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• It is important for the trauma surgeon to understand the basic principles of terminal gunshot ballistics and the study of the projectile's effect on striking soft tissue. The amount of kinetic energy dissipated to the tissue is directly related to the mass and velocity of the projectile as follows: K = MV 2 /2. Doubling the velocity quadruples the energy, while doubling the mass only doubles the energy. A temporary tissue cavity is produced as the striking projectile compresses the surrounding tissue; the higher the energy release, the more extensive the inapparent compressive damage. The permanent cavity that remains is the result of extrusion of tissue from the pathway of the projectile. The higher the velocity, the higher the likelihood of extensive damage. If the missle expands or fragments within the tissues, more damage will occur. ( Arch Otolaryngol 1983;109:313-318)

• The lacrimal drainage system is both an anatomic and a physiologic system. Anatomic abnormalities may be a result of congenital defects, infection, trauma, or tumors. The physiologic action of the eyelids, if altered, will affect the tear flow as well as disturb the lacrimal pump. Physiologic and anatomic abnormalities may be defined using the Schirmer, basic secretion, Jones I and II dye, and fluorescein dye disappearance tests. Once the correct diagnosis has been made, the appropriate surgical procedures restore the system's integrity. Punctal abnormalities and eyelid malpositions require surgical correction. Canalicular lacerations should be primarily repaired. Lacrimal sac obstruction is treated with a dacryocystorhinostomy and canalicular intubation. Placement of a Jones tube is required for obstruction of the upper collecting system. (Arch Otolaryngol1984;110:211-220)

• Before performing a blepharoplasty, the surgeon must completely evaluate the patient to ascertain the proper diagnosis and indication for surgery and to identify any potentially complicating factors. The anatomy and physiology of the eyelids and lacrimal system must be understood in detail. A complete ophthalmologic examination should be performed to document preoperative decreased visual acuity or limited visual fields. The prevention of complications and the satisfaction of the patient are the goals of the blepharoplasty procedure. These require accurate assessment, proper preoperative diagnosis, and meticulous surgical technique. (Arch Otolaryngol1985;111:394-397)

A number of innovative and helpful new instruments were presented by their developers or by those who have used them in clinical trials. By and large, these new instruments fell primarily into three general groups: otologic, computer/electronic, and general otolaryngologic. Stephen Levinson, MD, Fairfield, Conn, presented his experience with a new T-grommet design T-tube (Xomed), which has been fitted with a semipermeable membrane (Castelli). He is using these tubes for the treatment of chronic middle ear problems in both children and adults and reports a low incidence of complications as well as high water-resistant capabilities. New middle ear ossicular replacement design systems were presented by William Moretz, MD, and his colleagues at the Shea Otologic Clinic, Memphis, and by Moshe Ziv, MD, Columbus, Ohio. The Shea Clinic instruments are made of porous ultrahigh molecular weight polyethylene (Polycel). This implant material is fashioned into a "peg" whose length can be trimmed

Osseointegration is defined by Dr P. I. Branemark as "a direct structural and functional connection between ordered living bone in the surface of a load-carrying implant." Through the research efforts of Dr Branemark and his colleagues in Sweden, 1−3 these principles of osseointegration have been applied to clinical settings and are now being utilized widely in the United States. The primary utilization, at the present time, involves the permucosal implantation of titanium fixtures intraorally that will become osseointegrated with time, following which they are able to support the loads and stresses of fixed dentures. This application is aiding thousands of individuals with atrophic mandibles or after mandibular reconstruction who, in the past, were unable to be satisfactorily orally rehabilitated. Over the past two years, investigative centers in San Antonio, Tex, San Francisco, Minneapolis, and New York have been utilizing Food and Drug Administration (FDA)-approved clinical trials to demonstrate the efficacy

In the recent past, there has been a deep concern about the apparent movement of residents in otolaryngology—head and neck surgery toward general plastic surgery residencies, allegedly for them to feel more confident and competent in obtaining hospital privileges for performing facial plastic and reconstructive surgery. The leaders in our field have vocalized their concern both publicly and nationally, causing us to explore the reasons for such a trend. See also p 69. However, we recently have seen that trend changing. Fewer residents in otolaryngology—head and neck surgery are contemplating dual-specialty training, and more are seeking opportunities in facial plastic and reconstructive surgery within our own specialty. There are a number of reasons for the new interest in such training programs. First, most residency training programs in otolaryngology—head and neck surgery are now actively involved in teaching basic principles of facial plastic and reconstructive surgery. During five years of training

The editors are both Canadian plastic surgeons and have included many internationally renowned plastic surgeons as their contributing authors. However, they still accounted for the authorship of 13 of the 29 chapters, so the work greatly reflects their experience and concepts. This textbook is a large work with 720 pages of text, liberally including patient photographs, illustrations, and procedural techniques. The first section provides a general introduction to aesthetic plastic surgery, including a historical review of the subject as well as a chapter on the design and management of the aesthetic surgeon's office and surgery suite. The chapter on drugs for outpatient surgery is short, but concise and practical. A very important chapter on photography is included. The entire second section is devoted to a discussion of septorhinoplasty. It is well illustrated and quite easy to follow. One interesting chart shows the operative sequences in rhinoplasty comparing the steps according

In reviewing this book I have kept in mind the needs and training of the otolaryngologist who would be buying and reading this textbook. It should be understood by members of our field that a new subspecialty of dermatology entitled "dermatologic surgery" is receiving great attention and respect in the medical and surgical fields. It must be accepted that these specialists are performing more and more cosmetic surgery in the office and because of this the authors have answered a demand by their subspecialty for further basic and clinical information in the area of dermatologic cosmetic surgery. From an otolaryngologist's point of view, this book is valuable with respect to both the histopathology and the procedures involved in skin surgery for these entities. Initially, the benign facial lesions amenable to cosmetic surgery are identified clinically and histologically, followed by the appropriate skin surgery for these lesions. A complete chapter is