LETTERS TO THE EDITOR

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					 LETTERS TO THE EDITOR
                                                                                                                           J Oral Maxillofac Surg
                                                                                                                           62:391-392, 2004



  EXPANDING SCOPE, MAINTAINING STANDARDS                                    genic” myxoma of the lateral nose that extended to the
  OF CARE                                                                   medial canthus of the eye. The epicenter of this mass was
                                                                            located approximately midway between the apex of the
To the Editor:—Your editorial, “The Language and Meaning of                 canine and the medial canthus. On axial computerized
Scope” (J Oral Maxillofac Surg 61:743-744, 2003), has a great               tomographs, the mass eroded the pyriform aperture and
interest for me and is something I am faced with on an almost               anterior maxillary cortex, but its epicenter was predom-
daily basis now that I am a retired OMS and involved with the               inantly extraosseous. In short, the tumor appeared to be
practice of law; dental malpractice exclusively.                            extragnathic (although it abutted the alveolus); a connec-
   I believe “scope” must be defined as a synonym for “formal                tive tissue tumor arising outside the jaw cannot be con-
training and experience.” In 1968, having just returned from a              vincingly classified as odontogenic. Because of its loca-
year with professor Obwegeser, I was witness to the change in               tion, this myxoma is probably more closely related to
the “scope and awareness” of the practice of oral maxillofacial             sinonasal myxoma than odontogenic myxoma.1-4 Infantile
surgery. Orthognathic surgery instantly became a primary abil-              lateral nasal myxoma has a peculiar presentation: it typ-
ity of the modern OMS who had the background and training                   ically arises in a patient 1 or 2 years of age as a largely
to offer this unique service that no other specialist could                 extraosseous swelling at the junction of the cheek and
perform. Our “scope” was changed because of Obwegeser.                      nose; it appears to be an entity distinct from odontogenic
   The problem I currently see is the expanding “scope and                  myxoma.1-4
practice” that involves procedures that are still not part of
most training programs and are not universally promoted as an                                                         LEE J. SLATER, DDS, MS
OMS’ primary ability: botulinum toxin injections, cosmetic age                                                                 San Diego, CA
procedures, and transcoronal brow lifts.
   My observations unfortunately relate to failures, some I believe
based on inexperience, lack of formal training, and financial                References
enhancement unrelated to our purpose “to help” our patients. I              1. Heffner DK: Sinonasal myxomas and fibromyxomas in children.
recognize that “scope and awareness” changes and I do not hold                 Ear Nose Throat J 72:365, 1993
the old limited “DDS” attitude to be true, but to expand the scope          2. Ang HK, Ramani P, Michaels L: Myxoma of the maxillary antrum
means formal training, hard work, and supervised experience and                in children. Histopathol 23:361, 1993
active promotion by the profession.                                         3. Wachter BG, Steinberg MJ, Darrow DH, et al: Odontogenic
   Are we evolving our “scope” in the correct direction by                     myxoma of the maxilla: A report of two pediatric cases. Int J Ped
developing the same reliable excellence that we now demon-                     Otorhinolaryngol 67:389, 2003
strate in using safe ambulatory general anesthesia procedures               4. Fu Y-S, Perzin KH: Non-epithelial tumors of the nasal cavity,
that address jaw deformity, facial trauma, bony reconstruction,                paranasal sinuses and nasopharynx: A clinico-pathologic study.
                                                                               VII. Myxomas. Cancer 39:195, 1977
and exodontia?
   Only when designated teachers can train, demonstrate, and
promote the very best in patient care can cosmetic procedures
reach the highest level of skill. “Scope” already has been                  doi:10.1016/j.joms.2003.11.002
expanded for many specially trained and motivated surgeons,
but the profession as a whole must work hard to gain the                      BISPHOSPHONATES AND BONE NECROSIS
excellence that already exists for the “old scope.”                         To the Editor:—I am writing this letter in clarification and
                                          STANLEY W. LANE, DDS              expansion of our article published in the September edition
                                            Fort Lauderdale, FL             of the Journal (J Oral Maxillofac Surg 61:1104-1107, 2003).
                                                                            This article involves 3 patients who had developed bone
                                                                            necrosis in the maxillofacial region after cancer chemother-
                                                                            apy. In each case, part of the chemotherapy consisted of a
doi:10.1016/j.joms.2003.11.001                                              bisphosphonate, but in our discussion we tended to dismiss
                                                                            the concept that bisphosphonates could be the cause of this
  INFANTILE LATERAL NASAL MYXOMA: IS IT                                     necrosis since it had not been previously reported and did
  ODONTOGENIC?                                                              not seem to correspond with the metabolic action of
                                                                            bisphosphonates. However, since this article was published
To the Editor:—Fenton and associates (J Oral Maxillofac                     it has now become apparent that this phenomenon may
Surg 61:734-736, 2003) recently reported an “odonto-                        well be associated with bisphosphonates and Dr Salvatore



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