants were removed for esthetic reasons. Nine implants required repositioning.M. HARRIS Reprint requests to Dr. Whitaker: 3400 Spruce Street, Philadelphia. PA 19104.
Total Mandibular Subapical Osteotomy: A Report on Long Term Stability and Surgical Technique. Buckley MJ, Turvey TA. Adult Orthod Orthognath Surg 2:121, 1987 The total mandibular subapical osteotomy may be considered when mandibular dentoalveolar disharmony and malocclusion exists in the patient with adequate maxillary and mandibular skeletal balance. Mobilization of the entire maxilla or mandible in these cases may produce undesirable skeletal and esthetic changes. Previous reports have not documented the stability of the surgical alterations obtained with this procedure. The current report details posfoperative change in 13 of 17 patients who have undergone total mandibular subapical osteotomies. Surgical procedures are described in detail. Key elements include decortication of the buccal bone to allow direct visualization of the mandibular neurovascular bundle. Modifications of the posterior portion of the osteotomy for various surgical corrections and use of bone grafting are discussed. Operative and postoperative changes are detailed for 13 patients with a mean follow-up time of 2.1 years (range, 1 to 6 years). Positional changes in the 6 week to 1 year postoperative period included a slight posterior movement of the lower incisors regardless of whether the dentoalveolar segment was advanced or retropositioned. A slight posterior movement of point B was also seen during this period in advancement cases. No change in point B was observed when the segment was retropositioned. Slightly greater postsurgical changes occurred after the l-year postoperative period. A general
increase in the distance between the mandibular incisor and the mandibular plane was seen immediately following surgery. This dimension tended to decrease during the first year, then stabilize. All patients maintained a Class I canine relationship. Although six patients had a preoperative open bite, only one patient had this problem as a final result. This patient was unable to continue orthodontic treatment postoperatively. Intraoperative complications of mandibular fracture, damage to the neurovascular bundle, and condylar displacement are discussed. No patients required endodontic therapy and none reported mental nerve dysesthesia at longest follow-up. The authors consider their experience with the total mandibular subapical osteotomy favorable and that indicate that orthodontic therapy can generally compensate for most of the small changes that may occur postoperatively.S. C. BRYAN Reprint requests to Dr. Turvey: Department of Oral and Maxillofacial Surgery, School of Dentistry. University of North Carolina, Chapel Hill. NC 27514.
Localization and Retrieval of Bullets Under Ultrasound Guidance. Yiengpruksawan A, Mariadason J, Ganepola G. Arch Surg 122:1082, 1987 The authors demonstrate the use of ultrasound to localize bullets from the thigh, chest wall, and lower and upper back of six patients. The bullet is first identifyied with a high-frequency B mode real-time ultrasound unit followed by localization with a needle along the sound beam. The needle tip is identified on the screen as a high echogenic focus. A skin incision is made and the dissection is carried tangentially along the needle path to reach the bullet. All of the bullets were not palpable and were retrieved from a depth of 8 to 45 mm. The authors feel that ultrasound is a viable method in localizing bullets and is advantageous because it is portable, can be done at the bedside, poses no radiation hazard, and provides a dynamic image. It is more specific than metal detection because it can visualize both the object and neighboring structures. The entire localization and retrieval procedure can be done under direct, real-time visualization and therefore avoids inadvertant trauma and reduces operating time.-B. W. BURGER Reprint requests to Dr. Yiengpruksawan: Department of Surgery, College of Surgery Harlem Hospital Center, College of Physicians and Surgeons of Columbia University, 136th Street and Lenox Avenue. New York, NY 10037.
New Book Annotations Oral and Maxiilofacial Infections, 2nd ed. Topazian RG, Goldberg MH teds), with 17 contributors. Philadelphia, WB Saunders, 1987. 473 pages, illustrated. $10.00. What is already a classic textbook has been updated and expanded. Five new chapters have been added and additional color illustrations have been included. The latest information on diagnosis and treatment of infections, antibiotics, osteoradionecrosis, barrier technique, AIDS, imaging technology, and modern methods of rapid identification of microorganisms is provided. Biostats: Data Analysis for Dental Health Care Professionals, 2nd ed, revised. Weintraub. Douglass CW, Billings
439
LITERATURE
rates the advantages of rigid fixation avoiding the complications that may result with lag screws and wire osteosynthesis.-S. C. BRYAN Reprint requests to Dr. Niederdellman: UniversitSit Strasse 31. D-8400 Regensburg. Federal Republic of Germany.
Aesthetic Augmentation of the Malar-Midface Structures. Whitaker LA. Plast Reconstr Surg 80:337, 1987 The author presents his method of alloplastic augmentation of the midface, malar region, with proplast. The surgical technique described allows for precise implant placement without the need for suture fixation. Preoperative evaluation is essential. with specific attention paid to three areas in the malar-midface complex; these are the paranasal fullness. the malar prominence, and the zygomatic arch projection laterally and posteriorly. The implant thickness is individually tailored to accentuate the optimum fullness in each of these areas. The procedure is performed intraorally through a sulcular incision. A subperiosteal pocket is developed in the malar region, extending onto the zygomatic arch. The implant sits freely in the pocket, fixed in position by the soft tissue inferiorly and medially, and the tunnel over the zygomatic arch laterally. The author presents his experience with 106 patients. with 176 implants over a 6 year period. There were four unilateral infections and no permanent motor or sensory nerve problems. Three of the four implants were successfully reinserted. The other patient elected not to have the implant replaced. Six implants were removed for esthetic reasons. Nine implants required repositioning.M. HARRIS Reprint requests to Dr. Whitaker: 3400 Spruce Street, Philadelphia. PA 19104.
Total Mandibular Subapical Osteotomy: A Report on Long Term Stability and Surgical Technique. Buckley MJ, Turvey TA. Adult Orthod Orthognath Surg 2:121, 1987 The total mandibular subapical osteotomy may be considered when mandibular dentoalveolar disharmony and malocclusion exists in the patient with adequate maxillary and mandibular skeletal balance. Mobilization of the entire maxilla or mandible in these cases may produce undesirable skeletal and esthetic changes. Previous reports have not documented the stability of the surgical alterations obtained with this procedure. The current report details posfoperative change in 13 of 17 patients who have undergone total mandibular subapical osteotomies. Surgical procedures are described in detail. Key elements include decortication of the buccal bone to allow direct visualization of the mandibular neurovascular bundle. Modifications of the posterior portion of the osteotomy for various surgical corrections and use of bone grafting are discussed. Operative and postoperative changes are detailed for 13 patients with a mean follow-up time of 2.1 years (range, 1 to 6 years). Positional changes in the 6 week to 1 year postoperative period included a slight posterior movement of the lower incisors regardless of whether the dentoalveolar segment was advanced or retropositioned. A slight posterior movement of point B was also seen during this period in advancement cases. No change in point B was observed when the segment was retropositioned. Slightly greater postsurgical changes occurred after the l-year postoperative period. A general
increase in the distance between the mandibular incisor and the mandibular plane was seen immediately following surgery. This dimension tended to decrease during the first year, then stabilize. All patients maintained a Class I canine relationship. Although six patients had a preoperative open bite, only one patient had this problem as a final result. This patient was unable to continue orthodontic treatment postoperatively. Intraoperative complications of mandibular fracture, damage to the neurovascular bundle, and condylar displacement are discussed. No patients required endodontic therapy and none reported mental nerve dysesthesia at longest follow-up. The authors consider their experience with the total mandibular subapical osteotomy favorable and that indicate that orthodontic therapy can generally compensate for most of the small changes that may occur postoperatively.S. C. BRYAN Reprint requests to Dr. Turvey: Department of Oral and Maxillofacial Surgery, School of Dentistry. University of North Carolina, Chapel Hill. NC 27514.
Localization and Retrieval of Bullets Under Ultrasound Guidance. Yiengpruksawan A, Mariadason J, Ganepola G. Arch Surg 122:1082, 1987 The authors demonstrate the use of ultrasound to localize bullets from the thigh, chest wall, and lower and upper back of six patients. The bullet is first identifyied with a high-frequency B mode real-time ultrasound unit followed by localization with a needle along the sound beam. The needle tip is identified on the screen as a high echogenic focus. A skin incision is made and the dissection is carried tangentially along the needle path to reach the bullet. All of the bullets were not palpable and were retrieved from a depth of 8 to 45 mm. The authors feel that ultrasound is a viable method in localizing bullets and is advantageous because it is portable, can be done at the bedside, poses no radiation hazard, and provides a dynamic image. It is more specific than metal detection because it can visualize both the object and neighboring structures. The entire localization and retrieval procedure can be done under direct, real-time visualization and therefore avoids inadvertant trauma and reduces operating time.-B. W. BURGER Reprint requests to Dr. Yiengpruksawan: Department of Surgery, College of Surgery Harlem Hospital Center, College of Physicians and Surgeons of Columbia University, 136th Street and Lenox Avenue. New York, NY 10037.
New Book Annotations Oral and Maxiilofacial Infections, 2nd ed. Topazian RG, Goldberg MH teds), with 17 contributors. Philadelphia, WB Saunders, 1987. 473 pages, illustrated. $10.00. What is already a classic textbook has been updated and expanded. Five new chapters have been added and additional color illustrations have been included. The latest information on diagnosis and treatment of infections, antibiotics, osteoradionecrosis, barrier technique, AIDS, imaging technology, and modern methods of rapid identification of microorganisms is provided. Biostats: Data Analysis for Dental Health Care Professionals, 2nd ed, revised. Weintraub. Douglass CW, Billings