Dec 2016 IAOMS Face to Face by IAOMS

Issue 48 / December 2016

Editor-in-Chief Javier González Lagunas

Assistant Editor Deepak Krishnan

Graphic Designer María Montesinos

Executive Committee 2016 - 2017 Board of Directors Julio Acero, President Piet Haers, Immediate Past President Alexis Olsson, Vice President Gabriele Millesi, Vice President-Elect Arthur Jee, Treasurer Larry Nissen, IAOMS Foundation Chairman Mitchell Dvorak, Executive Director

Members-at-Large Javier González Lagunas Sanjiv Nair David Wiesenfeld

Regional Representatives Abdellfattah Sadakah, Africa Kenichi Kurita, Asia Nick Kalavrezos, Europe Alejandro Martinez, Latin America Arthur Jee, North America Jocelyn Shand, Oceania Nabil Samman, Editor-in-Chief, IJOMS

Committee Chairmen Rui Fernandes, Education Committee Joseph Helman, Research Committee Deepak Krishnan, IAOMS NextGen Committee Steve Roser, COGS Committee Fred Rozema, IT Advisory Committee Mark Wong, IBCSOMS Representative Nabil Samman, 23rd ICOMS-2017, Hong Kong Luiz Marinho, 24th ICOMS-2019, Brazil David Koppel, 25th ICOMS-2021, Glasgow

8618 W. Catalpa Ave., Suite 1116, Chicago, IL U.S.A. 60656 1.773.867.6087 / communications@iaoms.org

Letter from the Editor HOW I SEE IT Javier Gonzรกlez Lagunas EDITOR-IN-CHIEF

Innovation and high-tech is in the core of our speciality. Read the contributions of our authors and discover what is happening in Maxilofacial Surgery.

CONTENTS December 2016 10 SPECIAL REPORT

High technology in Maxillofacial Surgery FELLOWSHIP 20 The Voice of an IAOMS Fellow

22 DO YOU WANT TO WORK... ...in Czech Republic

FROM PROUST TO PIVOT 26 Dale Bloomquist

28 COPY ME

Reconstruction of pediatric cranio-facial defects NEXT GEN 30

Training in South America

32 REPORTS OF MEETINGS

A glimpse on AAOMS meeting EACMFS London 2016 WOMEN IN IAOMS 36 Brazil

44 WORKING IN PARADISE Amalfi Coast

48 BEYOND THE OR

WHERE ARE THEY NOW? 46 Dr. Victor Moncarz

Check Your Digital Profile

A NOTE OF THANKS

t this time of year, we often take a moment (or two) to reflect on the year and as importantly, to say thank you. In this column, I would like to do both –even if just briefly- -through some yearend highlights. Since I became Executive Director in April, we have focused on three areas: strategic planning and organizational management; strengthening HQ staff to be a better resource for members, and enhancing outreach to members through educational and networking events. Strategic Planning and Organizational Management At the Board Strategy Planning Meeting in Madrid this past April, we began development of a strategic plan which we will begin implementing in 2017. During the fourth quarter, we surveyed members about educational resources and the IAOMS Foundation and will integrate that feedback into the strategic plan. I will continue to update you on plan progress and metrics throughout the coming year. And I am pleased to report that we are ending 2016 with a solid financial foundation.

organizing committee and all of the presenters for a very successful event. On March 30, IAOMS will host the Next Level Forum, which is open to all ICOMS 2017 attendees. True to its theme, the Next Level Forum will help participants “Adapt and Lead” through presentations and an idea exchange. While the session is included in your ICOMS registration, we ask you to register for the Next Level Forum. We resumed our quarterly webinar series this month with a presentation from Dr. Gabriele Millesi. My thanks to her as well as Dr. Acero and Dr. Juan Antonio Hueto – and all of the e-learners who participated. Next year, I hope you can join us for more webinars in our series. To develop the next generation of OMS surgeons, we awarded the IAOMS Foundation Fellowship to three trainees and received a record number of applications for next year’s program. Special programming geared to trainees will be available, along with an idea exchange, at the ICOMS 2017 Trainee Council. It will be a great opportunity for networking and connecting with other trainees from around the globe, too.

Strengthened IAOMS Headquarters Team With our increased focus on membership and in response to her terrific work, we promoted Katie Cairns to Membership Manager. We added a new position – Manager of Office Administration and Governance Support (Kimberly Shadle) and brought on a new Communications Director (Naomi Gitlin). The new Headquarters Team looks forward to meeting with you and seeing you in Hong Kong for ICOMS 2017 and The Next Level Forum next spring.

Thank You

Enhanced Outreach to and Opportunities for Members In October, we welcomed many members and prospects – as well as trainees -- to our first International Symposium. Our thanks to our co-hosts in Medellin, Colombia, the ALACIBU-ACCOMF, for partnering with us on this educational event. We conducted the meeting in Spanish and will look at conducting these future meetings in the language of the host country. My thanks to IAOMS President Dr. Julio Acero who represented IAOMS and to the local

I look forward to working on your behalf to make 2017 an even better year as we help you build your practice and the OMS profession.

My sincere thanks to our Board of Directors, Executive Committee and the IAOMS Foundation Board of Trustees for their leadership, dedication, hard work and energy. And to our IAOMS members, thank you for your membership, which helps us provide the world of IAOMS to OMF surgeons. Whether you’re a trainee, a practicing surgeon or a life member, IAOMS has programming and resources for you.

Wishing you and your loved ones a happy holiday season. Best. ■ Mitchell Dvorak EXECUTIVE DIRECTOR, IAOMS

Letter from the President

n my last column, I announced a new initiative – the IAOMS International Symposia – designed to

bring the IAOMS closer to members throughout the world through regional scientific meetings. Now, as we approach the end of my first year as IAOMS President, I am proud to inform you about the success of the first IAOMS-ALACIBU-ACCOMF Symposium. Held last November in Medellin, Colombia, in collaboration with the Latin American and Colombian Associations of Oral and Maxillofacial Surgery, about 230 members and prospective members participated and heard more than 40 presentations. IAOMS Executive Director Mitch Dvorak and I met with with the leaders of 17 different Latin American associations. The Symposium was a great opportunity to deepen relationships, learn from each other and hear about advances in OMS patient care. On a personal note, I was especially impressed by the high quality of the trainee presentations during the Trainee session. Following the successful Colombian meeting, I travelled to Queensland, Australia, to represent the IAOMS at the ANZAOMS (Australia and New Zealand Association of Oral and Maxillofacial Surgeons) Conference and meet with Oceania representatives. My sincere thanks to Assoc. Prof. John Cosson, ANZAOMS President, who presented me with an Honorary Membership in the Association. The IAOMS also was present as a scientific sponsor at the PanAfrican Conference in Cairo, Egypt, under the Presidency of Prof. Sadakah. Our congratulations to our African colleagues on the Conference´s success. Preparations for the next ICOMS continue at an incredible pace. Last month, Mitch and I met with Prof. Nabil Samman and the ICOMS 2017 Local Organizing Committee in Hong Kong. Next year’s ICOMS is shaping up to be a terrific Conference in a wonderful venue: 1300 free papers have been submitted to be considered for presentation and more than 120 outstanding speakers are confirmed. o We are also very excited about some new IAOMS initiatives we will introduce, such as a half-day of programming and networking geared specifically to trainees and The Next Level Forum (formerly the Invitational Conference) a pre-conference activity which is being organized by our Vice President-Elect, Dr. Alexis Olsson, where we will bring together three leading speakers in conversations about best practices in leadership and management to give you new tools to “Adapt and Lead.” If you have not registered for ICOMS, I encourage you to visit www.icoms2017.com and register today.

Earlier in the autumn, we had a successful IAOMS Board meeting in London in conjunction with the European Congress, which was followed by our participation in the AAOMS meeting in Las Vegas. Mitch and I attended the ACOMS the Asian Congress of Oral and Maxillofacial Surgeons - in Manila, where we had productive meetings with the ACOMS Executive Committee. I was honored to offer greetings to all of those in attendance at the Congress. We recognize the role of the Asian Association in the international scenario and thank its leaders for their collaboration and good ideas. These new IAOMS initiatives, combined with our participation at meetings and conferences of affiliated associations and our strong Educational Program under the leadership of the Chairman of our Education Committee, Rui Fernandes with ongoing activities in Panama, Brazil, Latin America, and a new project to be developed starting January 2017 in Myanmar, further strengthens the IAOMS as the leading global association for oral and maxillofacial surgeons. I am proud to say that in addition to the numerous in-person activities, our Association is also increasing its presence in the digital world, a topic selected by Dr. González-Lagunas for this issue of Face to Face. A new series of live educational webinars (free to members) began with a presentation on Orthognathic surgery by Dr. Gabi Millesi. Thanks to Dr. J.A. Hueto, chairman of the e-learning sub-committee, for making this possible. Also, my gratitude to our staff at our Chicago headquarters for their tremendous work under Mitch’s leadership. This has been a very intense year where we have instituted a new, efficient structure at the Office and we have been improving services to members (which is expressed through an increase in our membership and in the many colleagues and national associations who seek to affiliate with the IAOMS. Please contact IAOMS Membership Manager Katie Cairns at kcairns@iaoms.org to renew your membership. Finally, I would like to take this opportunity to wish all of you and your families a happy and successful New Year. I look forward to seeing many of you in Hong Kong for our signature event, the ICOMS. With your support, the IAOMS helps you build your practice and our profession. Thank you for your membership and engagement. Kind regards,

Julio Acero IAOMS PRESIDENT 2016-2017

special report

HIGH TECHNOLOGY in Maxillofacial Surgery

Robotics in orthognathic surgery

By Dr. Haijun Gui Department of Oral and Cranio-Maxillofacial Science. Shanghai Ninth Peopleâ&#x20AC;&#x2122;s Hospital Shanghai Jiao Tong University of Medicine, Shanghai, P.R. CHINA

omputer-aided-surgery has been introduced in clinical practice to improve the surgical precision on the benefits of its optimal preoperative simulation and accurate intra-operative visualization. However, due to the instability of manual operations, it is still challenging to achieve the operation accurately enough to consistently follow the virtual planning in the complex craniofacial region.

robotic systems have been developed such as AESOP (Computer Motion Inc., Santa Barbara, CA), ZUES (Computer Motion Inc., Santa Barbara, CA), DA VINCI (Intuitive Surgical Inc., Mountain View, CA). Medical robots have proven to be reliable devices ensuring safety and effectiveness on the different fields of surgery, such as neurosurgery, orthopedic surgery, urology, and so on.

Since its introduction for clinical application in the early eighties, more and more commercial medical

The craniofacial region is a delicate and complex anatomic structure. Orthognathic surgery on this

10 iaoms.org

December 2016

FIGURE 1. The simulated operation room for skull experiment.

region demands exceptional skill and dexterity from a surgeon. The conventional method of performing orthognathic surgery is facing great challenges on how to further improve the technique, most especially in terms of better visibility and faster execution. From the theoretical standpoint, with its stable threedimensional movement, predictable virtual planning, precise surgical navigation, stable robotic operation, and real-time monitoring of surgeon, the use of medical robotic systems have several advantages when compared with the traditional technique in terms of the following: 1. Better anatomic reference; 2. More accurate diagnosis; 3. The optimal preoperative planning and simulation; 4. Improved visualization during operation; 5. More stable execution.

â&#x20AC;&#x153;Medical robots for soft tissue operations are playing a growingly important role in clinical practice.â&#x20AC;? Researchers from Shanghai Ninth Hospital reported their research on the development of a novel navigation-guided robotic system for orthognathic surgery to improve surgical accuracy. A new 7-degree-of-freedom robotic arm was designed and manufactured. Based on their self-developed navigation system TBNAVIS-CMFS, the key technique of integration was studied. The experimental surgery was carried out following the planned route using a skull model in the simulated operation room. The virtual plan (Le Fort I osteotomy) was firstly completed on the simulation platform of TBNAVIS-CMFS. After installing the digital reference frame (DRF) on the skull model and end effect of the robotic arm, the registration procedure was completed based on the anatomic landmarks. Since both the virtual plan and December 2016

surgical saw were shown on the screen in real time, the instructions were immediately conveyed to the robotic arm. The position of the surgical saw could also be tracked on the screen and guided to automatically perform a Le Fort I procedure following the virtual plan (Figure 1). The group of Esam Omar has published a research on model surgery with a passive robot arm for orthognathic surgery planning. Model surgery performed with the aid of a robot arm was significantly more accurate in anteroposterior and vertical planes than was manual model surgery. The robotic arm plays an important role in orthognathic surgery planning and in determining the biometrics of orthognathic surgical change at the model surgery stage. Another research on model surgery in seventeen patients undergoing orthognathic surgery has been published. Model surgery was performed in two groups by using a either the conventional technique or using the Robot Arm. Model surgery was performed in the horizontal (X-axis), vertical (Y-axis), and transverse (Z-axis) planes. Robot-guided model surgery was more accurate in all dimensions X, Y, and Z than the manual model surgery. In summary, no clinical application of medical robotics has been reported yet in the literature. Current research is focused on the development of the robotic arm and the technical route to implement the procedure. Medical robots for soft tissue operations are playing a growingly important role in clinical practice. Further research on medical robotics for bone operations such as orthognathic surgery, allowing pre-operative virtual planning and intra-operative accurate performance, will definitely be a key step in the development of oral and maxillofacial surgery. â&#x2013; iaoms.org 11

special report

The Role of Simulation in OMFS Education

By Daniel Buchbinder1 and Renata Khelemsky2 1

Professor and Chief, Division of Maxillofacial Surgery. 2Chief Resident, Division of Maxillofacial Surgery. Department of Otolaryngology Head and Neck Surgery, Icahn School of Medicine at Mount Sinai Hospital, New York, NY USA

ery little has changed in the way young surgeons train since the original Halstedian approach was introduced in the early 20th century. This method relies on the apprenticeship model, with graded responsibility over time, with the operating room providing the venue to demonstrate the surgical techniques, placing the patient at the center of the training process. Over the years, various efforts have been undertaken to improve and standardize surgical training but to this day, the development of objective metrics to evaluate surgical competence of trainees remains elusive. Furthermore, the implementation of restrictive trainee working hours has resulted in reduced patient contact opportunities for an ever-growing scope of procedures. This, coupled with a greater emphasis on patient safety and the recognition that human error is neither small nor rare, has led to a call by professional societies like the Institute of Medicine to find a better, safer method to train surgeons. Taking the lead from the aviation industry, it became clear that simulation could play an important role in procedural based surgical training. It was also clear that a need exists for a shift from time-based training programs to a competency12 iaoms.org

based system, and that well-constructed surgical simulators could provide objective metrics to assess trainee procedural competency. SIMULATION IS NOT NEW TO SURGICAL TRAINING. Generations of surgeons were trained using live animals and human cadavers to acquire their surgical skills because this method provided high face validity in terms of anatomy and haptic feedback. Ethical concerns and the high cost of procurement have made this model of training impractical. In its truest form, surgical simulation has roots in learning psychology, validation science, and in the case of VR simulation, computer engineering. It is imperative that all these factors are considered when implementing a comprehensive simulation based curriculum for a given surgical specialty. In our own experience, one must come up with a list of defined needs with objective assessment metrics before deciding on the technology platform. Expensive, high fidelity, full physics simulators are not required for teaching every surgical procedure. For the most part, simple simulators can provide adequate tools for the teaching and assessment of core procedures. Cognitive task trainers are also very December 2016

effective training tools as they can bridge the gap between low fidelity “black box” simulators and the highly sophisticated haptic based high end simulators. We have recently joined this effort by contributing the first two maxillofacial scenarios to a novel simulator called:

Touch Surgery Builds technologies to empower the global surgical community.

Figure 1 : Screenshot of the starting page of a Touch Surgery Simulated Prodcedure: Orbital Floor Reconstruction

Figure 2: Screenshot of step in the learning mode (A) and Test mode (B)

Figure 3: Performance results Including the number of Learn and Test trials (upper left) and Test scores indicating passing scores (last test and Top score) as well as an average score for all trials (in this case a failure score). The graph also indicates the steps that were performed correctly (blue) and errors (orange). Finally, the lower bars indicate the scores for precision (correct swipes) and Decision (correct answers to Multiple choice questions (MCQ) December 2016

That allows rehearsal of surgical procedures using cognitive task analysis (Figure 1). Touch Surgery runs from a handheld mobile device or tablet and is free to use. Residents interact with 3D animations and rehearse the cognitive steps of a given procedure from start to finish in “Learn Mode,” using high quality 3D virtual anatomical models to learn the steps, the same way an “expert” faculty member would teach them, considering the “risks” and “pitfalls” one might encounter (Figure 2). This is followed by a “Test Mode” that can objectively measure their understanding of the various steps and assess proficiency. We also have studied and demonstrated the face, content, and construct validity of this teaching tool. We are piloting a paced weekly curriculum for completion of 28 Touch Surgery modules on relevant core surgical procedures, and generating new ideas about improving both our surgical training as well as setting the stage for others to follow. Touch Surgery is now supplementing our blended core curriculum to bring residents one step closer to safer patient contact, whether it be a complex orbital floor exploration or a basic insertion of a Foley catheter, and providing the much-needed proficiency assessment tool (Figure 3). We hope to recruit other training programs in the U.S. and around the world to implement this valuable teaching tool into their programs and help build a standardized core OMFS curriculum that will one day, allow us to objectively assess the proficiency of our trainees. A ROLE FOR SIMULATION IN SURGICAL EDUCATION AND TRAINING APPEARS ASSURED. The benefit of being able to learn by repeatedly rehearsing a procedure and be allowed to make mistakes without harming a patient is unquestionable. Our specialty is uniquely positioned to embrace virtual surgical simulation given our track record with virtual software and three dimensional patterns of thinking. Ongoing research is filling the landscape with simulation development and promising results. Our colleagues in neurosurgery, orthopedic and general surgery have made massive strides to develop standardized programs for training curricula. The ultimate challenge will be determined by our ability to collectively develop a high quality OMFS curriculum that will allow us to assess both the learning and proficiency of our trainees and determine if the training benefit is worth the development effort. If you asked us today, we would safely predict that the answer would be a resounding “Yes!” ■ iaoms.org 13

special report

03 Navigation in

the 21st century

By Fuessinger Marc Anton, Metzger Marc Christian, Bittermann Gido, Schmelzeisen Rainer and Duttenhoefer Fabian Department of Oral and Maxillofacial Surgery, University of Freiburg, Germany

oday’s computer-assisted surgery (CAS) in the head and neck area offers support in cases of suboptimal visualization and delicate anatomical structures to reduce unpredictable intra-operative events and minimize complications. Interdisciplinary approaches by neurosurgeons, ophthalmologists, otolaryngologist and cranio-maxillofacial surgeons combined with the most recent technologies in the CASsector ensure predictable and successful results of head and neck trauma and cancer. KEY ELEMENTS OF THE CAS ARE DATA ACQUISITION, PLANNING OF THE OPERATION, the operation itself and the assessment to check the post-operative results. Data acquisition is conducted by taking three-dimensional (3D) radiographs like computed tomography (CT) or cone beam computed tomography (CBCT). During the planning step the obtained CT or CBCT data are used to create a virtual model to analyze the anatomical structures and simulate the results of the operation. The virtual reconstruction of the facial skeleton is performed by well-established software, like Brainlab or Materialise. After segmentation of DICOM (Digital Imaging and Communications in Medicine) data, unilateral defects of the skull will be reconstructed by mirroring procedures, where one side, usually the unaffected, healthy side, is mirrored as an overlay to reconstruct the defect site. The mirrored structures will be registered and aligned on the defect side. The operation is supported by CAD/CAM-derived stereolithographic models (SLMs), occlusal splints, 14 iaoms.org

A “Interdisciplinary approaches by neurosurgeons, ophthalmologists, otolaryngologist and craniomaxillofacial surgeons combined with the most recent technologies in the CASsector ensure predictable and successful results of head and neck trauma and cancer.” intraoperative navigation and landmark registration. In the field of guided implant surgery, surface scans can be combined with CBCT data to produce precise drilling guides.For tumor surgery, the re-section margins are defined pre-operatively using CT data to allow a reliable intra-operative localization of the re-section boundaries. After surgery, the marked boundaries improve the precision of following radiation. Communication between the surgeon and the pathologist tumor is characterized by informational loss. In our department, we were able to minimize this loss of information by marking tumor re-section boundaries to offer the pathologist a 3D information of the tumor. In cases of incomplete tumor resection, the analysis of this 3D information, provided by the pathologist, in combination with intra-operative navigation, allows a precise second re-section or subsequent radiation. December 2016

Figure 1: A. Marked midface are on the left side (light blue) B. Mirrored area from the left side to the right side (dark blue).

A Figure 2: Reconstruction of the left zygoma (and infero-lateral orbit) by SSM

B CURRENT RESEARCH FOCUSES ON THE SIMPLIFICATION OF THE DESCRIBED WORKFLOW AND THE EXTENT OF APPLICATIONS. Simplification of the planning step begins with the timeconsuming segmentation of the CT data. Surgeons demand higher precision as well as automatization and acceleration of the segmentation process of DICOM data. In 2013, the atlas-based segmentation was introduced to facilitate this first step of CAS. By using a virtual anatomical atlas, an automated non-threshold segmentation, integrated in known software packages, improves the segmentational step. The following virtual planning is still based on mirroring procedures. Mirroring procedures assume a symmetry of the skull. However, scientific progress revealed significant asymmetries of the human skull, which result in an imprecise reconstruction when using the common mirroring procedures. Together with the limited application in case of bilateral craniofacial anomalies or defects, there is a tremendous need to improve such planning workflows. To address this demand, recent studies investigate the mathematical algorithms for more precise adaptation, registration and alignment of mirrored structures. Furthermore, statistical shape models for virtual reconstruction of uni- and bilateral defects are tested. In a current study in our department, a statistical shape model (SSM) is obtained by unaffected CT scans of the skull where the resulting surface mesh can be deformed and adapted to the patientâ&#x20AC;&#x2122;s skull. The reconstruction process demands between four to six landmarks that are located on the unaffected bone parts of the skull. December 2016

A. Calculated surface by SSM of the unaffected right side. B. Calculated surface by SSM to the affected left side.

Results show a higher precision of the reconstructed bone parts compared to the known mirroring procedures. Moreover, bilateral defects and craniofacial anomalies can be reconstructed, too. The reconstructed skull can be exported as a Stereo-Lithography data (.STL). Thus, based on the reconstructed skull, patientspecific implants can be designed and manufactured. By fitting of the implant, the surgeon can reposition and fix the bony fragments. Time-consuming navigational steps or post-operative radiographs to verify the correct position of the osteosynthesis plate could be avoided because of the precise fitting of the implant on the surrounding bone. Progress in CAS offers a patient-specific treatment plan with less co-morbidities and higher reliability. Limitations of the CAS will be gradually reduced as new applications are introduced. â&#x2013; iaoms.org 15

special report

04 Smart Biomaterials

Elastin-Like Biomaterials (ELRs), the next step towards a complete tissue regeneration By Luis Miguel Redondo1. Israel González de la Torre2 1

Oral and Maxilofacial Surgeon, Rio Hortega University Hospital Valladolid. 2PhD in Chemistry. University of Valladolid. G.I.R. Bioforge

he relationship between humans and biomaterials is an old association since biomaterial can be understood as any material or object that helps provide a substitute for a part of the body that needs repair or replacement. In fact, some toe-prostheses found in Egyptian archeologic excavations suggest this long term relationship. While in those ancient times the final functionality of the implant, without care of the biocompatibility or possible side effects of the implanted materials was the main goal, in the last few decades this relationship has become more important from the bio-compatibilty and bio-activity perspective. As with many othermedical specialties, in the maxillofacial field the need for materials that can meet demanding surgical requirements has pushed biomaterial scientists to create more complex materials. Today, while good mechanical properties are required, others, such as osseointegration, biocompatibility within the surrounding tissues, bioactivity to induce a fast regeneration and tailored degradability to drive to a total new natural tissue are some e of the main features required in biomaterials. Increasingly, materials used to correct maxillofacial defects have evolved from inert or nonbioactive materials such as metals (stainless steel, CoCr alloys, titanium alloys and others), ceramic biomaterials such as aluminum oxides, several types of hydroxyapatites, polymeric materials (Polymetilmetacrylate, polytetrafluoroethylene, polyamide and composite materials to today’s bioactive materials. These bio-active materials should be bio-compatible, induce cell growth , proliferation and differentiation and there have been many efforts to achieve these characteristics. Some groups, such as 16 iaoms.org

Bioforge and TPNBT from the University of Valladolid (include the city where the university is located) in collaboration with maxillofacial surgeons from the Hospital Universitario Río Hortega, (include name of city) wanted to move closer to a scaffold that has the capability of replacing the functionality of a damaged tissue without producing any adverse reaction that could lead to an implant rejection. Moreover, these scaffolds have to be degradable leading in the final stage to a new natural tissue, but not degradable by themselves in a “chemical and fixed way;” they should be cell- demanding degradable. In other words, these December 2016

biomaterials should be remodeled solely by the cells while they colonize the scaffold and produce their own natural extracellular matrix (ECM). The new generation of biomaterials should mimic the natural wound healing process when the damage is critical and it cannot be repaired by natural mechanisms. So, it is important for these biomaterials to possess certain bio-activities that induce cell attachment and proliferation, produce angiogenesis in a controlled way that guarantees the supply of nutrients to the new growing tissue. For all these reasons and others, we believe there is a future for the use of genetically-engineered biomaterials in oral and maxillofacial surgery. For the last 20 years,

Valin-Prolin-Glicin-Valin-Glicin that gives elastin the elastic properties. They are designed at the genetic level, using the most advanced DNA-recombinant technologies which allows us to incorporate specific bio-functionalities such as specific or general cell attachment sequences, growth factors that induce angiogenesis, sequences that induce mineralization or cell protease sensitivities? for a cell-controlled degradation. Subsequently, scaffolds with the desired bio-activities can be created to be implanted, guiding the natural regeneration process without leaving any undesirable residue after the area has healed. Moreover, the rise of 3D printing technology opens

â&#x20AC;&#x153;Our philosophy is based on teamwork. The best treatment cannot be achieved by one professional or specialty.â&#x20AC;?

a new path to create scaffolds with the concrete geometry and precision in the micrometric scale. With this technology, we are designing new ELRs with functionalities to create, in real time, 3D scaffolds with the desired bio-functionalities that can be easily implanted by maxillofacial surgeons to create complete tissue regeneration.

we have developed scaffolds based on ElastinLike Recombinamers (ELRs) that are being used in several applications (such as cardiovascular, diabetes, osteochondral defects, etc.). They are protean biomaterials based on the elastin that all of us have in our tissues, concretely in the sequence of amino acids December 2016

I am sure that in the next 10 years the 3D bio-printing will provide a new concept of tissue engineering and biomaterial scientists will produce smart materials to create multi-tissue scaffolds that will lead to the regeneration of complex tissues and damaged organs. â&#x2013; iaoms.org 17

Hong Kong Hong Kong

As if Hong Kong didnâ&#x20AC;&#x2122;t already have enough attractions to get your blood pumping, next March the city is getting into attention by hosting its first ICOMS. In its twenty-third year, ICOMS will strive to be better than ever, with scientific meetings and social events to cater for all crowds. Jointly organized by the International Association of Oral and Maxillofacial Surgeons and the Hong Kong Association of Oral and Maxillofacial Surgeons, the commitment is on to organize a scientific meeting to draw together oral and maxillofacial surgeons internationally and provide a venue where the minds of educators and trainees meet as well as have fun.

is waiting for you!

For the scientific meeting, a diverse range of speakers will explore the theme â&#x20AC;&#x153;From Innovation to Excellence in Patient Careâ&#x20AC;? and cover an array of topics including reconstructive surgery, oncology, cleft lip and palate, oral and maxillofacial trauma, dental implantology, dentofacial deformity and orthognathic surgery, oral pathology, tissue engineering, digital surgery and much more, bringing together clinicians and their diverse interests for a weeklong event to share clinical experiences, review updates and report advancements in the field. Standing strong in its belief in the value of putting innovative minds together and supporting research, ICOMS committee will bring together Trainee sessions and showcase posters and research presentations. Expect a good trainees get-together to participate and enjoy knowledge and experience exchange.

Continue the adventure and do not miss the social highlights of the conference where you will be treated to a ton of different cultural experiences. The Opening Ceremony, held at the congress venue at the Hong Kong Convention and Exhibition Center, will house in vibrant performances encompassing the uniqueness of “East meets West” culture, while participants network through a reception of bubbles, canapés and light entertainment. Another highlight will that be of Hong Kong Night, held at the Sky 100 Hong Kong Observation Deck, offering a breathtaking 360-degree view of the territory and its famous Victoria Harbour at 393m above sea level. Indulge in a night with feet in the clouds, time back to the old Hong Kong heritage faced with a culture rich blend of history and modern living. Live through the night that leads you to the cosmopolitan and culinary mecca of Hong Kong and feast on a myriad of vibrant traditional street foods while enjoying the stunning view of the famous Hong Kong skyline. Anyone who is after some late night adventure, look no further and venture out into the city. The bright lights of the city are best seen in the darkness, and with a drink in your hand!

OPTIONAL TOURS THE TRIP IS NOT COMPLETE WITHOUT ENJOYING SOME OF THE FAMOUS ISLAND AND HERITAGE TOURS. ENJOY THE BUZZING CITY FOR ITS STREET FOODS, A GOOD BARGAIN HUNT OR A SHORT HIKE TO GLIMPSE AT THE PANORAMIC VIEW OF THE CITY. AWAY FROM THE MADDENING PACE OF THE CITY, THE RURAL SIDE OF HONG KONG OFFERS HISTORICAL SITES THAT WOULD WALK THROUGH 18TH CENTURY VILLAGE, TEMPLES AND ANCESTRAL HALLS. OPTIONAL NIGHT TOUR THROUGH THE “SYMPHONY OF LIGHTS CRUISE” ALLOWS AN EXCITING HARBOR NIGHT CRUISE WITH COCKTAILS SERVED ON BOARD WHILE CRUISING AROUND THE VICTORIA HARBOR AND WATCH THE SYMPHONY OF LIGHTS SHOW. THIS WOULD COMBINE LIGHTS, MUSIC AND NARRATION INVOLVING KEY BUILDINGS OF THE ISLAND TO CREATE AN ALL-ROUND VISION OF COLOURED LIGHTS, LASER BEAMS AND SEARCHING LIGHTS FOR UNFORGETTABLE NIGHT.

programme, c fi ti n ie c s e th From rings, and the the social gathe oms 2017 sure optional tours, ic r everyone! the fo g in th e om s s a h for the taking. re e th is e c n e ri expe December 2016

iaoms.org 19

Fellowship

THE VOICE OF AN IAOMS FELLOW

IRAK

BANGALORE

By Ahmed Maki (Irak) Bahgwan Mahaveer Jain Hospital (Bangalore, India)

T “I believe it’s the possibility of having a dream like this come true that makes life interesting.”

he IAOMS Foundation Fellowship fellowship of IAOMS is a unique, prestigious opportunity. I hope to increase my knowledge in and gain surgical skills to get more and more knowledge, improve my skills in surgery and to develop an unique experience in the field of craniofacial and cleft lip and palate surgery. It is important to move ahead, to achieve and never give up. Starting my surgical career in the OMS field through the IAOMS will shine a new way in my life. It will give me the ability to transfer the knowledge that I will gain to other colleagues in my country, so that we can start a society or a specialized center in craniofacial and cleft lip and palate to increase the qulaity of health care for many babies who suffer from congenital craniofacial anomalies. The IAOMS is known throughout the globe for advancing the standards of care through improving education and training. I believe it’s the possibility of having a dream like this come true that makes life interesting and gives us the hope to live and draw a smile on the faces of many children even with the many challenges we face in our countries. For more than a month now, I have been in India under the supervision of Dr. Krishnamurthy Bonathaya at the Bahgwan Mahaveer Jain Hospital. Day by day, I am learning and gaining experience. In my country, we have a five-year Fellowship Program in Oral and Maxillofacial surgery. The program includes two years in medical departments and three years in maxillofacial department, with five to seven Fellows per year. I finished that

“It is important to move ahead, to achieve and never give up.”

Fellowship in October 2015 (and ranked first among my colleagues). And I also have a bachelor’s degree (from a four-year program) from the Academy of Fine Arts (plastic department; painting and sculpturing). Unfortunately there is no postgraduate fellowship program in craniofacial and cleft lip and palate, or oncology and reconstruction surgery in Iraq, so this December 2016

is the first fellowship in craniofacial and cleft lip and palate surgery that I had been awarded through the IAOMS in my country. Through this opportunity, I am hoping to participate in improvinghealth services which have been affected by wars and terrorism which prevent the provision of health services to many children and families who really need it. ■ iaoms.org 21

So you want to work...

...IN CZECH REPUBLIC

By MUDr. Daniel Hrušák, Ph.D. Dpt. for MFS, University Hospital Pilsen, Charles University Prague, Medical Faculty Pilsen

he Czech Republic, an EU member state since 2004, is located in Central Europe. Please note the official abbreviated name of the country is Czechia not Chechnya or Chechia! The area of 78 870 km2 is surrounded by natural mountain borders to Germany, Austria, Slovakia and Poland. From east to west, you need to travel about 500 km., north to south it takes about 300 km. The population of 10.52 million citizens is distributed evenly throughout major cities and the countryside. The capital, Prague, is a well-preserved medieval town dominated by the 9th-century Prague castle and many other gothic, renaissance and baroque historical sites. Český Krumlov shows why the “Land of the Castles” is another name for Czechia. The kingdom of Bohemia 22 iaoms.org

issued by Frederick II in 1212 (The Golden Bull of Sicily) signified the exceptional status of Bohemia and the Czech Kings within the Holy Roman Empire. Czechoslovakia became independent from the AustroHungarian Empire in 1918. After WW II in 1948, it became a Communist-ruled state until 1989. In 1993, Czechoslovakia was peacefully dissolved into the current countries of Czech Republic and Slovakia. You may find out much more about Czechia not only in the official presentation of the Ministry of Foreign Affairs http://www.mzv.cz/jnp/en/diplomatic_missions/ czech_missions_abroad/index.html perhaps http:// www.mzv.cz/hague/en/general_information_on_the_ czech/facts_and_figures/index.html or some funny December 2016

Language The Czech language is one of the Slavic languages used in central and eastern European countries and incorporates the Latin alphabet with a few extra letters. Most of the locals usually also know some German, English, or Russian. The first precondition for a professional career in Czechia is the Certificate Language Certificate Exam (CCE) http://www.mvcr.cz/mvcren/article/czechlanguage-exam.aspx which is available through some universities in Czechia e.g. http://ujop.cuni.cz/en/exam/ czech-language-certificate-exam . It is also provided by Czech Centres worldwide (Berlin, Brussels, Bratislava Budapest, Bucharest, Düsseldorf, Kiev, London, Madrid, Milano, Munich, Moskow, New York, Paris, Rotterdam, Seoul, Sofia, Stockholm, Tel Aviv, Tokyo, Warsaw and Vienna) http://www.czechcentres.cz/ en/about-us/sit-cc/. The Czech Language Certificate Exam is offered at four levels of proficiency: CCE – A1, CE – A2, CCE – B1, CCE – B2, CCE – C1. You do need a Czech Language B2 certification for work in the Czech Republic. The exams abroad take place usually once or twice a year. The certificate has no expiration date and is issued in Czech and English. Infography on OMS in the country 1. Oral surgery in the Czech Republic is derived from Stomatolgists/Dentists by the Dental chamber continued education syste. It plays an important role in minor oral surgery and in cancer early diagnosis. 2. Maxillofacial surgery in the Czech Republic is given in two ways:

facts http://www.slavorum.org/25-facts-about-czechrepublic-that-you-didnt-know/. http://journeywonders. com/interesting-facts-czech-republic/ Conditions to move to a particular country For EU citizens, it’s quite easy to move to Czechia, Citizens of the EU and their family members have the right to move and reside freely within the EU territory, subject to certain conditions. This right is conferred directly on every EU citizen by Article 21 of the Treaty on the Functioning of the European Union. From outside the EU, a Schengen Visa http://www. schengenvisainfo.com/ is required to enter the Schengen area. December 2016

✔ OMFS – dental degree obligatory, (medical degree as second recommended and possibly acquired as the second degree during training) – most OMFS in the Czech Republic follow this path (five year training minimum)* ✔ MFS – medical degree, qualification obligatory following general surgery or ENT + two years, NO/ minimal Dental training. Both OMFS and MFS have the exactly same competencies regarding MFS, in fact the only difference in the scope is that those having a dental degree (stomatology) are allowed to insert dental implants. The major authorities are the Ministry of a Health of the Czech Republic http://www.mzcr.cz/Cizinci/ and the Institute for Postgraduate Medical Education / IPVZ/ http://foreigner.ipvz.cz/en/, the Czech Medical Chamber for MFS and Czech Dental Chamber for OMFS and oral surgery. iaoms.org 23

So you want to work...

Oral surgery, Oral and Maxillofacial surgery and Maxillofacial surgery lic b u p e R h c e z C in the ORAL SURGERY

ingle dental degree, requiring S special training provided by the Czech Dental Chamber

Number of oral surgeons

6 in hospital practice 4 522 in private office practice

Requirements for working as OMS in Czech Republic. ✔ Information concerning the qualification received in EU countries While there is free movement of specialists, medical professionals are subject to regulation. Authorities are responsible to decide when a professional from another member state wants to practise this regulated profession. In case of provision

There are 15 MFS Units distrubuted around Czech Republic. 7 Academic MFS departments

Oral surgery training 4 years minimum duration ORAL AND MAXILLOFACIAL SURGERY

MFS single dental (Dual degree O recommended) Listed under Basic dental training (Article 34 of Directive 2005/36/EC)

MAXILLOFACIAL SURGERY

axillofacial (single degree M medicine), first specialty ENT or general surgery.

Timing of second degree (if any)

epending on first degree and D individual study plan (3-5 years) for the second degree

Length of specialty training

OMFS – 5 years MFS – 5 years Gen. Surgery / ENT + 2 years MFS

Number of OMFS specialists

Number of OMFS trainees

Number of OMFS training rotations

9 Training centers

Major (Hub) units

rague (3), Pilsen, Hradec Kralove, P Brno (2), Olomouc, Ostrava, Usti/ Labem, Ceske Budejovice, Liberec, Pardubice, Zlin Listed under Specialist medical training (Article 25 of Directive 2005/36/EC)

National Czech association for maxillofacial SpecialtyAssociation surgery, CAMFS

Medical Association

Czech Medical Association of J.E. Purkyne

Useful resources and links

www.mfch.cz , http://www.dent.cz/ en/ , http://www.cls.cz/english-info

of service, the declaration must be sent to this authority prior to providing services. http://ec.europa.eu/growth/tools-databases/regprof/ index.cfm Professional Recognition Process is provided by the authority for the Ministry of Health of the Czech Republic. Requirements and Documents needed Automatic recognition of diplomas corresponding to

...IN CZECH REPUBLIC Directive 2005/36/EC are recognised in Czech on the condition that applicants provide certificates issued by the competent authority (Ministry of Health of the Czech Republic, Czech Medical Chamber for MFS and Czech Dental Chamber for OMFS and oral surgery). Licenses and credits are recognized by the same local authority. Other Requirements to work in Czechia are: full legal capacity, proof of good character and repute, fitness to practice (health of practitioner) and again sufficient knowledge of the Czech language.

FAQ: Is there some approbation exam? Answer: NO for those who have received qualification in EU countries. YES for those who have received qualification in non-EU countries. http://foreigner.ipvz.cz/en/approbation-tests/ basic-information-about-approbation-tests,mzcr.cz/ dokumenty/aprobacni-zkousky_1784_952_3.html *Footnote: To fully understand the Czech Oral Surgery, Oral and Maxillofacial surgery specialities, it requires a short lesson in Czech Medical, Stomatology and Dentistry degrees history. Stomatology was a medical speciality at one of the Medical Faculties of the universities in the Czech Republic. In the past, the Word stomatology (from Russian “Stomatologija”), was introduced because of the Russian influence after WW II later on the parallel English Term “Dentistry” was used as an attempt to look more western European. In fact, this has nothing to do with the level of expertise. Former DENTISTS (non-university educated skilled dental technicians, entitled to do some limited dental work) were given the last chance to complete medical studies in 1962-1963, now the last remaining I know is in the age of about 95 years. The study duration and degree title have changed. From the initial four years to five years , then 5.5 years, or six year, and finally five years again.

✔ Information concerning the qualification received in non-EU countries Physicians, dentists and pharmacists who as foreign nationals have obtained medical qualification outside the European Union and wish to practice their profession in the Czech Republic or the European Union must pass the approbation exam. Knowledge of the Czech language is one of the requirements for the successful completion of the approbation exam. Please note that all information for the approbation exam are given in the Czech language. December 2016

Regarding the name of the degree: Until 1955 - four years study of stomatology – graduation title,” only shortly during 1951–1953 the title was MSDr. “Medicinae stomatologicae doctor”). 1956 – 1990 - five years study of stomatology – title 1954–1966 was “Graduated Dental doctor” , since 1980 the title MUDr. the same title as for a doctor in general medicine (“Medicinae universae doctor in disciplina medicinae stomatologicae”). ■ iaoms.org 25

From Proust to Pivot

AN APPARENTLY INNOCENT QUESTIONNAIRE FOR ORAL AND MAXILLOFACIAL SURGEONS You’ve heard of the Proust Questionnaire Adapted and made famous in the back pages of Vanity Fair Magazine, it was named not for questions, but for the answers given by Marcel Proust to a set of questions asked by his friend Antoinette Faure. Then, for many years Bernard Pivot conducted a cultural program on French TV called “Apostrophes.” All his guests received the same 10 questions at the end of the interview. So, in , Face to Face, we think, those questions are a great way to learn about our interview subjects. Enjoy and compare these answers to those of celebrities!!!

Dale Bloomquist What is your favorite word? Freedom. What is your least favorite word? Trump. What is your favorite drug? Red Wine. What sound or noise do you love? Rain on a roof top. What sound or noise do you hate? A “snobby” voice. What is your favorite curse word? F*** Who would you like to see on a new banknote? Martin Luther King.

Dale at Mon terey. What profession other than your own would you not like to attempt? Periodontics. If you were reincarnated as some other plant or animal, what would it be? Bull Mastiff (Scary looking but really friendly and loyal). 26 iaoms.org

December 2016

If Heaven exists, what would you like to hear God say when you arrive at the Pearly Gates? I am glad to see you. What is your idea of perfect happiness? Being with family and Friends. What is your greatest fear? Fire.

What is the trait you most deplore in yourself? Laziness.

Which words or phrases do you most overuse? F***k

What is the trait you most deplore in others? Dishonesty.

What or who is the greatest love of your life? My wife, Heidi.

Which living person do you most admire? Paul Stoelinga.

When and where were you happiest? Arnhem, The Netherlands; 1980.

What is your most marked characteristic? Loyalty.

What is your greatest extravagance? Racing vintage cars.

Which talent would you most like to have? Skill at driving a race car.

What do you most value in your friends? Their friendship.

What is your current state of mind? Content.

If you could change one thing about yourself, what would it be? Devoting more time to be with old friends.

Who are your favorite writers? John Steinbeck, Bernard Cornwell and John le Carre.

What do you consider the most overrated virtue? “Book” Intelligence. On what occasion do you lie? When it is the wisest of two bad options and only if it is to benefit another individual.

What do you consider your greatest achievement? Continuing to learn. If you were to die and come back as a person or a thing, what would it be? Orthognathic Surgeon.

What do you most dislike about your appearance? My eyes.

Where would you most like to live? Napa, California.

Which living person do you most despise? Vladimir Putin.

What is your most treasured possession? My Friends.

What is the quality you most like in a man? Honesty.

What do you regard as the lowest depth of misery? The inability to work.

What is the quality you most like in a woman? Honesty.

What is your favorite occupation? Orthognathic Surgeon. December 2016

iaoms.org 27

Dale and Heidi.

Who is your hero of fiction? Richard Sharpe. Which historical figure do you most identify with? Abraham Lincoln. Who are your heroes in real life? Martin Luther King and Nelson Mandela. What are your favorite names? Marta, Danica. What is it that you most dislike? Self-absorption. What is your greatest regret? Not spending more time with Friends. How would you like to die? Quickly. What is your motto? Discipline of body and mind. ■

Copy Me RECONSTRUCTION OF PEDIATRIC CRANIO-FACIAL DEFECTS Pediatric head and neck malignancies are rare and biologically diverse from adult cancers. Unlike adult cancers which are mostly of epithelial origin, the majority of pediatric cancers arise from mesenchyme. While the treatment of malignant tumors often requires chemotherapy, surgery is indicated in benign tumors and those showing poor response to chemotherapy. Although ablative surgical principle is similar to that of adult tumors, the reconstructive needs are distinct. The major challenges of pediatric reconstructive surgery are to incorporate tissues that will facilitate facial growth.

A 7-year-old child presented with gradually progressive lower facial deformity. 28 iaoms.org

MONI ABRAHAM KURIAKOSE MD, FRCS1 SWAGNIK CHAKRABORTY MS, M CH2 SUBRAMANYA IYER M CH, FRCS3 1 Mazumdar-Shaw Cancer Center, Bangalore, India; 2Tata Medical Center, Mumbai, India 3Amritha Institute of Medical Science, Cochin, India

Radiographic examination revealed a bone destroying lesion of her right hemimandible involving the infratemporal fossa and middle cranial fossa.

December 2016

The patient underwent two debulking surgeries. The biopsy of the lesion suggested invasive fibromatosis. She underwent cranio-facial resection that involved excision of the right ramus and body of the mandible including the condyle and glenoid fossa, contents of the infratemporal fossa and clearance of tumor from the middle cranial fossa and tumor around the internal carotid artery and extending to the cavernous sinus.

The defect was reconstructed with a vascularized rib with costo-chondral junction, serratus anterior muscle flap, and a free calvarial bone graft to create a new glenoid fossa.

3 The immediate result demonstrated correction of the facial deformity with the new rib flap in place.

The patient was followed up serially during 12 years, demonstrating a symmetrical growth of the reconstructed mandible. However, the bone volume of the reconstructed mandible did not allow dental rehabilitation, requiring a secondary bone grafting. December 2016

iaoms.org 29

NextGen

TRAINING in South America universities and thus share our knowledge and extend learning. Are you Board-certified in your region? Since 2013, the Latin American Association of Bucomaxillofacial Surgery and Traumatology ALACIBU has created and promoted certification through the ALACIBU Latin American Board called BLACIBU. I believe that in order to be able to practice in a particular country, especially when you are a foreigner, it is important to be Board-certified. These certifications also allow patients to have greater confidence in their Oral and Maxillofacial Surgeons. I think that certification is necessary. 

By Maria Paula Villalobos Saavedra Maria Paula, first of all tell us about yourself: Where are you from, where did you train, why did you choose maxillofacial surgery? I was born and raised in Venezuela. I studied Dentistry at Zulia University in Maracaibo, my home town. I chose Oral and Maxillofacial as a speciality, because early in my undergraduate studies I observed that I obtained the greatest personal satisfaction when solving surgical diseases and alterations in the maxillofacial area. I like the dynamism of the profession and I feel that it definitely fits my personality. 

What is your scope of practice? And in what área would you like to specialize? I would like to focus on Reconstructive Surgery and the treatment of dentofacial deformities. I would like to further train in Orthognathic Surgery because I have a real passion for it! 

ell us about maxillofacial surgery in your country: T à How many surgeons are registered? How many training units? Is there a formal training program? Do you have a final examination? I live in Bogota (Colombia). Colombia has 201 specialists accredited by the Colombian Association of Oral and Maxillofacial Surgery to practice the specialty. I am finishing my 4-year training period in the Postgraduate Course of El Bosque University. My program has established national and international rotations (3-6 months). My program is led by Dr. Humberto Fernandez who enthusiastically encourages his team to pursue constant learning and research. Our postgraduate professors such as Dr. Carlos Ruiz, Dr. Diego Barreto, Dr. Miguel Escobar or Dr. Juan Pablo Gnecco take care of our training and evaluate our academic and surgical skills. In our rotations, we have the opportunity to interact with specialists from different schools and residents of other 30 iaoms.org

ow let´s talk about South America. Do you have N a system for rotations in neighboring countries? What do you envy (if anything) in other South American countries? In the postgraduate course of Oral and Maxillofacial Surgery of El Bosque University, there is a system of rotations abroad, that allows residents to discover other training centers. In my program we have established rotations in countries like Chile, United States (Jacksonville and Dallas), Venezuela and Costa Rica. I do not envy anything about the other countries, but I do feel a deep respect and admiration for the kindness with which they receive us.

Do you know IAOMS and its activities? What do you suggest to attract young surgeons to the association? The Colombian Association of Oral and Maxillofacial Surgery promotes the IAOMS activities through its website, so we are aware of all the available opportunities. If IAOMS wants to be more attractive for residents, it should offer more learning activities as hands-on courses, to learn specific surgical techniques from prestigious surgeons and teachers. à

What other suggestions do you have for international associations like ALACIBU or IAOMS? I would ask to have a more thorough integration in the activities of the local associations of the different countries, so that we have more contact and interaction, letting us all know more about the academic proposals that are suggested. ■ à

December 2016

THE IAOMS

LEARNING

NEXT LEVEL

EXPERIENCE

FORUM

EXCHANGE IDEAS THOUGHT-PROVOKING

TRENDS ADAPTING TO LEAD MARCH 30, 2017 • 8:00am REGISTER TODAY FOR THE IAOMS NEXT LEVEL FORUM (FORMERLY THE INVITATIONAL CONFERENCE) “Adapting to Lead” will focus on helping you advance your career and the OMS specialty by exploring a variety of topics related to management (personal and professional) and leadership. In four short hours, you will hear from experts in a variety of disciplines who will provide you with the tools you need to continue to Adapt and Lead. And there will be many opportunities for questions (and answers). This complimentary event is open to all ICOMS attendees; registration required.

I N T E R N AT I O N A L A S S O C I AT I O N O F O R A L A N D M A X I L L O FA C I A L S U R G E O N S

Report of Regional Meetings

A glimpse on AAOMS meeting By Deepak Krishnan

he 98th annual meeting, scientific sessions and exhibition of the American Association of Oral and Maxillofacial Surgeons (AAOMS) were held at the elegant Mandalay Bay Resort in Las Vegas, Nevada, September 18-23, 2016. Over 5000 attendees comprising oral and maxillofacial surgeons, resident trainees, professional allied staff including oral and maxillofacial surgery nurses, surgical assistants, practice managers, exhibitors and guests graced the event.

✔ To provide a platform for surgeon scientists to present their research ✔ To provide networking opportunities for OMSs, and their staff ✔ To exhibit the latest materials, equipment and services from different vendors to practitioners ✔ Annual meeting of the house of delegates, elections and administrative function including reference committee hearings

The annual meetings of the AAOMS typically serves the following major benefits:

The conference was preceded by two specific day-long pre-conference sessions – one on Anesthesia and the other on Head and Neck Cancer. All registered attendees had opportunities to participate in module programs on Implant Surgery, Obstructive Sleep Apnea and Facial

✔ To provide annual continuing education opportunities to its members 32 iaoms.org

December 2016

(ROAAOMS). This year the resident education program - Career Development: Practice Models and Transition Strategies for Rising OMSs was well attended and prompted much discussion. These sessions often draw large crowds of attendees, not only trainees. The practice management and allied staff sessions provided great learning opportunities for both the surgeons and their office and support staff on topics varying from infection control to keys to social medial marketing success. The meeting also provided opportunities to members to recertify in BLS, ACLS and PALS. Throughout the conference, surgeon scientists had opportunities to present their work as oral abstracts or posters. Forty-six oral abstracts and sixty-three posters were presented.

Aesthetic surgery. Sessions dedicated to these topics included lectures and panel discussions by content experts. Large symposia in topics ranging from pearls and pitfalls of virtual surgical planning to artificial lungs were presented. Additionally, fifty-two Surgical Clinics were offered : these are clinical courses that included case studies, technical hands-on courses, experts discussing innovative techniques and debating point/counterpoint of treatment options and general refresher courses for the clinicians who subscribe to life-long learning. Clinical interest groups (CIGs) in simulation, anesthesia, trauma, pediatric oral and craniofacial/ maxillofacial surgery and obstructive sleep apnea put on programs that serve members with interests in those aspects of the specialty. CIGs are excellent venues for networking and discussion for small groups.

The annual meeting serves as the venue for the three sessions of House of Delegates - the governing body of AAOMS. The new board of trustees and officers, such as the director of the American Board of Oral Maxillofacial Surgeons (ABOMS) get elected at these sessions. The change of guard of the top leaders of the organization also happens at these sessions. After a very productive year as President, Dr. Louis K Raffetto has passed on the scepter to Douglas W. Fain DDS, MD, FACS to lead the American Oral and Maxillofacial Surgeons. One of the largest collection of products, services and equipment for oral maxillofacial surgeons were exhibited at the meeting. More then two hundred companies participated in this year’s meeting exhibition. The exhibit hall also featured six corporate forums which drew large audiences. A virtual exhibit hall was a feature offered this year that allowed participants to visit the exhibitors online for their contact and product details. The large carnival of the AAOMS meetings with multiple concomitant sessions always has something to engage everyone throughout their time at the meeting. Attendees hopefully did venture out to be wowed by the sights, sounds and flavors of Vegas. The 99th AAOMS meeting is scheduled for October 9-14, 2017 in the “city by the sea” – San Francisco California. ■

A prominent group at the annual meetings are the OMS trainees and the Resident Organization of AAOMS December 2016

iaoms.org 33

Report of Regional Meetings

EACMFS London 2016 By Paul Grogger, MD Trainee at the Department for Department of Cranio-, Maxillofacial and Oral Surgery, Medical University of Vienna, Austria

he participants of this year’s Congress of the European Association for Cranio-Maxillo-Facial Surgery held in London were met with pleasant weather and a wide array of highly informative symposia, masterclasses, oral sessions and poster presentations. The congress was held in the centre of London, at the Queen Elizabeth II Conference Centre, which served as a convenient, modern venue. After a hassle-free registration, its friendly staff helped with the installation of the EACMFS Smartphone App, which provided guidance through the multitude of topics with a very helpful search function and the option of instant access to abstracts or summaries of any symposium, lecture or masterclass on which you desired information. Particularly interesting for new members of the OMFS community was the John Lowry Trainee Day, which covered topics ranging from academic writing skills to an overview of the basic principles of craniofacial surgery, as well as an introduction to 3D pathology visualization and microvascular and reconstructive surgery. The congress’ biggest auditorium, aptly named “Churchill”, hosted the symposia which attracted the most attention. The names of these symposia - “Human factors in 34 iaoms.org

surgery”, “Head and neck cancer”, “Craniomaxillofacial reconstruction”, “Cleft lip and palate”, “Facial cosmetic surgery”, “Craniofacial deformity”, “Temporomandibular joint”, “Skin cancer”, “Surgical simulation”, “Traslational research” and “Osseointegrated implants” - illustrate the spectrum and complexity of our profession. Every symposium was split into multiple individual sessions that offered insight into the basic principles of that particular topic and the opportunity to learn about its potentials and limitations. Parallel to these, numerous oral sessions and masterclasses were being held in the other 15 (!) auditoria and smaller lecture rooms. But in spite of its busy schedule, the congress provided ample opportunity to take a break and catch some fresh air in direct sight of Westminster Abbey, to talk to colleagues, meet the speakers or visit the exhibition area, and, of course, afterhours’ leisure time to enjoy London’s well-known pub scene. In conclusion, the 23rd Congress of the European Association for Cranio-Maxillo-Facial Surgery offered a multitude of excellent opportunities for professional education and networking and should thus encourage CMFS trainees to take a break from daily routine and attend such great international events. ■ December 2016

By Arthur Jee, D.M.D. Treasurer & North American Representative, International Association of Oral Maxillofacial Surgeons (IAOMS)

The International Association of Oral and Maxillofacial Surgery (IAOMS) is a member-sponsored, member-driven, member-leadership organization. This is reflected in the dedicated volunteers who serve the association as well as in its financial pictures. OUR REVENUES As noted in the graphs, the majority of revenues is derived from membership dues. There are two other sources of revenue for IAOMS. They are IJOMS and the ICOMS. Recently, IAOMS contracted a multiple year agreement with Elsevier for IJOMS. This will provide a yearly cash flow for IAOMS. 2016 is a non-ICOMS year. Therefore the ‘budget’ is modestly negative since there is no ICOMS generated income. So, are we losing money? During ICOMS years, there are positive revenues generated, thus balancing the budget for nonICOMS years.

$973.950,00

$525.000,00 $330.000,00

$40.000,00 $ MEMBERSHIP

JOURNAL

ADMINISTRATION

$77.950,00 $1.000,00 ENEWSBRIEF

ICOMS

CONTINUING EDUCATION PROGRAMS

TOTAL RECEIPTS

TOTAL REVENUES

“The financial responsibilities IAOMS to

serve its members are reflected in both

$628.381

IAOMS and IAOMS Foundation.”

$513.696

OUR EXPENSES On the expense side, the majority of disbursements are general, administrative and programmatic costs. These expenses reflect the international nature of IAOMS. Majority of general and administrative costs are website development, internet access, communications - electronic and written.

$254.263

$100.150 $67.000

$64.135 $19.750

GENERAL EXPENSES

JOURNAL

ALLIANCE MEETINGS

BOARD EXECUTIVE OF DIRECTORS COMMITTEE

DISBURSEMENTS

December 2016

iaoms.org 35

$75.000

$30.800 SALARIES

CONTINUING EDUCATION

IBCSOMS

TOTAL GOVERNANCE & ADMINISTRATION

Women in IAOMS

BRAZIL

THREE GENERATIONS OF SURGEONS

MARIA EDUINA DA SILVEIRA LUCCA

MARISA APARECIDA CABRINI GABRIELLI

Orthodontist and OMFS Specialist.

Graduation in Dentistry, Araraquara Dental School, São Paulo State University-UNESP, Araraquara, SP, Brazil.

OMFS Department Assistant at the OMFS Department /Hospital das Clinicas- School of Medicine, São Paulo University. Head of the Maxillofacial Deformities and Orthognathic Surgery Group. Dentistry Division- OMFS Department / Hospital das Clinicas. Member of the Brazilian OMFS Board. Author: Cirurgia da ARTICULAÇÃO TEMPOROMANDIBULAR (Grupo Gen/ Editora Santos 2014). Cirurgia Ortognática e Ortodontia (2edição Grupo Gen/ Editora Santos 2010).

MSc in Periodontology, Araraquara Dental School. PhD in Oral and Maxillofacial Surgery, Araçatuba Dental School, São Paulo State University-UNESP, Araçatuba, SP, Brazil. Fellowship in Oral and Maxillofacial Surgery, Kaiser Permanente Hospital, Oakland, California, USA. AO Faculty. Professor of Oral and Maxillofacial Surgery, Department of Diagnosis and Surgery, Araraquara Dental School. Chairman of the Department of Diagnosis and Surgery, Araraquara Dental School. Director of the Residence Program in Oral and Maxillofacial Surgery, Araraquara Dental School. 36 iaoms.org

December 2016

GABRIELA GRANJA PORTO MSc, PhD in Oral Maxillofacial Surgery – University of Pernambuco. Oral and Maxillofacial Surgery of Regional Agreste Hospital, Pernambuco. Professor at the University of Pernambuco. Post-graduation Coordinator at the University of Pernambuco. Member of the Brazilian College of Oral and Maxillofacial Surgery.

MARINA GUIMARÃES FRAGA Doctor of Dental Surgery – Faculty of Dentistry of the Federal University of Minas Gerais. Oral and Maxillofacial Surgeon. Hospital das Clínicas of the Federal University of Minas Gerais. Aspiring Member of the Brazilian College of Oral and Maxillofacial Surgery. Specialist in Temporomandibular Disorders and Orofacial Pain.

RENATA PITTELLA CANCADO Scientific Director of Brazilian College of Oral and Maxillofacial Surgery Professor. Universidade Federal do Espírito Santo February 2014 – Present (2 years 10 months) Vitória Area, Brazil German. AFS Intercultural Programs 1989 – 1990 (1 year). Pontificia Universidade Católica do Ro Grande do Sul. Doctor of Philosophy (Ph.D.), Oral/ Maxillofacial Surgery 1998 – 2001 Universidade Federal do Espírito Santo. Universidade Federal do Espírito Santo Graduation, Dentistry 1989 – 1993.

➤➤ December 2016

iaoms.org 37

Women in IAOMS

... A Conversation with What was your model or your inspiration to become a maxillofacial surgeon? I never set up a goal. Everything in my life led me here.

MARIA EDUINA DA SILVEIRA LUCCA

“I see a developing country sharing information with the world”

What qualities would you recommend for a successful career in OMFS? Hard work, persistency, dedication and love. Any advice for younger women entering the profession? Never give up your dreams. If OMS is what you want, define a target and go for it. How do you manage your private life, partner and family? For me this was never an issue, OMS is a wide embracing specialty; it allows you to balance your private and professional life.

MARISA APARECIDA CABRINI GABRIELLI

“Professional space is not obtained without merit and this comes by showing professional competence”

What was your model or your inspiration to become a maxillofacial surgeon? I always admired the work of health professionals and had a tendency to seek a career in that field. Having graduated from Dental School, my greatest affinity was Oral and Maxillofacial Surgery, which became my professional passion. What qualities would you recommend for a successful career in OMS? Dedication, commitment, continuous learning; a theoretical foundation and clinical knowledge. Any advice for younger women entering the profession? Acquire knowledge and dedicate yourself to your work. Professional space is not obtained without merit and this comes by showing 38 iaoms.org

December 2016

Is it problem for your partner if you are an OMS? Not at all. He has always been very supportive to me. How do you see OMFS in Brazil in 20 years? I see a developing country sharing information with the world, mostly due to the continuous improvement in scientific and technological knowledge. Tell us about the first years of your career It was hard in the beginning, because the country was different back then and so was OMS. Has being a woman affected your profession? I faced training and financial difficulties but I grew up in a family that gave the same opportunities for men and women, so being a woman has never been an issue.

professional competence. Without that, one becomes a disposable and temporary fixture. Treat your patients with respect and honesty, regardless of their social and economic background. How do you manage your private life, partner and family? My private life is dedicated to my family. My son and daughter have learned – since an early age -- that their mother has an extensive working schedule; they are used to spending only part of their time with me. However, the quality of the dedication to them, when we were together, was extremely important for them and they hada positive view of my work during childhood. Now, as adults, I perceive that they are proud of my work and see me as a role model. Relationship with my husband was always very easy. We are from the

BRAZIL: THREE GENERATIONS OF SURGEONS same professional area and this approximates us a lot. He was always very enthusiastic about my professional growth and success. His support during my whole professional career development was unconditional. Is it a problem for your partner if you are an OMS? Absolutely no problem. On the contrary, we support each other. How do you see OMS in Brazil in 20 years? In the last four decades, several Brazilian surgeons had the opportunity to train abroad and bring in knowledge from several countries. Many outstanding foreign surgeons came to Brazil to give courses and lectures. With that, OMS in Brazil advanced conceptually and clinically. At the same time, in the last 20 years, the training of Brazilian oral and maxillofacial surgeons acquired a new direction with the formal acceptance of the residence training, which was made official by gonverment regulatory organizations. That, added to the expertise of surgeons who were trained abroad, allowed the specialty to effectively occupy its proper space and to be consolidated in this country. Presently, we have several centers that are highly capable of offering adequate training to young surgeons and quality treatment to patients. On the other hand we still lack technologies and resources which are readily available in developed countries. Another important point I see, especialy in the young surgeon, is that the desire for fast financial gain

and visibility leads to sacrifice of the quality of treatment and even to a superindication? (please clarify the use of the word superindication) of surgical procedures. I hope that in the next 20 years standarts of education and training will be widely applied in Brazil, with discontinuing inadequate programs and training modalities which still exist today. Also, I hope that, with good practices and standarts of care, as well as less taxation and adoptio of compliance measures, the use of new technology, techniques and materials, will make OMS a more suitable cost and therefore more widely available in this country. Tell us about the first years of your career In the begining of my professional career, which was in the early 1990’s, I was hired as a teacher for the Araraquara Dental School by the São Paulo State University- UNESP in the division of OMS. At the time, I started to obtain the requirements for an academic career. During the first three years, I worked a lot, teaching undergraduate students with lectures and clinical practice. At the same time, my clinical work in the affiliated hospitals, involving facial traumatology, dentoskeletal deformities, tumors, reconstructions and procedures was developed under the supervision of highly capable surgeons from our surgical team. During that period I had the opportunity of a one year fellowship in a cleft patient hospital. Four years after being hired, I took the MSc program in Periodontology and after that the PhD program in Oral and Maxillofacial Surgery. During that period and afterwards it

December 2016

iaoms.org 39

was possible to participate in many national and international continuing education courses in OMS. Among those, several were eesential to my education and professional developement, such as several courses promoted by AO and IBRA. What is AO? I became an AO faculty in 1996 and this allowed me to get to know many great surgeons in the specialty. It was and still is very enlightening to have the opportunity to learn from them and to exchange individual experiences. Later on I had the opportunity of a fellowship in the USA. I am presently a full professor of OMS, Head of the Department of Diagnosis and Surgery and Director of our Residence Program in OMS, besides other administrative functions at the university. I supervise graduate students of our MSc and PhD programs in Diagnosis and Surgery. My current surgical activities are in the areas of craniofacial trauma, dentoskeletal deformities, tumors, maxillofacial infections, bone reconstruction, implants and temporomandibular joint. Has being a woman affected your profession? – See edits to this question on earlier profiles Being a woman did not affect my professional career. I have been able, through years of dedication, to obtain my professional space. Surgeons with whom I interact, residents and members of our surgical team treat me with a lot of respect, where my professional opinion and conduct are well regarded. As for patients, I never experienced a situation where there was a lack of confidence in my professional skills because I was a woman.

➤➤

Women in IAOMS

GABRIELA GRANJA PORTO

“The first thing about doing any profession is passion.”

What was your model or your inspiration to become a maxillofacial surgeon? It dates back to when I studied abroad, in the USA. My high school had a professional orientation program that allowed me to follow a maxillofacial surgeon for a day. This profession has its role to care for people and that fascinated me. I knew right away what I wanted to do for graduation. It was love at first sight! After that, my professors at a Brazilian University were responsible for keeping the flame lit by profession. What qualities would you recommend for a successful career in OMFS? The first thing about doing any profession is passion. When you do something you love, everything tends to get much easier. After that, commitment to studying is mandatory because without knowledge, it is impossible to go further. The third quality is to have the capacity to make quick decisions; a surgeon cannot be indecisive. Any advice for younger women entering the profession? Don´t give up! Even if this profession seems to be mostly for guys, women have their place in the front row. We have about the same strength as men plus a women´s sensibility. We can be surgeons AND wives AND mothers. We are able to fit all in our lives, we just need to adjust our time!

MARINA GUIMARÃES FRAGA

“In order to be a good surgeon, with no doubt, one has to be responsible, dedicated, resilient and studious”

What was your model or your inspiration to become a maxillofacial surgeon? Unfortunately, in Brazil we are still few woman in oral and maxillofacial surgery. I didn’t know any senior female surgeon during my entire undergrad and residency time. Therefore, I didn’t have a specific role model when I decided to become a surgeon myself. What led me to this path was that I saw surgery as a way to be able to lessen the pain and suffering of others. My inspiration was always the patient. I wanted to help and to care for people. 40 iaoms.org

December 2016

How do you manage your private life, partner and family? Time is a matter of organization and choice. It is possible to be a surgeon and have a healthy private life. Of course, you cannot fill up all hours of your day with many jobs. Instead, you can work nicely 40 hours per week without sacrificing your personal life. Is it a problem for your partner that you are an OMS? A real partner will want his soul mate to be happy no matter the profession she chooses. Thinking like that, I´m very lucky, I have a real partner. My profession does not bother him because I´m able to share my time so our relationship does not move to a second plan. There is time for each important thing in my life. How do you see OMFS in Brazil in 20 years? Brazil has worked very hard to get the specialty strong. We have a very large number of active surgeons who fight for our profession in their own states. Besides that, The Brazilian College of Oral and Maxillofacial Surgery works very hard and has done a great job showing the importance of Oral and Maxillofacial Surveons to both the population and the government. Because of this panorama, I see OMFS each year stronger and more recognized overall.

What qualities would you recommend for a successful career in OMFS? In order to be a good surgeon, with no doubt, one has to be responsible, dedicated, resilient and studious. To have a successful career, in my opinion, the surgeon has also to show intuition, empathy and to truly care for what he/she does. Any advice for younger women entering the profession? I will give an advice that an wise surgeon gave me when I was entering the profession as well, for which I am very grateful for: Man and Woman

BRAZIL: THREE GENERATIONS OF SURGEONS are both capable, but they are different indeed. Some of these differences, which could be seen as weaknesses, might be in fact strengths. Sensibility and kindness, for instance, are often sought and very appreciated by the patient. How do you manage your private life, partner and family? During my OMFS training I had no time for my private life at all. Now I think I can organize my time better, defining priorities and making choices. I am not a mother yet, but I plan to have children. I must be honest that this matter worries me sometimes, since I do not know how I will manage this additional task. But I guess that is an issue for all the full-time working mothers,

RENATA PITTELLA CANCADO

â&#x20AC;&#x153;I chose this area of healthcare with the intention to work to improve the quality of life of the population at large.â&#x20AC;?

in every profession. I think that being an OMS does not make this especially harder. Is it a problem for your partner if you are an OMS? My partner is very enthusiastic and dedicated to his work as well, and me being an OMS is not a problem for him. He understands the importance of my commitment to my patients and admires my work. That makes easier for him to deal with my busy schedule or absence sometimes. How do you see OMFS in Brazil in 20 years? It is hard to answer this question because Brazil is undergoing big changes and challenges at the moment, politically and economically.

What was your model or your inspiration to become a maxillofacial surgeon? I chose this area of healthcare with the intention to work to improve the quality of life of the population at large. I wanted to find a way to make a difference, even if only on a small or local scale. I was inspired and attracted to surgery being part of the overall healthcare ecosystem. I have never had any specific role model but always liked the idea of teamwork and the interactions with my team members is one of the reasons I chose this profession. Working shoulder to shoulder with others, as a team, is not always part of a daily routine in other healthcare professions, which may leave people feeling isolated. What qualities would you recommend for a successful career in OMFS? Without a question -- dedication, personal effort, study and staying on top of the latest developments are qualities essential to being an excellent surgeon. But a successful career as a surgeon also depends December 2016

iaoms.org 41

The Brazillian OMFS College and many surgeons are engaged in strengthening the specialty in our country and abroad, and they have been doing a great job. But I am afraid that without a proper healthcare policy that much effort may not really change the current scenario. The vast majority of the Brazilian population does not have access to an oral and maxillofacial surgery service nowadays. Without satisfactory financial resource for the health system, it is not possible to change this situation and allow more people to benefit from our service. Our specialty has a lot to grow yet and what I hope is that, in 20 years, most of the public and private hospitals have a OMFS service and that we can really improve the quality of life of our population at large.

on having empathy, mindfulness and caring about your patients. These are qualities I try to invoke in myself and practice on a daily basis. Any advice for younger women entering the profession? This one applies to everybody, regardless of gender â&#x20AC;&#x201C; stay connected to your human qualities, because above all we are all humans working with other humans. For younger women in my profession, I would say, try to avoid assigning every error or difficulty that happena to the fact that you are female. I sometimes see some women in some situations put themselves in the position of a victim because of their gender or allow themselves to be put in those situations. This is a mistake, because all of us, regardless of gender, find ourselves in situations which can be equally difficult whether you are male or female. How do you manage your private life, partner and family? Since the beginning of my career, I have established two important things. First are priorities, which

must be defined and respected. Secondly – dedicating adequate amount of time separately for realizing each priority. Using these two concepts, we will be able to better organize our daily tasks using parameters of rationality, without missing out on anything important. Is it a problem for your partner if you are an OMS? I currently don’t have a partner. This has been a personal choice that has nothing to do with the fact that I am an OMS. How do you see OMFS in Brazil in 20 years? For the profession as a whole, it is difficult to make any predictions because we live in a country that is undergoing change all the time. On

the other hand, I certainly see the OMFS profession being part of the healthcare policy of our country in the future, in an effort to build a better nation. I do have a hope, however, that with every passing ay, more and more professionals of my área join the ranks who base their professionalism on such qualities as ethics and science. As far as women in my profession are concerned, I have seen their numbers increasing from year to year and believe that this trend will continue in the future. Tell us about the first years of your career I have always wanted to work in surgery rooms as much as teaching and researching. I clearly remember

my first years as a time of total focus, dedication, often neglecting my family and hobbies because of the shortage of time, the time when I was looking to create space for these two passions of mine – performing surgery and teaching. Yet along with memories of sacrifice and hard work, I also remember the care and support of my colleagues and professors who have helped to make my journey a little easier. Over time, as I have been able to conquer these two areas, I also have been able to bring balance to my personal and professional lives. Has being a woman affected your profession? Broadly speaking, I don’t believe that being a woman has affected my profession. The differences can sometimes be seen in small details; perhaps in a more emotional way with some situations, which can be a good thing and sometimes not very much so. I believe there are men and women of all types but what we need the most these days are professionals whofocus on technical and scientific growth within our professional area and focus on improving the quality of life of the general population. ■

For further information regarding the 2017 SASMFOS Orthognathic Surgery Congress and Cadaver workshop programmes, congress registration and accommodation please visit the website of The South African Society of Maxillo-Facial and Oral Surgeons at www.sasmfos.org/congress.php or contact Prof JA Morkel at jamorkel@uwc.ac.za.

FOUNDATION CHAIRMAN REPORT

A bi g

yo u

Let’s propose a toast

to education

s we end 2016 and look forward to a New Year, we give thanks for the many blessings we have received this past year and anticipate new beginnings and a fabulous ICOMS 2017 in Hong Kong. The IAOMS programs continue to be overwhelmingly successful, but we are handicapped by the limited resources of the Foundation.

We again this year sponsored three trainees (from Iraq, Nigeria and Puerto Rico), who participated in the IAOMS Foundation Fellowship Program, a comprehensive immersion program in India and China where participants learn from and work with expert OMS practitioners and clinicians, in the areas of Cleft/Craniofacial and Oncology/ Reconstruction. Through our Surgeon-to-Surgeon Program, highly experienced surgeons and teachers travel to emerging countries to train young surgeons, helping them master innovative procedures to advance global care standards. The number of applications we received for next year’s IAOMS Fellowship is at an alltime high, highlighting the increased need for training opportunities. The only way to be able to expand these programs and in the future, fund seed money for research is to increase our giving to the IAOMS Foundation. Our Foundation is dedicated to funding IAOMS projects to further educational opportunities globally. I have donated to the Foundation for more than 10 years and I know my contribution supports these two vital programs and other initiatives. As an OMF for more than 35 years, I know the importance of making training opportunities available and supporting the next generation of OMF surgeons. If you have contributed to the IAOMS Foundation, THANK YOU. If you have yet to contribute, please consider contributing today. We are nearing the end of the third year of a five-year KLS Martin matching grant and WE NEED YOUR HELP! Each dollar donated will equal two dollars available for education. Thank you for supporting the next generation of OMF surgeons. Please visit: www.iaoms.org/mpage/foundation to contribute today and help us meet our match. Best wishes for a happy and healthy new year – and see you in Hong Kong for ICOMS 2017!

Larry W. Nissen IAOMS Foundation Chairman December 2016

iaoms.org 43

WORKING IN PARADISE

COAST By Maria Petrocelli

Department of Maxillofacial Surgery University of Naples Federico II

t all began in May 1983 when I was born in Maiori, a little town in the Amalfi Coast. I had always wanted to became a maxillofacial surgeon, maybe thanks to my mother. She used to tell me stories about dental malocclusion cases, third molar extractions cases and lots of other oral surgery cases during her dentistry work in her private practice.

44 iaoms.org

After medical school I did my residency at Federico II University of Naples. After that I became research fellow at the Department of Maxillo-Facial Surgery, directed by Professor Luigi Califano, of the same University. Iâ&#x20AC;&#x2122;m happy I have remained to work for the National Health System and not as a freelancer like at the beginning of my career. I have always lived in the Amalfi Coast even though I work in Naples, about 60 km away from Maiori. The Amalfi Coast is known in the world as the set of

December 2016

In small towns like those of the Amalfi Coast, word of mouth and familiarity with family doctors allows me to visit a lot of patients affected by maxillofacial pathologies, ranging from facial trauma to oncological pathologies of the head and neck. Certainly during the spring and the summer, motorcycle accidents are more frequent; victims, who often refuse hospitalization at the time of the accident, are affected usually by mandibular or maxillary fractures. It is not uncommon to I’m The tourist season excludes only a few visit patients with orbital or zygomatic happy to be months a year (s November, January fractures, victims of assault after useful to people and February). Tourists includes alcohol abuse at the disco. In this way and act as a bridge foreign groups, school groups, I can visit them, frame them clinically from the Amalfi Coast regional groups during autumn and and instrumentally and after that I to the maxillofacial winter time until the “crazy and can program their recovery at the center of excellence desperate” tourism during spring and Department of Maxillo-Facial Surgery, where I work. summer. In this period hotels, roads, Federico II University of Naples, for discopubs and beaches, become a surgical purposes. melting pot of people and odors.” Three times a week at our Department, we have, This large influx of tourists, locals and commuters under general anesthesia, traumatology surgery, would need a polyfunctional Hospital easily oncology of the head and neck surgery functional accessible from all towns that are part of the Amalfi endoscopic and , reconstruction surgery; twice Coast. Unfortunately, that does not exist. So the weekly we perform, under local anesthesia, oral territorial emergency system will sort the urgent surgery, and facial soft tissue surgery. cases such as polytrauma victims of car accidents, motorcycle collisions or boat misadventures at the So, I’m aware that I live in a beautiful place where nearest hospitals (minimum 20 km distance) from there’s still some improvements to be made in the the Salerno and Naples districts. The less urgent health care system. I’m happy to be useful to people cases are managed by family doctors and doctors and act as a bridge from the Amalfi Coast to the focused on tourists. maxillofacial center of excellence where I work. ■ countries ranging from Vietri sul Mare to Positano that have an ancient history from the Roman Empire (1 century a.c.) up to 800 d.c. age of the Duchy of Amalfi and of the Maritime Republic. Today, Amalfi Coast is still a VIP destination for naturalistic attractions, scenic views, historical monuments, mild climate, handmade crafts, tasty local products… and I think those are the many reasons why I like to live here!

December 2016

iaoms.org 45

WHERE ARE YOU NOW?

Today

Dr. Victor Moncarz, Oral and Maxillofacial Surgeon By Deepak Krishnan

ear Dr. Moncarz

Where are you now and what do you do these days? I am still in Toronto in private practice. I work less and I continue to teach at the University of Toronto both at the undergraduate and postgraduate levels. Sharon and I travel a lot, mostly by bicycle in different countries. I have taken up woodturning and I am enjoying it very much. What do you consider the single most meaningful contribution you made to the IAOMS? When I took over as Executive Director, our 46 iaoms.org

membership was at about 3,000. When I retired from the position, membership had grown to about 5,000. I was part of the Executive Committee that reach out to many new regions, especially French-speaking and African countries, by talking with enlightening them about the benefits of the IAOMS. I believe that I was a goodwill ambassador for the Association. What is your perception of how the specialty has changed from when you started to now? When I first started in 1973, there was no rigid fixation, only wire fixation and IMF. The only orthognathic procedures we did were the sagittal osteotomy of the mandible for retrognathism, an anterior alveolar osteotomy of the anterior maxilla and an open December 2016

subcondylar or oblique osteotomy of the ramus for prognathism. Cosmetic surgery, implants were not part of our specialty. What do you miss the most about working in the IAOMS? I miss the camaraderie and working with the many talented members of the Executive Committee. Do you keep in touch with former IAOMS colleagues? Yes. I always look forward to spending time with them at the ICOMS. What would you change about your career path if you could? I would have pursued an MD degree although I would not change the scope of the surgery that I did and that I am doing. Nor would I change the career choices that I made. Which technological advance in the specialty would have made a difference in your surgical activity? Rigid fixation, implants and grafting techniques related to implants and computer technology used in diagnostics and treatment planning.

What advice do you have for the OMS trainee starting training in 2016? Enjoy the training process and amass as much knowledge as you can. Continue to educate yourself once your career is launched. Develop a balance between your professional career and your personal life and family. Make time for yourself outside of the specialty. Give back to the profession and your community. What are you currently reading? The final volume of “The Clifton Chronicles” by Jeffery Archer. ■

Beyond OR

Check Your Digital Profile By Javier González Lagunas (follow me on

@golagunas)

es, you have to do it. Because it is very likely that your patients want to know who you are before making an appointment with you. And your digital profile is not only the information you share on Linkedin. All social media and websites contribute to your digital reputation, not only what you post, but also and most importantly, what your patients or others post about you. The Internet is now the main source of information for patients, more than “Word of mouth” recommendations. According to Doctoralia (one of the main portals for health information in Spain), international surveys in 2015 and 2016, show that more than 70% of patients search for information about their disease on the web. The groups that use the Internet the most are women, and individuals younger than 34. But you are wrong if you think that individuals 60 and older do not use digital resources. More than 60% of internet users in that age group use health information obtained from the Internet during their medical appointments. Internet searches related to health include information about particular disorders (96%), drugs (92%), doctors (91%), or medical procedures (89%). These Internet users also want to know the experiences shared by other patients with the same disease or doctor. Online doctors ratings are a key component of the professional profile. A patient´s decision to select you depends on the experience of previous patients, so do not ignore their opinions. Patients and prospective patients care about your manners, your empathy, the wait time in your practice, ease of scheduling/ availability and follow up. Not only that, they want to know about your reputation, your areas of expertise and the opinions of other patients. As a matter of fact, most patients are willing to share their opinion about their doctors. And they use not only specifically health-related websites like WebMD or Healthgrades in the U.S., but also platforms like Yelp, where customers rate trattorias in the neigbourhood, the on-time performance of airlines and also the kindness of your staff. The dark side of this abundance of information is that unfortunately comments and criticisms can be 48 iaoms.org

anonymous: unhappy or angry patients can easily defamate you. And once the posts are disseminated, there is not much you can do to defend yourself. Today there is no distinction between your personal online profile and your professional online profile. The first one is directed to your family and friends while the second one is directed to a public audience. But if you are not careful, the barriers of privacy can be broken broken. So, think twice when you are publically displaying pictures or comments – which can reflect on you as a physician.

The Internet is now the main source of information for patients, more than “Word of mouth” recommendations.

Be smart. Take advantage of the Internet resources and social media. Let your patients know that you are ahead of the curve. Use the paper you have just published in IJOMS or your lecture at ICOMS, update it and make it readable for the general population. Then, look for health forums related to that particular topic, and post your research. Most patients want relevant information they can trust. Keep your patients well informed and you will become their guiding light.

So check your digital profile. Learn what is available online about yourself and your practice or department. And then ask yourself: is that how you want to be seen? Your Internet presence will have a deep impact on your colleagues, employers and patients. ■ December 2016