Proper orientation of the consumer information program

LETTERS TO THE EDITOR J OralMaxillofac 4054S.

Surg

1982

ourselves into believing that the oral surgeon today can exist as an island with no need for hospitalbased support services: consultative, diagnostic, anesthetic, etc. This type of thinking is not only unrealistic and derisive but potentially dangerous. I believe I speak for many when I say the Consumer Information Program plays an important role in helping our specialty assume the position in health care it justly deserves. I am eager to see the results of the research being conducted this year to gauge just how successful our efforts have been. But I caution my colleagues who look to this program as a panacea for all the inequities they perceive as challenging our specialty today. Granted, many of the forces that ultimately determine how we do what we do are beyond our control. But it is within our purview to live up to the image set by the Consumer Information Program by putting the patient first-and demonstrating it.

PROPER ORIENTATION OF THE CONSUMER INFORMATIONPROGRAM To the Editor:-Dr. Jerome Friedman, in his April 1982 letter to the editor, offers perhaps the strongest argument I have heard supporting the continuation of the AAOMS Consumer Information Program. Friedman correctly asserts that the program was developed to educate the public as to who oral and maxillofacial surgeons are and what they do. Considering the diversity of our fellowship and the varied nature of the care we render, that undertaking poses no easy task. It would have been foolhardy had the persons responsible for this program presumed to lay the entire scope of the speciality at the feet of the consumer at once. Instead, I believe, funds were expended to realistically gauge what the average American knows about oral and maxillofacial surgery. The results of that survey-which I received last fall-indicated that a strong majority, 92% of a nationally projectable sample, associated oral and maxillofacial surgeons almost entirely with their expertise in the removal of third molars. To concentrate the main thrust of the consumer education effort-not to mention the bulk of the assessment dollars-or to further enlighten them in this regard would be counterproductive. However, emphasizing the oral surgeon’s expertise in dentoalveolar surgery is obviously important. Of the seven CIPROG messages that have been published to date, two have focused on what Friedman refers to as our “bread and butter.” The two messages on third molar removal have already appeared 12 times, reaching an estimated total reading audience of 49 million. I agree with Dr. Friedman’s statements regarding the oral surgeon’s expertise in outpatient anesthesia and was gratified to see that a 1982 message on the subject is appearing five times before 21.7 million people. The approach is subtle yet informative and addresses the safety of in-office anesthesia in an understated manner. To assume a more “hardsell” approach would, I believe, defeat the very purpose of a message on OMS anesthesia techniques. How could one over-emphasize the safety aspects without calling undue attention to what we all recognize as the potential hazards? The CIPROG messages can go just so far in educating our patients. We, the individual practitioners, must pull our weight by providing the most specific information on the treatment we prescribe. I was most disturbed by Dr. Friedman’s assertion that “proper training” would mandate that most oral surgical procedures be performed in the office. For any one of us to underestimate the importance of the hospital environment in oral surgical practice is to undermine significant advances made by our specialty in hospital-based practice, and to delude

BARRYH. HENDLER,DDS, MD 7955 Castor Avenue Philadelphia,PA 19152

SIGNIFICANCE

OF FLUCTUATION

IN FASCIAL

SPACE INFECTIONS

To the Editor:-The title of the article by Palmershiem and Hamilton in the June 1982 edition of the Journal of Oral and Maxillofacial Surgery might well be “Fatal Cavernous Sinus Thrombosis Secondary to Delay in Surgical Drainage of a Panfacial Abscess.” On the 21st postoperative day, the patient was described as having “extensive left facial edema with induration and tenderness over the left day, parotid region.” On the 27th postoperative “the facial swelling extended from the left temporal space to the inferior border of the left side of the mandible and from the left tragus to the midline.” On that day the initial incision and drainage was performed. The statement was made that on the 26th postoperative day “no localized collections of drainable pus existed.” The only way I know to determine that no drainable pus exists is to surgically open the area to explore for the pus. A very common concept that persists today is that if there is no fluctuation, there is no pus. This concept may be true ,in subcutaneous and submucosal infections but is not true in fascial space infections of the head and neck. Because of the thickness of the overlying tissues, submandibular, submasseteric, infratemporal, submental, parotid, and pterygomandibular space infections can contain pus and still not feel fluctuant. Even with today’s stage of antibiotic development and therapy, early surgical drainage is still the mainstay of treatment of fascial space infections of the head and neck. WILLIAM N. SMITH, MD, DDS 3782 Clairemont Drive SanDiego,CA 92117

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