illa and nasal orbital region, cerebral spinal fluid rhinorrhea, and laryngeal and tracheal trauma. The book is extremely simple but amazingly complete. It is essentially a series of well-done black and white figures demonstrating the major considerations and steps in the management of facial trauma and airway trauma. The book is well written and contains literally hun- dreds of illustrations.

My first impression when I began reading this book was that it was an over-simplified picture book, but as I read it I became increasingly impressed with its com- pleteness and the importance of the material selected. The book is an ideal atlas for head and neck surgical residents but would also be of interest to medical stu- dents. The book is perhaps a little too simple for the surgeon experienced in facial trauma, but for those sur- geons who only occasionally treat facial trauma, this book is an excellent review and would be a superb addi- tion to one’s personal library.

TERENCE M. DAVIDSON, MD San Diego, California

RECONSTRUCTIVE SURGERY OF THE TRACHEA* Edited by Rodolphe Meyer, 148 pp, illus, Georg Thieme Verlag, Stuttgart, 1982. Stenosis is by far the most frequent and most important complication of all of the afflictions that can alter the trachea. The fact that it can present itself in acute or chronic form, be derivative of a variety of congenital neoplastic, inflammatory, traumatic and iatrogenic etiologies in a highly specialized organ system that ac- commodates and supports breathing and speech estab- lishes high priority for a book on this subject. Drs. Meyer and Flemming have indeed compiled such a book that reviews the story of stenosis in great detail. There is no question that this book will prove of great value to all members of the medical profession inter- ested in the respiratory system and, in particular, to otolaryngologists, head and neck surgeons and chest surgeons.

They begin this work with a description of the em- bryology, anatomy and physiology of these structures, and on this background discuss both the common and obscure causes for tracheal stenosis. Their list of etio- logical factors focuses attention on the fact that these organs are frequently and unwittingly at risk that this

risk can be immediate and total or chronically progres- sive, and the causes for this are catholic in number. I t is startling to appreciate that the majority of the cases of tracheal stenosis seen in our generation have been caused by the application of surgical techniques or technology in a life-saving circumstance relating to in- tubation, cuffed endotracheal tubes, respirators, tra- cheostomies and resuscitation devices to maintain an airway system to support the heart and lungs. These undesirable sequelae have fortunately been reduced by a better understanding of the use and technique of these devices. Their substantive report on the causes and pre- vention of stenosis will add significantly to the diminu- tion of stenosis.

In addition and in particular, Drs. Meyer and Flem- ming have added their unique expertise to the funda- mental understanding of the anatomy and physiology of these specialized structures and their exceptional knowledge and creative ability to rehabilitate these de- formities by an ingeneous collection of surgical tech- niques. They emphasized the desirability of end-to-end anastomosis of the trachea, associated with superior and inferior release, but add an impressive list of re- gional flaps, free composite grafts, stents, single and multiple stage techniques with which they have had personal experience, indeed, their broad personal expe- rience gives authenticity t o many of the techniques, detail and this combined with an extensive review of the world’s Iiterature gives substance and a historical perspective to the state of the art.

The final chapter on revision surgery emphasizes the essentiality of following these patients for decades, as all rehabilitative procedures in this area are exposed to potential infection, scar contraction, aging processes and physiologic wear and tear. Indeed, some of the biological processes are progressive by nature and may not necessarily be permanently cured by a single opera- tion. The amazing fact is that so many of these tracheal deformities can be helped surgically, and we are in- debted to Drs. Meyer and Flemming for their superb accomplishment in writing about their experience with this difficult and often harrowing condition.

JOHN CONLEY, MD New York, New York

*Reprinted with permission of Reconstructive Surgery of the Trachea (Rodolphe Meyer, ed). Stuttgart, Georg Thieme Verlag, 1982, forward.

90 HEAD & NECK SURGERY October 1984