J Oral Maxillofac Surg 50:1142. 1992
I recently completed a 6-year term as an American Board of Oral and Maxillofacial Surgery examiner. What has struck me most about the recent candidates taking the examination for the Board has been their detailed knowledge of the more sophisticated procedures that we do, while at the same time demonstrating minimal knowledge regarding basic oral and maxillofacial surgery. This is verified by the glaring fact that the section of the Board with the highest failure rate for the past few years has been the section on basic oral surgery. I am in complete agreement with the call for no reduction in the requirements for anesthesia training in our residency programs. I believe strongly that these requirements should be increased so that the oral surgeon of the future will provide an even safer anesthetic than in our illustrious past.
MAINTAINING THE STANDARDS OF ANESTHESIA TRAINING To the Editor:-1 read with pride the editorial in the May 1992 issue of the Journal of Oral and MaxillofacialSurgery regarding the standards of anesthesia training. It was clear, concise, and to the point. Oral and maxillofacial surgery has made great strides over the past 20 years, but somehow during that time has lost its sense of heritage. The one modality that sets oral and maxillofacial surgeons apart from all other medical or dental specialists is the expert ability to deliver anesthesia in various forms in a safe, competent manner on an outpatient basis. To dilute this ability and privilege in any way does a great disservice to our specialty. In this day of increased competition between all overlapping specialties of both medicine and dentistry, it does not seem reasonable to surrender or diminish the one modality that sets us apart from everyone else. I believe that if we look for the force behind the recommendation for the revisions in the anesthesia requirements we will find that it is from program directors in various states or sections of the country where the state laws either limit or prohibit them from doing outpatient general anesthesia. These self-serving individuals are only concerned with the accreditation of their program and are not concerned with the overall quality of our specialty and care of our patients in an oral surgery office. I totally agree that the competence of a person educated only in administering deep sedation is suspect in management of serious general anesthesia problems on an outpatient basis.
ALBERTF. GIALLORENZI, DMD Scranton,Pennsylvania
AVOIDING MISDIAGNOSISOF TEMPOROMANDIBULARDISORDERS
To the Editor:-1 havejust finished reading the CPC in the May issue of the Journal of Oral and MaxillofacialSurgery. This tumor is indeed exceptionally rare in a structure such as the condyle. My own case of leiomyosarcoma, published in the Journal of Oral Surgery 28:698, 1970, is now 23 years postsurgery and my former patient is doing well. I saw him just a few weeks ago. It is extremely important that we educate our dental and medical brethren so that they understand that any disease is possible in the temporomandibular joint and that serious problems are not overlooked or misdiagnosed. In the last 12 months I have had three patients referred to me for “TMJ” who ultimately were shown to have metastatic breast cancer of the condyle, lymphoma of the superior pole of the parotid, and angina pectoris. TMJ indeed! MORTONH. GOLDBERG,DMD, MD Hartford,Connecticut J
1142
I recently completed a 6-year term as an American Board of Oral and Maxillofacial Surgery examiner. What has struck me most about the recent candidates taking the examination for the Board has been their detailed knowledge of the more sophisticated procedures that we do, while at the same time demonstrating minimal knowledge regarding basic oral and maxillofacial surgery. This is verified by the glaring fact that the section of the Board with the highest failure rate for the past few years has been the section on basic oral surgery. I am in complete agreement with the call for no reduction in the requirements for anesthesia training in our residency programs. I believe strongly that these requirements should be increased so that the oral surgeon of the future will provide an even safer anesthetic than in our illustrious past.
MAINTAINING THE STANDARDS OF ANESTHESIA TRAINING To the Editor:-1 read with pride the editorial in the May 1992 issue of the Journal of Oral and MaxillofacialSurgery regarding the standards of anesthesia training. It was clear, concise, and to the point. Oral and maxillofacial surgery has made great strides over the past 20 years, but somehow during that time has lost its sense of heritage. The one modality that sets oral and maxillofacial surgeons apart from all other medical or dental specialists is the expert ability to deliver anesthesia in various forms in a safe, competent manner on an outpatient basis. To dilute this ability and privilege in any way does a great disservice to our specialty. In this day of increased competition between all overlapping specialties of both medicine and dentistry, it does not seem reasonable to surrender or diminish the one modality that sets us apart from everyone else. I believe that if we look for the force behind the recommendation for the revisions in the anesthesia requirements we will find that it is from program directors in various states or sections of the country where the state laws either limit or prohibit them from doing outpatient general anesthesia. These self-serving individuals are only concerned with the accreditation of their program and are not concerned with the overall quality of our specialty and care of our patients in an oral surgery office. I totally agree that the competence of a person educated only in administering deep sedation is suspect in management of serious general anesthesia problems on an outpatient basis.
ALBERTF. GIALLORENZI, DMD Scranton,Pennsylvania
AVOIDING MISDIAGNOSISOF TEMPOROMANDIBULARDISORDERS
To the Editor:-1 havejust finished reading the CPC in the May issue of the Journal of Oral and MaxillofacialSurgery. This tumor is indeed exceptionally rare in a structure such as the condyle. My own case of leiomyosarcoma, published in the Journal of Oral Surgery 28:698, 1970, is now 23 years postsurgery and my former patient is doing well. I saw him just a few weeks ago. It is extremely important that we educate our dental and medical brethren so that they understand that any disease is possible in the temporomandibular joint and that serious problems are not overlooked or misdiagnosed. In the last 12 months I have had three patients referred to me for “TMJ” who ultimately were shown to have metastatic breast cancer of the condyle, lymphoma of the superior pole of the parotid, and angina pectoris. TMJ indeed! MORTONH. GOLDBERG,DMD, MD Hartford,Connecticut J
1142
