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LETTERS TO THE EDITOR
J Oral Maxillofac Surg
70:2492-2493, 2012tDRJ
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WHO IS AT FAULT?
To the Editor:—This letter to the editor is strictly based onmy opinion; there is no scientific research to back this up.It is based on my personal observation and communicationswith my colleagues, both in academics and in private prac-tice. Hopefully, this will cause some thought and consider-ation by you, my fellow oral-maxillofacial surgeons.
Our young residents coming out of training today are thebest-trained oral-maxillofacial surgeons that we have pro-duced so far. Although their residencies may seem long tothem, I think it is remarkable that they have enough time toacquire all the knowledge and surgical expertise that arerequired of them. Some have taken the term “super sur-geons” to describe these young women and men.
There within lies the problem as I see it. I believe that anumber or even the majority of these well-trained doctorsare not adequately applying the vast amount of expertisethat they have acquired. They tend to be satisfied with anoffice practice only, performing advanced alveolar surgeryand implant procedures. They are abandoning the veryfoundation that our profession was built on, that is, facialtrauma. We are the most qualified professionals to treatfacial trauma. Facial trauma has been the foundation of ourprofession. It helped legitimize our rightful place in thehospital and led to us expanding our surgical horizons,including orthognathic surgery, reconstructive surgery, andcosmetic surgery. I have heard some say that they paid backsociety while treating facial trauma patients in training. Thisis exactly opposite of the truth. Society trained these youngresidents, and now they should pay back society by render-ing the best facial trauma care possible. I know that traumais not a money-maker, and many have educational debts topay back, but removing oneself from the active staff oremergency department call at a hospital is not the answer.We must do what is right and best for our patients and ourspecialty.
Now who is at fault? Is it the American Association of Oraland Maxillofacial Surgeons, the American Board of Oral andMaxillofacial Surgery, the training centers, the private prac-titioners, governmental regulations, the present economicconditions, or the unknown, better known as universalhealth care? We know that the American Board of Oral andMaxillofacial Surgery has begun to address this issue, but itcannot do it alone. I personally dislike regulations, espe-cially governmental regulations. We cannot regulate tomake our young colleagues stay on hospital staffs and takeactive emergency department calls. There must be a betterway. Maybe it is time for our leaders to address thissituation. I believe the time has come for our leaders,associations, and private and academic oral-maxillofacial
surgeons to meet and come up with suggestions for aLetters to the Editor must be in reference to a specific article omust be submitted within 6 weeks of the article’s print publicatioit first appeared online. Letters must be submitted electronically vjoms. Letters are subject to editing and those exceeding 500 wophotograph may accompany the letter if it is essential to undermaterial or material published elsewhere. There is no guarantee tnot be provided. Submitting a Letter to the Editor constitutes tedition of the journal, in any form or medium.
2492
plan. I would also include oral-maxillofacial surgeonsfrom other countries.
So, are we at fault? Yes, we are all at fault to some degree.We have the talent to solve this problem before our foun-dation gives way and the building blocks of our specialtycome tumbling down upon us.
RONALD B. MARKS, DDSPast President, American Association of Oral and
Maxillofacial Surgeons 1992-1993
http://dx.doi.org/10.1016/j.joms.2012.07.047
PUTTING LITERATURE INTO CLINICAL PRACTICE
To the Editor:—The residency training program at LincolnMedical and Mental Health Center has a long-standing tra-dition of reviewing the current issue of the Journal of Oraland Maxillofacial Surgery monthly. Recently, an article byHsu et al1 entitled “Manual Reduction of Mandibular Frac-ures Before Internal Fixation Leads to Shorter Operativeuration and Equivalent Outcomes When Compared Witheduction With Intermaxillary Fixation,” published in the
uly 2012 edition, was reviewed.As a Level I Trauma Center in the South Bronx, New
ork, Lincoln Hospital provides the training program withver 200 operative trauma cases per year; approximately5% of these cases are mandible fractures. We are always
ooking for ways to decrease operative time, without sacri-cing surgical outcomes. After reviewing the article by Hsut al,1 we immediately applied the stringent inclusion/ex-
clusion criteria set forth in the article.An 18-year-old man with no significant medical history
was initially seen by his general dentist, complaining oftooth pain associated with the left mandibular third molar.A dental panoramic radiograph was taken and showed aminimally displaced left mandibular angle fracture. The pa-tient was referred to us for management. Clinical examina-tion showed stable and reproducible occlusion, with noinferior alveolar nerve paresthesia.
The proper inclusion/exclusion criteria were applied, asoutlined in the article.1 These include an isolated left angleracture, no involvement of the condyle, age greater than 16ears, no gross comminution, no concurrent facial frac-ures, and no history of previous facial fractures.
The patient was taken to the operating room for openeduction with manual reduction and internal fixation, asutlined in the article.1 A standard distal hockey-stick inci-
sion with an anterior buccal vestibular release was per-formed, and the fracture was exposed. Intraoperative eval-
uation showed that the associated tooth was not indicatedr editorial that has been published by the Journal. Lettersn or, for an online-only article, within 8 weeks of the dateia the Elsevier Editorial System at http://ees.elsevier.com/
rds may be shortened or not accepted due to length. Onestanding the subject. Letters should not duplicate similarhat any letter will be published. Prepublication proofs willhe author’s permission for its publication in any issue or
tusiassto
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al and
LETTERS TO THE EDITOR 2493
for immediate extraction. Centric occlusion was achievedwith only manual reduction, and maintained during fixationwith a Synthes (West Chester, PA) prebent Champy plate.The clinical and radiographic result of the procedureshowed stable, reproducible, pre-trauma occlusion (Fig 1).
By using the manual reduction technique, we were ableo reduce the operating time from our average of 72 min-tes to 21 minutes without any sacrifice of the desiredurgical outcome. We would, however, advocate additionalnclusion criteria: stable occlusion, favorable fracture, andnticipated satisfactory postoperative compliance with in-tructions. The knowledge of occlusion is what sets ourpecialty apart from others that treat mandibular trauma. Ifhe occlusion cannot be re-established through the methodsutlined in the article by Hsu et al,1 it is important that there
be no hesitation to use arch bars or another method ofintermaxillary fixation.
Obviously, there are a limited number of patients who fit
FIGURE 1. Pre- and post-reduction clinic
the inclusion criteria of this study; those who do, however,
may greatly benefit from this approach to treatment. It ishighly recommended that the technique described in thearticle by Hsu et al1 be used where indicated, and we lookorward to its continued use in the care of our patients.
BENJAMIN F. BUSH, DDSRAWLE F. PHILBERT, DDSMALCOLM B. ZOLA, DDS
New York, NY
Reference1. Hsu E, Crombie A, To P, et al: Manual reduction of mandibular
fractures before internal fixation leads to shorter operative durationand equivalent outcomes when compared with reduction withintermaxillary fixation. J Oral Maxillofac Surg 70:1622, 2012
radiologic views and occlusion attained.
http://dx.doi.org/10.1016/j.joms.2012.07.046