destroying some old myths

1

Click here to load reader

Upload: john-g

Post on 25-Dec-2016

213 views

Category:

Documents


1 download

TRANSCRIPT

Page 1: Destroying some old myths

LETTERS TO THE EDITOR J Oral Maxillofac Surg

46:94,1988

IF THEY COULD SEE Us Now!

Over these past two and a half years James Hayward, Charles Alling, Barbara Moles (Staff), and I have been compiling a history of our specialty, and in the not too distant future a publication will be forthcoming. The Board of Trustees has been most supportive of the AAOMS Committee on History and for this we are grateful. We regard this as a unique opportunity to bring to our membership the story of the building of our spe- cialty.

Recently the membership received a beautifully de- signed brochure with a photograph of our new home. The Board of Trustees, Building Committee, and Staff de- serve praise from each member of our Association for their perserverance in seeing this project through to its completion.

This great event caused me to think back in time and recall a small office space in Louisville, Kentucky, from which all the Society’s business was conducted. It was about 1956 that Fred Henny was in close contact with Harold Hillenbrand, Executive Director of the ADA, re- garding a move to Chicago. A committee was formed consisting of President G. Thaddeus Gregory, Don Bel- linger, James Cameron, Leslie Fitzgerald, Frank Hower, L. W. Peterson, Frank O’Halloran, and Chairman Fred Henny.

In February 1959, we moved to Chicago and into the American Hospital Association Building on Lake Shore Drive. Several “old guard” members objected to this move claiming that it would be too costly and an exces- sive financial burden on the membership. Time has proved them to be wrong.

Time will also prove the purchase of our own building and the move to Rosemont to be a most beneficial event in our history, but I somehow wonder what the “old guard,” if they were with us now, might be saying.

DONALD H. DEVLIN Member, AAOMS Committee on History

AN ODE To THE TMJ SURGEON

Sir, Let me get to the point You have derangement of the joint

Not to worry, you’ll be OK I’m the expert in TMJ

Pain in your head, neck, and face To have this disease is no disgrace

Your disc may be forward or in the back Nothing that can’t be fixed with a surgical tack

Surgery is easy, quick, but not free Just sign over your car or house to me

If you get better and are pain-free Tell all your friends about me

If you are worse or still in pain Buy a ticket and move to Spain

Call me a charlatan or call me rank I don’t care. I’m Dr. Montebank!

DAVID M. PAGAR, DDS Stratford, Connecticut

DESTROYING SOME OLD MYTHS

Some old ideas die slowly. That this is true in our science-based profession among men trained in objective thinking, disappoints me. wo old and wrong ideas are the taping of wire cutters to the bed of patients in maxil- lomandibular fixation (MMF) and the prescribing of hot salt water rinses. Let’s consider each of these.

I don’t know whether it is myth or fact that World War I soldiers aspirated vomitus and died while being trans- ported across the English Channel because they had MMF and got seasick, but the story has a point. Keeping a vomiting patient on his back while attempting to cut MMF wires is a very sure way to achieve aspiration of vomitus and possibly bits of wire. This is especially so if the attempt is made by a nurse or other nondentist. If you picture the situation of a struggling patient, poor light, inadequate retraction, etc., you can see how such a ma- neuver can be stupid and dangerous. A better way is to order, “If emesis occurs, get head down below shoulders quickly.” Gravity can thus assist the passage of the mate- rial out between and around the teeth, and if necessary, through the nose. In 1945 I saw several quarts of beer exit quickly through these two ports on a sick, drunken sailor with MMF, and I’ve had many patients vomit with their teeth in fixation since then, all without aspiration. I cannot recall reading of an aspiration death from MMF.

The patient should be informed of what to do, and that anything that goes in is liquid and it can come out easily. This is knowledge and it is reassuring. Psychologically, a wire cutter taped overhead is disturbing and worrisome to the patient, and to the family. If at surgery there is some question of airway, or if the stomach contents are unknown, a “rip cord” wire can be placed to permit im- mediate release of elastic fixation.

It seems absurd to take space in a major journal to point out that salt in water is not therapeutic. However, new generations of professionals keep ordering “hot salt water rinses.” “ Hot” is good, but salt does nothing ex- cept irritate because of the excess used by most patients. It was obvious in the times prior to antibiotic therapy that hot soaks, washes, and gargles were beneficial in treating infections. Augmentation of the inflammatory reaction is still valid therapy . . . but salt? We needn’t be concerned with isotonic&y. The patient should be made to under- stand that it is the heat that helps and with such under- standing they may use it more frequently.

This is a plea to the teachers and the writers of texts. Don’t endanger life or damage patients psyches by teaching the taping of wire cutters to beds, and the or, dering of salt water when it’s only hot water that’s needed. And don’t continue to send forth young oral and maxillofacial surgeons who order these modalities. Let these ideas die.

JOHN G. WHINERY, DDS Amarillo, Texas

94