1032
LETTERS TO THE EDITOR
2. Oikarinen K, Altonen M, Kauppi H, et al: Treatment of mandibular fractures. J Craniomaxillofac Surg 17:24,
1989 3. Wagner WF, Neal DC, Alpert B: Morbidity associated
with extraoral open reduction of mandibular fractures. J Oral Surg 37:97, 1979 4. Ewers R, Htirle F: Experimental and clinical results of new advances in the treatment of facial trauma. Plast Reconstr Surg 75:25, 1985 5. Davidson TM, Bone RC. Nuham AM: Mandibular fracture complications. Arch Otolaryngol 102:627, 1976 6. Theriot BA, Van Sickels JE, Triplett RG. et al: Intraosseous wire fixation versus rigid osseous fixation of mandibular fractures. J Oral Maxillofac Surg 45:577, 1987 7. Dodson TB, Perrott DH, Kaban LB, et al: Fixation of mandibular fractures: A comparative analysis of rigid internal fixation and standard fixation techniques. J Oral Maxillofac Surg 48:362, 1990
TREATMENT OF RHINOPHYMA WITH THE CARBON DIOXIDE LASER To
MANUAL SEPARATION OF THE PTERYGOMAXILLARY SUTURE To the Editor:-1 read with interest the technique described in the article “Pterygomaxillary Separation Without the Use of an Osteotome” by Precious et al (J Oral Maxillofac Surg 49:98, 1991), as I (and I suspect many of my colleagues) have not used an osteotome prior to maxillary downfracture during Le Fort I osteotomy for years. However, I would advise against the use of Tessier spreading forceps for the application of downward pressure on the osteotomy cuts as it is too easy to comminute the fragile bone edges with the instrument. Once the horizontal cuts have been made, using a saw or drill as preferred, firm down-pressure with the thumbs on the premaxilla is all that is necessary to distract the pterygomaxillary suture line. The hingeddown maxilla may then be grasped with Rowe or Epker disimpaction forceps and gently eased away from the pterygoid plates one side at a time. A finger on the pterygoid hamulus will confirm that separation has been achieved at the correct position, as the hamulus should remain immobile. If any reader doesn’t believe how easy it is to downfracture the maxilla with the thumbs, he should try it during the next Le Fort I operation and then discard the pterygomaxillary osteotome in the “unwanted instrument” box! In addition to the advantages of the nonosteotome technique described by Dr Precious and his colleagues, I would add one other. I believe there is still a place for post tuberosity bone grafting when a large anterior maxillary shift is planned, particularly if a graft is being taken anyway for placement at other osteotomy sites. With this atraumatic approach, a bone block may be neatly wedged between the intact posterior wall of the antrum and an intact pterygoid plate. In contrast, a surgeon who has resorted to the osteotome to achieve posterior maxillary separation will find it is usually a waste of time dropping a chunk of bone into the wound he has created, as it will assuredly disappear into the soft tissues and achieve nothing. JOHN TOWNEND, MB, FDSRCS Chichester, West Sussex, England
SPARKINGFROM
Surg Med 8:397. 1988 4. Greenbaum SS, Krull EA. Watnich K: Comparison of CO, laser and electrosurgery in the treatment of rhinophyma. J Am Acad Dermatol 18:363, 1988 5. Hallock GG: Laser treatment of rhinophyma. Aesthet Plast Surg 12:171. 1988 6. Wheeland RG, Bailin PL, Ratz JL: Combined carbon dioxide laser excision and vaporization in the treatment of rhinophyma. J Dermatol Surg Oncol 13:172. 1987
CERAMIC BRACKETS
To the Editor:-In a recent orthodontic debandingl debonding procedure, the use of an 1156 carbide bur at high speed produced a “shower of sparks” when inadvertently touched against the residual portion of a ceramic bracket on an adjacent tooth. Normally, any portion of the ceramic bracket that will not come off with the usual special instrumentation is taken off with diamond burs at high speed with copious water irrigation. Therefore this phenomenon had not been noticed before. It would be advisable for practitioners using steel or carbide instruments on a patient with ceramic brackets to be careful to avoid this contact. The consequences for patient/staff may be serious if occurring in the vicinity of flammable anesthetics/gases and should reinforce
LETTERS
TO THE EDITOR
tI-t
1033
he use of copious water to dampen any accidental act. and safety glasses for all concerned.
con-
LARRY K. AAGESEN,DDS, MS Rochester, MI
RECOGNIZING THOSE WHO ALSO CONTRIBUTE To the Editor:-As
I read the most recent JOMS News md Announcement section, it occurred to me how our specialty would benefit by an enhanced sense of fellowship through recognition of all the years of support each ind every member has made to our organization through their dues and participation. The names of those honored in the Journal become ramiliar to us and deserve the recognition accorded them. However, many others have quietly served a lifetime and provided the necessary resources that have :nabled others to excel. Those resources, ie, dues, subscriptions, and attendance fees, have allowed our organization to perform as it has on a national level. With the pressures rising on the health care system and our speciality. it could be a good time to increase our fellowship and possible overall participation, involvement, and strength. Perhaps as a society, in addition to a national listing of each of our members, we could list the year of their initial membership in our organization. For those who have served over 25 years. perhaps we could list their names in the Journal and later send by mail a certificate of recognition suitable for framing. For those serving over 35 years. a plaque or similar instrument could be presented. Finally, for those serving over 50 years, recognition could be given in a ceremony at the annual session of our society. DARRYLJ. PIROK,DDS. MS
Urbanna.
Virginia
KNOW THY ROOTS To the Editor:-During this period of rapid change in our profession, I think it is incumbent on us. the oral and maxillofacial surgeons of America. to remember our past as we look towards the future of our profession. In the educational arena, my concern has always been that the residents receive the best surgical training, and that they have available to them the educational opportunities to pursue whatever additional degrees they desire. 3f further concern to me is that expanded scope and privileges remain degree-blind. and that these are based strictly on competence and training. I believe all of this ;an be achieved and the integrity of our profession protected. However, one aspect of the current scene I find difficult to understand is why our colleagues agree to be placed on educational programs of other specialty organizations that are in direct competition with oral and maxillofacial surgery. They agree to teach these doctors
how to perform oral and maxillofacial surgeries, eg, temporomandibular joint surgery, orthognathic surgery, and rigid fixation techniques. These courses are given under the guise of continuing education. Why would anybody want to give a short course to other practitioners. We are potentially compromising patient care and perhaps our reputation and integrity. I also find it hard to understand our members lecturing to groups that allow only double-degree members into their society. What I fear most is that the dual degree issue has a propensity for producing a two-tier system. I, for one, will do everything to fight this. Those who possess the dual degree must remember that they are dentist-oral and maxillofacial surgeons who happen to have an additional degree, ie. the medical degree, and they are not physician-oral and maxillofacial surgeons who happen to have a dental degree. In the majority of the cases, it was the single-degree oral and maxillofacial surgeons who fought the “wars” so that our colleagues could obtain their medical training. Without a doubt. it is the dental background and training that makes this specialty uniquely qualified to render the traditional outstanding care to those afflicted with functional and esthetic problems of the oral cavity and facial skeleton. 1 ask all of you to take some time and reflect upon your roots and heritage. We have much to be thankful for. because our roots are well grounded in dentistry, where they should always belong. RONALDB. MARKS,DDS
Alexandria,
Louisiana
OPHTHALMIC COMPLICATIONS OF ORTHOGNATHIC SURGERY To th Editor:-1 am currently in the process of preparing an article on ophthalmic complications following orthognathic surgery. I would appreciate hearing from any surgeon who has experienced such a complication tie, blindness, decrease in visual acuity, ophthalmoplegia, lacrimal injury. and so on) who would be willing to share the details of his case with me. All replies will be kept strictly confidential. DENNIST. LANIGAN. DMD, MC
Saskatoon,
Canada
OMS LEADERSHIP To thr Editor:--In the July issue, the News and Announcement section contained a story about oral and maxillofacial surgeons who are deans of dental schools. Unfortunately, one was omitted-Dr James H. McLeran of the University of Iowa College of Dentistry. Jim has been dean since 1974, making him the person with the longest tenure. DONALDS. DANA, DDS
Fremont,
California
LETTERS TO THE EDITOR
2. Oikarinen K, Altonen M, Kauppi H, et al: Treatment of mandibular fractures. J Craniomaxillofac Surg 17:24,
1989 3. Wagner WF, Neal DC, Alpert B: Morbidity associated
with extraoral open reduction of mandibular fractures. J Oral Surg 37:97, 1979 4. Ewers R, Htirle F: Experimental and clinical results of new advances in the treatment of facial trauma. Plast Reconstr Surg 75:25, 1985 5. Davidson TM, Bone RC. Nuham AM: Mandibular fracture complications. Arch Otolaryngol 102:627, 1976 6. Theriot BA, Van Sickels JE, Triplett RG. et al: Intraosseous wire fixation versus rigid osseous fixation of mandibular fractures. J Oral Maxillofac Surg 45:577, 1987 7. Dodson TB, Perrott DH, Kaban LB, et al: Fixation of mandibular fractures: A comparative analysis of rigid internal fixation and standard fixation techniques. J Oral Maxillofac Surg 48:362, 1990
TREATMENT OF RHINOPHYMA WITH THE CARBON DIOXIDE LASER To
MANUAL SEPARATION OF THE PTERYGOMAXILLARY SUTURE To the Editor:-1 read with interest the technique described in the article “Pterygomaxillary Separation Without the Use of an Osteotome” by Precious et al (J Oral Maxillofac Surg 49:98, 1991), as I (and I suspect many of my colleagues) have not used an osteotome prior to maxillary downfracture during Le Fort I osteotomy for years. However, I would advise against the use of Tessier spreading forceps for the application of downward pressure on the osteotomy cuts as it is too easy to comminute the fragile bone edges with the instrument. Once the horizontal cuts have been made, using a saw or drill as preferred, firm down-pressure with the thumbs on the premaxilla is all that is necessary to distract the pterygomaxillary suture line. The hingeddown maxilla may then be grasped with Rowe or Epker disimpaction forceps and gently eased away from the pterygoid plates one side at a time. A finger on the pterygoid hamulus will confirm that separation has been achieved at the correct position, as the hamulus should remain immobile. If any reader doesn’t believe how easy it is to downfracture the maxilla with the thumbs, he should try it during the next Le Fort I operation and then discard the pterygomaxillary osteotome in the “unwanted instrument” box! In addition to the advantages of the nonosteotome technique described by Dr Precious and his colleagues, I would add one other. I believe there is still a place for post tuberosity bone grafting when a large anterior maxillary shift is planned, particularly if a graft is being taken anyway for placement at other osteotomy sites. With this atraumatic approach, a bone block may be neatly wedged between the intact posterior wall of the antrum and an intact pterygoid plate. In contrast, a surgeon who has resorted to the osteotome to achieve posterior maxillary separation will find it is usually a waste of time dropping a chunk of bone into the wound he has created, as it will assuredly disappear into the soft tissues and achieve nothing. JOHN TOWNEND, MB, FDSRCS Chichester, West Sussex, England
SPARKINGFROM
Surg Med 8:397. 1988 4. Greenbaum SS, Krull EA. Watnich K: Comparison of CO, laser and electrosurgery in the treatment of rhinophyma. J Am Acad Dermatol 18:363, 1988 5. Hallock GG: Laser treatment of rhinophyma. Aesthet Plast Surg 12:171. 1988 6. Wheeland RG, Bailin PL, Ratz JL: Combined carbon dioxide laser excision and vaporization in the treatment of rhinophyma. J Dermatol Surg Oncol 13:172. 1987
CERAMIC BRACKETS
To the Editor:-In a recent orthodontic debandingl debonding procedure, the use of an 1156 carbide bur at high speed produced a “shower of sparks” when inadvertently touched against the residual portion of a ceramic bracket on an adjacent tooth. Normally, any portion of the ceramic bracket that will not come off with the usual special instrumentation is taken off with diamond burs at high speed with copious water irrigation. Therefore this phenomenon had not been noticed before. It would be advisable for practitioners using steel or carbide instruments on a patient with ceramic brackets to be careful to avoid this contact. The consequences for patient/staff may be serious if occurring in the vicinity of flammable anesthetics/gases and should reinforce
LETTERS
TO THE EDITOR
tI-t
1033
he use of copious water to dampen any accidental act. and safety glasses for all concerned.
con-
LARRY K. AAGESEN,DDS, MS Rochester, MI
RECOGNIZING THOSE WHO ALSO CONTRIBUTE To the Editor:-As
I read the most recent JOMS News md Announcement section, it occurred to me how our specialty would benefit by an enhanced sense of fellowship through recognition of all the years of support each ind every member has made to our organization through their dues and participation. The names of those honored in the Journal become ramiliar to us and deserve the recognition accorded them. However, many others have quietly served a lifetime and provided the necessary resources that have :nabled others to excel. Those resources, ie, dues, subscriptions, and attendance fees, have allowed our organization to perform as it has on a national level. With the pressures rising on the health care system and our speciality. it could be a good time to increase our fellowship and possible overall participation, involvement, and strength. Perhaps as a society, in addition to a national listing of each of our members, we could list the year of their initial membership in our organization. For those who have served over 25 years. perhaps we could list their names in the Journal and later send by mail a certificate of recognition suitable for framing. For those serving over 35 years. a plaque or similar instrument could be presented. Finally, for those serving over 50 years, recognition could be given in a ceremony at the annual session of our society. DARRYLJ. PIROK,DDS. MS
Urbanna.
Virginia
KNOW THY ROOTS To the Editor:-During this period of rapid change in our profession, I think it is incumbent on us. the oral and maxillofacial surgeons of America. to remember our past as we look towards the future of our profession. In the educational arena, my concern has always been that the residents receive the best surgical training, and that they have available to them the educational opportunities to pursue whatever additional degrees they desire. 3f further concern to me is that expanded scope and privileges remain degree-blind. and that these are based strictly on competence and training. I believe all of this ;an be achieved and the integrity of our profession protected. However, one aspect of the current scene I find difficult to understand is why our colleagues agree to be placed on educational programs of other specialty organizations that are in direct competition with oral and maxillofacial surgery. They agree to teach these doctors
how to perform oral and maxillofacial surgeries, eg, temporomandibular joint surgery, orthognathic surgery, and rigid fixation techniques. These courses are given under the guise of continuing education. Why would anybody want to give a short course to other practitioners. We are potentially compromising patient care and perhaps our reputation and integrity. I also find it hard to understand our members lecturing to groups that allow only double-degree members into their society. What I fear most is that the dual degree issue has a propensity for producing a two-tier system. I, for one, will do everything to fight this. Those who possess the dual degree must remember that they are dentist-oral and maxillofacial surgeons who happen to have an additional degree, ie. the medical degree, and they are not physician-oral and maxillofacial surgeons who happen to have a dental degree. In the majority of the cases, it was the single-degree oral and maxillofacial surgeons who fought the “wars” so that our colleagues could obtain their medical training. Without a doubt. it is the dental background and training that makes this specialty uniquely qualified to render the traditional outstanding care to those afflicted with functional and esthetic problems of the oral cavity and facial skeleton. 1 ask all of you to take some time and reflect upon your roots and heritage. We have much to be thankful for. because our roots are well grounded in dentistry, where they should always belong. RONALDB. MARKS,DDS
Alexandria,
Louisiana
OPHTHALMIC COMPLICATIONS OF ORTHOGNATHIC SURGERY To th Editor:-1 am currently in the process of preparing an article on ophthalmic complications following orthognathic surgery. I would appreciate hearing from any surgeon who has experienced such a complication tie, blindness, decrease in visual acuity, ophthalmoplegia, lacrimal injury. and so on) who would be willing to share the details of his case with me. All replies will be kept strictly confidential. DENNIST. LANIGAN. DMD, MC
Saskatoon,
Canada
OMS LEADERSHIP To thr Editor:--In the July issue, the News and Announcement section contained a story about oral and maxillofacial surgeons who are deans of dental schools. Unfortunately, one was omitted-Dr James H. McLeran of the University of Iowa College of Dentistry. Jim has been dean since 1974, making him the person with the longest tenure. DONALDS. DANA, DDS
Fremont,
California
