- Email: [email protected]
Response to “Manually provided temporary maxillomandibular fixation in the treatment of selected mandibular fractures”
330
Otolaryngology–Head and Neck Surgery, Vol 139, No 2, August 2008
resents novel though nonstandard treatments for chronic sinusitis and obstructive sleep apnea, respectively. As such, they seek opportunity to gain market share for the common conditions they are intended to treat. One potentially dissuading concern about the fluoroscopy-guided sinuplasty device is lens radiation exposure. This article provides reassurance that the procedure involves a low and safe irradiation dose. The second article reports that “this study provides level I evidence that the palatal implant procedure can result in a significant decrease in AHI.” This is true, but probably does not best reflect the 55.2 percent failure rate indicated on the preceding page. I would respectfully submit that partnership with device manufacturers greatly helps defray costs of research. However, it appears that we should scrupulously strive for transparency when a financial interest is involved. When an article is published in this flagship otolaryngology journal, it comes with an inherent seal of approval. Furthermore, if the reader recognizes an author as being known for a particular expertise, it further supports that author’s credibility. This letter in no way means to detract from the efforts or credibility of these or other authors. I would suggest, however, that the Journal consider placing a more obvious label of financial interest on the title page of the article, rather than tucking it away at the end. Physicians are busy individuals. Whether right or wrong, we tend to skim articles for content to some degree. Most would better scrutinize an article if they knew that a device or product manufacturer provided support. Thus, a more visible financial disclaimer may better serve both physician and patient. Thank you for the opportunity to submit my thoughts. David A. Randall, MD 11830 Westline Industrial Drive, St. Louis, MO E-mail, [email protected]; [email protected]
REFERENCES 1. Church C, Kuhn F, Mikhail J, et al. Patient and surgeon radiation exposure in balloon catheter sinus ostial dilation. Otolaryngol Head Neck Surg 2008;138:187–91. 2. Friedman M, Schalch P, Hsin-Ching L, et al. Palatal implants for the treatment of snoring and obstructive sleep apnea/hypopnea syndrome. Otolaryngol Head Neck Surg 2008;138:209 –16.
layout is an improvement, I agree that a more “up front” disclosure would benefit readers. I would disagree, however, with the statement that an article published in this “flagship otolaryngology journal . . . comes with an inherent seal of approval.” We publish original research not because we approve— or disapprove— of the particular results, but because the editor in chief, associate editor assigned to the manuscript, and at least two external referees agree that the manuscript meets five criteria (which are listed in our Author Instructions): 1. Relevance to mission: Can the information in this manuscript be used to improve patient care and public health? 2. Internal validity: Are the study design, conduct, and analysis described in a manner that is unbiased, appropriate, and reproducible? 3. External validity: Was the study sample chosen appropriately and described in adequate detail for results to be generalized? 4. Level of evidence: Does this manuscript significantly improve the knowledge base beyond what is already published on this topic? 5. Ethical conduct: Is the manuscript original, approved by an institutional review board (if applicable), and free of undisclosed conflicts of interest? Nearly all manuscripts undergo one or more revisions, during which careful attention is paid to ensure that the analysis, presentation, and conclusions are “sanitized” of bias related to industry support or relationships. Of the two manuscripts referred to in your letter, one was revised once and the other twice. As noted in criterion 5 above, we also ensure ethical conduct by insisting that all potential conflicts of interest and industry relationships be disclosed. This disclosure allows readers (like you) to form your own conclusions, and I always welcome letters (like yours) with constructive feedback that helps improve the quality of what we publish. Richard M. Rosenfeld, MD, MPH Editor in Chief, Otolaryngology—Head and Neck Surgery SUNY-HSC/Brooklyn, Pediatric Otolaryngology Long Island College Hospital Brooklyn doi:10.1016/j.otohns.2008.05.021
doi:10.1016/j.otohns.2008.05.020
Response to: “Need for more obvious disclosure of potential author conflict of interest” I thank Dr Randall for his thoughtful comments about financial disclosure. We presently disclose all relationships in a separate paragraph at the end of the manuscript, under a bold subheading of “FINANCIAL DISCLOSURE.” Prior to use of this format, disclosures were listed in extremely small print at the bottom of the first manuscript page, where they were difficult to see and read. Although the present
Response to “Manually provided temporary maxillomandibular fixation in the treatment of selected mandibular fractures” The article “Manually provided temporary maxillomandibular fixation in the treatment of selected mandibular fractures” by Vural et al in Otolaryngology–Head and Neck Surgery is to be commended for proposing that an able assistant suffices to achieve temporary jaw fixation. The argument that temporary maxillomandibular fixation provided with arch bars and stainless steel wires is superior has already been criticized in the literature.1 Reasons cited
Letters to the editor
Randall
include increased duration of operation with temporary wire fixation. Dimitroulis2 found no difference in functional occlusion or fragment alignment whether temporary immobilization was achieved manually or by wiring the jaws. It has even been suggested that anatomic (manual) reduction obtains better occlusion with fewer discrepancies as compared with perioperative wiring.3 In our unit, we routinely use a second assistant to place and hold the jaws in stable fixation during surgery. This shortens operating time with obvious financial benefit to the patient when health care funding is not by an insurance company. In addition, we have found that multiple sharp wire ends encountered during maxillomandibular wiring place all members of the surgical team at risk for sharp injuries. We endorse the opinion of Vural et al because manual immobilization reduces operating time, improves occlusion, and prevents needlestick-like injuries. UNCITED REFERENCE This section comprises of references that occur in the reference list but not in the body of the text. Please position
331 each reference in the text or, alternatively, delete it. Any reference not dealt with will be retained in this section.3 Nakul Uppal, MDS Mohan Baliga, MDS Department of Oral and Maxillofacial Surgery Manipal College of Dental Sciences Karnataka, India E-mail, [email protected]
REFERENCES 1. Vural E, Ragland J, Key JM: Manually provided temporary maxillomandibular fixation in the treatment of selected mandibular fractures. Otolaryngol Head Neck Surg 2008;138:528 –30. 2. Dimitroulis G. Management of fractured mandibles without the use of intermaxillary wire fixation. J Oral Maxillofac Surg 2002;60:1435– 8. 3. Fordyce AM, Lalani Z, Songra AK, et al. Intermaxillary fixation is not usually necessary to reduce mandibular fractures. Br J Oral Maxillofac Surg 1999;37:52–7.
doi:10.1016/j.otohns.2008.05.012
Otolaryngology–Head and Neck Surgery, Vol 139, No 2, August 2008
resents novel though nonstandard treatments for chronic sinusitis and obstructive sleep apnea, respectively. As such, they seek opportunity to gain market share for the common conditions they are intended to treat. One potentially dissuading concern about the fluoroscopy-guided sinuplasty device is lens radiation exposure. This article provides reassurance that the procedure involves a low and safe irradiation dose. The second article reports that “this study provides level I evidence that the palatal implant procedure can result in a significant decrease in AHI.” This is true, but probably does not best reflect the 55.2 percent failure rate indicated on the preceding page. I would respectfully submit that partnership with device manufacturers greatly helps defray costs of research. However, it appears that we should scrupulously strive for transparency when a financial interest is involved. When an article is published in this flagship otolaryngology journal, it comes with an inherent seal of approval. Furthermore, if the reader recognizes an author as being known for a particular expertise, it further supports that author’s credibility. This letter in no way means to detract from the efforts or credibility of these or other authors. I would suggest, however, that the Journal consider placing a more obvious label of financial interest on the title page of the article, rather than tucking it away at the end. Physicians are busy individuals. Whether right or wrong, we tend to skim articles for content to some degree. Most would better scrutinize an article if they knew that a device or product manufacturer provided support. Thus, a more visible financial disclaimer may better serve both physician and patient. Thank you for the opportunity to submit my thoughts. David A. Randall, MD 11830 Westline Industrial Drive, St. Louis, MO E-mail, [email protected]; [email protected]
REFERENCES 1. Church C, Kuhn F, Mikhail J, et al. Patient and surgeon radiation exposure in balloon catheter sinus ostial dilation. Otolaryngol Head Neck Surg 2008;138:187–91. 2. Friedman M, Schalch P, Hsin-Ching L, et al. Palatal implants for the treatment of snoring and obstructive sleep apnea/hypopnea syndrome. Otolaryngol Head Neck Surg 2008;138:209 –16.
layout is an improvement, I agree that a more “up front” disclosure would benefit readers. I would disagree, however, with the statement that an article published in this “flagship otolaryngology journal . . . comes with an inherent seal of approval.” We publish original research not because we approve— or disapprove— of the particular results, but because the editor in chief, associate editor assigned to the manuscript, and at least two external referees agree that the manuscript meets five criteria (which are listed in our Author Instructions): 1. Relevance to mission: Can the information in this manuscript be used to improve patient care and public health? 2. Internal validity: Are the study design, conduct, and analysis described in a manner that is unbiased, appropriate, and reproducible? 3. External validity: Was the study sample chosen appropriately and described in adequate detail for results to be generalized? 4. Level of evidence: Does this manuscript significantly improve the knowledge base beyond what is already published on this topic? 5. Ethical conduct: Is the manuscript original, approved by an institutional review board (if applicable), and free of undisclosed conflicts of interest? Nearly all manuscripts undergo one or more revisions, during which careful attention is paid to ensure that the analysis, presentation, and conclusions are “sanitized” of bias related to industry support or relationships. Of the two manuscripts referred to in your letter, one was revised once and the other twice. As noted in criterion 5 above, we also ensure ethical conduct by insisting that all potential conflicts of interest and industry relationships be disclosed. This disclosure allows readers (like you) to form your own conclusions, and I always welcome letters (like yours) with constructive feedback that helps improve the quality of what we publish. Richard M. Rosenfeld, MD, MPH Editor in Chief, Otolaryngology—Head and Neck Surgery SUNY-HSC/Brooklyn, Pediatric Otolaryngology Long Island College Hospital Brooklyn doi:10.1016/j.otohns.2008.05.021
doi:10.1016/j.otohns.2008.05.020
Response to: “Need for more obvious disclosure of potential author conflict of interest” I thank Dr Randall for his thoughtful comments about financial disclosure. We presently disclose all relationships in a separate paragraph at the end of the manuscript, under a bold subheading of “FINANCIAL DISCLOSURE.” Prior to use of this format, disclosures were listed in extremely small print at the bottom of the first manuscript page, where they were difficult to see and read. Although the present
Response to “Manually provided temporary maxillomandibular fixation in the treatment of selected mandibular fractures” The article “Manually provided temporary maxillomandibular fixation in the treatment of selected mandibular fractures” by Vural et al in Otolaryngology–Head and Neck Surgery is to be commended for proposing that an able assistant suffices to achieve temporary jaw fixation. The argument that temporary maxillomandibular fixation provided with arch bars and stainless steel wires is superior has already been criticized in the literature.1 Reasons cited
Letters to the editor
Randall
include increased duration of operation with temporary wire fixation. Dimitroulis2 found no difference in functional occlusion or fragment alignment whether temporary immobilization was achieved manually or by wiring the jaws. It has even been suggested that anatomic (manual) reduction obtains better occlusion with fewer discrepancies as compared with perioperative wiring.3 In our unit, we routinely use a second assistant to place and hold the jaws in stable fixation during surgery. This shortens operating time with obvious financial benefit to the patient when health care funding is not by an insurance company. In addition, we have found that multiple sharp wire ends encountered during maxillomandibular wiring place all members of the surgical team at risk for sharp injuries. We endorse the opinion of Vural et al because manual immobilization reduces operating time, improves occlusion, and prevents needlestick-like injuries. UNCITED REFERENCE This section comprises of references that occur in the reference list but not in the body of the text. Please position
331 each reference in the text or, alternatively, delete it. Any reference not dealt with will be retained in this section.3 Nakul Uppal, MDS Mohan Baliga, MDS Department of Oral and Maxillofacial Surgery Manipal College of Dental Sciences Karnataka, India E-mail, [email protected]
REFERENCES 1. Vural E, Ragland J, Key JM: Manually provided temporary maxillomandibular fixation in the treatment of selected mandibular fractures. Otolaryngol Head Neck Surg 2008;138:528 –30. 2. Dimitroulis G. Management of fractured mandibles without the use of intermaxillary wire fixation. J Oral Maxillofac Surg 2002;60:1435– 8. 3. Fordyce AM, Lalani Z, Songra AK, et al. Intermaxillary fixation is not usually necessary to reduce mandibular fractures. Br J Oral Maxillofac Surg 1999;37:52–7.
doi:10.1016/j.otohns.2008.05.012