Issue 50 / July 2017
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 Eric Kahugu, 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 Alfred Lau, IAOMS NextGen Committee Steve Roser, COGS Committee Fred Rozema, IT Advisory Committee Mark Wong, IBCSOMS Representative Alfred Lau, Membership and Communications Committee Alejandro Martinez, Governance and Ethics Committee Luiz Marinho, 24th ICOMS-2019, Brazil David Koppel, 25th ICOMS-2021, Glasgow CONTACT US IAOMS
8618 W. Catalpa Ave., Suite 1116, Chicago, IL U.S.A. 60656 1.773.867.6087 / firstname.lastname@example.org
Letter from the Editor HOW I SEE IT
he new issue of Face to Face, opening the summer season, is now in your screen. With the arrival of heat, good weather, and the ensuing increase in outdoors activities, Oral and Maxillofacial Surgeons in the northern hemisphere will have to deal with the consequences of sports injuries that will often affect the faces of our patients. Facial trauma is the core of our speciality: few parts of Maxillofacial Surgery represent us as well as trauma does. We have in our hands the prevention of accidents: we have the responsibilty of educating the general population and sports authorities. But we can also directly recommend our patients the use of various helmets and mouth guards to protect the facial bones and the teeth, And when the accident occurs, we are also responsible to restore a face that meets all the aesthetic and functional parameters prior to the accident. Face to Face has more to offer. You will find our usual sections, with contributors coming from Italy, Panama, Indonesia, Sudan or Sweden. You will discover that our former President Dr. Laskin is not yet retired at 93. In this issue we pay special attention to NextGen. We are proud to introduce the members of the new council, who represent the youngest members of our association. Scientific associations need renewal, the entry of new leaders and new ideas that allow its adaptation to the new social and professional environments. And we hope that Nextgen is the seed that will help IAOMS to grow better, faster and stronger. And of course do not forget to read our President Julio Acero’s column, along with the rest of contributions of our officials. IAOMS is alive and extremely active, so do not lose any of the learning opportunities that our association has to offer.
Javier González Lagunas EDITOR IN CHIEF
“We have in our hands the prevention of accidents: we have the responsibilty of educating the general population and sports authorities.”
CONTENTS July 2017 10 SPECIAL REPORT
Sports and facial trauma A DAY IN THE LIFE OF... 16 a Maxillofacial Resident in Panamá
20 PROFESSIONAL AND LIFE EXPERIENCE
Safed, Israel SO, YOU WANT TO WORK... 22 ...in sweden
24 WOMEN IN IAOMS
Colourful Collaboration FROM PROUST TO PIVOT 26 Prof. Piero Cascone
29 NEXT GEN
The New NextGen Council FELLOWSHIPS 32 A voice from Sudan
34 WHERE ARE YOU NOW? Dr. Daniel Laskin
BEYOND THE O.R. 36
Hooke’s Law, Surgery and Burn-out Syndrome
DELIVERING VALUE FOR MEMBERS It’s the only association that makes me appreciate who I am, where I’ve been and where I’m going. I joined in 2001 when I was a resident and knew nothing.
’ve been reflecting on that comment since I heard it in conversation at ICOMS. It demonstrates how central IAOMS membership is throughout every stage of your career. And it is just one of the ways to sum up the experience of being an IAOMS member: when you join IAOMS, you join an international, collaborative community of fellow surgeons who are dedicated to research and providing the best possible patient care. And so often, these fellow surgeons become life-long friends. Membership – helping members build their practice, the profession and improve patient care -- is at the heart of IAOMS. For me, the “M” in IAOMS might be an abbreviation for “member.” As our membership continues to grow, I’m excited to share with you some new benefits: Next Level Forum/Digital At ICOMS, we introduced The Next Level Forum with a moderated panel discussion and Q&A before a live audience. Our goal: help members advance their career and the OMS specialty by exploring issues and best practices related to leadership and management (both professional and personal). Understanding the value that The Next Level Forum offered, we wanted to make it available to more members throughout the year – and that’s why we created the Next Level Forum/Digital Webinar Series: monthly, one-hour webinars featuring a 45-minute presentation (followed by a 15-minute Q&A). The first series is presented by Debra Zabloudil, the IAOMS Education Consultant and moderated by Dr. Alexis Olsson, IAOMS Vice President. The May webinar provided “Essential Tools to Turn Problems into Opportunities” while the June webinar helped participants identify the verbal and nonverbal communication skills required to effectively deliver a difficult message with confidence and clarity (“Difficult Conversations: More Gain, Less Pain”). The July webinar, “Pitching Your Ideas and Selling them Sideways,” will help IAOMS members understand how to develop a strategy to pitch an idea successfully.
If you are thinking of becoming an IAOMS member, now is a great time to join and participate in the June 29 webinar. Join IAOMS and you’ll receive an invitation to the Next Level Forum/Digital Webinar Series. Stay tuned for information on the fall line-up. We continue to offer our Scientific Webinars and we will announce the summer and fall topics soon. My thanks to Dr. Juan Antonio Hueto for his leadership in planning and facilitating these Scientific Webinars. Next Gen Council We launched this group of next generation OMF surgeons at ICOMS. The six leaders (one each from Africa, Asia, Europe, North America, South America and Oceania) will be working with Dr. Alfred Lau from the Hong Kong Association of Oral and Maxillofacial Surgeons to develop programming specific to the needs of the next generation. I look forward to sharing their progress with you. Looking Ahead: Greater Connections with Members We are updating and restructuring our online educational programming. Based on a comprehensive member study we conducted, we identified specific needs based on regions of the world. We will roll out the first wave programming for IAOMS members in Africa and then to our Next Gen members, focusing on their need for programming geared just for them. Watch for more information on these two programming areas – as well as others -- as we continue to expand IAOMS educational programming. On a related note, we are working on developing a new website that will be a central hub for member communications -- with increased functionality and a new look, to name just a few of the new features. Our members – and our volunteer leadership – are the heart and soul of the IAOMS. My thanks to all of you for your membership and your commitment to IAOMS and the IAOMS Foundation. With your energy, engagement and ideas, we continue to help you build your practice and the IAOMS profession. Regards, Mitchell Dvorak EXECUTIVE DIRECTOR, IAOMS
Letter from the President IAOMS: THROUGHOUT THE WORLD AND IN YOUR REGION Dear Colleagues and Friends:
fter the very successful ICOMS in Hong Kong, the intense activity of the IAOMS continued. During the last eight weeks, I’ve had the pleasure to represent the Society and meet with many of you:
• In Bangalore, India, at the IAOO World Oral Cancer Congress where I was honored to speak at the Inaugural Ceremony. My congratulations to Dr. Sanjiv Nair, the Organizing Committee Secretary, on a successful Congress where the presence of OMFS was very important. • In Beijing, where I visited the Oncology and Reconstruction Fellowship Training Center at the Department of Oral and Maxillofacial Surgery, Beijing University School and Hospital of Stomatology and gave a lecture as invited professor. My recognition to our Chinese colleagues for their commitment to the IAOMS and for the great hospitality and specially to Prof. Yu, current President of the Chinese Stomatological Society. • In Malaga, Spain, where I was honored to represent the IAOMS at the 24th Congress of the Spanish Society of Oral and Maxillofacial Surgery (SECOM). It was a great pleasure for me to attend the presentation of an honorary SECOM membership to Dr. Rui Fernandes, the IAOMS Education Committee Chairman. • In Naples, Italy, at the Congress of the Italian Society of Maxillofacial Surgery. Later in August, I will have the privilege of representing the International Association at the XX CIALACIBU (International Congress of the Latin American Association of Oral and Maxillofacial Surgery and Traumatology), to be held in Buenos Aires, Argentina. These travels give me opportunities to connect with OMF colleagues, many of them IAOMS members near and far and allow me to represent the IAOMS – an organization of which I am so proud -- while promoting the OMF Specialty worldwide. Whether I’m in Bangalore or Beijing or Buenos Aires, I’m reminded of the unique global reach of the IAOMS – and the expertise, dedication and collegiality of our members.
IAOMS Leaders Advance the Specialty I am also pleased to report on our leadership’s involvement in advancing the OMF specialty globally. My thanks to Dr. Piet Haers, the IAOMS Immediate Past President, and to Dr Nabil Samman, Chairman of the last ICOMS and Editor-in-Chief of the IJOMS, who participated in the Turkish ACBID conference and are contributing to a new IAOMS Symposium to be held in collaboration with our Turkish colleagues in Turkey next year. My thanks also to Dr. Alejandro Martinez who recruited several NextGen IAOMS members at the Mexican Conference on OMF Surgery. And my very special thanks to Dr. Larry Nissen, former IAOMS President and current Chairman of the IAOMS Foundation, for his tremendous work leading a
to help increase membership. I am happy to tell you that we are closing out our membership year on a high note. My appreciation to our headquarters staff, who under the leadership of our Executive Director, Mitch Dvorak, has been working with us on several important initiatives. I’m pleased to update you on some of them: • e-Learning Program The new series of live webinars which was launched recently under the leadership of Dr. Juan Antonio Hueto, Chairman of the E-learning sub-Committee, have been extremely successful. We are expanding this subCommittee with other colleagues including Dr. Michael Markiewicz (USA), Dr. Alberto Haddad (Spain), Dr. Eric Kahugu (Kenya) and Dr. Su (Hong Kong). • Next Level Forum/Digital We introduced the Next Level Forum concept at ICOMS – to help IAOMS members advance their career and the OMS specialty by exploring issues and best practices related to leadership and management (both professional and personal). Next Level Forum/Digital expands on that concept and offers live, one-hour webinars. The first series, (which features IAOMS Education Consultant, Debra Zabloudil), is moderated by IAOMS Fellow and Vice-President of the Association, Dr. Alexis Olsson. Topics include: “Difficult Conversations: More Gain, Less Pain” (Wednesday, June 28) and “Pitching Your Ideas and Selling Them Sideways” (Wednesday, July 26). successful Annual Appeal for the IAOMS Foundation. Through Dr. Nissen’s efforts and the generosity of many IAOMS members and corporate partners, he has secured donations of US $ 300,000, more than half of our 2017 goal.
Our Website Working Group under the leadership of Dr. Gabi Millesi, is moving ahead on planning the new IAOMS website. Later this year or early 2018, we look forward to the launch of the new website – which will provide greater functionality and enhance user experience.
Together, all of us – whether through scientific lectures, meeting with OMF colleagues, mentoring the NextGen and contributing to the IAOMS Foundation -- together we are building this organization and providing valuable benefits to members.
My thanks to all IAOMS members – for your work in and out of the O.R. and your practice. It is your energy and commitment that make the IAOMS the leading global association for OMF surgeons – and help us advance the specialty throughout the world.
Delivering Value to Members Since my Presidency started, my main goals have been to increase communication to our members and to make the Association a “go to” organization for OMF surgeons
Kind regards, Julio Acero IAOMS PRESIDENT 2016-2017
Sports facial and
01 Ice Hockey:
a Serious Risk for the Face By Glenn Maron, DDS Private Practice Atlanta, Georgia
The incidence of facial trauma in sports is approximately 18% of all sports- related injuries. Ice hockey had a particularly high incidence of facial trauma in the early years of the sport. In 1929, The first catastrophic injury, the loss of an eye occurred. After this, the National Hockey League (NHL) rules did not permit players to play with only one eye. The same rule was applied in the Canadian Amateur Hockey Association (CAHA) when a player from Ontario, named Frank Trushinski, suffered an injury to one eye and later to his other eye, leaving him legally blind. In 1959, Jacques Plante was hit in the face by a shot from New York Rangers player Andy Bathgate. When he returned, he was wearing a crude goalie mask. He refused to return to the goal unless he kept the mask. The Canadiens won 3-1. Plante subsequently designed his own mask and masks for other goalies. 10 iaoms.org
Dr. Maron was the team Maxillofacial Surgeon for the Atlanta Thrashers Hockey Club, the Atlanta Falcons football team and still serves the Atlanta Braves baseball team. Dr. Maron served on the NHL Team Physicians Executive Committee for 5 years, and has been involved in changing the emergency protocols for the NHL. He was the official Oral and Maxillofacial Surgeon for the 1996 Olympic Games in Atlanta. Most players, other than goalies, refused to wear masks. In 1978, ice hockey eye injuries gained international prominence. The first international ice hockey doctorâ€™s conference of the International Ice Hockey Federation (IIHF) met in Prague, Czechoslovakia. After this, the use of eye protectors for hockey players became common. Later that year came the introduction of the mandatory use of a full facemask in amateur hockey. The consequences of these changes show that blinding injuries are virtually non-existent when approved, full facemasks are used. Eye and facial injuries have decreased dramatically over the past 20 years as mandatory facial protection was instituted in collegiate and minor league play, too. The problem, however, remains that as soon as they enter the NHL, many players remove that layer of protection, making them vulnerable to injury. The risk of eye injuries is particularly concerning as permanent vision issues can lead to career-ending and catastrophic consequences. Sticks, pucks and direct blows from a fist are the common causes of these injuries. Over the course of the past few years, a number of injuries to the face continue to cause players to miss games and have led to the end of careers of several prominent players, including Chris Pronger, from name of team. Yet there remains a culture in professional hockey that tolerates players not wearing facial protection. This is an ongoing battle that those of us close to the game have been dealing with since 2007. Additionally, fighting is not only allowed, but is actually part of the game. No other sport, other than boxing or Mixed Martial Arts, allows players to fight to the point of actual injury. While team doctors and front office management continue to fight the battle over mandatory face shields, players who do get injured need to have access to the best possible care available. Oral and Maxillofacial surgeons are uniquely qualified to provide this care and around the have treated innumerable injuries. From minor lacerations, avulsive dental injuries to facial fractures, OMF surgeons in the NHL have been there to take care of our players. July 2017
The rewards to those of us treating these world-class athletes are something that is hard to explain but it is an extremely energizing part of our practices. When you get involved with an any sports team, be it high school, club or professional, you expand your practice on multiple levels. The feeling of belonging to something bigger than your practice or institution provides personal satisfaction as well. The goals of trauma care for professional athletes is the same as all trauma care. Stabilize the player immediately, assess airway and confirm c-spine stability and then proceed with definitive care as quickly as possible. The role of rigid fixation is extremely beneficial to provide excellent reduction and stabilization of fractures, but additionally by limiting or avoiding maxillomandibular fixation, the high nutritional needs of these individuals can be better maintained while they are healing and are released to play again. In summary, the oral and maxillofacial surgeons involved with professional hockey have an important role: they provide the highest level of facial trauma care. It is an honor to work with world class athletes, trainers and other medical professionals. We also have a responsibility to continue to push to provide a safe playing environment and contribute to research and developing equipment for athletes. â– iaoms.org 11
How to Protect your “Game Face”
By Stephanie J. Drew, DMD Private Practice, Long Island, New York
hat better time to remind us all about the importance of prevention of facial trauma than during National Facial Protection Month in April in the U.S. The movie “Concussion,” written by Peter Landsman, depicted the advancement of identification of the serious nature of multiple head injuries and the long-term effects on our health and psyche. The development of various head gear to protect the cranium with evolving technology to absorb the shocks of direct contact were then brought from test dummy labs to the professional and amateur fields. Team sports on fields and courts and rinks such as basketball, football, soccer and hockey, lacrosse and Rugby have a high risk of running into another player. Sometimes the goal is to run into another player! That being said, common injuries are strains and sprains, fractures, contusions and abrasions and of course, 12 iaoms.org
concussions. The risks of specific injuries for each individual sport dictate the need for specific types of protection. Contact sports require padding to protect primary contact points. Vital areas such as the head, neck, kidneys, and genitalia have priority for protection equipment. High velocity hazards such as pucks and ball sports require helmets, face masks, and eye protection. The face is on the top of the lists of common locations for these injuries for contact sports. How do we protect the rest of the face and jaw? What do we have out there to ensure that when we do make contact the hard and soft tissues of the face are protected to the best of our ability without interfering with our performance? The most common types of sports related face trauma are soft tissue injuries and fractures of the nose, zygoma, and mandible. July 2017
Dentoalveolar trauma occurs often in combination with theseinjuries.
BASKETBALL FOOTBALL BASEBALL/SOFTBALL
Starting from the orbits, sports goggles or guards attached to helmets are recommended for sports such as baseball, basketball, football, and soccer. The hockey world has recommended both goggles and face masks to protect players from punches, sticks and pucks.
STRAINS/SPRAINS FRACTURES CONTUSIONS/ABRASIONS LACERATIONS
CONCUSSION INTERNAL INJURY
LACROSSE/RUGBY HORSEBACK RIDING
RIES ED FACIAL INJU
TS RELAT COMMON SPOR
he teeth and soft tissues of the lips, T however, are not always protected from injury with just a helmet and sports goggles. About 30 percent of all dental injuries are sports- related. Face masks do help. However, if the chin is exposed, the mask may not fully protect the mouth or jaw from a direct shot to the chin. Mouth guards are recommended for all contact sports. The guards range from custom-made, boil and bite made of a special rubber, to ready-towear made of either rubber or polyvinyl. Orthodontic custom mouth guards are also made of rubber or polyvinyl. The custom guards are the most protective. It is difficult, but not impossible, to make guards for patients in braces.
SOFT TISSUE HARD TISSUES LACERATIONS LIPS OR SKIN MANDIBLE FRACTURES
he mouth guard helps absorb the shock of impact T and distributes the forces to protect the teeth and jaws. One other interesting fact is that when the guard is made properly, the teeth are separated.
ORBIT TRAUMA MAXILLARY FRACTURES TONGUE INJURY BLOW OUT FRACTURES DENTOALVEOLAR FRACTURES DENTAL TRAUMA NASAL FRACTURES SKULL FRACTURES ZYGOMATICO-MAXILLARY COMPLEX FRACTURES
Thus, the joint is down and away from the base of the skull. This also helps protect the brain from concussions because the jaw bone is prevented from slamming into the skull and creating a shock wave to the brain. The guard can actually absorb almost 40% of the impact energy! Decreasing the impact decreases the risk of neck injuries as well. To help prevent fractures and facial injuries from occurring, coaches and parents should make sure that the rules of the game are adhered to and decrease unnecessary roughness. Protective helmets and eyewear and mouth guards are a must. Coaches must keep watch on novice players because their skill level predisposes them to injury to themselves or other players. Coaches also should make sure their athletes have adequate rest. Tired players are sloppy players. â–
03 Cycling and facial trauma By Eduardo Sánchez Jáuregui (attending staff) and Álvaro Pastor (resident) Department of Oral and Maxillofacial Surgery. Hospital Universitario Ramón y Cajal, Madrid, Spain
acial trauma is one of the most frequent injuries treated at Emergency Departments and an injury maxillofacial surgeons deal with, each and everyday. Among the distinct and most common causes of facial trauma we will find traffic and sports accidents, violence, and domestic and occupational accidents. And men between their second and fourth decade of life arethe likely victims. Nowadays, riding a bicycle has become a healthy habit – good for individuals of all ages and for the environment. Combined with the increase in security measures concerning four-wheeled vehicles in many countries, cycling has become the most frequent
cause of facial trauma in the last few years. In 2016, 25,000 people died on European Union roads; a significant number were the so-called “most vulnerable users:” pedestrians, cyclists and motorcyclists. According to the University of Valencia’s “Analysis of the Cyclist Accident Figures 2008-2013” and based on official data from the Spanish National Department of Traffic (DGT), accidents caused by bicycles have doubled in that five-year timeframe in Spain, It is estimated that 25,439 cycling accidents (resulting in 303 deaths) have occurred. Another important fact to take into account is that half of the accidents involved cyclists wearing a helmet; this percentage decreases
when considering children under the age of 14, where 8 out of 10 were wearing helmets. When assessing a poli-traumatized patient for the first time, the priority must be the airway, as it is shown by the “ABCDE” sequence of poli-trauma management. Bicycle accidents can cause lesions, from the simplest ones, namely a contusion, to severe traumas such as traumatic brain injury or panfacial trauma. The complexity of the maxillofacial trauma depends on the affected areas and the severity and depth of the lesions. The main objective with these patients is restoring the osseous architecture, paying special attention to the facial proportions, maintaining the facial height, width and projection. All of this is achieved by an anatomic reduction, which would lead to the reconstruction of more complex structures (the orbit for example) and keeping in mind the correct occlusion. Signs and symptoms of this type of maxillofacial trauma include: facial pain, disocclusion, breathing problems, facial and intraoral bleeding and dental avulsion and mobility.
Maxillofacial injuries can be divided into three groups: 1. Inferior third: jaw fracture. 2.Middle third: orbital, orbithomalar, nasal bones, nasal-orbitho-ethmoidal fracture. 3. Upper third: orbital ceiling, frontal sinus and bone. In panfacial fractures, three levels are involved in the lesion. There are multiple articles that aim to set the order of treatment. In our hospital, the rule “from top to bottom” is strictly followed, from fixed areas to moving ones and in posterior-anterior direction. The most frequent cause of panfacial fractures is bicycle accidents, which have recently surpassed car accidents in frequency. Due to its anatomic position and the complexity of the lesions, the main fractures are usually those suffered in the middle third of the face (nasal fractures mainly), followed by maxillary and mandibular fractures and finally, fractures in the zygomatic-orbitho-malar complex. The severity of these lesions appears to be higher when the middle third and the upper third are involved. Injuries of these two thirds are more frequent in accidents involving sports and mountain bikes. However, injuries of the lower third are more common in urban and leisure cycling. ■
Hours A DAY IN THE LIFE OF A MAXILLOFACIAL RESIDENT IN PANAMÁ By Jorge Nuñez Chief resident, Oral and Maxillofacial Surgery Department Complejo Hospitalario Metropolitano Dr. Arnulfo Arias Madrid, Panama City
fter getting my DDS degree, I applied and was accepted into the Oral and Maxillofacial Surgery program at the Metropolitan Hospital Complex Dr. Arnulfo Arias Madrid in Panama. . This hospital serves as the main social security hospital in the country.
surgery clinic on those days for patients requiring local anesthesia. Wednesdays are for lectures and academic work until about 11 am. Later on, we do presurgical consultations and ambulatory surgeries under local anesthesia.
I am in the chief year. The program has a four-year curriculum which includes rotations to other hospitals around the city such as, the Children’s Hospital, the National Institute of Oncology, and Santo Tomás Hospital. The program also allows a fourmonth international rotation at any hospital in the world that the resident selects. Our department consists of four residents (one per year), the attending surgeons in Oral and Maxillofacial Surgery, and a few general dentists. Our week is broken down as follows: On Mondays and Thursdays we have an outpatient clinic in which we do oral surgery procedures under local anesthesia, pre-operative consultations, and postsurgical follow ups. Tuesdays and Fridays are our designated days in the operating room. On those days, we schedule elective surgeries but also take care of any last minute emergency cases under general anesthesia. Simultaneously, there is an oral 16 iaoms.org
8:00 a.m. Today it’s Tuesday, so I’m going straight to the operating room after rounds. I check that everything is as scheduled, including the playlist that keeps the boss relaxed. The only thing we need to wait for is the anesthesiologist’s approval so that we can take our patient back to the operating room. In addition, we must comply with all established hospital protocols prior to the operation. With the patient anesthetized, we start the surgical procedure. Under the supervision of the attending surgeon, who likes to ask me tricky questions while I operate, we carry out the surgical plan. At the end of the case, I critique my performance so I can continue to improve every day. The operating theater program runs until 3 pm, sometimes even later.
5:15 am The alarm sounds, my body and mind feel that I have slept only a few minutes. After having read, prepared, and mentally done the surgery of the patient we will have in the operating room today, I get up with energy and enthusiasm to make the theory a reality. I take a shower and eat a light breakfast.
I get into my car and turn on an application on my cellphone that looks for the best route to the hospital. I’m fine on time. The heavy traffic has not started yet. However, if I get set behind by five minutes, it is very likely that I will be late to work.
All residents meet in the hospital’s 7th floor ward to find out about the new patients that were admitted, their condition, and to prepare ourselves to present the patients to the attending surgeons.
The entire team rounds on all the patients that are admitted to our service and we make decisions about their cases, subject to the attending surgeons’ approval.
In between cases, if there is time, I try to eat a quick lunch.
All residents round on the inpatients who had been previously admitted, and do post-op checks on those operated today. The attendings are then updated on the condition of each patient. Today I’m not on call, so I get to go home.
After horrible traffic, I arrive home and receive my little boy who asks me to play with him. I have to find some strength so that I do not miss this valuable moment. My wife greets me and asks how my day was.
Hours 7:30 p.m.
Dinner is ready and we share as a family.
With low energy and a tired look, I go to sleep because tomorrow will be a lecture day and a lot of oral surgery procedures in clinic.
I give a goodnight kiss to my little boy. I start to read some articles to finish reviewing the presentation for tomorrow, and finish organizing photos from previous cases. I call the resident who is on-call to find out the condition of patients operated on today. Everything is going well.
My cell phone rings. It’s the resident on call telling me that there is a trauma patient with multiple facial fractures and traumatic brain injury. Neurosurgery will be taking the patient to the operating room and they want to know if Maxillofacial surgery would like to follow after they are done. I analyze the case next to my co-resident and we go over the CT scan images before reporting the case to the Maxillofacial surgery attending on call. We will follow Neurosurgeons. I immediately coordinate with the resident on call so that we can have all of the necessary equipment. I shower, get ready, and head over to the hospital. I know that I will not be coming back that night. Therefore, I kiss my son and wife goodbye, who are in their deep sleep. Once I get to the hospital, I wait for neurosurgeons to tell me when they are getting close to the end so that I can notify my attending surgeon.
It is our turn to operate on the patient. Although I only had a few hours of sleep, once I enter the operating room and I realize that I’m about to do one of the things that I most enjoy, energy starts to pump all over my body. We are able to open, reduce and fixate all of the facial fractures without any complications. The patient has a favorable prognosis.
It is now a few hours before our day starts again. I head over to the hospital’s on call bedroom to sleep at least one hour before the new day begins. ■
Next Level Forum/Digital
The IAOMS invites its members to participate in the Next Level Forum/Digital Webinar Series. We introduced the Next Level Forum at ICOMS 2017 to help you advance your career and the OMS specialty by exploring issues and best practices related to leadership and management (both professional and personal).
Topics for the first three Next Level Forum/Digital webinars: eading through Conflict: ✓ LEssential Tools to Turn Problems into Opportunities ✓ Difficult Conversations: More Gain, Less Pain ✓ Pitching Your Ideas and Selling Them Sideways Each one hour webinar will feature a 45-minute presentation followed by a 15-minute Q&A and will be live at 7:00 a.m. CDT; 13:00 CET and 20:00 HKT.
PITCHING YOUR IDEAS AND SELLING THEM SIDEWAYS (WEDNESDAY, JULY 26) In any organization, knowing how to sell an idea is important. Although every inspiration may seem possible, developing an idea and strategizing for buy-in will ensure the best chance of success. This webinar offers guidelines to ensure a successful pitch, buy-in from colleagues and how to take the thought of an idea from conception to execution. In this webinar, you will:
✓ Understand how to identify key audiences who will champion your projects and ideas ✓Identify key elements for packaging a successful pitch including learning how to get peers in agreement
✓ Ensure that new ideas are aligned with organizational goals and values ✓ Determine the type of pitch which will have the greatest likelihood of success
Dr. Alexis Olsson, IAOMS Vice President, will moderate the webinars and Debra Zabloudil, IAOMS Education Consultant, will present. July following 2017 iaoms.org 19 You will receive a certificate of attendance the webinar.
PROFESSIONAL AND LIFE EXPERIENCE Maxillofacial Surgery at Ziv Medical Center – Safed, Israel
TREATED BY THE “EVIL” By Dr. Alejandro Roisentul Specialist, Oral and Maxillofacial Surgery Head of the OMFS Unit Ziv Medical Center, Safed - Israel Immediate Past President of the Israeli Association of Oral and Maxillofacial Surgeons
was born in Buenos Aires, Argentina where I completed my dental degree at the Universidad de Buenos Aires (UBA) in 1986. Two years later, I emigrated to Israel where I did a residency and qualified in Oral and Maxillofacial Surgery. After spending a year as a Senior House Officer at the Queen Victoria Hospital at East Grinstead in the UK, my mentor and teacher Dr. Daniel Temkin asked me to open a new Oral and Maxillofacial Surgery service at the Ziv Medical Center in Israel’s northern Galilee. This peripheral hospital is situated at an aerial distance of 10 km from the border with Lebanon and 40 km from the Syrian frontier. It serves about 250,000 residents including Jews, Christians, Muslims, Druze, Circassians and Bedouin. This number rises significantly during holiday seasons when the Israeli population travels to the north to enjoy the activities around the Lake of Galilee and the beautiful weather in the mountains. The mosaic of the population is also reflected in the multi-ethnic medical and para-medical staff working together as one big family, regardless of ethnicity, with no discrimination.
The Ziv Medical Center was founded in 1910 and had a very important role in the Tuberculosis epidemic in those days. Today, in what used to be a new building since 1973, our hospital has 350 beds, 22 intensive care beds, 47 medical departments and 20 iaoms.org
seven operating theatres. The OMS service has a team of three OMS specialists: Dr. Daniel Lesmes, DMD, Dr. Keren Yudovich, DMD, MD, and me, and one Oral Medicine specialist, Dr. Zinat Awadieh, DMD. July 2017
I moved my family to a small town near the hospital where my wife Juliana and I raised our three children: Jonatan, Natanella and Ofir. I spent the first years developing the OMS service in a peaceful atmosphere enjoying the magical surroundings of the Galilee and Safed until the Second Lebanon war broke out in 2006. During 40 days, thousands of Israeli citizens left the north of Israel following the missile attack on the region, including bombs that hit the hospital. We treated around 1500 civilians and soldiers in the hospital, while under constant attack.
presented with old injuries and provisional treatments. Dr. Salman Zarka, the general director of Ziv today and colonel in the Israeli Defense Forces, was the first commander of the military field hospital for Syrian casualties in the Golan Heights.
After the war, normality resumed, but we understood that we were faced with a new challenge which required far greater protection for the patients and staff. Immediately, we started to plan new protected operating rooms where surgeons could work without fear of being injured, as well as a protected emergency room. We inaugurated a new children’s hospital in 2016 which has an auditorium which can be converted into a sheltered area with an infrastructure for about 100 hospital beds.
from war injuries but also seeking medical treatment for a variety of illnesses. Several young children and teenagers lost their limbs and eyes, but above everything they have lost their “identity.” Most of them were taught to hate us and never dreamt in their most dreadful dreams that they would be brought to Israel. One of the patients described his feeling precisely as “treated by the evil.”
In February 2013, we received an emergency call from the hospital’s Trauma Unit requesting us to treat seven “Syrian civilians” -- some of them unconscious and badly injured. No one could tell us who they were and how they came to our hospital. But one thing was absolutely clear: we had to treat them as we would any other patient. At first, these severe cases of land-mines, bullet and blast injuries presented a considerable challenge for the medical staff but in a short time, it became a tragic routine. Some of them July 2017
Today, around 3000 Syrians have passed through the closed Israeli-Syrian border to seek medical attention, more than 1000 of them have been treated at Ziv Medical Center. Ten percent of these patients are women, 17% children, and also 19 babies have been born here. Over the past four years, they have been brought here by the IDF, not only suffering
As surgeons, we don’t know who is “good” and who is “bad.” We just know that they are mothers, fathers, brothers, sons and daughters of families destroyed by the civil war raging in Syria for the past six years. MEDICINE HAS NO BORDERS. IT CAN SERVE AS A BRIDGE BETWEEN PEOPLE. THIS IS OUR STRONG BELIEF AND OUR WAY OF LIFE AS DOCTORS AND AS HUMAN BEINGS. We do this to save lives and our integrity as human beings, wishing for a better world. ■ iaoms.org 21
So, you want to work...
By Lars Rasmusson Professor, Department of Oral and Maxillofacial Surgery. University of Gothenburg
weden, (officially the Kingdom of Sweden), is a country in northern Europe and a part of Scandinavia. Sweden is a member of the European Union (EU). It is also, among many other international collaborations, a member of the European Union of Medical Specialties (UEMS).
and the southern Skane region. The rest of the country is less densely populated, but still with some major urban areas and cities, also in the northern part of the country. The official language is Swedish and it is mandatory to speak Swedish in all levels of healthcare. However, it is very easy to get around the country as a tourist since almost everyone manages the English language to a fairly high standard, including taxi drivers and other service personnel.
horities National Aut The National Board of Health and Welfare is the government agency that regulates all health care professions that require a license to work in the country. It also regulates specialty training for dentists and doctors (www.socialstyrelsen.se).
Sweden, with around 10 million citizens, has a long coastline, about 2.400 km, stretching from a rather warm and fertile agricultural south to a colder north with enchanting nature and fantastic sport facilities in winter. There are three major urban regions in the country: Stockholm and its surroundings, the southwestern region with Gothenburg as primus motor 22 iaoms.org
iations The Swedish Assoc of Oral and Maxillofacial Surgery There are two major societies that organize specialists in Oral and Maxillofacial surgery in Sweden; The Swedish Association of Oral & Maxillofacial Surgeons (www.kkf.nu), founded in 1953, which is open for both single and double-trained surgeons, and the Swedish July 2017
Society of Medicine, Section for Maxillofacial Surgery (www.sls.se), which is open to surgeons with a medical degree. This section was founded in 1946 with the name of Odonto-stomatology at the time. Sweden is represented in the UEMS (European Union of Medical Specialities).
has started to include one full year of General Surgery as core surgical training in accordance with the new regulations for other specialities (e.g., plastic surgery, urology etc.). The number of active surgeons is around 80, including 10 with both dental and medical degrees. â–
Specialty training Training (ST) in oral and maxillofacial surgery is four-tofive years for both single and double qualified doctors. To be a registered specialist, all rotations and core training in the specialty must be completed at a high standard. Passing the Board exam is also compulsory. Officially, the specialty is still under the dental regulation, but the three-year oral surgery training that exists in many other European countries is not accepted since the specialist surgeon is required to be well trained in facial trauma, TMJ-surgery, orthognathic surgery as well as tumour and reconstructive surgery. Also, singly qualified surgeons who have passed the board exam have the same right as a medical doctor to prescribe any medication to a patient. This means that colleagues from other European countries that move to work in Sweden, often are double-degreed. Specialist training in Sweden is open for applicants from the EU with a dental or dental plus medical degree. There is an exam in Swedish that one must pass (Svenska B) before one can start to work as a qualified specialist from another EU country. There are several training centers around the country with at least one training unit per county. At four units (Gothenburg, Uppsala, UmeĂĽ and LuleĂĽ), a medical degree is mandatory before starting speciality training or is included in the training. In that case, residency becomes longer, usually six to eight years. Rotations in anaesthesia, surgery, internal medicine, plastic surgery and ENT are required at all training units. As the first unit in the country, the oral and maxillofacial surgery at the Sahlgrenska University Hospital in Gothenburg July 2017
www.socialstyrelsen.se The National Board of Health and Welfare is a Swedish state administrative authority, which sorts under the Ministry of Social Affairs. The National Board of Health and Welfare is the administrative authority for health and other medical activities, dental care, health protection, social services, support and services for some disabled people, and alcohol and drug addiction issues. The agency was established in 1913 and received its current form in 1968 by merging with the Danish Medicines Agency. iaoms.org 23
Women in IAOMS
By Dr. Indradewi Sutikno Oral & Maxillofacial Surgery Department Dr. Sardjito Hospital. Indonesia
“A GOOD SURGEON MUST HAVE AN EAGLE’S EYE, A LION’S HEART AND A LADY’S HAND.” This old English proverb which is constantly mentioned by our senior consultant, Dr. Masykur Rahmat, has successfully encouraged each one of us in our institution. With three female surgeons out of six oral maxillofacial surgeons, and 13 women trainees out of 56 trainees in
OMS at the Surgery Department, Dr. Sardjito Hospital Yogyakarta, Indonesia, this is my working environment and that strong contagious sentence seems to put us into a deep comprehension – not sure what the author’s intent is -- understanding? always a ‘Lady’s’ part in a term to be a good surgeon, working side by side male and female. These words have encouraged me to walk out of the comfort zone and bravely work together with other associates. Like and dislike happens everywhere around
the world, but I dont see this too much in our institution regarding the gender problem. The action radius of Oral Maxillofacial Surgeons is covering oncology, trauma, aesthetic surgery etc. Overlap happens and good collaboration with other specialities becomes important for the good quality of care. Stay simple, this was how it actually began. I would like to thank Dr. Tanaya Ghinorawa, from Urology Department of Dr. Sardjito Hospital, who welcomed me in an informal discussion about how we could do more to improve the quality of life of our patients. Our first
“Mind, it is not only about our ego as specialists, but there is something bigger and greater than that: patient’s quality of life. If we replace ‘I ‘ with ‘we’, illness becomes wellness.”
patient was an old man with a ruptured urethra, and we tried to fix the defect using his own buccal mucosa. A large buccal mucosa was excised and sutured through gently dissection to prevent dehisence. Now we have done the collaboration surgeries for many cases such as urethroplasty, urether substitution and utherocutaneous fistula repair. Interesting: in this collaboration, we found out that all urology surgeons and trainees are male. We are so grateful for their smooth, friendly collaboration and hope it will stay well established and will grow in the future. It is a simple technique that even a new oral and maxillofacial surgeon can do and hopefully can open doors for other oral and maxillofacial surgeons. Mind, it is not only about our ego as specialists, but there is something bigger and greater than that: patient’s quality of life. If we replace ‘I‘ with ‘we,’ illness becomes wellness. ■ July 2017
From Proust to Pivot
AN APPARENTLY INNOCENT QUESTIONNAIRE FOR ORAL AND MAXILLOFACIAL SURGEONS
Dr. Piero Cascone is the Professor and Head of Department of Maxillofacial Surgery in University degli Studi di Roma La Sapienza. He is the past president of the European Society of Temporomandibular joint Surgeons (ESTMJS) and Italian Councillor in IAOMS.
What is your favorite word? Temporomandibula joint. What is your least favorite word? Hate. What is your favorite drug? Afternoon nap. What sound or noise do you love? Rock music. What sound or noise do you hate? The voice of a colleague. What is your favorite curse word? Perdindirindina.
Who would you like to see on a new banknote? Myself.
What is your idea of perfect happiness? A lovely hug.
What profession other than your own would you not like to attempt? Landowner .
What is your greatest fear? Pain.
If you were reincarnated as some other plant or animal, what would it be? An oak. If Heaven exists, what would you like to hear God say when you arrive at the Pearly Gates? You did it!
What is the trait you most deplore in yourself? Iâ€™m too good. What is the trait you most deplore in others? Too much self-confidence. Which living person do you most admire? The liberal Antonio Martino. What is your greatest extravagance? Synchronized swimming. What is your current state of mind? Under pressure. What do you consider the most overrated virtue? Beauty. On what occasion do you lie? Too many. h
wit Dr. Cascone his residents 26 iaoms.org
What do you most dislike about your appearance? Earsâ€™ hair. Which living person do you most despise? Many politicians. What is the quality you most like in a man? Stability. What is the quality you most like in a woman? Sweetness. Which words or phrases do you most overuse? Megagalattico.
Cascone with his wife Paola and daughters Vittoria and Costanza
What or who is the greatest love of your life? My wife.
What is your most marked characteristic? Passion.
When and where are you happiest? In Sicily during holidays.
What do you most value in your friends? Their ability to bear me.
Which talent would you most like to have? Know how to play piano.
Who are your favorite writers? Ian Fleming and George Simenon.
If you could change one thing about yourself, what would it be? My glasses. What do you consider your greatest achievement? My children.
Who is your hero of fiction? Clint Eastwood.
Piero and his son Alfredo
If you were to die and come back as a person or a thing, what would it be? A meteorite.
Who are your heroes in real life? My wife. What are your favorite names? The names of my children: Alfredo, Costanza, Vittoria.
Where would you most like to live? Roma.
What is it that you most dislike? Bad smells.
What is your most treasured possession? My family.
What is your greatest regret? To have left my children too alone to devote myself to work.
What do you regard as the lowest depth of misery? To be homeless. What is your favorite occupation? Surgeon.
Which historical figure do you most identify with? A soldier at the time of the Empire of Carlo Magno.
How would you like to die? I donÂ´t want to die! all patient With another sm July 2017
What is your motto There is a treasure everywhere.
FOUNDATION CHAIRMAN REPORT
A bi g
Exciting times for the IAOMS Foundation
Dear Friends, It is truly an exciting time for IAOMS and for our international community. Three months later, we are still celebrating a fantastic ICOMS in Hong Kong. I would like to again congratulate Professor Nabil Samman, the Hong Kong Association of OMS, and the Local Organizing Committee on a well-planned and well-executed conference. In addition, the IAOMS Foundation Board of Trustees would like to thank the Hong Kong Association and Local Organizing Committee for their generous donation of event proceeds. This was an unprecedented gift, and they should be acknowledged for their strong support. It’s also an exciting time for the IAOMS Foundation. We are in the midst of a historic initiative to raise U.S. $500,000 in commitments this year, and I am thrilled to share with you that we are nearing U.S. $300,000 toward our goal! I would like to thank each of you who has made a commitment to our Annual Appeal this year. Your generosity enables us to continue our work, and expand our impact around the world. In addition to our global Fellowship Program, we are hard at work organizing and planning for our two new programs we announced at ICOMS: ✔ Visiting Scholars – through which recipients will experience a 1-2 month destination training opportunity that will bring a much-requested complement to our longer Fellowship Program; and ✔ Research Fellowship Program – through which recipients will experience a 9-12 month destination training fellowship in either basic or clinical OMS research. Our goal through these programs, and all of the Foundation’s activities, is to educate and empower the next generation of OMS professionals around the world to provide the best patient care, and to pass along the gift of knowledge to others. Friends, I ask that you join us in our efforts. Challenge yourselves to consider what our specialty, as well as the IAOMS community, has meant to you and your career. Our goal is that every IAOMS member will get involved and consider making an Annual Appeal commitment at a meaningful level this year. You can visit our Foundation page and make a commitment at this link: https://iaoms.site-ym.com/donations/donate.asp?id=13705 On behalf of the IAOMS Foundation Board of Trustees, thank you for your support. We look forward to sharing more exciting progress with you soon! ■
Larry W. Nissen IAOMS Foundation Chairman 28 iaoms.org
THE NEW NEXTGEN COUNCIL I am a specialist in OMS working in the private sector and part-time in the University of Hong Kong. I have been recently appointed as the Executive Committee member of the IAOMS to Chair the NextGen. I founded the Young Oral and Maxillofacial Surgeon Group of Hong Kong (YOMS) four years ago, aiming to mobilize young doctors and trainees in OMS and spark their interest in OMS. IAOMS is a much larger and better platform for us to promote this great specialty to all the trainees and young surgeons around the globe. We shall make good use of this platform to do as much as we can. In Hong Kong we say, â€œLets add oil together.â€?
ALFRED LAU Chairman NextGen (IAOMS), Specialist in Oral and Maxillofacial Surgery Hon. Clinical Associate Professor OMFS HKU President, HK Association of OMS
ANDREW READ-FULLER, DDS, MD email@example.com
PAYAM AFZALI DDS, MD firstname.lastname@example.org I am a dental graduate from Columbia University in New York and did my formal Oral and Maxillofacial Surgery training and Medical School at UCLA in Los Angeles. The past two years I have been involved with postgraduate fellowship training focusing on both pediatric cleft/craniofacial surgery, as well as maxillofacial oncology and reconstructive surgery. I hope to spend most of my career treating under-served populations on a global level by expanding my international experiences. I am very excited to work with this very diverse and progressive group, as one of the IAOMS NextGen representatives. July 2017
I am a chief resident in Oral and Maxillofacial Surgery at UT Southwestern/Parkland Memorial Hospital in Dallas, Texas. I have been involved in organizations of Oral and Maxillofacial Surgery throughout residency, including serving as President of the Resident Organization of AAOMS from 2014-2015, Delegate and Alternate in the AAOMS House of Delegates (2013-2017), on the Board of Directors of the Oral and Maxillofacial Surgery Foundation, and as a liaison to six AAOMS committees. After finishing my residency, I will join the OMFS faculty at Texas A&M University College of Dentistry in Dallas.
MARTIN RACHWALSKI, MD,DDS martin¬email@example.com I received my Oral and Maxillofacial Surgery training at the University Hospital of Cologne/ Germany, which was followed by a Cleft, Lip and Palate Surgery Fellowship in India. Currently, I am a Fellow in Craniofacial Surgery at Hôpital Universitaire Necker-Enfant Malades and as a Research Associate at Imagine Institute of Genetic Diseases in Paris. I am also the deputy-trainee representative of the European Association of Cranio-MaxilloFacial Surgery (EACMFS) and member of the NextGen Council. Having been “infected by the international virus,” I am very excited to further learn from my colleagues around the globe and to establish enduring networks that will help promote our specialty and facilitate the training of young residents.
MICHEL BILA, MD, DDS firstname.lastname@example.org I have just finished my training in Oral and Maxillofacial Surgery in Belgium and I am involved in a Head & Neck Surgery Fellowship in UCLH, London. I have been involved with our scientific associations as European Trainee Representative in EACMFS and in NextGen IAOMS. I am very enthusiastic and look forward to collaborating with the promising NextGen team.
ERI UMEMURA, DDS email@example.com
NOOR AL-SAADI, DDS firstname.lastname@example.org I am a third year resident in Oral and Maxillofacial Surgery, training under the Oman Medical Speciality Board. My name means light in Arabic and bringing light to patients is what I hope to do one day. Since I was a little girl, I always wanted to be a doctor. As that passion grew each day, it was during my internship that I finally found myself in the speciality of Oral and Maxillofacial Surgery as a dream career. Oral and Maxillofacial Surgery is an inspiring, dynamic and very rewarding specialty where I find new personal and professional challenges every day. I am also looking forward to creating an imprint nationally and internationally by participating and sharing our experiences and projects. To be elected as one of the Asian representative in NextGen marked a very unique achievement at a personal level and an outstanding opportunity at a professional level to facilitate the connection between continents to advance the Oral and Maxillofacial Surgery speciality as a whole. 30 iaoms.org
I work at Saishukan Hospital and do research at Aichi Gakuin University Dental Hospital. At ICOMS 2017, I had the unique opportunity to share a broad range of topics with colleagues from across the globe. It is however, the time we shall go on to a next step. The next step means we shall start to think about issues - not only within our own country, but issues which matter beyond borders. Also, we shall start exchanging our experiences, problems, and their solutions. I see this NextGen Council as a platform to overcome these challenges. I am really looking forward to forming a new network that will provide solutions to problems, or ultimately, fulfill the misión of the IAOMS. Finally, I would like to express my gratitude to everyone in the IAOMS community for providing an arena that enables us to work together for future patients, trainees, and discoveries. I am honored to be the one of the asia chairs of the NextGen Council.
NATALIA ALVAREZ, DDS email@example.com
RODOLFO ASENSIO, MD, DDS firstname.lastname@example.org
Born in Formosa (Argentina,) I am a resident of Oral and Maxillofacial Surgey (OMFS) in the Medical School at Maimónides University in Buenos Aires. I am a member of our national association, ALACIBU and IAOMS. Belonging to IAOMS is highly significant: it keeps us informed of all the latest news related to our speciality. That is the reason why we, the NextGen Council, are the nexus to achieve the largest number of young professionals in training to become IAOMS members. We seek to promote new techniques, experiences and solutions to the different problems that might arise. Furthermore, we wish to encourage the exchange of experiences with a view to building and promoting a professional network around the world.
I am working in Guatemala as an Assistant Professor at Centro Infantil de Estomatología (Metodo Asensio) for cleft lip and palate treatment (San Carlos University). I am also Head of the trainee committee of ALACIBU 2015-2017. IAOMS is a knowledge, research and worldwide promoter of the highest standards in maxillofacial surgery. The NextGen Council is an important platform for evolution and integration of young surgeons to become involved in this mission of excellence.
JAMES KIRIMI MUNG’ATIA, DDS email@example.com
ABIR BEN OUAGHREM, MD firstname.lastname@example.org
I am an Oral Maxillofacial Surgeon working at a government hospital in Meru, Kenya. I received my maxillofacial surgery training at the University of Nairobi and graduated in 2016. My professional interests are in tumor surgery as well as cranio-facial trauma. I am inspired by every day stories from my patients and the impact reconstructive surgery has on them. When not working I love travelling, cooking and bird watching. IAOMS is wonderful for networking and professional development. The NextGen project is an excellent idea which will definitely help grow the profession among the younger generation and ensure the continuity of the association in the future. I am privileged to be involved in the NextGen Council.
I am a 4th year trainee in Oral and Maxillofacial Surgery in Tunisia. I am a member of several scientific associations of the speciality, including of course, IAOMS. The love of surgery has always motivated me since I began to study medicine. My admiration for beauty and my fascination for art quickly oriented my choice towards oral and maxillofacial surgery. The surgical practice I have acquired in Tunisia introduced me to orthognathic surgery, aesthetic surgery of the face and oncologic surgery. Furthermore, I gained a lot of experience in trauma, oral surgery and reconstructive surgery. To complement my knowledge and understanding of current practices, I have participated in international congresses such as ICOMS 2015 in Melbourne, EACMFS 2016 in London and ICOMS 2017 in Hong Kong.
OMAR BREIK, MD, DDS email@example.com I am a final year, accredited OMFS trainee in Melbourne, Australia. With dual training in Medicine and Dentistry, I am the trainee representative for the Board of Studies at the Royal Australasian College of Dental Surgeons. I have been activelly involved in clinical research, with a special interest in paediatric craniofacial surgery and head and neck cancer surgery.
LIAM MOORE, MD, DDS firstname.lastname@example.org I am an accredited OMFS trainee working in Auckland, New Zealand. I was awarded the ANZAOMS prize for the highest mark in the Surgical Science and Training Exam in 2016. I have a special interest in 3D planning for Orthognathic and Reconstructive surgery.
s p i h s w o l l e F
A VOICE FROM SUDAN
By Amel Salah Eltayeb, BDS, MD, MFD RCSI, FFD (OSOM) RCSI Oral and Maxillofacial Surgeon at Khartoum Teaching Dental Hospital, Khartoum , Sudan Assistant Professor of Oral and Maxillofacial Surgery, Nile College of Medical Sciences, Khartoum, Sudan
earned my undergraduate degree from the University of Khartoum-Sudan in 2009 and then spent five years in an oral and maxillofacial surgery training program in Sudan. I also had the Royal College of Surgeons in Ireland membership and finished the Fellowship of Oral Surgery and Oral Medicine last January.
When I was in my training program, there were about 33 registrars in our country. When I started my training there was one female registrar who was in her last shift and then after that I was the only female in the middle of 31 male registrars.
At that time, there were two registrars in each unit and eight house-officers. We used to see over 300 patients a day (dental patients, septic patients, Ever since I was an undergraduate, I knew that trauma, oral cancer, and oral pathology and OMS I wanted to be a surgeon. But to be honest, no emergencies). This duty included supervising house one agreed with my decision. I spent a one year officers (what are house officers?) on dental internship, which included all specialties of extraction and handling complications, dentistry and none of them changed my “When treating OMFS emergencies, trauma, mind about surgery. After one month I started inpatient care, preparing patients for of my permanent registration as a my training there was the referral clinic which was the next dentist, I took part 1 exam of oral and one female registrar maxillofacial surgery and two months who was in her last shift day. During my first shift, I remember later I started the OMFS training and then after that I was I was alone; the senior registrar disappeared for some reason and I program. the only female in the panicked. There were several patients middle of 31 male I still remember the first day of my around, questions and decisions to registrars” training. There were 10 seconds of make and I questioned myself: can I do silence when I entered the meeting room this training? I complained to one of my which was full of trainees and surgeons. I was seniors and the answer was “you know that it’s not a the only female in the room. After the meeting, woman’s job. Why are you taking it?” the training director talked to me in a friendly way; From that moment, I knew I was amidst a challenge he questioned my decision to pursue this difficult and I had to prove myself. Interestingly, I noticed that specialty. He asked me, “why surgery?” I remember I had no right to complain, because I was a woman. him saying, “there is no money if you are seeking Fortunately, I proved myself in front of my colleagues money from this specialty, and the playing ground is and professors. I scored the highest mark on Part 2 very tough and you won’t survive it.” I told him: of the exam and I was the only woman, as usual, out I want to be a surgeon, I know it’s a difficult field and of a total of seven candidates. Many women began difficult to succeed, I know the risks and I will take it. joining the training program. Today, there are more And another professor said he didn’t want a female than 20 women registrars. I am proud to supervise registrar to work with him because of the workload of five of them during their internship program. the unit. 32 iaoms.org
Now I work as an oral and maxillofacial surgeon self-esteem and have totally changed my at Khartoum Teaching Dental Hospital personality for the better. If I had to do it “I still face and also as assistant professor at Nile over again, I would still choose surgery. the question ”why College of Medical Sciences. I still My name (Amel) is from the Arabic surgery,?” but then face the question ”why surgery?” but word which means “HOPE.” That’s one of my students or then one of my students or registrars why I am always hoping for the best. registrars comes to me comes to me and tells me that I inspire I have been selected for the IAOMS and tells me that I inspire them to be a surgeon. The clouds just Foundation 2017 cleft lip/palate and them to be a surgeon. disappear. And now I am sure that one craniofacial fellowship program. The clouds just day, this question may no longer be asked I am really excited about this training disappear” when the number of women OMS increase. opportunity in this field which I am really In Sudan, female surgeons face many difficulties interested in, hoping to send a message to all from the medical field and the community. However, women in my country and other countries to have these challenges have helped me to improve my dreams to achieve regardless of your situation. ■
WHERE ARE YOU NOW?
Dr. Daniel Laskin By Deepak Krishnan Assistant Professor of Surgery, UC Health. Cincinnati
ear Dr. Laskin
How do you spend your time these days? When one loves what they do, it is difficult to stop and so I am still working, writing and travelling. What do you consider the single most meaningful contribution you made to the specialty of Oral Maxillofacial surgery? I have been fortunate in being able to contribute to our specialty as an editor, researcher, and participant in various leadership positions. However, such things are soon forgotten. I believe my most meaningful and lasting contribution has been the many residents who I have trained and who have then gone on to make their own contributions to the public welfare and the specialty. They are one’s true legacy. What is your perception of how the specialty has changed from when you started to now? Certainly, there have been many changes in our specialty over the years. A major change has been the continued expansion of our scope. This has led to our ability to provide improved patient care and to treat conditions that were originally not treatable. Along with this has been a more general acceptance of the oral and maxillofacial surgeon as an equal partner with our medical colleagues in the health care arena. Do you keep in touch with former colleagues? Fortunately, I am still able to travel all over the world for lectures and meetings and this has given me the opportunity to not only keep in touch with my many “old” friends, but also to make many new friends. 34 iaoms.org
“Fortunately, I am still able to travel all over the world for lectures and meetings and this has given me the opportunity to not only keep in touch with my many “old” friends, but also to make many new friends.” What would you change about your career path if you could go back and do so? During one’s career there are sometimes poor choices or adversities that at the moment make one wish they could change course. However, one needs to look at their career in totality, and in this regard I have no regrets. July 2017
Which technological advance in the specialty would have made a difference in your surgical activity? When I started my career, we used nitrous oxide for anesthesia, periapical radiographs to visualize the dental structures, chisels or a slow speed handpiece to remove bone, and wires for fixation of fractures. Orthognathic surgery was limited to the mandible and open reduction of a jaw fracture was considered a major operation. Implantology consisted of blade and subperiosteal implants. So what do I consider the major technical advances that have occurred since that time? I would say they are the panoramic radiograph, the high-speed handpiece and micro-saws, use of plates and screws and titanium dental implants. What advice do you have for the OMS trainee starting training in 2017? I was once asked what I thought are the things that should guide our professional life and I believe what I said then is still appropriate. They are: 1. Always put your patient’s welfare first. 2. Know your own limitations. 3. Never hesitate to seek consultation. 4. Be a constant student. 5. Always think critically. 6. Your fellow residents are your colleagues and not your competitors.
had significant involvement with the organization. In the early years there was considerable controversy over single and double degree education and scope of practice, and it was gratifying to be involved in helping resolve these issues and seeing IAOMS become a unifying international organization that is focused on educational and training efforts rather than political arguments. What are the qualities you most value in a career
“Most importantly, they need to have good judgment and always put the welfare of their patients first.” academic surgeon? Many of the qualities that one would seek in an academic surgeon are the same for all surgeons. Most importantly, they need to have good judgment and always put the welfare of their patients first. They need to be critical thinkers and remain a constant student. As an academic surgeon, in addition they need to be good teachers, nonauthoritative, and willing to admit when they do not have the answer. Finally, the academic surgeon needs to have an inquisitive mind, be a researcher and instill these qualities in his or her trainees. ■
How do you reflect on your involvement in the IAOMS? How important was the association in your career? I have had considerable involvement in IAOMS over the years. It began with being a member of the Executive Committee and eventually going through the offices to become president. Upon completion of that term, I was selected as the Secretary General and moved the headquarters from Amsterdam to the United States. When the decision was subsequently made to reorganize the structure of the organization and eliminate the position of Secretary General, I was hired to be the first Executive Director of IAOMS. So you can see that I July 2017
Hooke’s Law, Surgery and Burn-out Syndrome By Javier González Lagunas (follow me on
o you remember high school physics lessons? Let´s talk about the principle described by Robert Hooke (1635-1703), a UK scientist born on the Isle of Wight. Hooke was deeply involved with the Royal Society and his research was focused on mechanics, gravitation or astronomy. One of Hooke’s his key discoveries relates to the law of elasticity. Forces can cause objects to deform (i.e. change their shape). The way in which an object deforms depends on its dimensions, the material it is made of, the size of the force and its direction. Within the elastic limit of a solid material, the deformation produced by a stress of any kind is proportional to the force. If the elastic limit is not exceeded, the material returns to its original shape and size after the force is removed. But if the elastic limit is surpassed, it remains deformed or stretched. The force at which the material exceeds its elastic limit is called “limit of proportionality.” Moving this logic to the field of talent management, we could make an analogy between the effort made by a person (the surgeon) and the pressure that is applied by the company (the hospital
manager, the Head of Department). It could be said that a person’s effort is directly proportional to the pressure to which it is submitted as long as the pressure does not break the individual’s motivation. Often, an organization will add pressure, little by little, on its staff/employees, without either side noticing. A high-performing individual tends to accumulate more work. But the time might come when this person feels overwhelmed. A common way to cope with this situation is either by not accepting more tasks (to avoid more pressure) or request a change in working conditions (to increase the limit of elasticity). If there is no change, the individual will reach his elasticity limit and his motivation, attitudes and outcomes will steadily decrease (deform). The individual’s behavior against pressure will change radically and will (usually) undergo a process of gradual demotivation. Here comes burn-out syndrome. Burnout syndrome is defined by the triad of high emotional exhaustion, high de-personalization and low personal accomplishment. It affects an individual’s (surgeon’s) attitude towards work and the quality of care he provides. A dose-response relationship between the magnitude of burn-out and measures of sub-optimal patient care has been suggested. In our area Johnson conducted a survey of 395 members of the ASHN and the SHNS. A total of 34% who responded believed they were “burned out.” They had surpassed the limit of elasticity. So, if you are an employer, remember that pressure might produce a good response from surgeons, but excess stress might lead to poor patient outcomes. And if you are an employee, be aware of the signs that indicate that your organization is on the wrong path. ■
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