CURRENT LITERATURE

Abstracts

Simultaneous Repositioning of the Maxilla, Mandible, andChin. Bell WH, Jacobs 10, Quejada 10. Am J Orthop89:28, 1986

This article establishes the necessity for combining softtissue analysis with cephalometric analysis for optimalcorrection of dentofacial deformities. With meticulousand systematic analysis of facial esthetics, cephalometricanalysis and occlusal studies, combined with biologicallybased surgery and systematic postoperative neuromus­cular rehabilitation, combined maxillary, mandibular, andchin surgery can be accomplished with great success.The authors explain that the final esthetic results dependon the soft tissue changes; therefore, a soft tissue ap­proach to cephalometric analysis must be used. Cephalo­grams in natural head position, with a plumb line to es­tablish true vertical, are taken with care to give good softtissue delineation. The analysis outlined in this paperbegins with the maxillary incisor exposed with the lips inrepose, the single most important measurement in theevaluation of vertical facial proportions. Treatment ob­jectives include 2 to 4 mm of the maxillary central in­cisors exposed at rest and a G-Sn to Sn-Me ratio of I: I.The interlabial gap should be I to 2 mm, and the ratio ofSn-Stms to Stmi-Me should be 1:2. Anteroposterior fa­cial proportions are determined by evaluation in relationto a vertical line through subnasali (SnV). The relativeprominence of the nose, lips, and chin is then assessed bymeans of this line. The position and inclination of the in­cisor are critical and may be the limiting factors in thesurgical treatment. Also mentioned was the use of post­operative physical therapy to improve the long-term sur­gical outcome. Six cases were shown in which these cri­teria were used to determine the surgical procedure.-M.BUCKLEY

Reprint requests to Dr. Bell: Universityof TexasHealth ScienceCenter at Dallas, 5323 Harry Hines Boulevard, Dallas, TX75235.

Avoiding Problems in Tracheotomy. Kirchner JA. Laryn­goscope 96:55, 1986

Several techniques for minimizing bleeding during tra­cheotomy are outlined. The techniques mentioned in­clude using ligatures rather than electrocautery to controlvenous bleeding and dividing and suture ligating the thy­roid isthmus in the midline. The latter technique is alsoadvocated because an intact thyroid may displace a can­nula during swallowing. It is recommended that removalof a button of tracheal cartilage be avoided in infants,because the practice could lead to tracheal stenosis. Theauthor states that layered closure of deep tissues may re­sult in extensive subcutaneous and mediastinal emphy­sema. Other problems that may arise during the postop­erative period are outlined, and their prevention is dis­cussed.-B. C. WRIGHT

Reprint requests to Dr. Kirchner: Department of Surgery, POBox 3333, 333 Cedar Street, New Haven, CT 06510.

Mandibular Involvement by Oral Squamous Cell Carci­noma. Gilbert S, Tzadik A, Leonard G. Laryngoscope96:96, 1986

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A retrospective study of 104 patients who had under­gone segmental mandibular resection for oral squamouscell carcinoma was undertaken to determine the inci­dence of mandibular bone involvement. Since tumors in­vading bone are unlikely to be cured by radiation therapyalone, definitive treatment requires detection of any man­dibular involvement. In 23 patients tumor invasion of themandible was revealed by histologic examination. Thisevidence of bone involvement was assessed with respectto the site of the lesion, stage of disease, grade of tumor,clinical impression of bone involvement, and presence orabsence of neck disease. Preoperative bone scans and ra­diographs were also compared with the histologicfindings. The data obtained demonstrate significant man­dibular involvement with alveolar tumors and lesions ad­jacent to the mandible. Patients who had radiologic orbone scan evidence of tumor erosion also had a high inci­dence of histologic bone involvement. Patients fulfillingthese criteria should undergo segmental mandibulectomyto ensure adequate tumor margins.-MoNROE HARRIS

Reprint requests to Dr.Tzadik: Department of Surgery,Divisionof Otolaryngology, University of Connecticut Health Center,Farmington, CT 06032.

A Histological and Ultrastructural Study of Wound Healingafter Vomer Resection in the Beagle Dog. Squier CA,Wada T, Ghoneim S, Kremenak CR. Arch Bioi 30:833,1985

Interference with the vomer and the vomer-premaxil­lary suture is not uncommon during surgical closure ofcleft lip and palate. Trauma to the vomer during cleftpalate surgery may impair anteroposterior growth of thepremaxilla and maxilla. In this study the vomer was re­sected via a palatal flap in four 42-day-old beagle pups;four unoperated dogs served as controls. One experi­mental and one control animal was perfused at two, four,eight, and 12 weeks after surgery, and specimens fromthe vomer-premaxillary suture and from the vomer atthe level of the mid-palate were processed for light andelectron microscopy. Measurements of maxillary modelsshowed retardation in anteroposterior growth and devel­opment and an anterior crossbite in all but one of the ex­perimental animals. The small number of animals pre­cluded statistical comparison between groups. The au­thors concluded that a mass of contractile granulationtissue attached to the premaxilla and extending into thevoid originally occupied by the vomer could well restrictanteroposterior growth of the maxilla and lead to cross­bite.-THOMAS A. ESCHENROEDER

Reprint requests to Dr. Squier: Dows Institute for Dental Re­search, College of Dentistry,The Universityof Iowa, IowaCity,IA 52242.

Midazolam as an Intravenous Induction Agent in the El­derly. Kanto J, Aaltonen L, Himberg 11, Hovi-VianderM. Anesth Analg 65: 15, 1986

The use of Midazolam as an induction agent was evalu­ated in two groups of elderly patients. Group I (1/ = 14;mean age, 73.4 years) received either 5 or 10 mg of oraldiazepam the evening prior to surgery and again two

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hours prior to surgery. Group II (II = 9; mean age, 72.3years) received oral diazepam (10 mg) the evening priorto surgery and intramuscular atropine (0.01 rug/kg) andmeperidine (I rug/kg) one hour prior to surgery. Patientswho had been treated with benzodiazepines prior to entryinto the study were excluded. Droperidol (0.03 mg/kg)and fentanyl (I mg/kg) were administered 2 minutes priorto induction of general anesthesia with Midazolarn (0.15mg/kg). Anesthesia was maintained with fentanyl and ni­trous oxide and oxygen (N20f02 , 60:40). Midazolamblood levels were evaluated by gas-liquid chromatog­raphy (GLC) and total benzodiazepine plus active metab­olite levels by radioreceptor assay (RRA). The time toinduction, the degree of postoperative sedation, and pa­tient recall were tabulated. The results showed smoothinduction with eye closure in 59.3 seconds in group I andin 45 seconds in group II. Three to 15 minutes followinginduction, significant hypotension occurred in five of thepatients in group I and in one patient in group II. Fiveminutes following discontinuation of anesthetics, sevenpatients in groups I and II were very sedated. Thirteenpatients in group I and four patients in group II did notremember waking from anesthesia. Eleven patients ingroup I and two patients in group II had no recollectionof the recovery room. Based on prior Midazolam phar­macokinetic studies in younger subjects, no importantpharmacokinetic differences were seen between youngerand elderly patients. The greater response of elderly pa­tients to Midazolam (0.15 rng/kg) can be explained bypharmacodynamic alterations with advancing age. Thehigher drug levels measured by RRA than by GLC reflectthe amount of active metabolites of Midazolam after in­travenous administration in elderly patients. The authorsspeculate that the hypotension observed may have beendue to histamine release or direct cardiac depression.Hypotension might be avoided by administering Mida­zolam in small increments. When an amnestic effect isnot desired, oral diazepam in the evening and intramus­cular atropine plus meperidine may be substituted fororal diazepam as a premedication.-S. J. McKENNA

Reprint requests to Dr. Kanto: Departmentof Anaesthesiology,Turku University Central Hospital, Kiinamyllynkatu 4·8, SF20520, Turku 52, Finland.

Reanimation of the Long-standing Partial Facial Paralysis.Rubin LR, Lee GW, Simpson RL. Plast Reconstruct Surg77:41, 1986

Correction of the hemiparalyzed face is a difficult sur­gical problem because of the risk of increased facial nervemorbidity in its attempted repair. The authors presenttheir methods for reanimation of the partially paralyticface. Evaluation of the deficiency and indications fortreatment are presented. Techniques that have providedpredictable results include shortening or plicating ex­isting muscles and the transposition of facial muscles tothe appropriate position when the existing musculature istoo atrophic to plicate. The importance of postoperativephysiotherapy for retraining the surgically correctedmuscles is stressed.- WILLIAM R. WHITLOW

Reprint requests to Dr. Rubin: I IO Willis Avenue, Mineola, NYII 501.

A Three-dimensional Developmental Measurement of theTemporomandibular Joint. Dumas AL, Moaddab 1\18,

CURRENT LITERATURE

Homayoun NH, McDonough J. J Craniomand Prac 4:23,1986 .

This article presents the findings of a study of the tem­poromandibular joints (TMJs) from the skulls of 1002- to20-year-old subjects. The objectives of the investigationwere to l) evaluate developmental changes of the TMJoccurring during growth, 2) establish three-dimensionalnormal values for the TMJ region, 3) determine whethergrowth changes in the individual components of the TMJare related, and 4) determine whether asymmetries nor­mally exist in the TMJ components. All skulls chosen forthe study exhibited Angle Class I occlusion. Measure­ments were made directly on the skulls with a Boleygauge. The study found that l) all of the dimensionalcomponents of the TMJ increased between the ages of 2and 20 years, especially in the mediolateral direction; 2)at the time of eruption of the second molars all of thecomponents of the TMJ had reached at least 85% of theiradult size; 3) the anteroposterior length of the articulareminence increased 24% between the ages of 2 and 20years; 4) considerable variation existed in the relation be­tween the size of the glenoid fossa and the size of thecondyle, and asymmetry was a common finding; and 5)growth changes of the condyle, fossa, and eminence weresimilar to the growth changes of the craniofacial com­plex. The authors mention that one obvious clinical im­plication of their findings is that the radiographic inter­pretation of joint space size is open to misinterpretationdue to the finding of normal variations in the sizes of theTMJ components.c-Jxnss R. Hurr

Reprint requests to Dr. Dumas: Georgetown University, Schoolof Dentistry, 4000 Reservoir Road, NW, Washington, DC 20007.

Primary Lymphoma of the Mandible. Robbins KT, FullerLM, Manning J, Goepfert H, Velasquez WS, SullivanMP, Finkelstein JB. Head Neck Surg 8: 192, 1986

The mandible is an uncommon site for lymphomas, andmisdiagnosis is common. This article reports the findingsin II patients with lymphomas of the mandible. Primaryosseous lymphomas account for only 5% of all extranodallymphomas, with the pelvic girdle being the most fre­quent presenting site. In the head, the maxilla is the mostcommon site. Previous series found lymphoma of extra­nodal sites to occur in younger patients, but in thepresent series the average age was 57 years. Pain, jaw orgingival swelling, and mental nerve hypesthesia were themost common symptoms of mandibular lymphoma. Bonerarefaction was the predominant radiographic feature.Other radiographic findings included bony sclerosis, de­struction of the lamina dura or roots of teeth, and patho­logic fracture. Diagnosis of lymphoma of the mandible isdifficult even by histologic evaluation of biopsy material.Therefore, larger amounts of biopsy material are neces­sary when lymphoma is suspected to allow for specialstains, immunologic studies, and electron microscopy.Treatment usually involves both chemotherapy and ra­diotherapy.-i-Jxnss R. Hurs

Reprint requests to Dr. Robbins: Departmentof Head and NeckSurgery, MD Anderson Hospital, Houston, TX 77030.

Clinical Evaluation of Ramus Frame and Staple Bone Im­plants. Meyer J, Kotwal K. J Prosthet Dent 55:87. 1986

CURRENT LITERATURE

Eleven patients receiving mandibular implants wereevaluated. Nine of the patients received ramus frame im­plants , and two received staple bone plate implants. Allimplants were placed by the same surgical team. Prosth­odontic residents fabricated both surgical and definitivedentures. In one patient who received a ramus frame im­plant permanent bilateral lip paresthesia developed.Three other patients who received this implant had par­esthesia that totally resolved. This was the most commoncomplication following placement of the ramus frame im­plant. Neither of the patients who received the staple im­plant experienced paresthesia. The longest observation

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time for any implant in this study was 30 months. None ofthe implants had required removal at -the time of thestudy. By the second postoperative visit all of the pa­tients stated that they would undergo the procedure againif it became necessary to maintain denture stability. Theauthors emphasized the importance of early prostho­dontic intervention to restore stability and function as acritical factor in patient acceptance and satisfaction withthe implants.-JAMEs B. MURPHY

Reprint requests to Dr. Meyer: 6913 Sharrnel, Columbus, GA3t90-t.

New Book Annotations

The Dental Implant: Clinical and Biological Response ofOral Tissues. McKinney RV Jr, Lemons JE (eds) with 12contributors. Littleton, Massachusetts PSG PublishingCo, 1985,205 pages, illustrated.

This book, the proceedings of a 1983 symposium spon­sored by the American Academy of Implant Prostho­dontics, explores the most controversial subject in im­plant dentistry-the interface between the implant andthe tissues of the jaws. The ten chapters attempt to pro­vide answers to questions about downgrowth of gingivaltissue , tissue attachment to the implant, the soft and hardtissue interface , and the reactions of metals to bodyfluids. Each chapter is well referenced and is followed bya transcription of the discussion by the participants.

Craniofacial Dysmorphology: Studies in Honor of SamuelPruzansky. Cohen MM Jr, Rollnick BR (eds) with 48 con­tributors . New York, Alan R. Liss , 1985,364 pages, illus­trated , $76.00.

A wide range of topics of interest to clinicians in thefield of craniofacial anomalies are discussed by variousexperts in the field. The more than 25 papers are dividedinto sections on orofacial c1efting, cephalometric studiesof craniofacial anomalies, experimental animal studies,and miscellaneous contributions. Topics examined in­clude dysmorphic growth and development, gene expres­sion during craniofacial development, and associatedfindings in craniofacial anomalies.

Atlas for Maxillofacial Pantomographic Interpretation.Chomenko AG. Chicago, Quintessence Publishing Co,1985, 296 pages, illustrated. '

The focus in this atlas is on the three diagnosticproblems that most commonly lead to radiographic mis­interpretation: distinguishing radiographic variationsfrom anatomic changes, correctly analyzing the radio­graphic appearance of lesions , and correlating thefindings on panoramic and conventional radiographs. The23 chapters are divided into five sections: principles ofpantomography, interpretation of standard and modifiedpantomographs, correlation of panoramic and conven­tional films, localization of structures, and correction oferrors in pan tomography. In addition to the discussion of

standard pantomographs, the interpretation of films ofthe TMJ and midfacial regions is also included.

Nutrition in Oral Health and Disease . Pollack RL, KravitzE (cds) with 31 contributors. Philadelphia, Lea & Fe­biger, 1985,483 pages , 61 illustrations, $32.00.

This book deals with the much neglected subject of therelation of nutrition to the status of the oral tissues. Thefive sections include 28 chapters by authorities in thefield and cover nutrition as it relates to the various stagesof life, functional oral biology, nutrition in pathologic oralconditions, applied nutrition, and general nutritional in­formation. Significant chapters discuss the application ofdiet to aging, oral medicine, cancer, drug action, andwound healing.

Minor Oral Surgery, third edition. Howe GL. Littleton,Mass achusetts, PSG Publishing Co, 1985, 428 pages, il­lustrated , paperback, $17.50 .

This text, designed for dental students and generaldental practitioners, discusses the essentials of oral sur­gery in a very clear and readable form. In this third edi­tion the author has added some new material to variouschapters and updated the suggestions for additionalreading.

Dental and Oral Tissues, second edition. Moss-SalentignL, Hendricks-Klyvert M. Philadelphia, Lea & Febiger,1985,323 pages, 187 illustrations, $24.50 .

The intent of this text is to provide an introduction toorofacial histology and embryology. The second editioncontains new information on the connective tissues, cal­cification, and degenerative changes in the tooth pulp.Whenever possible, emphasis is placed on the clinical rel­evance of the material presented.

Color Atlas of Periodontology. Rateitschak KH, Rateit­schak EM, Wolf HF, et aI. New York, Thieme-Stratton,1985, 320 pages, 824 illustrations (color), $98.00.

All of the recognized methods of periodontal therapy,from curettage and root planning to resective and recon­structive procedures, are illustrated in this cornprehen-

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sive, full-color atlas. There are also sections on basicprinciples of periodontology, diagnosis, adjunctive treat­ment, and prevention. Each treatment category is accom­panied by clear and concise text that makes the variousprocedures easy to understand and duplicate.

Introduction to Radiographic Cephalometry. Jacobson A,Caufield PW (eds) with 2 contributors. Philadelphia, Lea& Febiger, 1985, 137 pages, 136 illustrations, $45.00.

As indicated by the title, this is a concise introductionto the principles and techniques of taking and interpretingcephalometric headplates. There are detailed chapters onthe Downs, Steiner, Ricketts, and "Wits" analyses. Alsoincluded is a step-by-step description of how to identifyand trace landmarks, points, and planes with a set oftransparent templates and a lateral cephalometric head­plate, which are provided with the book.

Effects of Anesthesia. Covino BG, Foggard HA, RehderK, et al. Baltimore, Williams & Wilkins, 1985, 224 pages,illustrated.

This book highlights the relation between anesthesiaand neurologic and cardiopulmonary function. The firstsix chapters discuss the molecular and membrane basisof anesthesia; the second five chapters deal with the ef­fects of anesthesia on the respiratory system, and the lastfour are concerned with cardiac and circulatory effects.Each chapter is written by an authority in the field andincludes extensive references.

Tissue-Integrated Prostheses: Osseointegration in ClinicalDentistry. Bronemark PI, Zarb GA, Albrektsson, T (eds)with 17 contributors. Chicago, Quintessence PublishingCo, 1985, 350 pages, illustrated.

The tissue-integrated prosthesis described in this bookis based on an extensive background of basic and clinicalresearch. The 20 chapters discuss the fundamental con­cepts of osseointegration and then describe patient selec­tion, surgical technique, and prosthetic procedures andapplications. Both the prosthodontic and the surgicalprocedures, as well as the laboratory techniques are pre­sented in precise detail.

Orofacial Pains: Classification, Diagnosis, Management,third edition. Bell WE Chicago, Year Book Medical Pub­lishers, 1985,420 pages, illustrated.

This is the third edition of what is becoming a classicdiscussion of orofacial pain. In this edition the author has

CURRENT LITERATURE

added considerable new material and revised and up­dated much of the remaining information. The 18chapters range from a discussion of the basic pain mecha­nisms and neural pathways to the clinical aspects of painof muscular, vascular, temporomandibular joint, skeletal,and neurogenic origin. Emphasis is placed on diagnosisand effective management.

Normal and Abnormal Bone Growth: Basic and ClinicalResearch. Dixon AD, Sarnat BG (eds) with 95 contrib­utors. New York, Alan R. Liss, 1985, 524 pages, illus­trated.

This book, the proceedings of an international confer­ence, reviews and updates current knowledge aboutnormal and abnormal bone growth in prenatal and post­natal development from both the gross and histologicstandpoints. Each of the four sections features an intro­ductory chapter that outlines the context of the subjectand a summary that integrates the clinical and researchfindings. The interdisciplinary approach used in this bookaffords a variety of perspectives on the subject and de­fines new directions for research.

Exercises in Oral Radiographic Interpretation, second edi­tion. Langlais R, Kasle MJ. Philadelphia, W. B.Saunders, 1985,224 pages, 344 illustrations, $19.95.

This new edition continues to use the examinationformat to teach radiographic interpretation. However,the scope has been expanded and the material reorgan­ized. In addition to the use of periapical radiographs,questions are now provided relating to occlusal, pano­ramic, and extraoral films. A section consisting of reviewquestions for state and national board examinations hasalso been added.

Advances in Pain Research and Therapy, volume 9. FieldsHL, Dubner R, Cervero F (eds). New York, Raven Press,1985,951 pages, illustrated, $153.00.

This volume presents the papers from the FourthWorld Congress on Pain. The various reports are catego­rized under the headings of primary afferent nociception,central mechanisms of nociception, thalamocorticalmechanisms, assessment of pain in man, painful periph­eral nerve injuries, central nervous system mechanismsof analgesia, cancer pain, general pain management, non­opiate drugs, surgical approaches, local nerve block, andpsychologic and biologic aspects of chronic pain. In­cluded in the discussions is information of significance inthe clinical management of orofacial pain problems.