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NextGen Scientific Symposium: What if Bad Things Happen? Focus on complications in oral and maxillofacial surgery with global leaders in the field. REGISTER TODAY AT icoms.iaoms.org/registration
Issue 56 / December 2018
Editor-in-Chief Javier González Lagunas
Assistant Editor Deepak Krishnan
Graphic Designer María Montesinos
Executive Committee 2018-2019 Board of Directors
Alexis Olsson, President Julio Acero, Immediate Past President Gabriele Millesi, Vice President Alejandro Martinez, Vice President-Elect Arthur Jee, Treasurer Larry Nissen, IAOMS Foundation Chair Mitchell Dvorak, Executive Director
Rui Fernandes Javier González Lagunas Sanjiv Nair
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 Chairs G.E. Ghali, Education Alejandro Martinez, Governance and Ethics Alfred Lau, Membership and Communications Sean Edwards, Research Luiz Marinho, 24th ICOMS-2019, Brazil David Koppel, 25th ICOMS-2021, Glasgow Ed Dore, 26h ICOMS-2023, Vancouver ©Copyright 2018. International Association of Oral and Maxillofacial Surgeons. Chicago, Illinois, USA. All rights reserved under international and Pan American copyright conventions.
CONTACT US IAOMS
8618 W. Catalpa Ave., Suite 1116, Chicago, IL U.S.A. 60656 1.773.867.6087 / email@example.com
Letter from the Editor HOW I SEE IT Dear friends and colleagues.
any maxillofacial surgeons dedicate a part of their free time and holidays to offer help to underdeveloped communities all over the world. Prevention of disease, education of our peers, medical and surgical treatment are basic and essential necessities for those living in poor countries. Poverty seems to be one of those politically incorrect words today, but it is a reality. Its definition according to World Bank Organization is as follows: “Poverty is hunger. Poverty is lack of shelter. Poverty is being sick and not being able to see a doctor. Poverty is not having access to school and not knowing how to read. Poverty is not having a job, is fear for the future, living one day at a time”. We have been able to reach just a few of the many maxillofacial surgeons who work for organizations that have an essential role in providing help to those with medical needs. The five continents have dark areas of poverty. Even some of the wealthiest countries in the world have a share of their population who cannot access medical care. We have also received a paper that shows us in first person the situation in Venezuela, or how the Realpolitik affects the life of the real population. Two important regional meetings were held during the last few weeks. In Munich, in September we had the 24th EACMFS meeting. One month later, AAOMS celebrated in Chicago its 100th anniversary. Some of our colleagues will share with us their impressions. What was the role of women surgeons in Munich? How is the AAOMS meeting seen by an American surgeon? But, how is it seen by an African colleague? Our fixed section on Nextgen travels to Australia this time with some insights on mentoring. An interesting case of venom snakehead and neck injuries comes all the way from Africa. And if you consider moving your practice to Central America, Guatemala can be a good option: we tell you the right way to do it. Our Proust questionnaire goes to Lille in Northern France: you will learn about Joel Ferrí way of thinking.
Poverty is hunger. Poverty is lack of shelter. Poverty is being sick and not being able to see a doctor. Poverty is not having access to school and not knowing how to read. Poverty is not having a job, is fear for the future, living one day at a time.
This winter issue has been particularly difficult for the editors. We had some papers and authors that dropped-off in the last minute. Only with the help and the great effort of some colleagues, we have been able to succeed and get through FACE TO FACE number 56. I want to personally thank them all for taking away time from their families and practices. The spirit of this magazine is solidly based on collaboration. Without your generous help and commitment, we would not be able to launch a single issue of FACE TO FACE. So again, and as we always do, we want to ask for your collaboration with the magazine. We are opened to all your suggestions and new ideas, no matter where you are coming from, or what kind of professional practice you have. Also, we want to ask you to share this issue with your peers in the hospital, with your National Associations and with all your network of professional contacts. The more they read us, best known IAOMS will be. It will be soon Christmas holidays in most parts of the world. From the editor’s office and from IAOMS we want to wish you all a MERRY CHRISTMAS AND A FANTASTIC, SUCCESSFUL, PROSPEROUS, SUPPORTIVE, AND UNIQUE 2019.
Javier González Lagunas EDITOR IN CHIEF
CONTENTS December 2018 10 SPECIAL REPORT
On a permanent mission.
SO, YOU WANT TO WORK... 24 In Guatemala.
26 WOMEN IN IAOMS
Women as spectators or women as participants?
FROM PROUST TO PIVOT 28 JoÃ«l Ferri.
30 COPY ME
Management of snake attacks.
NEXT GEN 34
Perspectives on surgical training: Standing on the shoulders of giants.
36 IN FIRST PERSON
Away from my island: a cuban abroad.
AAOMS MEETING 40
Views from the insider and from the outsider.
46 FIRST LATIN AMERICAN
MICROVASCULAR RECONSTRUCTION COURSE BEYOND THE O.R. 48
WW1 and Maxillofacial Surgery.
SHARING IN OUR COLLECTIVE SUCCESSES
hank you to IAOMS members, the Board and Executive Committees, our Foundation partners and our staff team for your commitment (and hard work!) to advancing our mission. Improving the quality and safety of health care worldwide through the advancement of patient care, education and research in oral and maxillofacial surgery is at the heart of what we do. As I look back on the work we accomplished together this year, I am proud of not only the initiatives and activities – but also how we worked – guided by our organization’s four values: • Promoting an inclusive and welcoming global community • Advocating for the highest standards of patient care and professionalism •Supporting continuous learning and rigorous research • Fostering honest, respectful collaboration and teamwork Before we turn the page to 2019, I want to acknowledge just a few of our collective successes this year, which include: LAUNCHING THE NEW IAOMS website -- Through the Website Working Group, a collaborative effort led by Dr. Fred Rozema and IAOMS staff, we launched a new website that reflects the IAOMS brand and provides increased functionality and ease of use for IAOMS members and visitors. Through this new platform, users can register for live (and view on-demand) webinars and register for conferences, such as ICOMS. We also are continuing to build out the NextGen community page, which provides a virtual meeting place specifically for young OMF surgeons (though any OMF surgeon is invited to participate). HOSTING THE WORLD CAFÉ, a unique event that brought together OMF surgeons from more than 11 countries to discuss various approaches to patient care as well as emerging techniques. My thanks to Education Chair Dr. Ghali Ghali for leading this initiative and for his keynote presentation. PARTNERING WITH NATIONAL ASSOCIATIONS -- We continued to strengthen our relationship with the American Association of Oral and Maxillofacial Surgeons (AAOMS) and its Foundation through an International Reception held before the start of the AAOMS 100th Annual Meeting in Chicago. Thank you to Dentsply-Sirona for its exclusive sponsorship of what we hope will be an annual event. And IAOMS hosted a one-day joint meeting at the 13th Annual ACOMS in Taipei where IAOMS leaders from around the world shared their knowledge.
PROVIDING MORE MEMBER-FOCUSED COMMUNICATIONS -- In addition to inBrief, which we publish six times annually, we also developed a “new member kit” to provide new (or returning) members an easy reference guide with staff contact information and programming highlights. We continued to elevate the IAOMS brand through new advertising and exploring additional options to increase awareness. OFFERING MORE EDUCATIONAL OPPORTUNITIES – THROUGH THE NEW VISITING SCHOLARS PROGRAM, an opportunity for young specialist members of IAOMS to travel to other countries and visit, for short periods, prestigious OMS Departments to enhance their postgraduate education where they will observe and study with top surgeons and professors. The IAOMS Foundation gratefully acknowledges the American Association of Oral and Maxillofacial Surgeons (AAOMS) and its OMS Foundation, for sponsoring the first Visiting Scholars. INTRODUCING A NEW, VIRTUAL CONFERENCE – we began planning the first virtual conference – to bring the IAOMS closer to its members. More details on how you can register and participate are coming soon! And of course, the Local Organizing Committee has put together an outstanding roster of speakers and topics for the 24th ICOMS in a beautiful neighborhood just west of Rio de Janeiro. If you’ve not registered for ICOMS Rio, please register today. IAOMS members receive the best rates – so if you’ve not yet joined the IAOMS, I encourage you to join today. (Even if you buy an IAOMS membership, you will still pay a lower fee – and you’ll enjoy our member benefits throughout the year!). We’ve been sharing information about some wonderful, one-of-a-kind social events, so we hope to see you during those evenings, too; tickets are available on a first-come, first-served basis. Finally, members make this organization possible. My thanks to each and every one of you for your membership, your collaboration and your work on behalf of the IAOMS. Through this collaboration, we continue to strengthen the IAOMS, which allows us to engage more OMFs – and ultimately, improve patient care. Wishing you and your loved ones a joyous holiday season and best wishes for a happy new year. See you in Rio!
Mitchell Dvorak EXECUTIVE DIRECTOR, IAOMS
Letter from the President COLLABORATING AROUND THE WORLD = SUCCESS Dear Colleagues and Friends :
Success is best when it is shared
nd what a success this was: the 13th Annual ACOMS in Taipei, the first joint meeting of the Asian Association of Oral & Maxillofacial Surgery and the IAOMS. All who attended will agree, that this event was a great success: a terrific venue, scientific content and high participation, illustrating the power of collaboration and hard work. Professor Shou-Yen KAO, President of the Asian Association, together with Dr. Michael Yuan-Chien Chen, Local Organizing Chair, Dr. Elliot Shih-Jung Cheng, Scientific Committee Chair and Dr. Charles Kuan-Chou Lin, - International Affairs, along with all the volunteers and staff, are to be congratulated for such a well-run meeting and for their wonderful hospitality. The IAOMS’ relationship and partnership with the Asian Association is just one of the many partnerships we have cultivated and grown with national and regional associations through the years. These relationships help the IAOMS and all of us advance the mission of improving the quality and safety of health care worldwide through the advancement of patient care, education and research in oral and maxillofacial surgery. These examples of collaboration and support help all our organizations attract participants, speakers and generate a return on investment -- the investment in the future of our specialty. If you are a leader in your national or regional association and you would like to explore partnership opportunities with the IAOMS, please contact Kimberly Shadle. Another example of our global association “acting locally” is the recent, first-ever microvascular course for Oral & Maxillofacial Surgeons in Mexico City. An identified surgical need for Mexican healthcare, this course has the full support of the Mexican Academy of Surgery, the National University of Mexico (UNAM) and the Institute for Social Security and Services for State Workers (ISSSTE). Through the impetus of Dr. Alejandro Martinez, IAOMS Vice President-Elect, the Mexican Association of Oral & Maxillofacial Surgeons (AMCBM) leadership under President Maria Luisa Lopez Salgado, the Consejo Mexicano de Cirugía Oral y Maxilofacial (the Mexican Board of OMFS) and its President Jose Luis Cadena are
to be congratulated for the key cooperation and vision in bringing this course together. The next course in the series of three courses is slated for 2019. Back in the U.S., in Chicago, we celebrated the 100th Anniversary of the American Association of Oral and Maxillofacial Surgeons (AAOMS). This magnificent meeting showcased the development of our specialty in the United States, as well as launching the next 100 years. The IAOMS was honored to participate in this meeting through two special events. The World Café, a first-of-itskind opportunity at AAOMS for OMFs from around the world to meet and discuss approaches to specific “real life” patient cases. We also co-hosted the IAOMS/AAOMS International Reception, which was a great success and brought together American and international surgeons in support of the OMS and IAOMS Foundations. I want to personally thank Immediate Past President Dr. Brett Ferguson, President Dr. Tom Indresano, and the AAOMS Board of Trustees for its continued commitment, growing support and collaboration with the IAOMS. I turn now to South America where in fewer than six months we will gather for our signature event: ICOMS 2019 in Rio de Janeiro, Brazil, May 21-24. Along with our Board, Executive Committee and staff, I look forward to welcoming you to Barra da Tijuca, a neighborhood just west of Rio de Janeiro. You’ll enjoy the area’s quiet and pleasant streets as well as its many restaurants, shopping, sightseeing and miles of beaches. Our social events will offer unique experiences for you, as Brazil also serves as gateway to South America. I encourage you to register for ICOMS. As we approach the end of the year, I would like to thank you for your IAOMS membership (and remind you to renew your membership for 2019). Your support makes it possible for us to advance our mission and help train the next generation of oral and maxillofacial surgeons. Wishing you and your loved ones Happy Holidays and Healthy New Year.
Alexis B. Olsson IAOMS PRESIDENT 2018-2019
On a MISSION, permanently 01 International Humanitarian projects in OMFS: an INDIAN perspective By George Paul Salem (India)
ndia is perhaps the best example of a country that has gone from hosting humanitarian projects to providing training and service to other countries in a span of only three decades. My personal experience is an example of this paradox. In the 1990s I served as a Rotary Volunteer serving in several third world countries while at the same time hosting surgeons from other countries in my hometown. As Medical Director of Sharon Cancer Center (SCC), I had the opportunity of inviting OMFS surgeons and oncologists from several countries. Sharon was a charitable cancer facility servicing the requirements of a large population (about 5 million) in the North West of Tamilnadu, India. A chance meeting with two British Maxillofacial surgeons was the beginning of a series of visits by several surgeons who provided free service as well as training for hundreds of Maxillofacial surgeons and trainees from different parts of the country. The
team comprising Mr Brian Avery and Mr. Colin Edge from Middlesborough, UK, performed several ablative surgeries and conducted the first handson workshop on microvascular surgery in the region. They also did the first radial forearm flap to close a buccal mucosa defect during their first visit to SCC in 1996. Several young OMFS surgeons who attended the sessions were inspired to take up cancer and have gone on to excel in the field in several cities in Tamilnadu and other parts of India. It also provided the drive to local surgeons who excelled in head and
neck cancer. When Avery and Edge returned after 3 years with a BBC team, the patient who had received the first microvascular reconstruction of his cheek was there to receive them. It was prominently broadcast on BBC the same year. Sharon Cancer Centre continued its yeoman service and several surgeons from India like Dr. Sanjiv Nair and Dr. David Tauro have operated in the facility for many years afterwards. Today, they have converted SCC to a palliative care centre because of various administrative reasons. HISTORY OF HUMANITARIAN OMFS PROJECTS IN INDIA India has been a beneficiary of humanitarian medical projects for several decades. It provided the momentum for wider training and competence to a new generation of surgeons in a burgeoning speciality. Today OMFS in India is a self-sufficient speciality with young surgeons performing a range of surgery in most parts of the country. One of the first International OMFS to serve in India was Richard Topazian from the University of Connecticut who served in the Christian Medical College (CMC), Vellore in Tamilnadu between 1959-1962 (1). While introducing newer surgical techniques, Dr Topazian also learnt a lot about tropical infections. The photographs from Vellore in his book Oral and Maxillofacial Infections (Topazian and Goldberg) is a testimony to his service in India. Several humanitarian teams visited CMC Vellore through the Health Volunteers Overseas (HVO), serving the OMFS department until a decade ago. Many teams from around the world have served in many parts of the country, imparting skills and taking home the experience of numbers, from a country that is more populous than the combined population of North America and Europe. In the last twenty years, humanitarian projects to deal with clefts and craniofacial surgery have been established across the country. While many of these were established through funding from other countries, the surgeons are essentially local.
“While international surgeons visit India to serve humanity, Indian surgeons are training surgeons from other countries to be a part of the humanitarian programme.”
SERVICE AND TRAINING THROUGH INTERNATIONAL COLLABORATION International humanitarian projects in India have taken a paradoxical turn. While there are several centres hosting surgeons from other countries, OMFS has advanced significantly in India to provide training to surgeons from the developing and developed world. Let me give an example of each. The Jabalpur Hospital and Research Centre, like many other centres, deliver humanitarian service and provides a platform for young surgeons in India to observe and train. It is a large multi-speciality hospital in the central Indian city of Jabalpur. The director of the Hospital, Dr Rajesh Dhirawani, has been hosting surgeons from around the world since 1996. It was started as a joint endeavour between Dr Dhirawani and Dr Bruce Macintosh through the Health Volunteers Overseas for a period of five years. They now conduct a week-long project every year focussed only on OMFS and operate on a variety of cases ranging from Cleft and Craniofacial surgery, Head and Neck Oncology, TMJ surgery and other pathologies. International surgeons who have operated and conducted training sessions include Eric Carlson (USA) Robert Ord (USA) GE Ghali (USA), Tony Marcus (UK) Tony Pogrel, Patrick Diner (France), Karsten Gundlach (Germany), Tim Turvey (USA) and several others. Several eminent OMF surgeons from India like JN Khanna and others also took part as surgical faculty to train young surgeons while providing service to the poor. Organisations such as Smile Train and the Hyderabad Cleft Society perform thousands of Cleft and Cleft related surgery completely free of charge today. Smile Train started working in India in the year 2000. It funds about 40,000 surgeries in India by 215 accredited surgeons in 165 partner hospitals. About 25 of the surgeons are OMFS. In addition to providing free Cleft surgery, these centres also train OMFS from around the world. While international surgeons visit India to serve humanity, Indian surgeons are training surgeons from other countries to be a part of the humanitarian programme. In other words, India is no more a oneway street. Dr Krishnamurthy Bonanthaya, an OMF
surgeon and his team who run the Smile Train unit in Mahavir Jain Hospital in Bangalore, train surgeons from Argentina, Venezuela, Oman, Iraq, Sudan, Israel, Myanmar and other countries. Such is the impact of their training that the Smile Train programme in Myanmar is completely run by OMFS. Other such units include the Hyderabad Cleft Society headed by Dr Gosla Srinivasa Reddy an OMFS, who also started his hospital in the year 2000 through humanitarian funding for free surgeries. The GSR Hospital has done more than 28,000 Cleft and Craniofacial surgeries to date. He collaborates with several surgeons including Tony Marcus, Herman Sailor, Stefan Berge, Ann Kummer, Anne Marie Kujipers, Joachim Obwegeser and Likith Reddy among others. Today the Hyderabad Cleft Society and GSR Hospital provide training to hundreds of local surgeons and trainees from several countries around the world. LOGISTICS AND FINANCIAL ASSISTANCE India provides a temporary licence for surgeons. OMFS comes under the Dental Council of India. Host sites will be able to obtain the licences if candidates send the necessary documents to them. They can obtain visa for travel from the embassies or consulates in the countries from which the surgeons are arriving. It is usually not a problem, but there can be hiccups if the paperwork is not thorough. Most host sites do not provide international travel fares. However local hospitality and travel are usually taken care of. Similarly, trainees need to obtain visas that allow them to train for longer periods. Rotary has stopped the paid volunteer programme that had funded my travel and stay in the 1990s. CONCLUSION Humanitarian projects involving OMFS is active around the world and several countries host visiting surgeons in Asia, South America and Africa. India is a classic example of having benefitted by these projects and has the unique privilege of paying back the global community by training surgeons from other countries to go back and give service to their own disadvantaged people. ■
Surgery in DICTATORIAL TIMES
By Humberto Fernández Olarte El Bosque University. Bogotá (Colombia)
ictionaries define dictatorships as "an authoritarian form of government, characterized by a single leader or group of leaders, with the faculty to enact and modify laws at will". What a poor definition! Excluded in this definition, are words such as hunger, suffering, abandonment and illness. What else have I missed out? That's where I will go, where I've gone several times, all of them accompanied by residents. They have learned that serving is not just an option, it is an obligation. Simón Bolívar _the Liberator_ once said: "It is not enough to be big, it is necessary to be useful". The action must be motivated by a simple word, whose true meaning is not understood most of the time love. There must be love for our profession, and we must not confuse this love for infatuation, which is the state of being carried away by an unreasoned passion in the heat of the moment. Just as many times in the past, on this occasion I took a flight to Cúcuta (Colombian city located in the northeastern part of the country, on the border with Venezuela), where undergraduate students from the local Antonio Nariño University took me to the border, where I was received by good friends of mine, all of
whom were Venezuelan surgeons, to cross on foot to the other side. The fact of crossing sounds like a simple thing, but doing it is very different from actually just feeling it. Seeing a whole population walking in the opposite direction, passing in front of me, possibly with thoughts and hopes of never returning.... what a deep sensation of pain! Hours later, we arrived at San Cristóbal, where we met a group of Oral and Maxillofacial Surgeons, who came from several cities from around the country to help, serve, and operate. We all think alike; we are not alone, we are many, we are a team! I am obviously not the only one with the same thought. That night, we shared a dinner among friends, enjoying the pleasures of the local food that graced our table. Meanwhile, I can’t avoid to stop looking out
"It is not enough to be big, it is necessary to be useful". Simón Bolivar
the window, at the street, where there is hunger in every corner, and I feel impotence.
The night passes, and the next morning the academic exchange that nourishes our specialty, begins. However, my mind can't remain idle, it keeps on thinking about the next day in the operating room, where we will find a very harsh reality, not only with those people dealing with a physical misfortune, but also with those people dealing with hurt souls. By this time, I don’t have any doubt: we will make a change, affectionately working for a group of children with cleft lip and cleft palate, for which hunger and malnutrition have been sad companions. Together with their families, these little patients see in us an opportunity, and hope for a better life. Such a great responsibility! What a beautiful setting I have before me ... the operating rooms! It looks like a magical place, in which for some strange reason, nobody is prey to hunger or fatigue, and if someone experienced something like that, it remains imperceptible. It is impossible not to experience the feeling of a heart beating with all its strength. At the end of the day, we feel the satisfaction of the work done, overcoming the limited material resources by using our unlimited human will. Once the mission is complete, I must return to my country, to my family… how many of the people we met wouldn’t love this opportunity! I must return to my duties as Director of the Oral and Maxillofacial Surgery Residency at the University El Bosque – Bogotá, Colombia. I definitely returned more motivated and more convinced of my obligation to teach and train…. and I ask myself all the time: how do you teach yourself to love? To fall in love with this
specialty? Is it impossible to include this subject in our programs? I bet we would have more of us willing to serve… to gift of ourselves to others. In Colombia there are several foundations that are dedicated to operate children and adults with facial malformations; serious entities that assume their work with respect and dedication. Congratulations to each of them! In the same way, I would like to extend this acknowledgement to all those people around the world who dedicate part of their lives to this beautiful work. I also want to thank my University for all its support, and to my residents (why my residents? because they are a part of me) for their endless motivation. My respect and love for all those who are focused on doing and not on pretend, for whom I dedicate the following thought: "When the essential thing is the money, the art of healing loses its true magnitude of greatness"
Serving we will meet December 2018
A mission in PERU By Josep Rubio Hospital Sant Joan de Deu. Barcelona (Spain)
DR. RUBIO, PLEASE TELL US ABOUT THE AREA WHERE YOU LAST WENT ON A MISSION. We went to Arequipa, the second biggest city of Peru. The mission took place at Hospital Paz Holandesa, a hospital founded by Marjan van Mourik, (a Dutch tourist who went to Peru and gave up her personal life to serve the poorest people) with the purpose to treat cleft lip and palate patients. NOW, LET US TALK ABOUT THE TEAM: IS IT AN INTERNATIONAL GROUP? ON THE OTHER HAND, IS IT SPANISH BASED? WHICH SPECIALTIES ARE INVOLVED? FES Fundación organized the mission. Dr. Francisco Parri (a Pediatric Plastic Surgeon from Barcelona) created this foundation in 2005. The goal of the foundation is to treat cleft lip and palate patients (FES means cleft in Catalan) in areas with limited resources. They have done missions in India, Ethiopia, Peru and next year will start a new project in Guinea Bissau. A multidisciplinary team of surgeons, anesthesiologists, nurses, dentists and nutritionists forms the missions in order to offer a comprehensive treatment. WHAT KIND OF SURGERY DID YOU PERFORM? HOW MANY CASES ARE TYPICALLY DONE IN EACH EXPEDITION? I work in Barcelona’s Sant Joan de Deu Children’s Hospital and my major activity is to perform the secondary correction of cleft patients. Of course, we are involved in the management of general pediatric maxillofacial surgery, orthognathic and distraction osteogenesis. The majority of the surgical missions
abroad are focused in the treatment of the primary cleft lip and palate. Nevertheless, the goal of our mission goes beyond that: we perform the same secondary procedures that we usually do in our department in. Barcelona. This group of patients is often forgotten in developing countries. We truly believe that we are causing a major impact in their quality of life and social relationships. We treated palatal fistulas, alveolar clefts with iliac crest grafts, rhinoplasties, lip scar revisions and pharyngoplasties. During the 14 missions, FES Foundation has treated more than 250 patients. WHO TAKES CARE OF THE OPERATED CASES WHEN YOU ARE GONE? ARE YOU TRAINING LOCAL SURGEONS TO PERFORM THE SAME PROCEDURES AS YOU DO? The project of FES Fundació is very solid and one of its principles is to teach the local surgeons in order to follow the patients and to be able to perform the surgeries by themselves. The Foundation offers a Fellowship to a local surgeon to visit Barcelona and
learn the management and our treatment protocols in the cleft lip and palate patients. Once this goal is achieved, the Foundation focuses its efforts in a new country.
lip, next the palate...) which increases the relationship with the surgical team. HOW DID YOU PERSONALLY FEEL WHEN WORKING IN PERU? I felt very comfortable working in Arequipa and they had a lot of hospitality. I am grateful to have had this opportunity to be a part of this mission and felt we were useful in treating Peruvian patients in the same way we treat cleft patients in Barcelona.
DID YOU HAVE ANY RELATIONSHIP WITH THE PERUVIAN ASSOCIATION OF ORAL AND MAXILLOFACIAL SURGERY? IS THERE A PARTICULAR NEED OF MAXILLOFACIAL WORKFORCE IN THAT AREA OF PERU? The Foundation has done eight missions in Peru and we keep in touch with the local maxillofacial surgeon (Dr. Gustavo Florez) who takes care of the patients. He had visited our hospital in Barcelona a few years ago. During the mission, we also gave some clinical sessions about the surgical and anesthetic management of the cleft lip and palate patients in Universidad Alas Peruanas. We believe that the treatment of these patients in Arequipa has increased thanks to the effort of Marjan van Mourik: all facilities are given to international teams that go to Hospital Paz Holandesa to operate. Now, there are teams from US and Netherlands that go there periodically. TELL US ABOUT HOW THE LOCAL COMMUNITY OF PATIENTS RECEIVE YOUR TEAM Local people are very grateful and we feel they value our presence. Some patients are operated in consecutive campaigns (one year we take care of the
DO YOU PLAN TO RETURN IN THE NEAR FUTURE? I hope I can. Perha ps will be back to Peru or in another place with more needs. I would definitely recommend any surgeon to participate in these kind of missions to treat the patients and train the local surgeons. â–
You can receive more information about the projects at fesfundacio.org and follow the missions in the social networks.
Oral and Maxillofacial Surgery and DOCTORS WITHOUT BORDERS
By Melissa Amundson Portland, Oregon (USA)
édecins Sans Frontières (MSF) translates to Doctors without Borders. The organization provides medical assistance to people affected by conflict, epidemics, disasters, or exclusion from healthcare. MSF is a non-profit, self-governed, member-based organization founded in 1971 by a French group of journalists and doctors in response to a famine in Nigeria. Today it is a worldwide organization comprised of over 40,000 staff. The actions of MSF and its staff are guided by medical ethics and the principles of impartiality, independence and neutrality. As volunteers, members understand the risks and dangers of the missions they carry out and make no claim for themselves for any form of compensation other than that which the association might be able to afford them.
1. OT team featuring anesthesia, surgery, and OT staff. Local and MSF staff. 2. Me with Dr. Ben resident for Usmanu Danfodiyo University – Despite my vanity, I included this pic. It was the end of the trip, I look a bit frazzled!
The interventions take place four times a year for approximately 3 weeks. MSF’s Noma
3. The MSF team in at the entrance of the hospital. 4. Anesthesia and OT nurses, in gifted outfits from the hospital.
team is a plastic surgeon, a maxillofacial surgeon, two anesthesiologists (at least one with pediatric training) and an operating room nurse. The first Noma intervention took place in 2014 and works in conjunction with local staff, doctors, and nurses at the Noma hospital year-round. It exemplifies collaboration between the MOH and a large NGO. The multi-disciplinary team also includes mental health and postoperative physiotherapists. The mental health team works with patients and family to build trust, support them in speaking with medical staff, and help them understand the complicated procedures associated with Noma surgery, which usually require several stages. In addition, they help develop social skills to kids that may have missed this critical aspect, as patients suffering from Noma are often shunned by society.
"NOMA: The neglected disease that destroys faces and lives" Dr. Melissa Amundson is the first American oral and maxillofacial surgeon to participate in the project and was the first American in the surgeon’s pool for OMS.
Dr. Amundson’s road to the Noma project began 18 months prior to her actual departure, with a lengthy vetting process required by MSF. MSF is known to be quite selective, as health care providers are expected to maintain a level of excellence despite challenging conditions and limited resources. Additionally, prior to the Noma project, there has not been a substantial need for OMS by MSF, further reducing the acceptance rate. Many of the resource pool OMF surgeons sourced from other expat locations, such as the trauma hospital in Amman, Jordan rely primarily on nearby surgeons. The project continues to grow and flourish in Sokoto with increasing attention to training local surgeons including residents from Usmanu Danfodiyo University. Noma and WHO have set an aggressive goal to eradicate Noma by 2023. The disease is 100% preventable, and rarely seen in high and middle-income countries. Hopefully MSF and Dr. Amundson will be there to help make this goal a reality. ■
Inaugural IAOMS/AAOMS International Reception
A Huge Success! Thank you to the more than 130 oral and maxillofacial surgery leaders from around the world who gathered to celebrate the growing relationship between the International Association of Oral and Maxillofacial Surgeons and the American Association of Oral and Maxillofacial Surgeons. On behalf of IAOMS Foundation Board Chair Dr. Larry Nissen and the Board of Trustees, a special thank you to Dentsply Sirona, our exclusive sponsor of the International Reception.
Advancing global care standards through education and training December 2018
IAOMS Foundation 8618 W. Catalpa, Suite 1116 Chicago, Illinois 60656 USA
Phone: +1.773.867.6087 www.iaomsfoundation.org
My experience as a cooperator in AFRICA By Marta Redondo Alamillos Hospital Universitario 12 de Octubre. Madrid (Spain)
t was not my first time in Africa, but it definitively felt so. I could not imagine what I would find when arriving there. I had contradictory feelings of fear and desire. It was 2014, and I was in my last year of training when they gave me the opportunity to accompany one of my consultants in her trip to Tanzania with FECS (Spanish Foundation for Health Cooperation). Two years later, I returned to Africa as a consultant, but I still experienced identical fears as I had then the pressure of being in charge of the surgeries. I could feel the fear of failure, which is always the main obstacle to achieving our dreams in life.
Children hospital Ndala.
FECS is a small organization created in 2001 and chaired by Fernando GarcĂa MarĂn, a Spanish oral and maxillofacial surgeon. Its aim is to promote health care in the most exposed communities in the world, considering health as one of the keys to sustainable development. The entity primarily directs its activity to children and women because they suffer the most the consequences of disease and poverty. They are responsible for several projects in Equatorial Guinea and Ghana and since 2012 they have established in Tanzania with a new project in the region of Tabora. The project is carried out in collaboration with local organizations, in order to join efforts and get better value for money.
to a previous screening by radio and through word of mouth, all the patients were already waiting for us at the hospital. There were campaigns for patients with cleft lip and palate, in a country where the percentage of patients with this condition that have access to surgical treatment is very low.
After a long trip from Spain including more than 8 hours through unpaved roads, we arrived at Ndala Hospital, which was run by the Sisters of Charles Borromeo under the Archdiocese of Tabora. Thanks
The campaign lasted around 10 days, and we were able to treat 20 patients, with ages between 8 months and 52 years. We also attended the patients in the out-clinic, both the new ones and the follow-
up of surgeries done on other trips of FECS. The organization aims to keep a follow-up of the patients, even though they might live a long distance away from the hospital. Long travel distance and times, unfortunately, mean a lack of systematic follow-up. We also had the opportunity to visit Mwanzugi, another town in Tabora where FECS has helped to build a school and a basic health centre, where outpatient care to women and children is provided. Also, some operation rooms for complicated deliveries and C-sections are now available. My experiences with FECS did not leave me indifferent to the needs of Africa. When in 2017 I had the opportunity to join another team of surgeons going to Kenya, I did not hesitate to volunteer and I even repeated the year after. I definitively plan to make it a habit if circumstances allow it. I am talking about â€œSurgery in Turkana", an organization that began its work in 2004: since then, 15 campaigns have already been carried out. The objectives are to provide health care to the Turkana population in the field of General Surgery, offering every year surgical assistance in the Lodwar Hospital to the population of the Turkana region, the poorest of Kenya. The number of surgeons working in the hospital is small considering the huge size of the territory: the consequences are terrible, and patients die due to the lack of medical attention. The organizationÂ´s future goal is to train the medical staff so they can function in a sustainable and independent manner in the field of general surgery. This would ensure that the hospital could operate continuously throughout the year with local staff. When I first travelled with them in 2017, they decided to incorporate a maxillofacial surgeon in the team as they had found lots of patients with cleft lip and palate that could benefit from surgical
Spanish surgeons and local team Turkana 2018.
1. Mwanzugi school. 2. Children hospital Ndala.
treatment. Travelling with such a big team gave me more confidence, even though I was the only maxillofacial specialist. There were also general surgeons, gynaecologists, traumatologists, anesthesiologists, medical students, an endocrinologist, a nurse, a photographer and logistics staff. We also had the possibility of using telemedicine with radiologists in Spain since we took with us a portable ultrasound machine. The screening here was done months before we arrived: many people in the area are nomads and live in huts without access to any health care. During the two weeks that we spent in Turkana the patients were already in the hospital waiting for us, both those from Lodwar as those that were brought from far away in the region. As a maxillofacial surgeon, I mainly performed cleft lip and palate correction, but also provided help in facial trauma, salivary glands, neck pathology, neurofibromatosis, large keloids, etc. What I really love about this team is that medical doctors from different specialities work together helping and supporting each other. And this works this way mainly because of the team leader, Dr Carmen HernĂĄndez, a general surgeon who makes this project a central part of her life and shares with us her enthusiasm. From my short experience in medical cooperation, there are several concepts that I would like to mention. First, gaining awareness of the different realities of the world and put the so-called First world problems into their proper perspective. Then, the importance of respect and tolerance with the people from the area where we travel. We have to understand that we are foreigners going to their place: we have to respect their culture, their customs and do not try to impose our criteria because sometimes what is normal and natural in your habitat is not in theirs. We have to work together with the local team, trying to transmit everything we know,
but listening to and learning from them and adapting to their way of working. I realized the importance of the translator, not only to transmit the literal meaning of what the patients say but also to help us understand their situation. They do not want superheroes coming from another country to save their lives, the patients need doctors that can listen to them, do not look in another direction when problems arise and do whatever is in their hands to heal them, improve their quality of life and accompany them in the process. I must also say that I have experienced situations that were emotionally overwhelming. Although it is a very rewarding experience, it can also very hard. Looking back I have to admit that I would have done some things differently, but I am very grateful for having had the opportunity to participate in these projects. The attitude to adopt is never giving up when facing the injustices and the misfortunes of the world. A foreigner looking with a face of sorrow is useless to them. A positive, respectful and hardworking attitude is basic because getting their world and our world to meet is what makes it all possible. I cannot end this paper without expressing my gratitude to all the people that made this experience possible: my family, my colleagues in my hospital in Madrid, and all the people involved in the functioning and coordination of the projects, mainly the directors of these two organizations. â–
FOUNDATION CHAIRMAN REPORT
A bi g
yo u Dear Friends,
s we near the end of another year, it’s a great opportunity to look back on all of the progress we’ve made together. Thanks to the generous commitment and support of individuals and organizations around the world, we have accomplished amazing things. Let’s take a look back at these exciting accomplishments of the past two years, since we revitalized the Foundation’s development and programmatic efforts: ✓ In 2017, we launched our first formal Annual Appeal with a goal of raising $500,000 in total commitments. With your help, we reached this goal, and are again on track for another successful year in 2018. ✓ We continued the growth of the FELLOWSHIP PROGRAM, with three fellows currently in the midst of 12-month international training appointments. For the coming year, we have received yet another record number of applicants, with almost 250 individuals applying in the past three years alone. ✓ We launched the brand new VISITING SCHOLARS program, which provides an award for two surgeons to undergo two-week observational training appointments at international institutions. The first even winners of the award will be announced soon. ✓ We are finalizing plans for the launch of the RESEARCH FELLOWSHIP program, which will provide the opportunity for a 12-month research training appointment at the University of Michigan. ✓ We established the ICOMS SCHOLARSHIP program, through which members of supporting regional associations receive a funding award to attend the International Conference (the upcoming 2019 ICOMS is in Rio de Janeiro in May). ✓ We have formed partnerships with and received financial support from nine regional and national OMS associations around the world, with more to come. ✓ Thanks to a growing relationship with the American Association of Oral and Maxillofacial Surgeons (AAOMS) and the OMS Foundation, we held the first annual IAOMS/AAOMS INTERNATIONAL RECEPTION at AAOMS’ 100th Anniversary meeting in Chicago. This was a landmark event, with more than 125 leaders from around the world gathering to celebrate our collaboration.
None of this progress could have happened without the commitment of so many, both financially and through volunteer service. For that, I would like to thank all of you, on behalf of the IAOMS and IAOMS Foundation Boards. Friends, I can’t wait to share with you the Board’s plans for what is next in the coming months. Our goal is to expand the global impact that the Foundation has, and we have an ambitious plan. Would you join us now, at the end of the year, to help us maximize our results in 2018? Please visit the Foundation’s website at IAOMSfoundation.org to make your gift today. Thank you all for your ongoing support. We look forward to sharing more exciting news with you soon! ■
Larry W. Nissen IAOMS Foundation Chairman
So, you want to work...in
“The country of the eternal spring” By Rodolfo Asensio Hospital Escuela Centro infantil de Estomatología, Guatemala
uatemala, country of the eternal spring. Are you considering our country for your Maxillofacial and Oral Surgery training? Guatemala is located in the northeast of Central America. The Caribbean and Pacific waters surround it. It is regarded as the cradle of the Mayan civilization. Guatemala City, where both of our Maxillofacial Surgery training centers are located, is the capital and largest city of the country, and the most populous in Central America. ORAL AND MAXILLOFACIAL SURGERY IN GUATEMALA Oral and Maxillofacial surgery in Guatemala is a subspecialty whose practitioners are organized under the Guatemalan Association of Oral and Maxillofacial Surgery and affiliated with the Latin-American Association of Oral Surgery (ALACIBU); it is a dental specialty - so as a first requirement you need to have a Degree in Dentistry. In Guatemala City, there are two training programs in Maxillofacial Surgery. Both are run by the Dentistry School of the State University San Carlos de Guatemala. OMS Training programs are three years in duration. Training takes place in a third level state Hospital that are referral centers for the entire country. Referred patients present often with pathology related to trauma, temporomandibular joint or other head and neck tumors. In order to apply, one needs to contact the Postgraduate Department of the Dental School at Universidad San Carlos de Guatemala. Following completion of a submission process, they will assign
a date for a comprehensive basic dentistry test. If selected, a personal interview will be requested. Usually there are 16-20 applicants (international students included), of which only an average of 4 are accepted. Before the applicant receives the final decision of acceptance, a propaedeutic program is mandatory. PROPAEDEUTIC PROGRAM Before accepting an applicant to the Maxillofacial and Oral surgery program, a 1-month program of strictly supervised surgical, academic and administrative activities is mandatory. The objective of this program is to discover the personal and professional
competences of every applicant, as to know if they have basic knowledge and some surgical skills that matches to the subspecialty standards. WHERE CAN YOU EXPECT DURING YOUR TRAINING? Expect 3 years of hard work and big goals on your professional life, a program with multiple rotations inside the hospital complex including the Departments of Internal Medicine, Neurosurgery or General Surgery. In addition, there are some rotations outside the hospital complex - the Cleft Lip and Palate rotation at Centro Infantil de Estomatología in Antigua, Guatemala and the Head and Neck cancer rotation at Instituto Nacional de Cancerología in Guatemala City. We encourage the participation of the students in scientific meetings, courses or symposiums, national or international as a reinforcement to their academic formation and skills development.
SUMMERY 1. DEGREE IN DENTISTRY SURGERY 2. APPLICATION TO THE POSTGRADUATE DEPARTMENT OF THE ODONTOLOGY FACULTY AT UNIVERSIDAD SAN CARLOS DE GUATEMALA a. Take a basic dentistry knowledge test b. Personal Interview 3. PROPEDEUTIC PROGRAM 4. ACCEPTANCE NOTICE
AFTER YOU HAVE BECOME A MAXILLOFACIAL SURGEON In Guatemala there are several options to practice surgery, both in the public and private sectors. In the public sector, you can practice in different regions of the country, but the largest influx and main reference centers are in the city. On the other hand, private practice is probably a good bet, because of the high percentage of the population that has health insurances, allowing them to be treated in private hospitals and private clinics. ■
Women in IAOMS
WOMEN AS SPECTATORS OR WOMEN AS PARTICIPANTS? XXIV Congress of the European Association for Cranio Maxillo Facial Surgery (EACMFS) By Ada Ferrer Fuertes Hospital Clinic. Barcelona (Spain)
ondon, Prague, Barcelona, Dubrovnick, Brugge. After having been hosted in many of Europeâ€™s big cities, the EACMFS meeting has made its way to Germany. It was the third time that this meeting visited that country, after Hamburg in 1982 and Muenster in 2002. Under Klaus-Wolffâ€™s presidency, the 24th Congress of the European Association for Cranio-Maxillo-Facial Surgery (EACMFS) was held between September 17 and 21 in Munich (Germany).
More than two thousand Oral and Maxillofacial Surgeons from all over the world attended the meeting. Such a great success implied at some times that some of the halls of The Gasteig were closed because they exceeded their maximum number of attendants. While that may have upset some delegates, it speaks volumes about the popularity of this meeting. The overall impression was that the programs presented encompassed the main areas of interest in our speciality - oncology, cranio-facial surgery, oral surgery and implantology, new technologies and virtual planning, TMJ, traumatology, facial palsy, vascular malformations, reconstructive surgery, pediatric surgery, aesthetic surgery and osteonecrosis. As it is normal with these type of large conferences, having several simultaneous sessions force the attendees to choose according to their interests, making it impossible to attend all the sessions. Nearly 1200 speakers walked up to the podium and shared their experiences. I made a couple of observations in regards to the participation of women at this meeting. More than 25% of the presenting faculty were women. Several
regional and national organizations met during the conference. My own national association SECOM, had a round table with 6 speakers and 3 moderators. However, we did not have participation from one of our women members at that session. On the
Are these trends truly reflective of the reality of gender diversity in our speciality? Even though many of the most renown speakers of Maxillofacial Surgery have traditionally been men, every day there are more women entering our speciality that contribute meaningfully and considerably. It is my opinion that since FACING THE FUTURE was the motto of the meeting, the organizers would have been prudent and progressive had they taken an extra effort to make this meeting inclusive of female surgeons. As we move forward, perhaps we must come to terms with the fact that the realities within our specialty in regards to gender is addressed. One can certainly hope that organizers of the future meetings in Paris and Madrid take heed. â–
other hand, it was noteworthy to mention the gender parity in the session organized by SFOMK, the Scandinavian society. In many similar sessions, there were no female speakers at all. In fact, if one does not consider the free paper sessions, only 17 female speakers spoke between Monday and Friday. I suspect that similar trends are not unusual in other congresses of Maxillofacial Surgery. It is also noted that there were not any women in the scientific, organizing and reviewing committees. December 2018
From Proust to Pivot
AN APPARENTLY INNOCENT QUESTIONNAIRE FOR ORAL AND MAXILLOFACIAL SURGEONS
Prof. J oël
te ith my daugh Fishing trip w
What is your favorite word? Bravery. What is your least favorite word? Betrayal. What is your favorite drug? Work. I am really addicted to it! What sound or noise do you love? The sound of the waves on remote beaches. What sound or noise do you hate? The car horns in big cities. What is your favorite curse word? I don’t have one. Who would you like to see on a new banknote? Crick and Watson: the two scientists who have discovered the DNA structure and role.
Centre Hospitalier Régional Universitaire de Lille (France)
What profession other than your own would you not like to attempt? I like my profession. The one I hate the most; politician (that is different than true state men) unfortunately we have more and more politicians and less and less state men. If you were reincarnated as some other plant or animal, what would it be? No idea. If Heaven exists, what would you like to hear God say when you arrive at the Pearly Gates? What great a job you did! What is your idea of perfect happiness? Freedom and good health. What is your greatest fear? To see my relatives suffering.
What is the trait you most deplore in yourself? I don’t know. What is the trait you most deplore in others? Hypocresy. Which living person do you most admire? I don’t know, but I don’t think that there are gods on earth… What is your greatest extravagance? It doesn’t seem to me that I have extravagance. I suppose that I can be extravagant in certain circumstances but this question should be asked to my closest friends. What is your current state of mind? Optimistic.
European gala diner in Prague with Dr. Ricard his wife and mine.
What do you consider the most overrated virtue? Difficult to say but I would say Honesty. On what occasion do you lie? I case of necessity... What do you most dislike about your appearance? I don’t know. Which living person do you most despise? No one.
Gala diner of my presidency of the French association 2011.
What is the quality you most like in a man? Bravery. What is the quality you most like in a woman? Intelligence and beauty. Which words or phrases do you most overuse? I don’t know (that should be asked to my residents…) What or who is the greatest love of your life? My family. When and where were you happiest? On a boat in a remote river or sailing on the ocean. Which talent would you most like to have? To be a good maxillofacial surgeon: you can’t do well many professions in one life. If you could change one thing about yourself, what would it be? No idea. What do you consider your greatest achievement? I don’t have one. I hope to be able to make my specialty stronger and to offer to my family a happy life.
If you were to die and come back as a person or a thing, what would it be? I don’t know. Where would you most like to live? Where I live today. What is your most treasured possession? My family. What do you regard as the lowest depth of misery? Difficult to say…
Salvador de Madariaga, and many others… Who is your hero of fiction? I don’t have one. Which historical figure do you most identify with? I don’t know. Who are your heroes in real life? Non one. There is no “superman” in the real life… What are your favorite names? I don’t know.
What is your favorite occupation? Maxillofacial surgery and fishing.
What is it that you most dislike? Wasting time with the hospital administration.
What is your most marked characteristic? That should be asked to my friends.
What is your greatest regret? Difficult to say… We always regret something but I don’t have at the moment a precise point to mention.
What do you most value in your friends? Loyalty. Who are your favorite writers? Jack London, Adam Smith, Serge Gruzinski, Claude Levi Strauss,
How would you like to die? Very old (I adore life) and suddenly in perfect health! What is your motto? I don’t have one. ■
Copy Me MANAGEMENT OF SNAKE ATTACKS J.D., a 22-year-old male, was taking a nap in the bush while herding his cattle. He woke up to a hissing sound and the next thing he knew, a snake had spat into his left eye. He was rushed to a nearby hospital and made it to our unit four days later. He presented with conjunctivitis and ptosis of the left eye and an impressive large abscess of the left eyelid, extending cranially to the fronto-parietal region of the same side. His vision was intact. There were no puncture bite wounds in the affected area. He also did not illicit any signs of systemic envenoming (no signs of shock, respiratory failure, renal failure or coagulopathies). All his signs and symptoms were suggestive of local envenoming. We also did not have the benefit of knowing what species of snake had attacked him but it was obvious, we were most likely dealing with a snake spit ophthalmic injury. Since he presented to us four days later, it was too late to administer any anti-venom. Anti-venom is more effective to prevent local necrosis when administered hours after the injury. We therefore began conservative management. In this case, managing the suppuration and trying to avoid necrosis of the affected flap.
ya Emily N
EMILY NYAMU Consultant Oral and Maxillofacial Surgeon Nyeri County Referral Hospital, Kenia ROBERT MANDELA
Resident Oral and Maxillofacial Surgery
On presentation, prior to the OR: conjunctivitis and ptosis of the left eye and a massive abscess of the left eyelid, extending cranially to the fronto-parietal region. 30 iaoms.org
Incision and drainage in OR; copious amounts of pus were drained followed by profuse irrigation with hydrogen peroxide and normal saline.
3 To prevent necrosis of the cranial flap, two improvised vacuum drains were inserted to keep the flap well attached to its vascularized bed on the cranium. A corrugated drain was used in the dependent area of the eyelid, to drain by gravity.
We performed twice-daily irrigation of the abscess area with normal saline and dilute hydrogen peroxide. Broad-spectrum antibiotic coverage and analgesia constituted medical management in addition to Tetracycline eye ointment.
5 The flap was watched for signs of necrosis. We achieved very good results with no flap necrosis, as we had feared.
KEEP AN EYE ON RIO! By Luiz Marinho Chairman of the Local Organizing Committee 24th ICOMS
s 2018 closes its curtains, we are closer to the next ICOMS. It is my great pleasure to cordially invite you to the beautiful city of Rio de Janeiro for the 24th International Conference on Oral and Maxillofacial Surgery - ICOMS, to be held at the Windsor Barra Convention Center, 21â€“ 24 of May, 2019. It is a privilege to host the largest international event of our specialty in Brazil and the local organizing committee and the IAOMS office have being working diligently together to offer an unforgettable event in an unforgettable city. The 24th COMS will take place in a new conference center located at Barra da Tijuca, a beautiful, beachside neighborhood west of Rio de Janeiro. We will have innovative and stimulating 5-day scientific sessions, which begins with a preconference program tailored to the Next Gen and Next Forum Levels, carefully planned by Drs. Gabriele Millesi and Ghali Ghali. The program that will highlight the latest developments in our specialty is designed to nurture discussions in controversial areas of OMS. We have more than 100 confirmed keynote speakers and over a 1000 abstracts submitted from more than 70 countries. On top it all, Dr. Bryan Bell will deliver the Presidential Lecture. Industry will be well represented through preconference Corporate Forums and outstanding exhibition and trade fair. In such an inviting scenarium, we will also celebrate our specialty and our international fraternity with a December 2018
rich social program prepared to deliver a piece of our cultural diversity. Rio de Janeiro offers great tourism and leisure opportunities, with the striking contrast of a city blessed with a tropical forest and a wonderful bay and its beaches. It is a real feast for the eyes that can be savored in many ways. We are planning an excellent scientific program and wonderful social events and your active participation in the conference is essential for its success. Let us welcome the world with open arms in an atmosphere of joy, peace and certainty that we will have a successful Conference. We are looking forward to welcome you in Rio de Janeiro.
Perspectives on surgical training:
STANDING ON THE SHOULDERS OF GIANTS By Omar Breik Royal Derby Hospital. Derby (UK)
ne of the advantages of training in Oral and Maxillofacial Surgery being so long when you do both medicine and dentistry is that you see different ways of teaching and training within a variety of settings. Even within the time of my own training in the Australian Oral and Maxillofacial training program, there was significant change. Being a member of IAOMS also means that we meet and interact with many OMF surgeons from many different countries, all with different programs. The evolving nature of our training system gives us a unique opportunity to explore how we can improve the quality and nature of training for the coming generations. The structure of surgical training now is a by-product of the work by William Halsted MD, a famous American surgeon credited with developing the first formal surgical training programmes at John Hopkins Hospital. He believed that surgical training should be accomplished in a set period of time, have a progressive increase in responsibility and operative experience, and have a final period of independent activity. In the early system, surgical trainees worked very long hours, learning to operate ‘on the job’ with variable levels of supervision. Generally, people got accepted into the program if they were liked by the head of unit, and progression through the training system was strongly associated with the practice, beliefs, attitudes and perspectives of the consultant who leads the team. The environment in which we train now is very different. In some ways, it is now better, with more stringent criteria on getting accepted into training, formalised feedback 34 iaoms.org
on trainee performance throughout their training, work hour restrictions and rotation through multiple centres throughout training all leading to a broader experience. However, there is merit in holding on to some of the aspects of the ‘old way’ which I feel at times made better surgeons. I will reflect on some of those from my own experience, and then give some advice to trainees and trainers for the future. When I first started training, the system in Australia involved getting accepted into the training program usually 2 years after completing dental school. Once you were accepted, as a ‘Basic Surgical Trainee’, you performed a year (or two) as an OMF registrar/ resident, and then commenced medical school. This was a great introduction into the training program. Firstly, as a trainee you get a taste for what the program and the job is like, clarifying your decision to go ahead with training. Secondly, it allowed for me to begin to foster relationships with my peers and consultants early, allowing me to continue to assist on major surgical cases, stay on the on call rota, and further my education in OMF while I was a medical student. The training program has changed in Australia and New Zealand since then, now a prospective applicant needs to complete both degrees before applying. From my perspective, this means they miss out on years of exposure, December 2018
â€œI was lucky to work with a variety of gifted surgeons who made the time to be involved in teaching and made extra time to educate despite their busy commitments.â€?
mentoring and learning during those formative years. My advice for the associations and training programs in different countries is to try to engage those going through their second degree and throughout their training, keep them involved with the unit or research, guide them through their years and be a source of motivation and inspiration for them. This should be something that both current trainees and trainers can do. Being engaged with those applicants also helps retain their interest in the speciality. After completing medical school, I commenced my training program in Melbourne. I had a great set of trainers with a wide range of experience. I was a motivated registrar/resident who was happy to work late, do extra on call and assist on the weekend wherever I could. I was lucky to work in an environment where this was encouraged and supported. Without the extra work I did, I would not have acquired as much experience as I have. My advice to every trainee is to seize all the opportunities they can during their years of training, and the more you do, the more competent you will be. I was lucky to work with a variety of gifted surgeons who made the time to be involved in teaching and made extra
time to educate despite their busy commitments. These include A/Prof. David Wiesenfeld, Prof. Andrew Heggie, A/Prof. Alf Nastri, Mr. Ricky Kumar, Mr. Tim Wong, just to name a few. These trainers who go the extra mile to teach deserve greater recognition. In general, however, not all trainees have been as lucky with their trainers. Not enough emphasis is placed on training surgeons to become good educators. The skills required to be a good educator differ markedly from the skills needed to be a good surgeon. These separate competencies need to be identified, practised and coached to result in knowledgeable and effective educators. Since completing my training program, I have been a head and neck oncology fellow in the UK. I have been working at the Royal Derby Hospital, and here I have experienced another form of surgical training. A form which requires a particular level of commitment from trainers: the apprenticeship model. Working with Mr Keith Jones and Mr David Laugharne has felt like being an apprentice. Due to their full-time commitment to the department, the fellow is able to learn from the whole treatment process from pre-op to post-op to long term follow up. Through having a strong one-on-one training relationship with an experienced consultant like Mr Jones, I was able to more quickly absorb and learn and hone a particular skill set. Although I will be leaving the unit soon, such a training model has given me strong mentors for the remainder of my career. Surgical training is evolving, and it has changed over the past few decades. It is our responsibility as the next generation of surgeons to guide the next evolution in training to further improve patient outcomes. The experiences that shaped my training have always revolved around the quality of the trainers around me. The importance of mentoring, actively involved and engaged trainers, and adopting an apprenticeship model are all different ways to deliver surgical training. As more integrated programs develop, program directors should strive to incorporate various models into their training programs. Programs to trainer the trainers are also needed to teach surgeons how to educate. Only through standing on the shoulders of engaged and motivated giants will future advances be made. â–
In First Person
AWAY FROM MY ISLAND: A CUBAN ABROAD By Carlos Espinosa Fariñas Hospital Quirónsalud. Barcelona (Spain)
migration is always complex, but not always necessarily negative. The experiences acquired in the process enrich the spirit. It is a long road, sometimes a bumpy one. In most cases it requires leaving your family, your neighborhood, your friends, your culture and language. The feeling of loneliness accompany you for many years, sometimes for the rest or your life. The psychosocial aspects that help to define your identity are left behind. Cuban of birth and with deep roots in the island, at the age of 28 I decided that I had enough - economic precariousness was suffocating, the administrative and bureau-cratic framework seemed designed so nothing would work, the social model they were looking for 36 iaoms.org
was dead. We were lagging behind the rest of the world. I studied medicine at the Higher Institute of Medical Sciences of Havana. Medical stud-ies in Cuba last 6 years and is free, including registration and books. Access is through selective tests and a scale. The last year of studies must be carried out in the form of “practices¨. You are in charge of a specific population, located in places of little acces-sibility and well below the poverty line. The anecdote of this episode was that of a birth in a hut of wood and straw. Imagine at 2AM, at 80 miles of stone and mud roads from the nearest hospital, without means of transport, in a gloomy hut, with a woman screaming in pain, a pale husband of fright and you, you have not graduated! December 2018
1. Graduation. Higher Institute of Medical Sciences of Havana. 2. Venezuela
“By luck” I had been in that place for 6 months, and the countless Ascaris Lumbricoides, nephritic colics, accidental wounds, fistulas, pustules and abscesses had hardened me. But this situation was different, the outcome would mark me and that family for life. With interlaced hands so that the tremor was not noticeable and clarifying the throat so that the choked voice muffed, I began to give indications. Luckily, labor is a physio-logical process, and evolution has brought us this far. Between the sweat, bloody rags and one last push, a 36-weekold boy, mestizo complexion and 1900 grams of weight was born. I have experienced this adrenaline and professional satisfaction a few times.
“The feeling of loneliness accompany you for many years, sometimes for the rest or your life.” After graduating as a doctor my dreams of becoming a surgeon were cut short, the country needed something else. They needed general doctors to go to work in Latin America. Do not kid yourself, it was not an option, it was the only option. The communist/socialist regimes are what they are, one or two “thinking persons”in turn deciding what the best is for millions of people. At that stage, I practiced general medicine for almost 2 years in Venezuela, a country of enormous natural wealth but precarious social development. After living between gunshots, drugs and a total lack of respect for human life, after observing and suffering the policies supposedly destined to improvement of the quality of life of those people, after a reflection of several months and the unconditional encouragement of my travel and life partner, we decided to embark on a new path. December 2018
This trip took us through several countries and cities; this is where the story probably has more interest for the reader. In the United States, it was necessary to resume medical and specialty studies, which led us to evaluate the advantages and disadvantages of the possible candidate countries. In the universe of developed countries, we are left with the United States where we lived at that time and within Europe, with Spain. The choice of such a place are determined by several factors often determined by the re-cipient country: the limitations or ease of access to studies, the language and the per-ception of people in that country about immigrants. The other group of factors are those that determine your psychosocial situation: your economic situation and budget, the age at which you decide to take the step and your ease of adaptation to chang-es. We decided to move to Spain because it is an immigration-friendly country. Further, Spain validated University degree and permited access to a medical specialty in a shorter period of time which required less budgetary effort. The training program for specialists in Spain is called MIR (Resident Medical Intern). Fol-lowing a year of intensive study, applicants present to an examination. They are awarded further training in a specialty and hospital of their choice based on their score in that exam. The specialty of Oral and Maxillofacial Surgery has experienced a thriving development in recent decades although its origin seems stuck and confused in different regions. There are two main models the American model linking it to dentistry and the Euro-pean model links it to medicine (although it is not uniform for the entire EU). The details of these variations are beyond the scope of this article in the form of a personal review, but the history of the specialty is exciting in its different aspects, full of characters whose great effort and dedication promoted the specialty. In Spain, the specialty of Oral and Maxillofacial Surgery was recognized in 1978, while in Europe it was iaoms.org 37
not recognized until 1989. In many ways, despite the fact that the spe-cialty has 30 or 40 years of history, it can be considered newborn. The most exciting aspect of Maxillofacial Surgery is the versatility in its scope of practice, taking into account the anatomo-morphological region in which it operates. We can treat specialized joints, manage bone and soft tissues as well as develop knowledge of vascular and neurosurgery. The study of facial traumatology, oncology and its recon-struction, cranio-facial deformities, the pathology of the salivary glands and the tempo-ro-mandibular joint offer us tools that sometimes become diffuse among other special-ties such as plastic surgery or ENT to name a few examples, but no other specialty is able to solve the singularities of these pathologies. The specialty also offers advantages in the labor sphere; it can perform its work both in a tertiary care hospital and in a pri-vate practice without the need of great resources.
With Prof. Juan Carlos De Vicente.
I eventually trained as an Oral and Maxillofacial Surgeon at the Central University Hos-pital of Asturias belonging to the University of Oviedo. I learned from an excellent and demanding team headed by Prof. Juan Carlos De Vicente. I am currently developing my professional career in Hospital Quironsalud in Barcelona integrated in a first-class team of maxillofacial surgeons. â–
th YEARS ANNIVERSARY BOB COOK, Past President of IAOMS
1992-1995 celebrated his 90th birthday on the 12th of November 2018. A party with family and friends in Melbourne was held on 25th November. Surrounded by his wife Gillian, children and grand-children Bob spoke of his life. Born in New Zealand, he migrated to Australia with his parents at the age of 7 years. After completing his Dental Studies he became the first Dental Resident at The Royal Melbourne Hospital. Further training in England ensued, with marriage to Gillian after his return to Australia where he became the Head of Oral and Maxillofacial Surgery at The Royal Melbourne Hospital. Practicing in the years before the advent of compulsory seat belts in Victoria meant an endless stream of patients with severe facial injuries to manage. 38 iaoms.org
Bob dedicated himself to patient care and teaching of young Oral and Maxillofacial Surgeons. He was teacher and mentor to a whole generation of Surgeons in Australia. His interest in international affairs lead to the IAOMS Council and President of IAOMS. Bob was also the Inaugural Chairman of The IAOMS Foundation in 1996. Never one to shirk his duties and always looking for an opportunity to contribute, he served as Patron of the highly successful Melbourne ICOMS 2015. At the party video messages were received from friends around the world, including IAOMS President Alexis Olsson. â– December 2018
IAOMS Virtual Conference February 27, 2019 8:00–10:15 a.m. CST (US) USD $99 for IAOMS members/USD $149 for nonmembers
Join us for the first IAOMS Virtual Conference. This new format allows OMF surgeons to participate live from the comfort of your home or office and features four IAOMS members. KE Y N OT E S E S S I O N
B RE A KOU T S E S S I O N S 9:15–10:15 a.m.
Juvenile Idiopathic Arthritis — Pearls for Oral and Maxillofacial Surgeons Shelly Abramowicz, DMD, MPH, FACS
Overview of the Management of Obstructive Sleep Apnea and Robotic Sleep Surgery
Management of Two Common Complications in Sagittal Split Ramus Osteotomy: Bad Split and Nerve Injury
G.E. Ghali, DDS, MD, FACS, FRCS(Ed)
Mike YY Leung, BDS HK, MDS HK, MOSCRCS Edin, FHKAM (DS) FCDSHK (OMS), PhD HK
Details on the third breakout session are coming soon.
For more information, email firstname.lastname@example.org
Report of Regional Meetings
THE AMERICAN ASSOCIATION OF ORAL AND MAXILLOFACIAL SURGEONS, CENTENNIAL MEETING
VIEWED FROM OUTSIDE By Eric Kahugu Nairobi (Kenia)
have been attending the American Association of Oral and Maxillofacial Surgeons (AAOMS) Annual Meetings for the past 16 years or so. These meetings have always been a highlight of my work related travel, because of their size, interesting locations, diversity of attendees, variety and quality of papers presented. The centennial meeting held this October, which celebrated 100 years of an association that represents over 10,000 Oral and Maxillofacial Surgeons, lived up to its billing. 40 iaoms.org
This meeting, held in Chicago was especially poignant for me as a member of the IAOMS Executive Committee, because it was at a previous AAOMS meetings held there, that Professor Rui Fernandes encouraged me to be a part of IAOMS leadership. Chicago was also the first place I attended a dedicated Maxillofacial Oncology and Reconstructive Surgery (MORS) forum, probably one of the best forums I had ever attended.
The AAOMS centennial meeting, like other annual meetings, was full of grandeur. For a visiting surgeon that will always stand out, from the number of attendees, size of the venue to the assorted ceremonies. For a first time attendee that can be quite a sight to behold (fortunately I have attended many, and know what to expect). This particular meeting had an especially grand opening ceremony, followed by a welcome reception held in the historical Hilton Chicago Ballroom, which added to the historical feel with its grand old chandeliers and exquisite drapery. The AAOMS Presidents event/dinner held at the
Art Institute of Chicago added to the cultural and historical feel of the meeting. The conference itself like most other AAOMS conferences was a treat, because of the wide variety of topics covered and good scheduling, that make itâ€™s relatively easy to pick and choose which ones to attend. Being such a large meeting and held in a large convention centre, the use of a dedicated conference app (which I have seen used in most AAOMS meetings), helped one organise their day relatively easily, with its appropriate reminders and
prompts. The app also provides maps of all the floors and rooms of conference centre and means to communicate with other attendees. The content of the scientific presentations was excellent and the plenary sessions also provided a historical perspective of Oral Maxillofacial Surgery over the past 100 years. For a visitor coming from another country where Maxillofacial Surgery is much younger, it was eye opening to listen to narrations of how the fields of trauma care and oncology, developed over the years. This was very well presented and summarised by the various speakers, who provided good historical references and content to these very broad fields. The centennial meeting was special for the International Association of Oral Maxillofacial Surgeons (IAOMS), not only because of the special reception held in its honour and special award given during the opening ceremony to its President. It was also the first meeting where the IAOMS Education Committee organised a special forum called the World Cafe. This was the developed to provide an opportunity for surgeons from all over the world, to sit in a round table manner and discuss the management of particular cases. This created an opportunity to hear how different regions of the world, manage similar pathology and reach consensus on some matters. The event was a great success and I believe this should be carried through to all other international meetings. Like other AAOMS meetings, the centennial also had several associated events such as corporate 42 iaoms.org
forums, new exhibitor spotlights, clinical interest groups and special interest groups that provided avenues where specific topics, new technologies and techniques could be demonstrated and discussed in detail. The AAOMS meetings always have grand exhibitor halls and the centennial was no exception. This year an added feature was a special centennial zone, with a wall celebrating the past 100 years in pictures and an area where all attendees could pen a comment on a huge card and take pictures against a historical backdrop. For a visitor this is always quite amazing seeing the extent at which industry participates in conferences in the US. It is also a treat to be able to interact with virtually all the major manufacturers in the industry and many other smaller players, who focus on very unique and exciting products. The evenings were filled with social events such as alumni receptions and corporate receptions, where one got a chance to catch up with old friends, meet new ones and exchange ideas and experiences. A very enjoyable aspect of the AAOMS meetings is the friendliness of the colleagues one meets. They are keen to know where one is from and invite you to join in their activities. I pleased to have been invited to several alumni evenings and corporate receptions through such interactions. All in all the centennial was a great celebration and well worth the long travel. â– December 2018
VIEWED FROM INSIDE By Benjamin Noblitt, DMD Resident. University of Cincinnati Oral and Maxillofacial Surgery. Ohio (USA)
he 100th annual meeting of the American Association of Oral and Maxillofacial Surgeons (AAOMS) took place from October 8th to the 13th of 2018 in Chicago, IL. The very first meeting was held in 1918 with 29 surgeons who referred to themselves as “Exodontists”. Dr. Menifee Howard was interested in meeting with other exodontists and contacted as many as he could to attend a meeting in Chicago. This meeting was the founding event for the following 100 years of annual meetings.
“The AAOMS meeting is a place to learn, experience new ideas, meet new people and re-connect with contemporaries. It is has grown from humble beginnings to become the icon event for oral and maxillofacial surgeons everywhere.” As a resident at the University of Cincinnati’s Oral and Maxillofacial Surgery program, I had never attended the annual AAOMS meeting. The fact that this was the centennial year added to my excitement in attending this historic event. While the entire annual meeting spans a course of six days, the first two days were administrative in nature, so I only attended the scientific sessions, which were on the last four days of the meeting. The theme of this year’s meeting was “Safety and Innovation for the Next Century” that is an extension of AAOMS’s commitment to apply evidenced based medicine to achieve positive patient-reported outcomes, December 2018
and raise the standards for delivery care among practitioners of the specialty. The open session of the program was a grand ceremony with the organization acknowledging its annual achievements and accolades. The cherry on that cake was keynote speaker of the evening General Colin Powel. He spoke about his experiences iaoms.org 43
in leadership, politics and the American military. He drove home the importance and value of “taking charge” of a situation and of life in general. As many aspiring and current Oral and Maxillofacial Surgeons know, we are an assertive and successful group of individuals, so this address was well received. The scientific program over the next few days were exemplary. I was able to attend lectures on every topic related to the OMS field from grafting, to implantology, to orthognathic surgery, to anesthesia, to pathology and reconstruction, to practice management including the business of becoming or hiring a new associate. The scale and extent of the topics covered was immense to say the least. With such a large-scale production, it becomes difficult to attend all the lectures that one truly wishes. Several of the speakers were experts whose articles and work I was familiar with, and what a pleasure it was to hear them teach, in person. It was humbling to meet many of the surgeon authors who wrote the books I study as well. One large aspect to the meeting is the exhibition hall of vendors. Every Oral and Maxillofacial Surgeon works with instruments and various pieces of technology in order to improve and streamline their practice. This is pertinent for both private practice and academics surgeons alike. As a resident, I am still learning the different techniques and instruments and honing the ones that work best in my hands. It was a very valuable experience to be able to see what else is available and to see what I might try to 44 iaoms.org
use someday. The latest technology in surgery and anesthesia was on display, cool toys, products, gizmos everywhere! It was as if Christmas had arrived early in Chicago. The resident organization of AAOMS (ROAAOMS) activities are an important and integral part of the meeting. My peers who represent us in the ROAAOMS executive committee worked hard on putting together some excellent scientific sessions as well as networking receptions at this meeting. The Resident Organization has liaisons on several AAOMS committees as well as in its House of Delegates and play a crucial role of representing the voice of the trainee members in the national organization. I was able to see and meet up with many other residents from all across the country, and even some from outside of the country as well. The University of Cincinnati’s OMS training program worked hard to allow the majority of my co-residents, attending surgeons, assistants, and nurses to take part in the event. This was a valuable experience for us because we were all able to sit in on different lectures and share the key points and highlights with each other. The broad scope of lectures paired with the sharing of ideas and information amongst our peers allowed for a wealth of knowledge to be gained. In summation, the AAOMS meeting is a place to learn, experience new ideas, meet new people and re-connect with contemporaries. It is has grown from humble beginnings to become the icon event for oral and maxillofacial surgeons everywhere. ■ December 2018
UNIQUE SOCIAL EVENTS IAOMS FOUNDATION LUNCHEON AT WINDSOR ROOM (atop the Windsor Barra Hotel) Wednesday, May 22, 2019
Learn about the latest Foundation programs and connect with colleagues. Details on the speaker and topic will be announced soon.
GRAND CARNIVAL BALL AT CITY OF SAMBA Wednesday, May 22, 2019
Enjoy Carnival with music and a Samba performance, along with drinks, canapés, snacks and dessert. Special hand-made Carnival masks will add to the festivities.
BLACK TIE GALA DINNER AT CASA DAS CANOAS Thursday, May 23, 2019
The ICOMS Rio Gala will transport you to Old Rio in the heart of the Tijuca Forest, among the world’s largest urban green spaces. Enjoy a wonderful evening with music and a three course dinner.
Register today at icoms.iaoms.org/registration
Report of Meetings
FIRST LATIN AMERICAN MICROVASCULAR RECONSTRUCTION COURSE A Resounding Success
By Hugo Martinez (Mexico)
icro-vascular anastomosis is a difficult art, it can be learned and perfected only by practice. We are proud to announce the first cycle of microvascular practical courses in Mexico City. A dream come true this past October. It is well known that microvascular surgery has been practiced by other specialties in Latin America. Today we can say that our specialty achieved a huge step forward in the reconstruction field. Twelve young Mexican promising surgeons were selected to be trained by world-class professors under the leadership of Dr. G.E. Ghali in a hands-on intensive course - A two-day program focused on skill development in the use of microvascular surgical techniques. Attendees were able to receive extensive, individualized training through centered courses, including a
hands-on, eight-hour workshop and a two-day review course on such topics. Attendees worked with the well-suited instructors Dr. A. Meram and Dr. D. Montes focusing on individual skill levels. It was a privilege to have IAOMS President Dr. Alexis B. Olsson who is highly supportive and inspiring.
As in any other domain. more so in microsurgery, surgeons are either trained at their own institutions or sent to centers that conduct microsuturing courses. Currently many programs have integrated training in microvascular anastomosis techniques in their curricula. The limited time, resources and opportunities to practice microsurgical technique in clinical settings, along with the serious consequences of failure, have led IAOMS to the establishment of microsurgical training courses. We are proud of the Mexican Oral and Maxillofacial Association’s commitment to support this course, divided in 3 sections. The first phase was performed with theorical lectures and lab practice, with
the classical training schemes in microsurgery lab experimental on the rat model. Following which, attendees will be taken through a series of microsurgical maneuvers that would develop their skills working at mid to high-range magnification. During the event, we were honored with the presence of the dignitaries and authorities from the Mexican College of Surgeons, which clearly demonstrated the support from medical community and we are appreciative for their continued support of the specialty. In addition, knowing the importance of educational opportunities for IAOMS members and demonstrating support of improving microvascular surgery in Mexico, Universidad Autónoma de Mexico (UNAM) one of the world’s largest universities jointly accredited by the Mexican Association of Oral and Maxillofacial Surgeons (AMCBM) provides continuing education credits for the attendees. Understanding that a complex operation such as a maxillary reconstruction is a highly demanding procedure for the young maxillofacial surgeon, this course is just the latest example of how IAOMS is inspiring to develop the next generation of Microvascular Surgeons. Training in the art of microvascular anastomosis is difficult and can be learned only by practicing. This will promote younger colleagues and trainees to take up and perfect this difficult art and certify them for doing similar surgeries in human patients. Thank you everyone who participated in the organization of this course. We look forward to seeing you in the next phase of this magnificent project. ■
WW1 and Maxillofacial Surgery By Javier González Lagunas (follow me on
happened to be in Paris last November 11th. It was not aware of the importance of the date until I tried to get to my hotel in Avenue Kleber. It was the Centennial of the Armistice Day, the day that the Allies and Germany signed the End of WW1. That particular day, more than 80 head of states and representatives from countries of all over the world gathered in Paris to commemorate the Armistice Centenary. Moving around the city was not easy, Police everywhere, I had never experienced that level of security. The President of a European country was staying in the same hotel I did, so I felt under surveillance and scrutinized the whole weekend. The role of wars in the development of our specialty cannot be understated. The mainstay of management of jaws fractures was intermaxillary and interdental wiring, and dentists performed it. That was probably the first time when the role of our specialty was recognized. A well-known actor of those times was Varaztad Kazanjian. Dr. Kazanjian was born in Armenia and left for the States at the age of 16. He qualified as a dentist in Harvard in 1905. During WW1, he joined the Army, and moved to UK with the Harvard unit. He was the chief of the first maxillofacial treatment center established in France by the British Army. After the war, he was Professor of Oral Surgery and later of Plastic Surgery in Harvard. Other particular contributions were done by Robert Ivy, an American who served in Vichy treating a huge number of maxillofacial injuries, His experience there gave place to his classic book Fractures of the Jaws. In UK, Sir Kelsey Fry served in France with the Royal Welch Fusiliers. Later on, he joined Sir Harold Gillies, a plastic surgeon to create a pioneer reconstructive maxillofacial surgery unit at Sidcup. During WW2, he was also involved in the foundation of the East Grinstead unit. In France, some important surgeons were involved in the development of our specialty: Hippolyte Morestin and Leon Dufourmentel made important advances in that field. Many of the soldiers that were injured during WWI suffered head and neck injuries, with some kind of facial mutilation. They were called the Gueles Casées (broken faces). The overall incidence of head and neck injuries in WW1 Was around 15%. Even today, a Gueules Casses association exists in France.
Robert H. Ivy and Varaztad H. Kazanjian. National Archives of Plastic Surgery, Gift of the Kazanjian family, 1973.
On the other side of the trenches, the role of German surgeons was also of utmost importance for the development of Maxillofacial Surgery. The Düsseldorf Hospital for the facially injured (Die Düssledorfer Lazarette für Kieferveletzte) founded by Prof. Lindeman and Bruhn in 1914, was the first facial surgery unit in the world. German surgeons were probably the first to offer a team approach to maxillofacial injuries. Surgeons, dentists and laboratory technician’s work together to heal the wounded patients. Maxillofacial and plastic surgeons of those times were not isolated of the medical advances of the era. The use of anesthesia, the recognition of bacterial contamination as the source of infections and hence the development of aseptic surgery, together with the introduction of the concept of debridement set the general framework where our pioneers could develop their skills. Military surgeons also introduced new concepts that were later adopted in all branches of medicine: mobile surgical treatment, triage or rapid medical evacuation were all born in the battlefield. The 1918 promise of “NEVER AGAIN” should be kept in mind. After the 20th century battles, today a strong and united European Union seems to exist, at least on paper. However, signs of a return to the 19th and 20th nationalism are starting to thrive in all corners of the world: euroskepticals, Brexit, walls, protectionist movements of the “Syldavia First” kind coming from the right, anti-globalization movements coming from the left.
Don’t you feel uneasy? ■ December 2018
FACE TO FACE ASPIRES TO BE A COLLABORATIVE MAGAZINE. That means that we are seeking your suggestions, proposals, projects, and ideas, regardless of where you are from, your scope of practice or your current position. We invite enthusiastic Oral and Maxillofacial surgeons with the drive to take our association and our specialty one step forward. Feel free to contact us, and join us on our path of improvement. Dr. Javier Gonzรกlez Lagunas Dr. Deepak G Krishnan
8618 W. Catalpa Ave., Suite 1116, Chicago, IL 60656 U.S.A. www.iaoms.org