Trends in temporomandibular joint surgery.

We examined a large population of patients undergoing temporomandibular joint (TMJ) surgery and provide a documentation of the average patient population, frequency of procedures, frequency of repeat procedures, and trends in open (arthrotomy) versus closed (arthroscopy) TMJ surgery. Data on 194 TMJ surgical procedures was extracted from line item claims information collected by Trigon Blue Cross/Blue Shield of Virginia. The frequency of arthroscopy increased during the study, while the incidence of arthrotomies remained relatively low. Approximately half of the hospitals statewide did not perform either procedure. There was a low frequency (3%) of repeat procedures. In the Commonwealth of Virginia, since the advent of TMJ arthroscopy, it has become the preferred surgical technique for treatment of internal derangement. There is a low incidence of repeat procedures for both types of treatment. Analysis of insurance carrier computer records is a valid technique for evaluating trends in surgical care.

A retrospective analysis of 6,387 cholecystectomies.

This is the largest retrospective analysis of biliary tract surgery ever reported involving 6,378 patients operated on during a three year period, 1990-1992. During this time interval, the frequency of laparoscopic procedures has increased dramatically. The use of laparoscopic procedures was associated with a significant decrease in the total length of hospital stay and total charges as compared to the open procedures. Because of laparoscopic surgery's increased acceptance, we propose that the frequency of laparoscopic surgery of the biliary tract should be used as a quality control measure.

The evolution of functional endoscopic sinus surgery in the Commonwealth of Virginia.

This is the largest retrospective analysis of sinus surgery ever reported involving 5,860 surgical as well as 6,769 diagnostic sinus procedures during a six year period, 1988-1993. During this time interval, the frequency of endoscopic procedures has increased dramatically. Because of the increased frequency of this procedure, we see the need for strict definition of the clinical indications for surgery for patients with chronic or acute sinusitis. In addition, the number of open procedures, namely the Caldwell-Luc procedure, as a treatment for sinusitis remained relatively constant despite the frequent use of endoscopic technique. Because of the endoscopic surgery's increased acceptance and advantages over the open surgical technique, we emphasize the need for continuing educational programs to train surgeons to perform the endoscopic procedure or referral of the patient to an otolaryngologist experienced in this technique.

Prosthetic valve endocarditis developing after an infected scalp laceration.

This case report describes a 21-year-old man who developed prosthetic valve endocarditis (PVE) from an infected scalp laceration. Despite intravenous antibiotic therapy, the infectious process could not be controlled and the patient required replacement of the aortic valve. Our patient is the fourth case of late PVE occurring after a subcutaneous infection. In each case, antibiotic prophylaxis of infective endocarditis was not practiced. Current antibiotic regimens for prophylaxis of PVE are reviewed.