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Recent advances in plastic surgery (vol 4)
Book reviews Recent Advances in Plastic Surgery (Vo14). By I. T. Jackson & B. C. Sommerlad. 1992. Churchill Livingstone. pp 200. Price f39.95. ISBN O-443-04453-8.
and intriguing vascularised methods such as that incorporating a temporal galea pcdiclc on the superficial temporal vessels. There is only one contribution by an oral and maxillofacial surgeon namely a sound critique of methods of ‘Maxillary-mandibular discontinuity reconstruction with composite grafts (autogenous free iliac bone and titanium endosseous osseo-integrated implants)’ emanating from E. Kcllcr of the USA. This is based on an overall experience of 2800 Branemark endosseous implants placed in over 700 patients where 80 of the subjects had implants combined with composite bone grafts for reconstruction. Sound principles are emphasised and a strong cast is presented for implant placement at a separate operation from that performed to carry out bone grafting in the case of the mandible, although in the maxilla a one-stage procedure may be necessary if the implants are used to secure the graft to the underlying skeletal base. Tissue expansion has been a major advance in reconstructive surgery since the 1980s so that the contribution on this subject is a worthwhile one reviewing the current situation. Thcrc is a section on its application in the head and neck which cmphasiscs the relatively high complication rate in this region pointing out that the most common problem is expander exposure due to folds in the expander envelope; useful applications are however cmphasiscd such as the combination of a temporary skin graft for cheek neoplasms combined with the insertion of an expander which allows eventual excision of the temporary graft. Mohs’ chemosurgical excision method is discussed in two complementary contributions one of which cmphasiscs the potential advantages and the other the pitfalls, such as slowness. The discussion proves valuable in an era where laser excision techniques may be used utilising similar principles of histologically guided resection. There is an interesting discursive article on the problems of developing micro surgery in a developing country (in this case India) where finances are limited-- we are beginning to experience similar problems with our dwindling Health Service! The remaining chapters deal with rather more peripheral subjects for the OMFS surgeon such as hypospadias, flexor tendon repair with early mobilisation and immediate breast reconstruction with expansile implants. Breast reconstruction may seem outside the spcctrum of the activities of our specialty although I recall a colleague from the USA telling me that his female orthognathic patients on a number of occasions had asked him to complete the job by carrying out a mammoplasty and he had obliged! All in all, this is a worthwhile publication with much to interest the busy oral and maxillofacial surgeon and perhaps make him prolong his coffee break to read more. It may also make him wonder whcthcr we should not as a specialty, be producing our own ‘Recent advances’.
This is the fourth volume of Recent Advances in Plastic Surgery brought out by Churchill Livingstone. It is an attractive large format book with a shiny, clinically-white cover and it is slim enough, at 200 pages, to slip into the briefcase for a self-improvement session during the morning coffee break (caffeine free of course for the budding micro surgeon!). There are seven American contributors, six British and one Indian author providing a useful spectrum of subjects many of them of direct interest to the oral and maxillofacial surgeon. Audit is on everybody’s lips at the moment so that it is topical that pride of place as first article goes to ‘Interccntre Clinical Audit for Cleft Lip and Palate-a Preliminary European Investigation’. This is the product of a research group formed by two orthodontists from each of six cleft palate ccntrcs who with commendable energy set out to analyse objectively and impartially postoperative results from the units involved. It provides an object lesson in audit method and we learn of such entities as Goslon scoring (a score of 1 denotes a protrusive maxilla and a score of 5 a retrusive one so that a rating below 3.5 indicates the likely need for maxillary osteotomy). As has been found in other branches of surgery, centres where surgery is performed by operators with high personal case loads ranks highest in quality of result whereas those with large numbers of low volume operators rank lowest. This CLP section is complcmcntcd by a useful contribution on the surgical anatomy of the velum and pharynx (which underlines the growing consensus that the musculus uvulae is important in aiding velo-pharyngeal closure) and two articles from separate American centres on the double opposing Z-plasty for palate closure. This tcchniquc, developed by one of the contributors, L. T. Furlow, Jr. is claimed to be a significant improvement in cleft palate repair giving better speech results, fewer fistulae and the possibility of less interference with maxillary growth; with regard to the latter consideration however there is a lack of quantitative data which was so central to the audit study so that one misses a user-friendly Goslon rating! There is an excellent summarising chapter on ‘The Radial Forearm Flap in Head and Neck Reconstruction’ from Glasgow which provides a valuable review including such modifications as the bi-paddle design and a summary of measures to eliminate skin grafts such as the ulna transposition flap. The list of references is a useful one but it seems a shame that there is no recognition of the contribution to the literature by our own specialty. Another excellent chapter is that on ‘Calvarial bone for head and neck reconstruction’ provided by Ian Jackson; this is a very comprehensive review of techniques including tips for producing split thickness grafts such as the creation of a l-2 cm gutter periphcrally to allow osteotome angulation, methods for repair after full thickness grafts by using harvested cranial bone dust
Professor
132
P. F. BRADLEY of Oral and Maxillofacial Surgery The Royal London Hospital
and intriguing vascularised methods such as that incorporating a temporal galea pcdiclc on the superficial temporal vessels. There is only one contribution by an oral and maxillofacial surgeon namely a sound critique of methods of ‘Maxillary-mandibular discontinuity reconstruction with composite grafts (autogenous free iliac bone and titanium endosseous osseo-integrated implants)’ emanating from E. Kcllcr of the USA. This is based on an overall experience of 2800 Branemark endosseous implants placed in over 700 patients where 80 of the subjects had implants combined with composite bone grafts for reconstruction. Sound principles are emphasised and a strong cast is presented for implant placement at a separate operation from that performed to carry out bone grafting in the case of the mandible, although in the maxilla a one-stage procedure may be necessary if the implants are used to secure the graft to the underlying skeletal base. Tissue expansion has been a major advance in reconstructive surgery since the 1980s so that the contribution on this subject is a worthwhile one reviewing the current situation. Thcrc is a section on its application in the head and neck which cmphasiscs the relatively high complication rate in this region pointing out that the most common problem is expander exposure due to folds in the expander envelope; useful applications are however cmphasiscd such as the combination of a temporary skin graft for cheek neoplasms combined with the insertion of an expander which allows eventual excision of the temporary graft. Mohs’ chemosurgical excision method is discussed in two complementary contributions one of which cmphasiscs the potential advantages and the other the pitfalls, such as slowness. The discussion proves valuable in an era where laser excision techniques may be used utilising similar principles of histologically guided resection. There is an interesting discursive article on the problems of developing micro surgery in a developing country (in this case India) where finances are limited-- we are beginning to experience similar problems with our dwindling Health Service! The remaining chapters deal with rather more peripheral subjects for the OMFS surgeon such as hypospadias, flexor tendon repair with early mobilisation and immediate breast reconstruction with expansile implants. Breast reconstruction may seem outside the spcctrum of the activities of our specialty although I recall a colleague from the USA telling me that his female orthognathic patients on a number of occasions had asked him to complete the job by carrying out a mammoplasty and he had obliged! All in all, this is a worthwhile publication with much to interest the busy oral and maxillofacial surgeon and perhaps make him prolong his coffee break to read more. It may also make him wonder whcthcr we should not as a specialty, be producing our own ‘Recent advances’.
This is the fourth volume of Recent Advances in Plastic Surgery brought out by Churchill Livingstone. It is an attractive large format book with a shiny, clinically-white cover and it is slim enough, at 200 pages, to slip into the briefcase for a self-improvement session during the morning coffee break (caffeine free of course for the budding micro surgeon!). There are seven American contributors, six British and one Indian author providing a useful spectrum of subjects many of them of direct interest to the oral and maxillofacial surgeon. Audit is on everybody’s lips at the moment so that it is topical that pride of place as first article goes to ‘Interccntre Clinical Audit for Cleft Lip and Palate-a Preliminary European Investigation’. This is the product of a research group formed by two orthodontists from each of six cleft palate ccntrcs who with commendable energy set out to analyse objectively and impartially postoperative results from the units involved. It provides an object lesson in audit method and we learn of such entities as Goslon scoring (a score of 1 denotes a protrusive maxilla and a score of 5 a retrusive one so that a rating below 3.5 indicates the likely need for maxillary osteotomy). As has been found in other branches of surgery, centres where surgery is performed by operators with high personal case loads ranks highest in quality of result whereas those with large numbers of low volume operators rank lowest. This CLP section is complcmcntcd by a useful contribution on the surgical anatomy of the velum and pharynx (which underlines the growing consensus that the musculus uvulae is important in aiding velo-pharyngeal closure) and two articles from separate American centres on the double opposing Z-plasty for palate closure. This tcchniquc, developed by one of the contributors, L. T. Furlow, Jr. is claimed to be a significant improvement in cleft palate repair giving better speech results, fewer fistulae and the possibility of less interference with maxillary growth; with regard to the latter consideration however there is a lack of quantitative data which was so central to the audit study so that one misses a user-friendly Goslon rating! There is an excellent summarising chapter on ‘The Radial Forearm Flap in Head and Neck Reconstruction’ from Glasgow which provides a valuable review including such modifications as the bi-paddle design and a summary of measures to eliminate skin grafts such as the ulna transposition flap. The list of references is a useful one but it seems a shame that there is no recognition of the contribution to the literature by our own specialty. Another excellent chapter is that on ‘Calvarial bone for head and neck reconstruction’ provided by Ian Jackson; this is a very comprehensive review of techniques including tips for producing split thickness grafts such as the creation of a l-2 cm gutter periphcrally to allow osteotome angulation, methods for repair after full thickness grafts by using harvested cranial bone dust
Professor
132
P. F. BRADLEY of Oral and Maxillofacial Surgery The Royal London Hospital