Surgical treatment of mandibular osteoradionecrosis: Versatility of scapular osteocutaneous flap

CURRENT LITERATURE Reprint requests to Dr Ariyan: Connecticut Center for Plastic Surgery, 60 Temple St, New Haven, CT 06510. Ketorolac Tromethamine and Hemorrhage in Tonsillectomy: A Prospective, Randomized, Double-Blind Study Bailey R, Sinha C, Burgess L. Laryngoscope 107:166, 1997 The study was conducted to determine bleeding risk of Ketorolac Tromethamine in a tonsillectomy patient model. Eighty patients with an average age of 24.3 years were randomized into two groups. The first group consisted of 37 patients who received 30 kg ketorolac intramuscularly 24 hours postoperatively. The second group consisted of 43 patients who received 75 mg meperidine intramuscularly 24 hours postoperatively. Approximated 3 doses were used for each group. The patients for each group were statistically similar in age, sex, and preoperative bleeding time. The results showed that the incidence of hemorrhage was not significantly different for either group. In the Ketorolac group 7137 patients experienced hemorrhage and 3143 patients experienced hemorrhage in the Meperidine group. Postoperative bleeding times showed statistically significant increases with the Ketorolac group (5.19 preoperative to 6.27 postoperative) but not with the Meperidine group (5.74 preoperative to 5.44 postoperative). The authors concluded that although there was not a statistical increase in the incidence of hemorrhage for the Ketorolac group, there was an increase in postoperative bleeding time. Based on this result, the authors agree with the manufacturer warning that perioperative use of Ketorolac is contraindicated in those surgical procedures where hemostasis is critical.-R. HOLLOWAY Reprint requests to Dr Burgess: Department of Surgery, ATTN: MCHK-DSH 1 Jarrett White Rd, Tripler AMC, HI 96859.5000. Hypoglossal-Facial Nerve Side-to-End Anastomosis for Preservation of Hypoglossal Function: Results of Delayed Treatment With a New Technique. Sawamura Y, Abe H. J Neurosurg 86:203, 1997 If it can be performed within 24 months from the date of injury, the procedure of choice to re-animate the paralyzed face is restoration of facial nerve continuity. When the central stump of the facial nerve is not available, and the mimetic muscles are still viable, hypoglossal-facial nerve anastomosis has been the favored technique. In the classic technique, however, the hypoglossal nerve is sacrificed, leading to hemitongue atrophy. To avoid or reduce this problem, modifications in the technique have been developed. This reports describes an additional new technique to improve outcomes because it does not necessitate the use of nerve grafts or hemihypoglossal nerve splitting. In this technique, the mastoid process is partially resected to open the stylomastoid foramen and the descending portion of the facial nerve is exposed and transected distally. The hypoglossal nerve beneath the internal jugular vein is exposed at the level of the axis and dissected as far proximally as possible. One-half to two-fifths of the hypoglossal nerve is transected rostally, allowing approximation of the distal stump of the atrophic facial nerve. They are sutured without tension. This technique has been used in 4 patients with long-standing facial paralysis and it provided satisfactory results and no evidence of hemitongue atrophy. The technique is described in detail in the article.-R.E. ALEXANDER

897 Reprint requests to Dr Abe: Department of Neurosurgery, University of Hokkaido, School of Medicine, North-15, West-7, Kita-ku, Sapporo 060, Japan. Surgical Treatment of Mandibular Osteoradionecrosis: Versatility of Scapular Osteocutaneous Flap. Nakatsuka T, Harii K, et al. Stand J Plast Reconstr Hand Surg 30:291, 1996 The purpose of this study is to show the versatility of the scapular osteocutaneous flap for treatment of mandibular osteoradionecrosis. The authors used scapular osteocutaneous flaps in eight patients. The ninth patient received both a scapular osteocutaneous flap and a radial free flap. Six of the nine patients had uneventful postoperative courses. The complications included one case of partial flap loss with nonunion, an orocutaneous fistula, and one case of skin necrosis. The advantages of the scapular flap include the availability of an adequate amount of bone and the availability of an adequate amount of soft tissue. Both of these factors enable the scapular flap to be useful in reconstructing mandibular osteoradionecrosis in one-stage surgery.-W. CARVAJAL Reprint requests to Dr Nakatsuka: University of Tokyo, Hongo, Bunkyo-ku, Tokyo 113. Clinical Results of Therapeutic Temporomandibular Joint Arthroscopy: A Prospective Study of 34 Arthroscopies With Prediscal Section and Retrodiscal Coagulation. Chossegros C, Cheynet F, Gola R, et al. Brit J Oral Maxillofat Surg 34:504, 1996 This study evaluated the effect of arthroscopy on pain, click, mouth opening, and diet. The aim was to determine if arthroscopy of the temporomandibular joint (TMJ) including lysis, lavage, prediscal release, and retrodiscal coagulation was a safe applicable treatment for disc displacements with or without reduction. A total of 25 patients were treated who had not responded to non-invasive treatment (occlusal rehabilitation, physiotherapy, or medical measures) over a period of 3 months. All patients had TMJ disorders with evidence of pain, trismus, or hypermobility. Clicking alone was not indicated for treatment although it was present in over half of the cases. A standard arthroscopy technique was used using lysis and lavage with Ringer’s solution. Pain improved in 71% of cases, but deteriorated in six and clicking was relieved in 78% of cases. Mouth opening improved by 12.4 mm in patients with non-reduced discs and 7.9 mm in reduced discs. Joint noises disappeared in 29% of the cases. Diet improved in 97% of cases. Complications in this study involved two transitory pre-auricular hypoesthesia and one infratemporal infection. This study concluded that therapeutic arthroscopy is safe and should be indicated in disc displacements with or without reduction and in joint luxation in cases of medical treatment failure. Joint pain and mouth opening are the two indications for this technique.-JOHN A. ELLIS, Jr Reprint requests to Dr Chossegros: Centre Hospitalier et Universitaire Timone, 13385 Marseille cedex 5, France. Seven Deadly Sins of Statistical Analysis. Kuzon WM Jr, Urbanchek MG, McCabe S. Ann Plast Surg 37:265, 1996 Plastic surgical research has become increasingly sophisticated and the use of statistical analysis for the interpretation