J Oral Maxlllofac 49:665-W,
surg
1991
by the authors may not detect this. Furthermore, many patients with malignancy have elevated levels of fibrinogen,’ so knowledge of the fibrinogen following the bleed is meaningless without the benefit of a preoperative level. The use of immunohistochemical staining for prostate-specific antigen (PSA) is widespread in determining the site of origin of poorly differentiated adenocarcinomas, but the authors are wrong in their assertion that “PSA antigen stain selectively marks acid phosphatase in the tissue.” The two proteins are immunologically and biochemically quite different.’ Finally, although historically estrogens have been used in the treatment of DIG secondary to disseminated prostatic cancer, they themselves cause a thrombotic tendency by reducing circulating levels of antithrombin lll.3 The availability of other antiandrogens that are less “thrombogenic” makes their use preferable in this scenario. A.S. ADAMSON, MB, FRCS
POSSIBLE PROBLEMS WITH THE BICORONAL INCISION To the Editor:-1 enjoyed reading the article by Abubaker et al on the use of the coronal incision for reconstruction of severe craniomaxillofacial injuries (J Oral Maxillofac Surg 48:.579, 1990). I agree wholeheartedly that this approach is excellent for all the reasons indicated in the article. Another addition to its uses, I feel, is in the treatment of medial wall blowout fractures of the orbit. In discussing the results postsurgery, the authors did not comment if any of their patients experienced an uncomfortable itching sensation in the region of the coronal incision line. I find that this is quite a common complaint by patients after the coronal approach. This complaint appears to be independent of the presence of supraorbital nerve anesthesia or paresthesia, and appears to be quite persistent in nature. Finally, I wonder if any of the patients in their series required blood transfusion. I find that the infiltration of a local anesthetic agent with epinephrine, as the authors often do, minimizes bleeding prior to the application of Raney neurosurgical clips and obviates transfusion requirements.
London, England
References 1. Bick RL: Alterationof haemostasis associatedwith malig-
J. CLIFF BEIRNE,MB, BDS, FFDRCSI, FRCS (ED) Dublin, Ireland
nancy. Aetiology, pathogenesis, diagnosis and management. Semin Thromb Hemost 5: 1, 1978 2. Lilja H, Abrahamson PA: Three predominant proteins secreted by the human prostate. Prostate 12:29, 1988 3. Buller HR, Boon TA, Henny CP, et al: Estrogen induced deficiency and decrease in antithrombin II1 activity in patients with prostatic cancer. J Ural 128:72. 1982
The authors reply:-An itching sensation in the region of the coronal incision postsurgically has not been mentioned by any of the patients operated on in our institution. Infiltration with a local anesthetic containing epinephtine, and the use of Raney neurosurgical clips, significantly reduces blood loss. Blood transfusion is not required when red cell counts are normal and there are no other severe injuries. Some patients in our series did require blood transfusions when red cell counts were low initially because of other injuries (abdominal, chest, extremities, etc).
FAILURE WITH THE VISIBLE LIGHT-CURED RESIN SYSTEM To the Editor:-Considering our past experience with hydroxyapatite granules, hydroxyapatite blocks, and the interpositional temporomandibular joint implant materials, I would hope that oral and maxillofacial surgeons would present only materials and methods that are clinically successful. Drs Scuba and McLaughlin, in their well-written technical note published in the December issue of the Journal, describe the use of the Triad system for splint fabrication. Our experience with five consecutive lingual splints fabricated for reduction and fixation of mandibular fractures using this method was less than satisfactory. Because of the brittleness of the material, three failed during splint application and two failed during the first week of fixation. With a 100% failure rate, we have discontinued the use of this system.
GEORGEC. SOTEREANOS, DMD Pittsburgh,Pennsylvania PROSTATE CANCER AND
DIC
To rhe Editor:-1 read with interest the case report of Catrambone and Pfeffer (J Oral Maxillofac Surg 48:858, 1990), which is a further example of the involvement of the hemostatic system in malignant growth and spread. Several points are worth further discussion. As the authors state, many patients with cancer are in a compensated state of chronic disseminated intravascular coagulation (DIG). Routine investigations as used
RICHARDH. HAUG, DDS JON P. BRADRICK,DDS
Cleveland,
Ohio
The authors reply:-TRIAD is not without its faults, but it has a place in our practice. No dental material is perfect. I have broken TRIAD, self-curing, and processed acrylic splints, and cast metal arch bars while trying to “make” them fit. We have found TRIAD more brittle than the self-curing acrylic used in splint fabrication. The “ivory” is too brittle for our needs, but the “pink reline material” has worked well. Because of this prop-
665
surg
1991
by the authors may not detect this. Furthermore, many patients with malignancy have elevated levels of fibrinogen,’ so knowledge of the fibrinogen following the bleed is meaningless without the benefit of a preoperative level. The use of immunohistochemical staining for prostate-specific antigen (PSA) is widespread in determining the site of origin of poorly differentiated adenocarcinomas, but the authors are wrong in their assertion that “PSA antigen stain selectively marks acid phosphatase in the tissue.” The two proteins are immunologically and biochemically quite different.’ Finally, although historically estrogens have been used in the treatment of DIG secondary to disseminated prostatic cancer, they themselves cause a thrombotic tendency by reducing circulating levels of antithrombin lll.3 The availability of other antiandrogens that are less “thrombogenic” makes their use preferable in this scenario. A.S. ADAMSON, MB, FRCS
POSSIBLE PROBLEMS WITH THE BICORONAL INCISION To the Editor:-1 enjoyed reading the article by Abubaker et al on the use of the coronal incision for reconstruction of severe craniomaxillofacial injuries (J Oral Maxillofac Surg 48:.579, 1990). I agree wholeheartedly that this approach is excellent for all the reasons indicated in the article. Another addition to its uses, I feel, is in the treatment of medial wall blowout fractures of the orbit. In discussing the results postsurgery, the authors did not comment if any of their patients experienced an uncomfortable itching sensation in the region of the coronal incision line. I find that this is quite a common complaint by patients after the coronal approach. This complaint appears to be independent of the presence of supraorbital nerve anesthesia or paresthesia, and appears to be quite persistent in nature. Finally, I wonder if any of the patients in their series required blood transfusion. I find that the infiltration of a local anesthetic agent with epinephrine, as the authors often do, minimizes bleeding prior to the application of Raney neurosurgical clips and obviates transfusion requirements.
London, England
References 1. Bick RL: Alterationof haemostasis associatedwith malig-
J. CLIFF BEIRNE,MB, BDS, FFDRCSI, FRCS (ED) Dublin, Ireland
nancy. Aetiology, pathogenesis, diagnosis and management. Semin Thromb Hemost 5: 1, 1978 2. Lilja H, Abrahamson PA: Three predominant proteins secreted by the human prostate. Prostate 12:29, 1988 3. Buller HR, Boon TA, Henny CP, et al: Estrogen induced deficiency and decrease in antithrombin II1 activity in patients with prostatic cancer. J Ural 128:72. 1982
The authors reply:-An itching sensation in the region of the coronal incision postsurgically has not been mentioned by any of the patients operated on in our institution. Infiltration with a local anesthetic containing epinephtine, and the use of Raney neurosurgical clips, significantly reduces blood loss. Blood transfusion is not required when red cell counts are normal and there are no other severe injuries. Some patients in our series did require blood transfusions when red cell counts were low initially because of other injuries (abdominal, chest, extremities, etc).
FAILURE WITH THE VISIBLE LIGHT-CURED RESIN SYSTEM To the Editor:-Considering our past experience with hydroxyapatite granules, hydroxyapatite blocks, and the interpositional temporomandibular joint implant materials, I would hope that oral and maxillofacial surgeons would present only materials and methods that are clinically successful. Drs Scuba and McLaughlin, in their well-written technical note published in the December issue of the Journal, describe the use of the Triad system for splint fabrication. Our experience with five consecutive lingual splints fabricated for reduction and fixation of mandibular fractures using this method was less than satisfactory. Because of the brittleness of the material, three failed during splint application and two failed during the first week of fixation. With a 100% failure rate, we have discontinued the use of this system.
GEORGEC. SOTEREANOS, DMD Pittsburgh,Pennsylvania PROSTATE CANCER AND
DIC
To rhe Editor:-1 read with interest the case report of Catrambone and Pfeffer (J Oral Maxillofac Surg 48:858, 1990), which is a further example of the involvement of the hemostatic system in malignant growth and spread. Several points are worth further discussion. As the authors state, many patients with cancer are in a compensated state of chronic disseminated intravascular coagulation (DIG). Routine investigations as used
RICHARDH. HAUG, DDS JON P. BRADRICK,DDS
Cleveland,
Ohio
The authors reply:-TRIAD is not without its faults, but it has a place in our practice. No dental material is perfect. I have broken TRIAD, self-curing, and processed acrylic splints, and cast metal arch bars while trying to “make” them fit. We have found TRIAD more brittle than the self-curing acrylic used in splint fabrication. The “ivory” is too brittle for our needs, but the “pink reline material” has worked well. Because of this prop-
665
