fortschritte der kiefer- und gesichts-chirurgie

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BOOK REVIEWS I99 consist of a device which will vibrate at approximately the frequency of the human voice and which is connected to the tracheostomy tube. From the vibrator a tube leads into the mouth where the vibrating column of air can be modified into speech. In some cases the frequency can be raised or lowered depending upon the force of expiration and a case is cited of a priest who uses such a device to preach each Sunday; not only can he preach with it? he can sing! The alternative approach IS to introduce only a vibrating tone into the oral cavity. Tiny loud speakers set into upper dentures, realistic looking tobacco pipes containing batteries and vibrators, and hand-held vibrators pressed against the outside of the pharynx have all been tried and the latter two are still in use. Intelligible speech can be achieved but it is flat and monotonous and the sound “H” which requires a flow of air cannot be obtained. This is a well written informative book in which the writer pays the reader the compliment (undeserved in the present case) of being fluent in French, German and Spanish and he quotes without translation from papers in these languages. It may be read in an hour or two and should be by all who have to care for the laryngectomised patient. T. GIBSON Fortschritte der Kiefer- und Gesichts-Chirurgie, Volumes 16 and 17. Primary and Secondary Treatment of Clefts of the Lip and Palate. Edited by K. SCHUCHARDT,G. STEINHARDT and N. SCHWENZER. Pp. 392 with 388 illustrations. (Stuttgart: Georg Thieme Verlag, 1973.) DM. 270. Volumes 16 and 17 of the Fortschritte are bound together and are the proceedings of the 1970 and 1971 congresses of the Deutsche Gesellschaft fiir Kiefer- und Gesichtschirurgie which were devoted to the primary (1970) and secondary (1971) repair and reconstruction of clefts of the lip and palate. The last Fortschritte which had as its main theme cleft lip and palate surgery was Volume I published in 1955 and much water has flowed under the arch since then. In Volume I Nordin and Johansson for example presented z cases in which they had used bone grafts to reconstruct secondary palatal deformities; this and the contemporary activity of Eduard Schmid sparked off the enthusiasm for primary palatal bone grafting which subsequently reached such a pitch that it became almost unethical to repair a cleft palate without a bone graft. In the current volume Stellmach sketches the history of primary bone grafting “from the idea to the reality after a decade” and tells how one after another of the initiators gave it up. This of course highlights the great difficulty of assessing any treatment of cleft lip and palate in much less than 20 years and is one reason why this volume is so valuable. As another example Herman Schweckendiek described in Volume I his technique of palate repair in which only the soft palate is closed in infancy, the hard palate being repaired at age 11-12. Now his son Wolfram is able to review 464 cases treated thus, 124 of which are 1-j or more years old. There are 108 authors who cover virtually every aspect of cleft lip and palate rehabilitation and it is impossible to comment individually. I must refer, however, to the continuing ingenuity of Eduard Schmid who describes the use of a tongue flap for the same purpose as an Abbe flap. He has also recon- structed a columella with a tongue flap wrapped around a piece of cartilage. In both instances of course the mucous covering of the tongue was later excised and replaced with a full thickness skin graft. This volume is almost as comprehensive as a textbook and contains a wealth of reasonably up to date information; it should be available to all who are concerned with care of the cleft child. It seems a pity however that the practice of having a short English summary of each chapter has been abandoned. T. GIBSON Symposium on the Treatment of Burns. Edited by J. B. LYNCH and STEPHENR. LEWIS. Pp. xii + 253 with 339 illustrations. (St Louis, The C.V. Mosby Company, 1973.) This book is Volume 5 in a series of symposia of the Educational Foundation of the American Society of Plastic and Reconstructive Surgeons. If fulfils the objective stated in the preface of providing a concise, current summary of the treatment of burns. All aspects are dealt with from the pathophysiology through the actual stages of early treatment to methods of reconstruction of post-burn deformities. The chapters concerned with fluid management and involvement of the respiratory tract are very useful and the chapter on renal considerations provides a good basis for understanding the problems of renal failure in burned patients. Infection is dealt with thoroughly, the varying regimes of topical applications, patient isolation and septicaemia are fully discussed. Due emphasis is given to allograft coverage of the burn, with mesh-autografting and skeletal suspension described. The present status of synthetic materials as dressings is also dealt with. The last quarter of the volume deals with the more common post-burn problems in a short and helpful way.

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Page 1: Fortschritte der kiefer- und gesichts-chirurgie

BOOK REVIEWS I99

consist of a device which will vibrate at approximately the frequency of the human voice and which is connected to the tracheostomy tube. From the vibrator a tube leads into the mouth where the vibrating column of air can be modified into speech. In some cases the frequency can be raised or lowered depending upon the force of expiration and a case is cited of a priest who uses such a device to preach each Sunday; not only can he preach with it? he can sing!

The alternative approach IS to introduce only a vibrating tone into the oral cavity. Tiny loud speakers set into upper dentures, realistic looking tobacco pipes containing batteries and vibrators, and hand-held vibrators pressed against the outside of the pharynx have all been tried and the latter two are still in use. Intelligible speech can be achieved but it is flat and monotonous and the sound “H” which requires a flow of air cannot be obtained.

This is a well written informative book in which the writer pays the reader the compliment (undeserved in the present case) of being fluent in French, German and Spanish and he quotes without translation from papers in these languages.

It may be read in an hour or two and should be by all who have to care for the laryngectomised patient.

T. GIBSON

Fortschritte der Kiefer- und Gesichts-Chirurgie, Volumes 16 and 17. Primary and Secondary Treatment of Clefts of the Lip and Palate. Edited by K. SCHUCHARDT, G. STEINHARDT and N. SCHWENZER. Pp. 392 with 388 illustrations. (Stuttgart: Georg Thieme Verlag, 1973.) DM. 270.

Volumes 16 and 17 of the Fortschritte are bound together and are the proceedings of the 1970 and 1971 congresses of the Deutsche Gesellschaft fiir Kiefer- und Gesichtschirurgie which were devoted to the primary (1970) and secondary (1971) repair and reconstruction of clefts of the lip and palate.

The last Fortschritte which had as its main theme cleft lip and palate surgery was Volume I published in 1955 and much water has flowed under the arch since then. In Volume I Nordin and Johansson for example presented z cases in which they had used bone grafts to reconstruct secondary palatal deformities; this and the contemporary activity of Eduard Schmid sparked off the enthusiasm for primary palatal bone grafting which subsequently reached such a pitch that it became almost unethical to repair a cleft palate without a bone graft. In the current volume Stellmach sketches the history of primary bone grafting “from the idea to the reality after a decade” and tells how one after another of the initiators gave it up.

This of course highlights the great difficulty of assessing any treatment of cleft lip and palate in much less than 20 years and is one reason why this volume is so valuable. As another example Herman Schweckendiek described in Volume I his technique of palate repair in which only the soft palate is closed in infancy, the hard palate being repaired at age 11-12. Now his son Wolfram is able to review 464 cases treated thus, 124 of which are 1-j or more years old.

There are 108 authors who cover virtually every aspect of cleft lip and palate rehabilitation and it is impossible to comment individually. I must refer, however, to the continuing ingenuity of Eduard Schmid who describes the use of a tongue flap for the same purpose as an Abbe flap. He has also recon- structed a columella with a tongue flap wrapped around a piece of cartilage. In both instances of course the mucous covering of the tongue was later excised and replaced with a full thickness skin graft.

This volume is almost as comprehensive as a textbook and contains a wealth of reasonably up to date information; it should be available to all who are concerned with care of the cleft child. It seems a pity however that the practice of having a short English summary of each chapter has been abandoned.

T. GIBSON

Symposium on the Treatment of Burns. Edited by J. B. LYNCH and STEPHEN R. LEWIS. Pp. xii + 253 with 339 illustrations. (St Louis, The C.V. Mosby Company, 1973.)

This book is Volume 5 in a series of symposia of the Educational Foundation of the American Society of Plastic and Reconstructive Surgeons.

If fulfils the objective stated in the preface of providing a concise, current summary of the treatment of burns. All aspects are dealt with from the pathophysiology through the actual stages of early treatment to methods of reconstruction of post-burn deformities.

The chapters concerned with fluid management and involvement of the respiratory tract are very useful and the chapter on renal considerations provides a good basis for understanding the problems of renal failure in burned patients.

Infection is dealt with thoroughly, the varying regimes of topical applications, patient isolation and septicaemia are fully discussed.

Due emphasis is given to allograft coverage of the burn, with mesh-autografting and skeletal suspension described. The present status of synthetic materials as dressings is also dealt with.

The last quarter of the volume deals with the more common post-burn problems in a short and helpful way.