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The Dangerous Claim of “Being First”
The Journal of Emergency Medicine, Vol. 50, No. 2, pp. 337–338, 2016 Copyright Ó 2016 Elsevier Inc. Printed in the USA. All rights reserved 0736-4679/$ - see front matter
Letters to the Editor , THE DANGEROUS CLAIM OF “BEING FIRST”
REFERENCES 1. Gorchynski J, Karabidian E, Sanchez M. The “syringe” technique: a hands-free approach for the reduction of acute nontraumatic temporomandibular dislocations in the emergency department. J Emerg Med 2014;47:676–81. 2. Iserson KV. Improvised Medicine: Providing Care in Extreme Environments. New York: McGraw-Hill; 2012:389–90.
, To the Editor: Claiming to be the first one to describe a medical technique is always a dicey proposition. When the claim encompasses a variety of procedures, you can be rather certain that omissions have occurred. This seems to be the situation with Gorchynski et al.’s recent article on nontraumatic mandibular dislocations, in which they claim that their technique is “the first described in the medical literature that does not require intraoral or external manual manipulation of the mandible for the reduction” (1). Although the technique described in their article seems to work well for nontraumatic mandibular dislocations, I described, in Improvised Medicine: Providing Care in Extreme Environments, a technique that oral surgeons have used for all types of mandibular dislocations, including those that present >48 h after occurring. “In either difficult cases or when no anesthetic is available, a TMJ dislocation can be gradually reduced by first placing as many tongue depressors as possible, stacked one on top of the other, into the existing space on the side with the most prominent dislocation. Then insert new tongue depressors, one at a time, into the stack. The TMJ spasm should gradually relax enough for the joint to relocate” (2). This describes a progressive technique rather than the “rolling fulcrum” described as the “syringe” technique. Nevertheless, the clinician does not need to insert their hands in the mouth or manipulate the mandible for it to work.
, IN RESPONSE TO “THE DANGEROUS CLAIM OF ‘BEING FIRST’” , To the Editor: Dr. Iserson has brought to my attention, through his Letter to the Editor of The Journal of Emergency Medicine, that one should be careful when claiming to be the first to describe a technique because I had not cited his book, published in 2012, which describes a method to reduce temporomandibular jaw (TMJ) dislocations that does not necessitate the clinician placing their hands inside the patient’s mouth or externally on the mandible. I would like to emphasize that I acted prudently and responsibly when several of my colleagues and I did an exhaustive search of the medical literature for TMJ dislocation reduction techniques using various search engines. However, we did not find the technique that Dr. Iserson mentioned and his book did not show up in our literature search. I understand that just because we could not find another hands-off technique for reduction of TMJ dislocations in the literature search does not mean that one does not exist or that it is not cited elsewhere. I understand that there may be obscure citations that are unavailable through the usual means, are not able to be located using the standard typical search engines, or are not provided in peer-reviewed journals or other commonly read medical literature. Therefore, I chose my words carefully, clearly stating in our article that, “to our knowledge, our technique is the first described in the medical literature that does not require intraoral or external manipulation of the mandible for the reduction of acute nontraumatic TMJ dislocations in the ED” (1). This accurately conveys
Kenneth V. Iserson, MD, MBA, FACEP, FAAEM Fellow, International Federation for Emergency Medicine Professor Emeritus The University of Arizona Tucson, Arizona http://dx.doi.org/10.1016/j.jemermed.2015.02.055
337
Letters to the Editor , THE DANGEROUS CLAIM OF “BEING FIRST”
REFERENCES 1. Gorchynski J, Karabidian E, Sanchez M. The “syringe” technique: a hands-free approach for the reduction of acute nontraumatic temporomandibular dislocations in the emergency department. J Emerg Med 2014;47:676–81. 2. Iserson KV. Improvised Medicine: Providing Care in Extreme Environments. New York: McGraw-Hill; 2012:389–90.
, To the Editor: Claiming to be the first one to describe a medical technique is always a dicey proposition. When the claim encompasses a variety of procedures, you can be rather certain that omissions have occurred. This seems to be the situation with Gorchynski et al.’s recent article on nontraumatic mandibular dislocations, in which they claim that their technique is “the first described in the medical literature that does not require intraoral or external manual manipulation of the mandible for the reduction” (1). Although the technique described in their article seems to work well for nontraumatic mandibular dislocations, I described, in Improvised Medicine: Providing Care in Extreme Environments, a technique that oral surgeons have used for all types of mandibular dislocations, including those that present >48 h after occurring. “In either difficult cases or when no anesthetic is available, a TMJ dislocation can be gradually reduced by first placing as many tongue depressors as possible, stacked one on top of the other, into the existing space on the side with the most prominent dislocation. Then insert new tongue depressors, one at a time, into the stack. The TMJ spasm should gradually relax enough for the joint to relocate” (2). This describes a progressive technique rather than the “rolling fulcrum” described as the “syringe” technique. Nevertheless, the clinician does not need to insert their hands in the mouth or manipulate the mandible for it to work.
, IN RESPONSE TO “THE DANGEROUS CLAIM OF ‘BEING FIRST’” , To the Editor: Dr. Iserson has brought to my attention, through his Letter to the Editor of The Journal of Emergency Medicine, that one should be careful when claiming to be the first to describe a technique because I had not cited his book, published in 2012, which describes a method to reduce temporomandibular jaw (TMJ) dislocations that does not necessitate the clinician placing their hands inside the patient’s mouth or externally on the mandible. I would like to emphasize that I acted prudently and responsibly when several of my colleagues and I did an exhaustive search of the medical literature for TMJ dislocation reduction techniques using various search engines. However, we did not find the technique that Dr. Iserson mentioned and his book did not show up in our literature search. I understand that just because we could not find another hands-off technique for reduction of TMJ dislocations in the literature search does not mean that one does not exist or that it is not cited elsewhere. I understand that there may be obscure citations that are unavailable through the usual means, are not able to be located using the standard typical search engines, or are not provided in peer-reviewed journals or other commonly read medical literature. Therefore, I chose my words carefully, clearly stating in our article that, “to our knowledge, our technique is the first described in the medical literature that does not require intraoral or external manipulation of the mandible for the reduction of acute nontraumatic TMJ dislocations in the ED” (1). This accurately conveys
Kenneth V. Iserson, MD, MBA, FACEP, FAAEM Fellow, International Federation for Emergency Medicine Professor Emeritus The University of Arizona Tucson, Arizona http://dx.doi.org/10.1016/j.jemermed.2015.02.055
337