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ICURRENT LITERATURE IJ Oral Maxillofac Surg51:99-102.1993


Responses of Neural Elements in Experimentally InducedCarcinoma of the Hamster Tongue: An ImmunohistochemicalStudy Using Antibodies to Neurofilament Protein (NFP) andGlia-Specific S-100 Protein. Izumi K, Maeda T. Jpn J OralMaxillofac Surg 38:896, 1992

Innervation of carcinomas induced by application of9,10­dimethyl-I,2-benzanthracene (DMBA) was investigated inthe hamster tongue by using immunohistochemistry fordemonstration of neurofilament protein (NFP) and glia-spe­cific S·100 protein. The tumors were well-differentiatedsquamous cell carcinomas showing cordlike invasion of theunderlying fibrous tissue and muscle layer. The characteristicfeature of the innervation was the extreme scarcity of NFPand S-100 protein-irnmunopositive neural elements seen inthe stroma and around blood vessels of the carcinomas. Thefew NFP-positive neural elements that were observed in thecarcinoma invading zone were very fine and did not bearany relation to blood vesselsor tumor nests. Unlike calcitoningene-related peptide-positive nerves, which were intenselypositive in arterioles in the surrounding muscle layer, a densedistribution of S-100 protein-positive neural elements wasnot seen around .the abundant arterioles in the carcinoma­invading zone. The results suggest a high pain threshold andthe absence of an autoregulatory mechanism in the bloodvessels of the carcinoma tissue.-T. NAKAJIMA

Reprint requests to Dr Izumi: First Department of Oral and Maxil­lofacial Surgery, School of Dentistry, Niigata University, 2-5274,Gakkocho, Niigata City95I, Japan.

Antibiotic Prophylaxis in Head and Neck Cancer Surgery.Saginur R, Odell TF, Poliquin JF. J Otolaryngol 17:2, 1988

Postoperative infection rates of 20% to 80% have been re­ported in various series of major head and neck surgery pa­tients undergoing therapeutic cancer surgery. The role in theseinfections of facultative and aerobic gram-negative bacilli isuncertain. Even though these are common isolates in infec­tions in this group of patients, arninoglycoside prophylaxis,in addition to prophylaxis directed against anaerobes andgram-positive organisms, has resulted in an insignificantchange in infection rates. There have been a number ofstudieson the effect of prophylactic antibiotics in head and neckcancer surgery patients and, after review of these, there issome concern whether these antibiotics are therapeutic orprophylactic. There is no generally accepted practice of pro­phylaxis in patients undergoing cancer surgery of the upperaerodigestive tract . It has been well documented that pro­phylaxis is generally effective. A review of the literature re­vealed that single dose prophylaxis was of no effect whengiven more than 3 hours after bacterial inoculation subcu­taneously into rats, but was of maximum effect when ad­ministered immediately before the bacterial challenge. Thesestudies in rats were substantiated by studies in humans byStone, in which he showed ccfazolin given both preoperativelyand postoperatively was more effective than the same agentgiven postoperatively only. Other than this critical periop­erative period ofeffective antibiotic levels, several other prin­ciples apply to antibiotic prophylaxis in surgery. Tissue levels


of antibiotics should be maintained throughout the operation.Antimicrobial spectrum ofthe agent used should include mostall of the expected pathogens (the agent may not be the agentofchoice for therapy ofinfections at that given site.) It shouldbe nontoxic and inexpensive. It should be given sufficientlyclose in time to the surgery to preclude the development ofresistant flora preoperatively. The duration of prophylaxisshould be minimized for reasons of acquired resistance, ex­pense, and toxicity. The authors evaluated cefamandole inhead and neck cancer surgery patients in which the mucousmembrane of the aerodigestive tract was violated. The studywas placebo-controlled, double-blinded, and randomized.The initial dose of prophylaxis was given on call from theward to the operating room. The initial dose was 2 g, followedby I g 4 hours later, and I g 8 hours after the initial dose.Patients were evaluated for evidence of wound infection orrespiratory infection. Wounds were graded on a scale of0 to3, with the 0 being normal healing and 3 being purulentdischarge or dehiscence. A wound infection for the purposeof this study was defined as a wound with purulent drainage.Patients were followed for a minimum of 4 weeks postop- .eratively. The study was planned to include 40 patients; butthe study was stopped at 20 patients for ethical reasons be­cause of significant differences between the two groups.Wound infection developed in 27% of the antibiotic groupand 55% of the placebo group. Microbiology revealed a mixedflora. The duration of use of prophylactic antimicrobials hasover the years diminished progressively from prolonged (Iweek or more) to relatively brief. Previous studies have givenprophylactic antibiotics in major head and neck surgery fora duration as brief as 24 hours. In this study, 8 hours oftherapy was effective.There was twice the incidence of woundinfections in the control group, but the small number pre­cluded statistical significance. The study was stopped becauseof excessive morbidity in the placebo group.-E.L. MOSBY

Reprint requests to Dr Saginur: Department of Medicine, OttawaCivic Hospital, 1053CarlingAve,Ottawa, Ontario, Canada KIY4E9.

Cholesterol Granuloma of the Maxillary Antrum. GatlandDJ, Young RP, Jeffrey 11M. J Otolaryngol 17:131, 1988

"Cholesterol granula" is a histologic term, not a clinicaldiagnosis. It is not related in any way to cholesteatoma. It isa foreign body reaction to the presence ofcholesterol crystalsand shows no abnormal growth of epithelium. It is a lesionwhich is well recognized in the middle ear, mastoid area,testes, fallopian tube and arterial atheroma, and followinghemorrhage into thyroid'adenomas, Their behavior has beencharacterized as ranging from benign to destructive. Theredoes not appear to be any cause that has been demonstratedand they do not respond to conservative therapy. There doesnot appear to be any correlation between the duration oftheir symptoms and their benign or destructive behavior, assome patients have been asymptomatic while the majorityhave had symptoms that have ranged from 6 months to 6years. The symptoms occurring appear to be nonspecific,being predominantly nasal obstruction. The histologic ap­pearance does not vary with the tissue in which it occurs.Review of the literature suggests that a closed space with

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poor ventilation or drainage is the prime factor in their de­velopment. It is felt that a chronic effusion of hemorrhagethen leads to cholesterol precipitation. The traditional viewis that the cholesterol crystals are derived from the hemor­rhage. Some feel that slow lymph drainage might also besignificant. The case report on this patient showed that thelesion occurred in a 70-year-old white male with a 6-weekhistory ofprogressive painless swelling ofhis right cheek, hischief complaint being that his denture no longer fit. Therewere no other symptoms and clinical examination, except aspertained to the area of the lesion, was within normal limits.There was a non tender spongy swelling of the right cheekand a cystic 5 X 3-cm swelling replacing the upper alveolusand hard palate on the right side. A plain film radiographshowed a large soft tissue mass occupying the right maxillaryantrum with thinning and ballooning out of the superior andlateral walls with destruction of the hard palate. These filmswere consistent with carcinoma. Tomograms were orderedthat showed that the bony margins of the antrum appearedto be intact. The patient was taken to surgery where aspirationproduced 60 mL of brown fluid and a biopsy of the soft tissueshowed typical features ofa cholesterol granuloma with nu­merous cholesterol clefts surrounded by foreign body-typegiant cells embedded in granulation tissue. The antrum wasfound to be filled with pallapoidal material and there wasinspissated mucus present on the inferior and medial walls.The wallswere found to bedeficient inferiorly and posteriorly.Contents of the antrum were completely stripped and anintranasal antrostomy created. Histologic examinationshowed similar features to that of the frozen biopsy and con­firmed that the lesion had eroded bone. There was no reportedhistory of trauma as a source for the hemorrhage.-E.L.MOSBY

Request reprints to MrGatland: ENT Department, St Bartholomew'sHospital, W Smithfield, London Eel England.

New Book AnnotationsDrugs, Diseases, and the Periodontium. Seymour RA, Heas­man PA, Macgregor IDM. New York, NY, Oxford UniversityPress, 1992, 206 pages, illustrated, $89.00

This book discusses in detail how the periodontal tissuescan be affected by specific disease states and various otherfactors such as drug therapy, aging, smoking, diet, and sexhormones. There are also chapters on the beneficial effectsof antiplaque and anticalculus agents, antimicrobials and anti­inflammatory drugs. While aimed mainly at the periodontistand general dental practitioner, there is still considerable in­formation provided that is ofgeneral interest to the oral andmaxillofacial surgeon.

Complications and Problems in Aesthetic Plastic Surgery.Peck GC (ed), with 15 contributors. New York, NY, GowerMedical Publishing, 1992, 300 pages, 750 illustrations,$149.50

As implied by the title, this book focuses on the compli­cations that may beassociated with various forms of aestheticsurgery. Of the II chapters, at least 7 arc of interest to theoral and maxillofacial surgeon. These include chapters onrhinoplasty (2), face lift, forehead lift, blepharoplasty, chinand malar augmentation, and chemical face peel. By dis­cussing complications and their solution, the authors hopeto enable the reader to avoid similar situations from occurring.

Atlas of Replantation and Transplantation of Teeth. An­dreasen JO (ed), with 4 contributors. Philadelphia, PA,Saunders. 1992, 304 pages, 1106 illustrations. $1 10.00


The treatment procedures described in this classic bookhave been tested clinically over a 20-year period, and arcbased on extensive experimental investigation. Thoroughlydescribed and beautifully illustrated are chapters on surgicalanatomy and wound healing; replantation of avulsed teeth;intentional replantation; autotransplantation of molars, pre­molars, canines, and incisors; cryopreservation of teeth; au­totransplantation and orthodontic treatment planning; andrestoration of transplanted teeth. Each chapter concludes witha comprehensive list of references.

Perloperative Care of the Oral and Maxillofacial SurgeryPatient. Davis LF, Ruskin JD (eds), with 19 contributors.Oral and Maxillofacial Clinics of North America, vol 4, no3, 1992, 733 pages, illustrated

This volume brings together a comprehensive group ofarticles covering the gamut ofpreoperative considerations inthe surgical patient. Included are discussions of cardiovas­cular, pulmonary, hepatic, renal, endocrine and hernotogicevaluation, as well as special considerations in the irnrnu­nocompromised and pregnant patient. Also discussed arepreoperative pain control, the various aspects of preanestheticevaluation, and fluid, electrolyte, and nutritional status.

Tissue Expansion. Magalon G, Aubert J-P, Bardot J, PaulheP (eds), with 7 contributors. Marseille, France, ImprimerieLarny, 1991, 255 pages, illustrated

This book provides detailed information on an evolvingprocedure that willcontinue to find increased use. It discussesequipment, incisions, histology, microbiology, techniques,indications, complications, and results. The extensive sectionon the uses in the head and neck region is supplemented withnumerous, well illustrated case reports.

Advanced Osseointegration Surgery: Applications in theMaxillofacial Region. Worthington P, Branemark poI (eds),with 39 contributors. Chicago, IL, Quintessence PublishingCo, 1992, 404 pages, 668 illustrations (363 color), $140.00

This extensive text is designed for the surgeon already ex­perienced in routine implant surgery. It addresses such prob­lems as severe bony atrophy, use of bone grafting, manage­ment of the partially edentulous patient, and treatment ofthe patient who has undergone ablative surgery. Many new,advanced, and even experimental techniques are described.Also included are chapters on psychological aspects, cost­benefit considerations, maintenance and monitoring, medi­colegal aspects, and management of soft and hard tissueproblems.

Craniofacial Anomalies: An Interdisciplinary Approach.Brodsky L, Holt L, Ritter-Schmidt DH (eds), with 28 con­tributors. St Louis, MO, Mosby Year Book, 1992,254 pages,illustrated, $59.00

This book is the result of a conference on the interdisci­plinary approach to the assessment and treatment ofcleft lipand palate and other craniofacial disorders. It provides basicinformation about the various conditions, as well as aboutthe specific contributions of those disciplines participatingon the craniofacial team. Emphasis is placed on the inter­action of the various team members and their overlappingroles in provided coordinated care.

Head and Face Pain Syndromes. Cailliet R, Philadelphia,PA, EA. Davis, 1992,229 pages, 130 illustrations, $18.25,paperback -

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FoJlowing a chapter on the anatomy, physiology, andpathophysiology of head and face pain, the author discussesmigraine and migraine variants, cluster headache, commonheadache, the various facial neuralgias, cervical spine pain,myofascial pain syndromes, posttraumatic headache, andtemporomandibular joint pain. There arc also discussions ofthe management of head and face pain, psychological testing,and clinical aspects of depression in patients with chronicpain. Emphasis is placed on the diagnosis and rational man­agement of the various pain problems.

Rigid Fixation of the Craniomaxillofacial Skeleton. Yarem­chuk MJ, Gruss JS, Manson PN (eds) with 56 contributors.Boston, MA, Butterworth-Heinemann, 1992,696 pages, il­lustrated, $225.00

Written by surgeons from various disciplines, this bookbeginsby discussingthe biologicand biomechanical principlesunderlying the use of the different systems used for internalrigid fixation. It then provides an atlas of surgical proceduresand diagnostic and clinical guidelines for their applicationin various craniofacial sites. Because this is still an evolvingtechnology, the different areas of controversy are exploredand the authors express their individual opinions and pref­erences, based on their experiences.

Dentistry, Dental Practice, and the Community (ed 4). BurtBA, Eklund SA. Philadelphia PA, Saunders, 1992,352 pages,66 illustrations, $33.00 paperback

This new edition has been thoroughly revised since it waslast published in 1983. However, its purpose is still to discussdentistry and dental practice in relations to economic, tech­nologic, and demographic trends. It begins with discussionsof the social role of the dental profession, followedby chapterson methods of oral epidemiology, the distribution of oraldiseases, disease prevention, and the delivery of dental care.There are also discussions on financing dental care and dentalpersonnel.

The Branemark System of Oral Reconstruction-A ColorAtlas. Rasmussen RA. St Louis, MO, Ishiyaku EuroAmerica,1992,305 pages, 784 color illustrations, $175.00

This color atlas begins with a chapter on the history andevolution of oral implantology. It then takes the readerthrough the various steps in the use of the Branemark systemfor oral reconstruction starting with diagnosis and treatmentplanning and continuing with surgical protocol, stage I and2 surgery, and restorative management. The book concludeswith a chapter on maintenance of the implants and the pros­thesis.

Advances in Periodontics. Wilson TG Jr, Kornman KS,Newman MG (eds), with 29 contributors. Chicago, IL, Quin­tessence, 1992,383 pages, illustrated

The chapters in this text are divided into four sections:examination, diagnosis, and treatment planning: therapy forperiodontal disease; adjunctive therapy; and implant den­tistry. Most chapters have a review of current concepts fol­lowed by the clinician's synthesis of the material and how itapplies to the treatment of patients. Each chapter concludeswith a summary of the material presented for quick review.

Principles of Oral and Maxillofacial Surgery (vol 1-3). Pe­terson LG (cd), with 89 contributors. Philadelphia, PA, Lip­pincott, 1992, 2,256 pages, illustrated, $375.00

This three volume text fills the need for a current, com­prehensive reference source for the oral and maxillofacial


surgeon. It presents treatment modalities and surgical tech­niques for all of the conditions currently within the scope ofthe specialty. Each chapter discussesthe underlying principleson which the diagnosis, treatment planning, and surgery arebased. Although the traditional forms of management arepresented, new and innovative methods and techniques arcalso emphasized.

Tissue Integration in Oral, Orthopedic and MaxillofacialReconstruction. Laney WR, Tolman DE (cds), with 125con­tributors. Chicago, IL, Quintessence, 1992, 394 pages, illus­trated, paperback

The material presented in this monograph represents theproceedings of the Second International Congress on Oral,Orthopedic and MaxiJlofacial Reconstruction held in 1990.It contains over 50 short papers and abstracts on such topicsas the physical and chemical aspects of implant materials,the implant-tissue interface, cell biology and biomechanics,load transfer, orthopedic fixation, tissue preparation, patientselection, and long-term clinical results. Summaries of 16.poster presentations and four consensus panels, as well ascomments made during discussion periods, are also included.

Clinical Outline of Oral Pathology: Diagnosis and Treatment(ed 3). Eversole LR. Philadelphia, PA, Lea & Febiger, 1992,469 pages, illustrated'

This third edition maintains the general format ofpreviouseditions. Each chapter discussesthe diseasesaccording to theirpresenting signs and symptoms and describes the various fac­tors used to differentiate them from other conditions withsimilar signs and symptoms. It also provides a brief com­mentary on the treatment of each disease. Preceding eachchapter are clinical taxonomic tables followed by diagramsthat elucidate the pathogenic basis for the collective clinicalsigns characterizing the various diagnostic groups.

Otolaryngology-s-Head and Neck Surgery. Meyerhoff WL,Rice DH (eds), with 83 contributors. Philadelphia, PA,Saunders, 1992, 1,168 pages, 565 illustrations, $160.00

This book covers the broad surgical aspects of otolaryn­gology. The seven sections are divided into general consid­erations; the ear; the nose, paranasal sinusesand nasopharynx;the oral cavity, oropharynx, hypopharynx and salivary glands;the neck and larynx, disorders of the soft tissues and skeleton;and related topics, including aJlergy, laser surgery, cancerchemotherapy, sleep apnea, and Mohs micrographic surgery.The author(s) of each section comprehensively review thevarious aspects of diagnosis, treatment, and follow-up care.Each modality discussedis the approach favored by the authoras the best solution to the problem.

Illustrated Atlas of Cutaneous Surgery. Fewkes JL, CheneyML, PoJlack SY. Philadelphia, PA, Lippincott, 1992, 373pages, illustrated in color

This book provides a stepwise, procedural approach for avariety of surgical techniques ranging from scar revision tocomplex esthetic surgery. Each of the 34 chapters contains aconcise narrative that defines the principles of the techniqueand the rational for therapy, followedby a detailed descriptionof the procedure accompanied by color illustrations. Com­plications and alternative therapies are cited when indicated.Each chapter concludes with suggestions for readings for ad­ditional information.

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Alias of Orbital Surgery, Leone CR Jr, Gra ve AS Jr, LloydWC III, Wojno TH. Philadelphia PA, Saunders, 1992, 187pages, 270 illustrations, $70.00

This book focuses on providing step-by-step instructions,accompanied by illustrations, for the management of com­monly performed orbital surgical procedures. Section I coversbasic surgical anatomy and preoperative considerations, sec­tion 2 covers surgical approaches to the orbit, section 3 isdevoted to management of Graves' dysthyroid orbitopathy,section 4 reviews orbital trauma, and section 5 addresses thesurgical management of a variety of special orbital diseases.Each procedure is described in specific detail. Postoperativecare and complications are described when indicated.

Introduction to Orthognathic Surgery-s-A Color Atlas. Rey­neke JP, Evans WG, McCollum AGH. St Louis, MO, Ishi­yaku EuroAmerica, 1991, 125 pages, 266 color illustrations,$75.00

This atlas is designed for use in discussing orthognathicsurgery with the patient. The general principles of treatmentare presented, followed by illustrations of the techniques usedfor correction ofproblems related to discrepancies in the an­teroposterior, vertical, and transverse planes, and in themanagement of facial asymmetry. The atlas concludes withsections on prosthodontic considerations and orthognath icconsiderations in the cleft lip and palate patient.

Exercises in Oral Radiographic Interpretation (ed 3). LanglaisBA, Kasle MJ. Philadelphia, PA, Saunders , 1992,269 pages,403 illustrations, $35.00, paperback

The style of presenting a variety of radiographs involvingnormal structures, exposure and processing errors, identifi-


cation offoreign bodies, developmental and acquired defectsof the teeth, and lesions ofthe jaws, accompanied by specificquestions, and followed by the answers in the back of thebook, is still maintained in this new edition. In addition tothe inclusion of many new radiographs , a section consistingof multiple choice questions similar to those found on stateand national dental board examinations has been provided.

Atlas of Oral and Maxillofacial Surgery. Keith DA (ed), with22 contributors. Philadelphia, PA, Saunders, 1992,328 pages,424 illustrations, $125.00

This book has been designed for oral and maxillofacialsurgeons in training and in practice who wish to review spe­cific techniques and improve their knowledge and skills. Theemphasis is on procedures most practitioners perform, andincludes treatment of fractures, cryosurgery, salivary glandsurgery, microneurosurgery, orthognathic surgery, surgery ofthe maxillary sinus, TMJ surgery, tumor surgery, and man­dibular reconstruction, among others. Numerous photo­graphs and line drawings complement the text material.

Modern Practice in Orthognathic and ReconstructiveSurgery,vols 1,2. Bell WH (ed), with 122 contributors. Philadelphia,PA, Saunders , 1992, 1803 pages, 1,824 illustrations, $300.00

This encyclopedic treatise is destined to become a classicin the field. Volume I providesdetailed discussions of variousaspects of treatment planning, facial esthetic surgery, andmanagement of temporomandibular dysfunction. Volume 2discusses reconstructive surgery, implantology, aspects ofcraniofacial surgery, and patient rehabilitation. The 49 chap­ters are written by experts from the United States and Europeand the material in each is presented in great detail and ac­companied by numerous illustrations. An extensive bibli­ography also accompanies each chapter.

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