LETTERS TO THE EDITOR
this AAOMS committee and other professional societies cannot recommend its use in clinical practice.
TOMAS FELIPE DONOSO, DDS STEFAN DOMANCIC, DDS JUAN ARGANDON~A, DDS, MFS Santiago, Chile
DR. SALVATORE L. RUGGIERO, DMD, MD Lake Success, NY
PAROTID SIALOCELE OR TRAUMATIC PSEUDOCYST To the Editor:—‘‘It was deja vu all over again.’’1 This was one of the thoughts that came into my mind as I read the recent article by Donoso et al.2 The treatment of a traumatically induced parotid sialocele has a long history in the surgical data. In their discussion, Donoso et al2 referenced previous studies on this subject dating back to 1963. However, in their literature search, they missed the report by Meyer and Gordon,3 which reported on the exact same operation that they performed on their patients. Perhaps our use of the terminology ‘‘traumatic pseudocyst of parotid duct,’’ rather than ‘‘parotid sialocele,’’ eluded discovery in their literature review. All of which serves to remind us, as surgeons, that ‘‘there is nothing [or, at the least, very little in the surgical field] that is new under the sun.’’4 As each new generation of surgeons enters the practice of our honored profession, it stands on the shoulders (or accomplishments) of its predecessors, hopefully to raise the bar of surgical expertise ever higher.5 For those of us who came before, it always feels good to know we were remembered or acknowledged.
CORONECTOMY OF THE MANDIBULAR THIRD MOLAR: A RETROSPECTIVE STUDY OF 185 PROCEDURES AND THE DECISION TO REPEAT THE CORONECTOMY IN CASES OF FAILURE (J ORAL MAXILLOFAC SURG 73:587, 2015) To the Editor:—I read with interest the report by Frenkel et al1 entitled ‘‘Coronectomy of the mandibular third molar: A retrospective study of 185 procedures and the decision to repeat the coronectomy in cases of failure’’ published in a recent issue of the Journal. This report should encourage all surgeons to adopt this technique to avoid any damage to the inferior alveolar nerve, which could result in neuropathic pain. One of my patients developed allodynia of the inferior alveolar nerve at day 7 after a stretch injury of the nerve during an attempt to remove a deeply impacted mandibular third molar. No spontaneous improvement occurred over time, and she was referred for nerve exploration and neurolysis. However, it did not result in any improvement of sensory function or reduction of allodynia.
ROGER A. MEYER, DDS, MS, MD Greensboro, GA
References 1. Berra L, in Brewer’s Famous Quotations. London: Weidenfeld & Nicolson; 2006, p 264. 2. Donoso T, Domancic S, Argandona J: Delayed treatment of parotid sialocele: A functional approach and review. J Oral Maxillofacial Surg 73:284, 2015 3. Meyer RA, Gordon RC: Method for repair of traumatic pseudocyst of the parotid duct: Report of case. J Oral Surg 27:281, 1969 4. Ecclesiastics 1:9, in The Holy Bible (New International Version). East Brunswick, NJ: New York International Bible Society, 1978, p 755. 5. Meredith AW: Looking to the future on the shoulders of giants. J Am Coll Surg 214:385, 2012
REPLY To the Editor:—We would like to clarify that it was never our intent to describe the surgical technique described in our article as ‘ novel.’ This is further emphasized by its title: ‘ .a functional approach.’’ rather than ‘ .a new/novel approach..’’ Our intention was to recall attention to this technique and highlight the reasons that make it the first-line treatment in our opinion. We agree with Ecclesiastes and Dr Meyer: ‘ There is nothing [or, at least, very little in the surgical field] that is new under the sun.’’
FIGURE 1. Photograph showing detailed view of the root surface after staining with methylene blue and rinsing with saline. No apparent staining of periodontal ligament was apparent. Clinically, ankylosis of the remaining root was found. Letters to the Editor. J Oral Maxillofac Surg 2015.
LETTERS TO THE EDITOR Because of the debilitating nature of neuropathic pain that can result after any nerve injury, all possible techniques available should be adopted to avoid this injury. After reviewing the published coronectomy data, this technique was adopted, with some modifications, as described in subsequent paragraphs. One of the key points for success for coronectomy is the completeness of removal of dental enamel.2 Methylene blue is commonly used to stain the periodontal ligament and thereby determine the completeness of the resection of the root in microsurgical endodontic treatment.3 This technique was used in 15 cases in which coronectomy of a mandibular third molar was performed by applying methylene blue on the dried root surface after removal of the crown and part of the root, as described by Gleeson et al.2 The procedure was performed under magnification using a dental microscope. If no staining occurred of the periodontal ligament (Fig 1), ankylosis of the root to the remaining bone will be very probable, and no further attempt should be made to remove the remaining parts of the root. Another property of methylene blue is the staining of nerves. In all cases, the remaining pulpal tissues were visualized after applying methylene blue. An additional advantage of this staining technique could be that any exposure of the inferior alveolar or lingual nerve will become apparent and,
thus, any additional nerve damage will be avoided. This needs additional investigation. The improved visualization of the operating field under the microscope allows precise evaluation of the mobility of the root, another key point in the success of the coronectomy procedure.2 BERNARD BONTE, MD, DDS, PHD Oostende, Belgium
References 1. Frenkel B, Givol N, Shoshani Y: Coronectomy of the mandibular third molar: A retrospective study of 185 procedures and the decision to repeat the coronectomy in cases of failure. J Oral Maxillofac Surg 73:587, 2015 2. Gleeson C, Patel V, Kwok J, et al: Coronectomy practice. Paper 1. Technique and trouble shooting. Br J Oral Maxillofac Surg 50:739, 2013 3. Kim S: Color Atlas of Microsurgery in Endodontics. Philadelphia, WB Saunders, 2001