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Photography for arthroscopy documentation
LETTERS TO THE EDITOR
Complete duplication of the mandibular canal: Case report To the editor: During the course of a routine diagnostic evaluation, a 3 3-year-old edentulous male patient was noted to have bilateral mandibular canal abnormalities as seen on a panoramic radiograph. The right canal appeared duplicated for at least part of its course. The left canals were more well defined than the right canals. In fact, the left canals were separated for their entire course, as each canal appeared to have a distinct mandibular and mental foramen. The more accurate description for this variation would then be complete duplication of the mandibular canal. This appears to be very rare, as the Langlais et al. 1 study of 6000 panoramic surveys and the Nortj6 et al. 2 review of 3612 surveys identified no radiographs with this specific presentation. Duplicated or bifid mandibular canals in patients may cause difficulties in obtaining adequate local anesthesia. Alternative anesthetic methods should be considered in these cases. In addition, surgical ap-
proaches in the area, especially osteotomies, may need to be modified) This patient reported no history of inadequate anesthesia or surgical problems on either side of his mandible.
Richard E. Fredekind, DMD, MA Assistant Professor, Department of Diagnostic Sciences University of the Pacific School of Dentistry
Thomas Schiff, DMD, FICD, FACD Professor, Department of Diagnostic Sciences Section Head, Radiology University of the Pacific School of Dentistry
Viveca Valeriano Senior Dental Student University of the Pacific School of Dentistry REFERENCES
1. Langlais RP, Broadus R, Glass BJ. Bifid mandibular canals in panoramic radiographs. J Am Dent Assoc 1985;110:933-36. 2. Nortj6 CJ, Farman AG, Grotepass FW. Variations in the normal anatomy of the inferior dental (mandibular) canal: a retrospective study of panoramic radiographs from 3612 routine dental patients. Br J Oral Surg 1977;15:55-63. 3. Epker BN. Vascular consideration in orthognathic surgery. ORALSURGORALMED ORALPATHOL1984;57:467-72.
Fig. 1. Panoramic radiograph demonstrates duplication of left mandibular canals.
Photography for arthroscopy documentation To the editor: The article, Surgical documentation form for T M J arthroscopy by Mosby & Cline (1995;79:146-9), makes an excellent contribution in that it allows for standardization of arthroscopic data. Photography of 666
the joint pathology, taken during arthroscopy, is also an excellent tool for teaching, research, and documentation of intra-articular pathologic findings for use by insurance carriers. It has been used in orthopedic arthroscopy for many years and is relatively easy to perform without great expense. As arthroscopy has become more popular, the insurance industry has become concerned about over-
June 1995 ORAL SURGERYORAL MEDICINE ORAL PATHOLOGY
Letters to the editor
ORAL SURGERY ORAL MEDICINE ORAL PATHOLOGY
667
Volume 79, Number 6 use and abuse. A color i n s t a n t photo to confirm the presence of entities such as hyperemia and synovitis, as well as adhesions and chrondromalacia, the presence of which are subject to operator interpretation, can be dated, signed by the operator, initialed by a circulating nurse, and attached to the patient's c h a r t for future reference or research, as well as sent to the i n s u r a n c e carrier for review by the oral and maxillofacial c o n s u l t a n t if deemed necessary. Operative note
terminology, such as " m i l d hypervascularity" or " m o d e r a t e d e g e n e r a t i o n " need s u b s t a n t i a t i o n if we are to have m e a n i n g f u l research a n d quality assurance.
Morton H. Goldberg, DMD, M D Director, Department of Dentistry, Hartford Hospital Clinical Professor, OMFS, University of Connecticut 263 Farmington Ave., Farmington Conn. 06030
CALL FOR LETTERSTO THE EDITOR
A separate and distinct space for Letters to the Editor was established by Larry J. Peterson, editor in chief of ORALSURGERY,ORAL MEDICINE, ORALPATHOLOGY,ORALRADIOLOGY,AND ENDODONTICS
in his Editorial in the January 1993 issue. Dr. Peterson also encouraged brief reports on interesting observations and new developments to be submitted to appear in this letters section as well as Letters commenting on earlier published articles. Please submit your letters and brief reports for inclusion in this section. Information for authors for the Journal appears in this issue of ORALSURGERY,ORAL MEDICINE, ORALPATHOLOGY,ORALRADIOLOGY,AND ENDODONTICS. We look forward to hearing from you.
Complete duplication of the mandibular canal: Case report To the editor: During the course of a routine diagnostic evaluation, a 3 3-year-old edentulous male patient was noted to have bilateral mandibular canal abnormalities as seen on a panoramic radiograph. The right canal appeared duplicated for at least part of its course. The left canals were more well defined than the right canals. In fact, the left canals were separated for their entire course, as each canal appeared to have a distinct mandibular and mental foramen. The more accurate description for this variation would then be complete duplication of the mandibular canal. This appears to be very rare, as the Langlais et al. 1 study of 6000 panoramic surveys and the Nortj6 et al. 2 review of 3612 surveys identified no radiographs with this specific presentation. Duplicated or bifid mandibular canals in patients may cause difficulties in obtaining adequate local anesthesia. Alternative anesthetic methods should be considered in these cases. In addition, surgical ap-
proaches in the area, especially osteotomies, may need to be modified) This patient reported no history of inadequate anesthesia or surgical problems on either side of his mandible.
Richard E. Fredekind, DMD, MA Assistant Professor, Department of Diagnostic Sciences University of the Pacific School of Dentistry
Thomas Schiff, DMD, FICD, FACD Professor, Department of Diagnostic Sciences Section Head, Radiology University of the Pacific School of Dentistry
Viveca Valeriano Senior Dental Student University of the Pacific School of Dentistry REFERENCES
1. Langlais RP, Broadus R, Glass BJ. Bifid mandibular canals in panoramic radiographs. J Am Dent Assoc 1985;110:933-36. 2. Nortj6 CJ, Farman AG, Grotepass FW. Variations in the normal anatomy of the inferior dental (mandibular) canal: a retrospective study of panoramic radiographs from 3612 routine dental patients. Br J Oral Surg 1977;15:55-63. 3. Epker BN. Vascular consideration in orthognathic surgery. ORALSURGORALMED ORALPATHOL1984;57:467-72.
Fig. 1. Panoramic radiograph demonstrates duplication of left mandibular canals.
Photography for arthroscopy documentation To the editor: The article, Surgical documentation form for T M J arthroscopy by Mosby & Cline (1995;79:146-9), makes an excellent contribution in that it allows for standardization of arthroscopic data. Photography of 666
the joint pathology, taken during arthroscopy, is also an excellent tool for teaching, research, and documentation of intra-articular pathologic findings for use by insurance carriers. It has been used in orthopedic arthroscopy for many years and is relatively easy to perform without great expense. As arthroscopy has become more popular, the insurance industry has become concerned about over-
June 1995 ORAL SURGERYORAL MEDICINE ORAL PATHOLOGY
Letters to the editor
ORAL SURGERY ORAL MEDICINE ORAL PATHOLOGY
667
Volume 79, Number 6 use and abuse. A color i n s t a n t photo to confirm the presence of entities such as hyperemia and synovitis, as well as adhesions and chrondromalacia, the presence of which are subject to operator interpretation, can be dated, signed by the operator, initialed by a circulating nurse, and attached to the patient's c h a r t for future reference or research, as well as sent to the i n s u r a n c e carrier for review by the oral and maxillofacial c o n s u l t a n t if deemed necessary. Operative note
terminology, such as " m i l d hypervascularity" or " m o d e r a t e d e g e n e r a t i o n " need s u b s t a n t i a t i o n if we are to have m e a n i n g f u l research a n d quality assurance.
Morton H. Goldberg, DMD, M D Director, Department of Dentistry, Hartford Hospital Clinical Professor, OMFS, University of Connecticut 263 Farmington Ave., Farmington Conn. 06030
CALL FOR LETTERSTO THE EDITOR
A separate and distinct space for Letters to the Editor was established by Larry J. Peterson, editor in chief of ORALSURGERY,ORAL MEDICINE, ORALPATHOLOGY,ORALRADIOLOGY,AND ENDODONTICS
in his Editorial in the January 1993 issue. Dr. Peterson also encouraged brief reports on interesting observations and new developments to be submitted to appear in this letters section as well as Letters commenting on earlier published articles. Please submit your letters and brief reports for inclusion in this section. Information for authors for the Journal appears in this issue of ORALSURGERY,ORAL MEDICINE, ORALPATHOLOGY,ORALRADIOLOGY,AND ENDODONTICS. We look forward to hearing from you.