Editor's Commentary: Blood Collection Within the Maxillary Sinus Following Fracture Repair: The Impact of Mesh Implants and Drains

The reviewer’s task is challenging, as they are given varied manuscripts and are expected to be expert in all subjects. I have been editing for many years, and can recall from my first years when those who agreed usually reviewed, and there was general agreement on each potential publication about the worth/non-worth of the potential publication by the reviewers. Mostly, their opinions were mostly similar, and most comments and most criticisms were in agreement.

Now, the situation is different and one-third of those who are asked to review do not respond, one-third respond yes and never review, and one-third respond and review. Half of the reviews are so brief that it is of little value, and half of the reviews are still excellent.

So, with this article, one of our best reviewers said “reject” and had good reasons, and another excellent reviewer said “minor revision” again with good reasons. Having read the article several times, the “requests” of the “reject” reviewer were simply not possible to complete without at least a totally new study, and perhaps were not even possible with a new study.

So, after studying the issues, I decided to publish the article with several abstracted comments of the first (excellent) reviewer, so that the readers would have the benefit of the thought and worth of the publication but were also advised of the comments of the negative reviewer. Additionally, another good and somewhat similar publication exists [1] for the interest of the inquisitive reader.

Abstracted comments of one reviewer are as follows:

• The authors’ assumptions about the effects and amounts of blood necessary in the maxillary sinus are unproven.
• The blood could have as well come from maxillary sinus mucosa as the orbit.
• The pattern of drain use by the individual surgeons was highly variable, and probably influenced by factors not mentioned. The surgeons sometimes used one implant and sometimes another, and sometimes drained and sometimes did not.
• The blood that passed thru the drain to the environment was not measured.
• The amounts of blood that were found in the drained and non-drained cases seem so varied as to be random.
• The authors never address the question of what the “dangerous” amount of blood within the orbit is, and focus on a difference of 2.4 mL, which is well below even the amount which ophthalmologists inject routinely for a retrobulbar block without ill effect. The ranges of blood collected were so wide as to have little objective significance, it seems.
• Why a patch and/or frost suture postoperatively? The patient’s vision cannot be assessed easily.
• The timing of surgery was not mentioned and may affect the results.
• We do not know how effective the drains were (how much blood was drained) and perhaps the effect of suction versus nonsuction and drain type.
• How much blood in the orbit would it take to actually cause damage or too much pressure?

These comments are provided to connote the basis of one reviewer’s objections to publishing the manuscript. Another article is reference 1.