Issue 46 / July 2016
Editor-in-Chief Javier González Lagunas
Graphic Designer María Montesinos
Executive Committee 2016 - 2017 Board of Directors Julio Acero, President Piet Haers, Immediate Past President Alexis Olsson, Vice President Gabriele Millesi, Vice President-Elect Arthur Jee, Treasurer Larry Nissen, IAOMS Foundation Chairman Mitchell Dvorak, Executive Director
Members-at-Large Javier González Lagunas Sanjiv Nair David Wiesenfeld
Regional Representatives Abdellfattah Sadakah, Africa Kenichi Kurita, Asia Nick Kalavrezos, Europe Alejandro Martinez, Latin America Arthur Jee, North America Jocelyn Shand, Oceania Nabil Samman, Editor-in-Chief, IJOMS
Committee Chairmen Rui Fernandes, Education Committee Joseph Helman, Research Committee Deepak Krishnan, IAOMS NextGen Committee Steve Roser, COGS Committee Fred Rozema, IT Advisory Committee Mark Wong, IBCSOMS Representative Nabil Samman, 23rd ICOMS-2017, Hong Kong Luiz Marinho, 24th ICOMS-2019, Brazil David Koppel, 25th ICOMS-2021, Glasgow
CONTACT US IAOMS
8618 W. Catalpa Ave., Suite 1116, Chicago, Illinois 60656 U.S.A. (224) 232-8737 / firstname.lastname@example.org
Letter from the Editor HOW I SEE IT
here is no better way to start the summer season then reading a fresh issue of Face to face. In this particular issue we wish to pay a tribute to Chirurgie Oral et maxilllofaciale, oral and maxillofacial surgery in French speaking countries. The influence of French language and culture around the world is still superb. We cannot forget that 29 sovereign states recognize French language in their constitution, 13 as the only official language, and 16 as co-official, The numbers are huge: “220 million” francophones (around 3 % of the world population) that will increase up to “700 million” in 2050 (8 % of the the world population), basically because of the demographic trends in Africa. Sixty percent of French speakers are under 30 years old. Only speakers of Mandarin, Spanish, English, Arabic and Hindi have larger numbers. Also, the influence of medical education and surgical training of the French metropolis is huge. Language is important for bilateral and multilateral collaboration, not only in politics but also in health relatedissues. Not only France and other countries in Europe, but Canada, the Caribbean or Western and Northern Africa are places where professionals in top-ranked medical systems speak French. But we have a few more things for you in this issue. We are launching a new section called Working in Paradise. If you happen to practice in Hawaii, Bali or the Seychelles and you want to share with us your experience of working in these beautiful places, just let us know. We start the series with a report from Sheyla Sironvalle, who takes care of maxillofacial patients in the white island of Ibiza. You will also find a guide that will let you know where in the world this association is having an impact in speciality training. And don’t forget to read columns from Dr. Acero and Mitchell Dvorak, our new Executive Director “strategy meeting” we held in Madrid a few weeks ago. Enjoy summer, your profession and reading Face to Face. ■ Javier González Lagunas EDITOR-IN-CHIEF
“In this particular issue we wish to pay a tribute to Chirurgie Oral et maxilllofaciale, oral and maxillofacial surgery in French-speaking countries.”
CONTENTS July 2016 10 SPECIAL REPORT
Maxillofacial surgery in french key SIGNS The latest initiative of the IAOMS
18 FEMALE TO FEMALE
A long road travelled
FROM PROUST TO PIVOT 20 Cyrille Chossegros
24 COPY ME
Paranasal bone augmentation with simultaneous malar implants
A DAY IN THE LIFE OF 26 A maxillofacial resident in OHIO Dr. Ryan Wallis
30 OMS ON A MISSION Faces of Fiji
WORKING IN PARADISE 32 Ibiza
36 BEYOND THE OR
To tweet or not to tweet
BUILDING ON SUCCESS
’m six weeks into my new role. And while I’m continuing to learn about IAOMS through meetings with the Board of Directors, Executive Committee and other volunteer leaders and members, I do know that I will be building on the successful work of my predecessors, and particularly, Pierre Desy. In this first column, I want to update you on the IAOMS strategic planning process, highlight some of our strengths and preview what’s ahead. At the end of April, I participated in a “think tank” strategy session with the Executive Committee in Madrid to define the fundamentals of IAOMS: the association, membership, industry partners and the patients and families we serve -- so that we can begin work on a three-year strategic plan. As I reflect on that meeting and our discussion of core values, purpose and brand promise, I continue to study the McKinley Advisors IAOMS member survey results. McKinley was retained by IAOMS to administer ongoing surveys beginning in February 2016 to better understand member needs as well as to ensure IAOMS delivers value to members. The information will help us compare our data to a number of similar associations and assist leadership in making sound decisions about our future. Three key findings are of particular note: ✔ Members enjoy high overall satisfaction with IAOMS. In fact, their satisfaction level is higher than the industry average and higher than other healthcare peer organizations. ✔ IAOMS publications (IJOMS and this publication) are the most used member benefit; members say that every IAOMS program and service is important. ✔ Members feel exceedingly positive about the state of their profession and their careers and are optimistic about the oral and maxillofacial surgery field. Clearly, we are fortunate to build on this success. In my conversations with leadership and members, we’ve identified four priority areas to build upon and into our strategic plan: 1. Membership: Members are the lifeblood of IAOMS. Surveying members, lapsed members and various member segments will help ensure that we always have a solid understanding of member needs and a formal mechanism for feedback. In addition to providing member insights, the surveys are a baseline and benchmark to track progress against our priority areas. Beyond the surveys we are exploring strategies, such as a Trainee Advisory Council, to increase the number of trainees to help ensure we have a leadership (and membership) pipeline. 2. Education: IAOMS and the Foundation are committed to advancing the standards of care in this specialty through
improved education and training. Watch for online education modules in multiple languages to help you keep current on a variety of topics and learn from the profession’s top surgeons. The highly regarded IAOMS review course continues to help prepare candidates for the international Fellowship examination administered by the International Board for Certification of Specialists in Oral and Maxillofacial Surgery. The next exam will be administered in October in Bangalore, India. We also invite you to join the discussions in our newly launched online communities and ask or answer questions of your peers. And finally, our Foundation’s Fellowship Program annually funds up to three trainee surgeons in developing countries in oncology and reconstructive surgery and cleft lip and palate/craniofacial surgery learn skills to make an impact in their community. Applications for the 2017-18 Fellowship Program will open August 1. 3. Communications: In the coming months, we will assess our communications with and among members and with other national and regional OMS associations. We continue to enhance IOAMS.org, our re-vamped and recently re-launched website. 4. Engagement: There are multiple forms of and venues for engagement. I’m excited to attend the 23rd ICOMS in Hong Kong (March 30 – April 3, 2017), with Dr. Nabil Samman chairing the local organizing committee. In Hong Kong we will present a day-long Futures Conference on March 29. I have the great pleasure of working on this Conference with Dr. Alexis Olsson, vice president, IAOMS. Our working theme is “Adapting to Lead” and we will promote engagement through presentations similar to TED talks, to maximize conversation between presenters and the audience. And in the fall of 2016, we will launch an International Symposia in collaboration with the ALACIBU and the national association in Colombia, South America. The International Symposia is a new initiative and will be held in a different region every other year, helping IAOMS continue to attract and grow a diverse membership. I hope you will join with other OMS surgeons, trainees and other allied health professionals to attend these events. I look forward to getting to know and work with each of you. I would like to especially thank IAOMS President, Dr. Julio Acero, for his leadership, and the entire Board of Directors, Executive Committee and staff for the warm welcome to this dedicated community of OMS professionals. Together, we will build on success to move IAOMS from value to impact. ■
Mitchell Dvorak, MS, CAE EXECUTIVE DIRECTOR IAOMS
Letter from President
ear colleagues and friends, IT IS MY PLEASURE to report on the many important developments occurring in the association in the last few weeks.
A landmark that will have a critical impact on the future evolution of the IAOMS, was the meeting of the Board of Directors and the Executive Committee held in Madrid in late April. I express my recognition to all IAOMS officials, and also to the dedicated staff of the association (under the leadership of our new Executive Director, Mitch Dvorak), and to Barcelo´s technical secretariat for the commitment and great work which contributed to an efficient, well-organized and productive meeting. I would like to highlight the strategy and “Think tank” session held with the participation of all members of IAOMS committees, acting as facilitators André Vietor and Juanjo Garcia, international experts in strategic thinking and planning of associations. It was a very interactive session that provided key ideas to plan the future of IAOMS. During the meeting, important changes in the committee structure were approved, which will contribute to a more modern and efficient IAOMS, with an increased focus on member needs and engagement. After intense work, the new ICOMS guidelines were finally approved: we expect that the new regulations and the incorporation of Barcelo as our core PCO will have a significant impact in the future of the ICOMS, one of the crown jewels of IAOMS. During the meeting, the preliminary results of the Members Survey conducted early in my Presidency were presented. The rate of the member´s satisfaction with IAOMS is high but we still have to improve the methods for members application and renewals. It is my pleasure also to announce that the new website has been launched. I encourage you to visit and enjoy www.iaoms.org. The new website, will not only be a tool to to participate the association´s life, but it will also be a platform to improve membership management. I would like to express my gratitude to everyone involved in the development of the new IAOMS website but very specially to Lisa Markowic.
Unfortunately Lisa has left IAOMS after many years of dedication due to personal reasons. On behalf of the association, may I wish her all the best in her career. We continue offering exciting educational opportunities worldwide. Recently the IAOMS Foundation awarded the 2016-2017 Fellowships to Dr. Ignacio Velasco (Puerto Rico); Dr. Timothy Aladelusi (Nigeria); and Dr. Ahmed Maki Merza (Iraq). Applications for the 2016-2017 Fellowships will open soon. The Education Committee under the leadership of Rui Fernandes continues developing programs at a global level. I will be attending the last session of the educational program we have carried out in Sri Lanka as well as the Congress of their national association. It is also my pleasure to announce that the IAOMS will launch a new educational project consisting in the organization of IAOMS International Symposia to be held at the highest level in different regions. The opening symposium will take place in Medellin, Colombia in October 14-15, 2016 in collaboration with the Latin American Association (ALACIBU) and the Colombian Association. This new project will enhance IAOMS as the global organization in the OMFS field and will increase partnership opportunities with the Regional and National Associations, opening a new path for member´s participation in IAOMS activities. FINALLY, let me remind you those dates: March 31st-April 3rd, 2017. The global OMFS community will meet in Hong Kong at the 23rd International Conference on Oral and Maxillofacial Surgery (ICOMS). The organizing committee chaired by Nabil Sammann is working hard in order to prepare an amazing scientific and social event. Call for abstracts is now open. I invite you to visit the Conference website (www.icoms2017.com) and to send your scientific works to actively participate in the success of ICOMS. ■
Julio Acero IAOMS PRESIDENT 2016-2017
in french key
Maxillofacial surgery in France
By Pr. J. Ferri
President of the National Council of Stomatology, Oral and Maxillofacial Surgery. French Representative at IAOMS of the French Society of Stomatology, Oral and Maxillofacial Surgery
he so-called “Stomatologie et chirurgie maxillo-faciale” is one of the oldest medical specialties in France. It was 1888 when Dr E. Magitot created the first “Société de Stomatologie”. The idea to create this new specialty was to have one practitioner with the knowledge of both medicine and dentistry. Indeed many initially “dental” pathologies had consequences on general health. 10 iaoms.org
IN 1894 THE “REVUE DE STOMATOLOGIE” WAS FOUNDED. One year later the first chair of Stomatology was created at the Catholic University of Lille. It was the first in France and Professor Redier was its chairman. In 1907 the “Association Stomatologique Internationale” was founded at Lille with roughly 20 nations involved. The French School of Stomatology was built in Paris in 1910. It stood at its initial address until 1963 when it moved to the Salpétrière Hospital.
THE FIRST WORLD WAR BROUGHT Maxillofacial Surgery attention of the public. The large number of French soldiers with facial injuries made the specialty largely recognized by the medical community. It was also the beginning of a new age of practice (facial reconstruction) opening the specialty to more complex treatments (especially surgical ones). In 1920 the medical faculty of Paris created a professor of Stomatology that was occupied by Pr. Chompret. Following this decision, chairs were created in Bordeaux (Pr. Cavaille and later Pr. Dubecq), Marseille (Pr. Beltrami), Lille, Lyon, Nantes, and Nancy.
Professor Delaire (Nantes)
The modern specialty as we know it today was born. AFTER THE SECOND WORLD WAR, CHAIRS of Stomatology were created in the majority of the medical schools throughout France. The extension of the reconstruction practices put the specialty clearly in the surgical field. The speciality was renominated into “Stomatologie et chirurgie maxillofaciale” (Stomatology and Maxillo-facial surgery)
Professor Michelet (Bordeaux)
Professor Stricker (Nancy)
BY THE END OF THE SIXTIES, the scope of practice of the specialty was clearly established including dento-alveolar surgery, TMJ disorders, facial trauma, plastic and aesthetic reconstruction of the face, tumors of the head and neck, orthognathic surgery and other head and neck deformities, and oral medicine and pathology. SOME DEPARTMENTS BECAME MORE SPECIALIZED in particular fields. Professor Delaire in Nantes was involved in malformations and cleft surgery (Figure 1). Professor Stricker in Nancy was recognized as an expert in facial surgery (Figure 2). It was with the work of Professor Michelet (Bordeaux) (Figure 3) and Champy (Strasbourg) (Figure 4) that the concept of rigid fixation arose.
4 Dr. Champy (Strasbourg)
THE SPECIALTY REMAINED THE SAME UNTIL 1984, when a new organization of the medical studies was set up involving an important reduction of the graduated specialists in every specialty.
procedures considering dentistry a secondary knowledge.
THIS NEW REGULATION AFFECTED Stomatology and Maxillofacial surgery because the number of residents that were admitted in the training program was reduced by three. In addition, many residents wanted to practice maxillofacial surgery and were less prone to treat what they thought to be “minor” cases (oral surgery or stomatology). Two trends appeared in the academic community. The first one wanted to maintain a traditional “Stomatology and Maxillo-Facial Surgery” with a strong knowledge in Dentistry, while the second was more likely involved in Cranio-Maxillo-Facial Surgery and plastic
TODAY THE TWO TRENDS of the specialty remain very present but everyone considers that knowledge in both dentistry and surgery are mandatory to practice our specialty. The university community was recently asked to propose a new training program for every medical specialty that should be applied in 2017. For the first time the university section of oral and maxillo-facial surgery suggested a double qualification for maxillofacial surgeons. If this new training is accepted it would be an important alignment of our society with the international community. ■
02 Where OMS in
America is spelled ‘’Chirurgie buccale et maxillo-faciale’’… By Pierre Eric Landry
Professor and Immediate Past Director. Graduate OMS Training Program. Laval University. Quebec City
hen, in the early 1960’s, André Charest returned to Quebec City from England where he had trained under Norman L Rowe at Roehampton, little did he really know what his future held. But he must have had if not the hint of a vision at least a good eye for opportunity. IN NO TIME HE WEDGED his skills between a private practice in advanced dento-alveolar surgery, which was the hallmark of the specialty for those days in America, and an eventually much needed, appreciated and very usefull presence in most of the city hospitals. The added value of his European surgical education, his availability and improved results gave him ample access to major surgery, particularly in maxillofacial trauma. These times were, all over our continent, the dawn of but an era which would give rise to oral and maxillofacial surgery (OMS) as we know it today, an emerging specialty at the time. He was already convinced and had integrated into his own professional activity the crucial importance of the confluence of dental, medical and surgical training. HE SOON GAINED ACCESS AND OPERATORY PRIVILEGES to our contemporary home, l’Hôpital de l’Enfant-Jésus of the Centre Hospitalier Universitaire de Québec, nowadays a Level 1 trauma center primarily centered on neurosurgical, orthopedic and maxillofacial trauma. The advancement of his yet undefined but unavoidable project came to fruition in 1971 when he structured a residency program tailored to his convictions with the help and approval of his fellow 12 iaoms.org
neurology, general surgery and internal medicine close partners. THIS INSTITUTION HOSTS, JOINTLY with the Dental Faculty at l’Université Laval in Quebec City, the only French -speaking North American fully- accredited training program in OMS. It is the alma mater of approximately 75% of all practicing surgeons in that specialty throughout the province of Quebec. Since its inception, close to 75 OMS surgeons have been trained in their mother tongue; and 12 residents are now heading to graduation in the rejuvenated facility we have settled in recently. THE PROGRAM HAS GROWN OVER TIME from a standard four-year curriculum with a strong medicalsurgical upbringing to a six-year, fully-integrated dual degree (with MSc) since 2014, entirely tied to both the Medical and Dental Faculty. The original two founders, Drs. André Charest and Guy Maranda, have long since handed over the reins to the contemporary team of four university-appointed professors fiercely supported by six clinical assistant and attending teachers. OUR PROGRAM HAS CLOSE TIES WITH ALL THE OTHER CANADIAN programs from Nova Scotia (Dalhousie University, Halifax), to Ontario (University of Toronto and Western University in London) and Manitoba (University of Winnipeg). The local relationships with the McGill University unit in Montreal are even sharper.
Quebec City skyline.
Dr. Guy Maranada and T. Ward
Dr. Andre Charest
Scientific meeting 1983
THE STAFF AND ALLIED SURGEONS ARE ALSO COMMITTED and involved in various international organizations as the AO, ATLS, ITI and a few other privileged professional societies and governing bodies, namely the Royal College of Dentists of Canada and the National Dental Examining Board of Canada. They also participate in the direction of the Quebec Association of Oral and Maxillofacial Surgeons, namesake of our corporate identity. July 2016
2016, the 45th anniversary of the program, will also go down in history as the graduating year of our first European resident, a Bordeaux class of 2010 dental student from Basque ascent, and a truly fine person. How much more francophone and international can we get?
WE ARE DEEPLY INDEBTED TO L’UNIVERSITÉ LAVAL DE QUÉBEC for supporting the hospital department and the academic aspects of our clinical activities. But most of all, we are forever grateful for Doctor André Charest to have pushed and realized his vision with such foresight and tenacity. Had it not been for his outstanding talent, as well as his unique charisma and dedication to his patients, the face and fate of our world and future would never have been so bright, bold and booming. I could not have said it any better in French! ■
Tunisia a old town of Medina terrace of Palais d’Orient.
Oral and Maxillofacial Surgery in the Maghreb. State and perspective By Professor Bouzaiene Montacer Oral and Maxillofacial Surgery. Mahdia. Tunisia
he development of oral and maxillofacial surgery in the Maghreb and precisely in Tunisia has made a tremendous breakthrough at the end of the 1970’s, due to the fruitful contribution of our seniors. Today more than 80 active specialists in Tunisia are divided equally among public and private practice. THE FACULTY OF DENTISTRY OF MONASTIR is the oldest and most renowned institution in Africa and most of the practitioners belonging to the Frenchspeaking countries have attended it. In fact, there are 14 iaoms.org
about 4,000 dentists practicing in Tunisia. I estimate we’re luckier than our colleagues in the neighboring countries who are too few and lack basic infrastructure to set up an oral and maxillofacial association. The Tunisian Society of Oral and Maxillofacial Surgery, founded in 2005 and lately affiliated with the IAOMS, is the only scientific association representing the specialty in the Maghreb. THE FUTURE ORAL AND MAXILLOFACIAL SPECIALISTS must follow a long academic process starting with general medical studies followed by a July 2016
highly competitive national exam. Eligible candidates of these countries. Our objective of enlarging our undergo core trainings of the specialty. As a society, work’s impact on the African Continent on a steady we always have been concerned with excellence in basis remains conditioned by the improvement of the training and practice. That’s why we have set high overall political climate there. goals for future oral and maxillofacial surgeons. We’re HOWEVER, I MANAGED, AS A PRESIDENT OF also keen on granting them a sound quality training THE TUNISIAN SOCIETY of Oral and Maxillofacial and a mastery of every single field Surgery, to establish English as the of our study domain. Moreover, an unique congress language during its We have more on going cohesion and continuity annual meetings. Hence, I indirectly between the senior and the future than 80 active encouraged our colleagues field fellows is fundamental to to communicate in English in specialistsserving ensure the practice’s continuity both the public and the presence of honorable and development. We have international and renowned guests unfortunately noted that the lure the private system whom I’d like to thank for accepting for larger incomes and greater our invitation. By doing this, our career opportunities have interns are convinced of the tempted a good number of our fellow colleagues need of going abroad to expand their experiences. and interns to shift to plastic surgery at the expense We encourage them to participate in international of the oral and maxillofacial field. That’s why we congresses and events to forge positive attitudes have been envisioning the possibility of setting up to enable us to meet our objectives concerning the a society likely to gather all the faculty experts in future of our field. the French-speaking zone where they can exchange FINALLY WE SHOULD IMPLEMENT all the knowledge and experience. Yet, the main obstacle to possible conditions to protect our territory of action the fulfillment of this objective remains the climate and continue to improve our knowledge. ■ of political insecurity and civil wars in a number
Bureau of the Tunisian Society
The latest initiative of the IAOMS
Dr. Sanjiv Nair MDS, FFDRCS
axillofacial surgery, a nascent speciality, evolved over the last eight decades. The training pathways differed widely across continents. The pendulum shifted from a medical foundation to dental and back again. But the scope and target of practice remained the same. With increased technological advances, the ability to keep surgeons abreast was the biggest challenge and also possibly the easiest. The IAOMS, with its focus on learning and delivering value to its members, has looked at various avenues to spread knowledge and techniques. The biggest however were the special interests of the surgeons and the regional, linguistic and social barriers that existed across continents and individual surgeons. The launch of SIGNS, an acronym for “special interest groups in surgery” has been the latest initiative of the IAOMS. Association is in the process of identifying niche surgical interest groups such as clefts, reconstruction, pathology, trauma, implantology and any more that may emerge. The aim of this group is to link surgeons with common interests who can participate actively in their are of interest, allow active participation in case discussions and satellite meetings under the aegis of IAOMS. 16 iaoms.org
“Our biggest achievement would be to allow seamless access between an expert and a trainee on a platform provided by IAOMS. ” July 2016
The future of SIGNS is largely dependent on active participation by IAOMS members. The ability to form regional groups in different sub-specialties is a big challenge but possible at the regional level.
Because difficulties remain in terms of language in logistics, the IAOMS has initiated the same in Cleft and Cancer and reconstruction. This is the focus of the upcoming meetings in Cairo and Hong Kong. July 2016
Surgeons can sign up for SIGNS on www.iaoms.org and join a discussion group. The next step is for us to integrate case discussions and opinions from experts. Academic activities like literature criticism will be part of this venture. As Chair of SIGNS, I hope that there is active participation in this new initiative. â– iaoms.org 17
Female to female
A LONG ROAD TRAVELLED
Prof Jocelyn M. Shand Oceania Representative, IAOMS
he training to becoming an Oral & Maxillofacial Surgeon is generally a long one. My training started in Otago, New Zealand and then involved living and working in England, United States and finally, Australia. Like most people in my generation from Commonwealth countries, an overseas expedition to the United Kingdom for professional development is a well-established route. Following a dental degree in New Zealand, I had the opportunity to work in Cambridge for two years before moving to Melbourne, for formal surgical training that involved a medical degree and a Masters Degree leading to the Australasian College Exit Fellowship. The next move was across the Pacific to the USA for two Fellowship years. First, a year in Oklahoma City and then to Pennsylvania, for a now well-known pediatric surgery Fellowship. Opportunities are often about being in the right place at the right time and I was very fortunate to be 18 iaoms.org
offered this post at the University of Pittsburgh. The hardest decision was choosing between returning to my family and homeland of New Zealand or seeking to practice in the much larger city of Melbourne. I chose to return to Australia after I was privileged to be offered a specialist post at The Royal Childrenâ€™s Hospital in Melbourne and a place in a wellestablished private practice to begin the next phase of work as a Consultant. July 2016
â€œThe hardest decision was choosing between returning to my family and homeland of New Zealand or seeking to practice in the much larger city of Melbourne." I have enjoyed my involvement at all levels of our wonderful speciality and have had the opportunity to serve as President of our binational Association (ANZAOMS) and continue as the current Chair of the Board of Studies that oversees training and accreditation. Work at the Royal Childrenâ€™s Hospital remains the most interesting and stimulating part of my practice ranging from the management of upper airway obstruction in infants to trauma, congenital and developmental deformity as well as pathology. Collegiality is an important feature of our specialty and my professional life has enabled travel to many countries for conferences to meet international colleagues and to visit different destinations. To young aspiring surgeons, mentors are important and I have been fortunate to have had support from several key surgeons who have provided constant encouragement, guidance and given me the confidence to nominate me for leadership positions. With an increasing number of female surgeons entering our specialty, it is important to encourage established female surgeons to be involved in training. There have been many difficulties along the way, some related being a female surgical trainee and surgeon. However, in retrospect, these challenges have helped to bring a sense of mastery and self-esteem. It has been a long road in training across four countries with different systems, and certainly a long way from home in southern New Zealand, but it has definitely been worth it. If I had to do it over again, I would still choose surgery and our great specialty as my preferred vocation. â– July 2016
From Proust to Pivot
AN APPARENTLY INNOCENT QUESTIONNAIRE FOR ORAL AND MAXILLOFACIAL SURGEONS You’ve heard of the Proust Questionnaire adapted and made famous in the back pages of Vanity Fair Magazine. It was named not for questions, but for the answers given by Marcel Proust to a set of questions asked by his friend Antoinette Faure. Then, for many years Bernard Pivot conducted a cultural program on French TV called “Apostrophes”. All his guess received the same 10 questions at the end of the interview. So, in Face to Face, we thought that these questions would be a great way to learn about each other. Enjoy and compare their answers with those of celebrities!!!
Cyrille Chossegros What is your favorite word? Optimistic What is your least favorite word? Impossible What is your favorite drug? Sports and friendship What sound or noise do you love? Harp What sound or noise do you hate? The noise the burr is doing on titanium miniplates ! What is your favorite curse word? None Who would you like to see on a new banknote? The first facial graft! What profession other than your own would you not like to attempt? A profession that obliges you to stay in the same place all your life long
If you were reincarnated as some other plant or animal, what would it be? An elephant, who lives long and sees the world from the top If Heaven exists, what would you like to hear God say when you arrive at the Pearly Gates? So early!
Cyrille Chossegros is the Head of Department of Maxillofacial Surgery in the Conception CHU, Marseille. He is a worldknown speaker on minimally invasive surgery of the salivary glands.
What is your idea of perfect happiness? To have a paper accepted in a prestigious journal! What is your greatest fear? To lose a child or a patient What is the trait you most deplore in yourself? Saying yes too often to my patients
Friendship & sports. Marathon des Sables
Family’s first. My wife, 5 daughters, 2 genders and 1 granddaughter
What do you regard as the lowest depth of misery? Killing people to make money
What is the trait you most deplore in others? Hypocrisy
was born, even if I was a little worried
Which living person do you most admire? Julio Acero because he does so many things, always with simplicity and a smile
Which talent would you most like to have? To be a talented musician
What is your greatest extravagance? To do extreme sport, not reasonable for a grand father What is your current state of mind? Cool, but still interacting between IAOMFS and French OMFS
If you could change one thing about yourself, what would it be? To be bigger ;-) What do you consider your greatest achievement? First, my five daughters… Second to have impulsed the new specialty for OMFS in France with double degree
Which living person do you most despise? A Chief of Department who is only practicing private and does not take care of his trainees
Which words or phrases do you most overuse? None
What do you most value in your friends? Honesty, and ability to have fun together Who are your favorite writers? Eric Emmanuel Schmitt, Isaac Bashevis Singer, Stefan Zweig
Which historical figure do you most identify with? The Général de Gaulle, because of the similarity in Physionomy ;-))
What do you most dislike about your appearance? None
What is the quality you most like in a woman? Elegance
What is your most marked characteristic? Being a normative person, (maybe too normative?)
Who is your hero of fiction? Korben Dallas in the 5th element. Unfortunately it is only fiction
What do you consider the most overrated virtue? Saying that ENT or plastic surgeons are operating better than we do
What is the quality you most like in a man? Generosity and honesty
What is your favorite occupation? Teaching motivated trainees
Who are your heroes in real life? Missionaries, like mother Teresa
Lenin Peak, with my wife
If you were to die and come back as a person or a thing, what would it be? A Benedictine Monk, praying and working
What or who is the greatest love of your life? My wife, because she is still tolerating me after more than 32 years
Where would you most like to live? In France, around the Mediterranean Sea. Marseilles seems to be an acceptable place to live or organize an OMFS Congress
When and where were you happiest? When my first daughter
What is your most treasured possession? Determination July 2016
What are your favorite names? Religion, Faith, possible, hope What is it that you most dislike? Jealousy, mediocrity, always complaining What is your greatest regret? Not having doing enough for: others, my patients, my family, or for humanitarian actions How would you like to die? Without any regret What is your motto. “Rather than complaining that you are in the dark, stand up and turn the light on”. ■
Copy Me PARANASAL BONE AUGMENTATION with simultaneous malar implants
Paranasal augmentation is a common procedure when an increased mid face volume is required. It can be performed as an isolated procedures or associated with orthognatic surgery or rhinoplasty. Alloplastic materials such as high density porous polyethylene are frequently utilized for this purpose. The use of bone grafts from the Iliac crest, calvaria and coronoid process have also been reported. Midface deficiency is frequently associated with an excessive mandible or chin. In these cases, our protocol is to augment the paranasal area with autogenous bone grafts obtained from the chin when a reduction genioplasty is performed. We present a case of a 22 year old female patient with an excessive chin and midface deficiency.
VICTORIA PEZZA, DDS German Hospital. Buenos Aires, Argentina Current Councillor of IAOMS for Argentina
Preoperative profile with an excessive chin and midface flatness. Occlussion shows dental compensations.
General anesthesia with oral intubation. Notice the unattractive midface concavity.
Planning for simultaneous malar implants. Pockets are marked bilaterally.
4 High density porous polyethylene malar implants are placed and fixed with titanium screws. Notice the infraorbital.
Temporary stabilization to check symmetry with contralateral side before fixation. Â†Â† July 2016
Reduction genioplasty: chin plate fixation and suture of geni muscles to the plate.
Paranasal bone grafts stabilized with 1.5mm screws.
V-Y closure for upper lip lengthening.
Postoperative views show that paranasal augmentation with this technique improved the overlying soft tissue contour achieving the desired convexity, not affecting nasal projection. This simple skeletal augmentation resulted in powerful camouflage effects in midface aesthetics.
FOUNDATION CHAIRMAN REPORT
A bi g
WHERE DO WE GO FROM HERE?
Over the past few years, I have reported to you that your IAOMS Foundation, since 1996, has funded over $800,000 on Fellowship education, surgeon to surgeon education and facilitated numerous opportunities to expand OMS knowledge across the globe. Our members, corporate partners and friends have donated over $1.5M USD and have impacted tens of thousands of lives – providing exceptional oral and maxillofacial surgical care. The Fellowship program, which provides up to three Fellows per year to train in Cleft Craniofacial Oncology Reconstruction. This last year, we had almost 100 inquiries about this program and over 40 applications. The surgeon to surgeon education includes basic OMS courses in developing areas that allow experts to teach those who may not have access to such educational opportunities and microvascular courses to extend these complex reconstructive procedures to those who need them most. I congratulate all of you have have donated your time or funding to the Foundation. While I thank you for your generosity, our task has only begun. Looking ahead, we cannot afford to only maintain the status quo. Opportunities exist to provide research funds, even if it is only seed money for obtaining more extensive grants. Research IS the future of our specialty. The Foundation has been asked to consider funding travel for trainee exchange opportunities, further expanding the global influence of our specialty and enhancing cultural understanding. As a participant in an exchange program in North Wales over 30 years ago, I can testify that this experience was one of the most valuable of my training. Other possibilities include scholarships to participate in IAOMS Review Courses, attendance at a SIGNS meeting or even ICOMS. The potential for our Foundation and its impact on the IAOMS and our specialty are limitless – only bounded by financial constraints. As Chairman of the Foundation, I ask that all of you reprioritize the IAOMS Foundation in your current and future philanthropic plans. YOUR DONATION CAN AND WILL MAKE A DIFFERENCE. And, donations to the IAOMS Foundation will be matched dollar-for-dollar by The KLS Martin Group until December 31, 2016. Donate today at www.iaoms.org/foundation. I thank you for your continuing support. ■ Larry W. Nissen IAOMS Foundation Chairman July 2016
Hours A DAY IN THE LIFE OF A MAXILLOFACIAL RESIDENT IN OHIO By Dr. Ryan Wallis, Chief resident in Oral and Maxillofacial Surgery at University of Cincinnati Medical Center (UCMC), Ohio, U.S.A.
finished dental school at The Ohio State University and then spent four years in the United States Air Force as a general dentist. After my military service I came back to my hometown for my residency at UCMC. In the United States, trainees are referred to as “residents” as they historically resided at the hospital.
Our program is a 4-year OMS residency with a total of 11 residents. The two fourth-year residents alternate weekly as Operating Room Chief and Clinic Chief. The O.R. Chief is also second resident on call for the entire week. Today is Wednesday, and I am O.R. Chief.
I wake up, shower, and don my scrubs. During my residency, I’ve learned to be very stealthy in the morning to avoid waking my wife at such an early hour. When I was an intern, she used to wake up momentarily when I kissed her goodbye. Now she doesn’t stir, but I kiss her anyway. I tiptoe through the house so I don’t disturb my four sleeping children ages ten, eight, six, and four. I grab a protein shake to drink in the car on the way to the hospital. I live about 15 miles away, which is farther than I’d like, but in the suburbs we have good schools and a house that fits our family.
Residents meet for morning rounds to check on patients who had surgery the day before. First year residents, or interns, have already pre-rounded to check vitals and overnight events. We see each patient with the attending surgeon. Wounds are inspected, diets advanced, and discharge plans made. 26 iaoms.org
Case Conference begins promptly. Chief residents review cases from last week. Decisions on patient management are presented by residents and questioned by attending surgeons. The Chiefs also present a PowerPoint showing cases scheduled for the upcoming week. This is not a spectator-sport, so chief residents and attending surgeons quiz the junior residents throughout the conference.
All residents, even those off-service, are asked to come to weekly Grand Rounds. This week, one of our junior residents presents his research on finite element analysis, and he describes a model heâ€™s designed for treating mandibular angle fractures with ladder plates. In our research efforts we are encouraged to collaborate with minds outside our own Division, so he has enlisted the help of the engineering department at U.C.
Residents split up. Most head to the outpatient clinic where senior residents perform dentoalveolar surgery under general anesthesia and junior residents see consults, post-ops, and perform minor surgery with local anesthesia. This is my week in the O.R., so I take one of the interns with me to the first case.
First case is a right TMJ diagnostic arthroscopy/ arthrocentesis on a 52-year-old woman with internal disc derangement and pain who failed conservative therapy. Entry into the joint is straightforward and our view is good. I struggle less to enter a TMJ than I did even a few months ago.
Second case is an ORIF of a left mandibular angle fracture. Our 64-year-old patient is from Senegal where he was in a motor vehicle crash four months ago. He was referred to our service only recently with a significant malunion of his left angle. We approached the mandible through the neck, mobilized the fracture, and placed a large reconstruction plate. After closure July 2016
of the neck incision, we extracted his remaining teeth. Without teeth and a large step in his alveolar ridge, he can now accommodate complete dentures and/or dental implants. The most difficult part of this case was figuring out how to give post-operative instructions in his native language, Wolof!
Third case is a right TMJ arthroplasty with hemimandibular prosthesis. We performed a right hemimandibulectomy on our 67-year-old patient three months ago for a multicystic ameloblastoma. We access the glenoid fossa with a pre-auricular approach and the anterior mandible through the neck. After securing the fossa prosthesis and the hemimandible, we close and remove his arch bars. I walk out of the O.R. confident that this Italian man will soon be enjoying his wifeâ€™s cooking again.
All residents and attending surgeons meet in the conference room for journal club where we meet several private practice Oral and Maxillofacial Surgeons from the community. We review five scholarly articles, and a different resident presents each one. Emphasis is placed on strength of studies and whether study conclusions would prompt a change in our current practice. iaoms.org 27
I’m back at the hospital with our intern to assess the patient with the complex scalp/forehead laceration. The wound is full of hair and debris, and I can see exposed calvarium. Despite her subdural hemorrhage and pneumothorax, she is quickly cleared for the O.R. by neurosurgery and the trauma service. Dr. Krishnan comes in to staff the case. I’m always impressed at his eagerness to come in after hours and do these cases with us.
Patient is finally asleep in the O.R., and we carefully debride her scalp and forehead. The layered closure is tedious, and I’m glad there are two of us sewing to make the work go faster.
Before I go home, I ask our intern on call if there are any consults pending. He tells me there’s a patient with a forehead laceration in the Emergency Department. I go home knowing a simple forehead laceration is well within the skill set of any of our capable interns.
I race home to meet a woman interested in buying my car. Since I’m graduating in less than three months, I’m trying to get rid of my 22-year-old car with 260,000 miles. At the exact moment I turn onto my street my phone rings, and I see an unfamiliar car parked in front of my house. The phone call is from the intern, and the unfamiliar car belongs to the woman interested in buying my old car. According to the intern, the forehead laceration is actually a degloving, stellate forehead and scalp laceration on a 19-yearold female involved in a rollover motor vehicle crash. This will need to go to the O.R. I discuss the details on the phone with the intern, while at the same time I describe the features and benefits of my rusty old car that has faithfully taken me from point A to point B for most of my adult life. I hang up with the intern and agree on a sale price with the woman. Just then my wife and kids arrive home from a play date. I relish the few minutes I have to ask each of my kids how their day was while wolfing down some leftovers from dinner last night. My wife, always understanding, wishes me well as I leave to go back to the hospital while she stays home to puts the kids to bed by herself… again. 28 iaoms.org
On late nights I usually stay in one of our call rooms if I’m at the hospital past 11:00 pm. Even though our case finishes at midnight I decide to go home anyway. There’s something nice about sleeping in my own home even though my family will be asleep when I arrive and still sleeping when I get up to return to the hospital the next morning. These are long days, these are long years. It is so easy to lose perspective on life in general and all things that ultimately matter when one is in the thick of one’s training. ■
Our residency pr ogram emphasizes th rules of residenc y as follows – ea e t you can, sleep w hile you can, call while your significant other whenever you can, as much as you read can. July 2016
OMS on a mission
FACES OF FIJI The philosophy of our overseas aid mission By Mr Ricky Kumar, Oral and Maxillofacial Surgeon and Prof Alf Nasrti, Oral and Maxillofacial Surgeon.
Royal Melbourne Hospital, Melbourne, Australia. Visiting OMFS team to CWM Hospital in Suva, Fiji.
he Fiji Islands have long been renowned for being amongst the world’s friendliest countries. Behind the huge Fijian smiles lie the fears of modern medicine and the familiarity and comfort of “traditional healers.” This fear has lead to classically late presentations for major illness in all areas of medicine. Maxillofacial pathology is no different, with most presentations of head and neck tumours at very late and advanced stages. 30 iaoms.org
In addition to the fear of modern medicine, and the fact that there were no formal Oral and Maxillofacial surgical services prior to 2012, a great need to provide these services to Fiji was identified. Our mission grew from one surgeon visiting in 2012 to three surgeons and two anaesthetists in our most recent 2016 visit. As with any overseas aid mission, numerous challenges have to be overcome. We believe the July 2016
success of our missions to date lies in the following pillars of good quality aid work:
OUR MISSION GREW FROM 1 SURGEON VISITING IN 2012 TO 3 SURGEONS AND 2 ANAESTHETISTS IN OUR MOST RECENT 2016 VISIT
Gaining the trust of the locals It took two years of visits to gain the trust of the local team. Once the local surgeons had observed the results of the surgery performed during our visits and the postoperative management provided, they came onboard further. Once this is achieved, co-ordinated referral and patient management also becomes much easier.
The true sense of trust was demonstrated during this year’s visit when one of the patients came in with a large pleomorphic adenoma of her parotid and said that she would like the surgery because she saw her friend’s result (whom we had treated for the same pathology the year before). This was a true vote of support for the mission.
Teaching and training the local team A famous quote states- “Give a man a fish and you feed him for a day. Teach a man to fish and you feed him for a lifetime.” This quote is also very true when it comes to charity missions. The visiting team can perform impressive surgical procedures and these are obviously needed by the population. However, equally important is to teach and train the local team to be able to manage straightforward cases.
This has been our mission from the beginning. We have also emphasised taking a team to Fiji that was keen on teaching and training. We have purposefully avoided taking our own trainees, as this would dilute the surgical experience of the local team. July 2016
Quality surgical care This has to be our mission statement. We endeavor to provide the same quality surgical care that we provide at home. All our surgeons work within the scope of practice performed at home. These charity missions should never be about “learning” to do procedures not normally done at home. The people of the receiving nation deserve the best quality care and no compromises should be made.
Finally... audit process Like any other surgical unit, the work of a charity mission needs to be audited and documented. We have self-audit as well as external audit (Surgical College) of the cases performed. Our main strength lies in being able to return to our main hospital center and follow up on patients treated on previous trips (the first trip was five years ago). This long term, selfauditing and follow-up protocol keeps us honest and provides quality surgical care on our missions going into the future. ■ iaoms.org 31
WORKING IN PARADISE
By Dr. Sheyla Sironvalle
Head of Department of Oral and Maxillofacial in Hospital Can Misses in Ibiza
t all began in June 2010 when my mother and I disembarked from the ferry with a full car, and my heart full of joy and uncertainty. I had always wanted to become a maxillofacial surgeon. My father was one and he used to tell me stories about life during his training: orthognathic cases, nasal reconstructions, third molar extractions and lots of other things about this field that caught my eye. After my medical school I did my residency at Juan Canalejo Hospital in A Coruña. Finding a job as a specialist was not easy, but I was determined to work for the National Health System, because I didn´t want to enter private practice at the beginning of my career. I had an interview with Dr. Pepe Iriarte, Head of Department of OMFS in Palma de Mallorca, who made a proposal I could not reject: starting a new department in Ibiza, from the ground up, with just one member, myself. I thought about it a couple of minutes, and guess what I decided to do! Ibiza, Eivissa in Catalan, is also known as the White Island. Some people claim that Ibiza is ruled under the sign of Scorpio, which gives the island its special magnetism and is the key to the proliferation of 32 iaoms.org
alternative therapies including meditation, yoga and reiki. The island is known worlwide for its parties, nightclubs and the DJs coming weekly to play their music. But there is another Ibiza: crystal-clear waters, sandy beaches, hidden “calas,” and the breathtaking countryside with a reddish ground I have not seen anywhere else. The year is divided in two seasons: the tourist season, from May to October, and the rest of the year. But if you hear somebody talking about the “season” you know they are referring to the first one. The main difference between my life here and the one I had in Madrid is the time I save everyday (short distances, no traffic jams), not to mention living next to the sea. On the weekends we usually go to the beach, or just to have breakfast by the sea. It gives us energy to start the week again. Of course there are some drawbacks in insularity: eating out and groceries are very expensive, we depend on planes and ferries to go anywhere else, limited cultural activities off-season, traffic jams or impossible parking during the tourist season, etc. Our department includes three oral and maxillofacial surgeons. We have a small operating July 2016
room in the outpatient clinic where we perform operations under local anaesthesia. Twice a week we perform surgery under general anaesthesia. Our outpatient clinic is open daily, and we have a weekly Oncology Tumor Committee. Complex reconstructive cases are operated in Palma de Mallorca by the team that performs microsurgery. The communication between both departments is very fluid, and our patients take advantadge of this good relationship. As for emergencies, one of us is on-call everyday, to give assistance to the population of Ibiza and Formentera and the thousands of tourists who come to the islands. Our working scenario changes with the season. During off-peak season we visit our patients in the clinic, perform scheduled operations, prepare orthognathic cases and attend to emergencies. From May to October Ibiza changes completely and so does the Hospital. Emergencies gain prominence. Accidental falls turn into alcohol and drug intoxications, aggressions and politraumatic patients. The emergency waiting room changes Spanish language into English, German, French or Italian. Hospital bracelets are collected by tourists as if they were from Ushüaia or Amnesia. Zygomatic-orbital fractures, mandible fractures, severe facial wounds, dental avulsions, all types of Le Fort fractures: an endless list of traumatic patients wait for us. The etiology is varied: alcohol abuse, use of illegal substances, roads overcrowded with inexperienced drivers, blind bends , quad bikes, partial helmets for motorcycle riders, not to mention the lately infamous “balconing”. Some patients July 2016
What is it
like to live and work in Ibiza? I can tell you it is not a 24/7 vacation. During the week, I work from 8 am to 3 pm. I live 2-minutes far from the hospital, so it doesn´t take me long to go to work and come back home. During the summer season it is very common to spend also the afternoons and nights at the Hospital, in the OR or evaluating patients in the emergency wards.
don´t need surgery, others need it but prefer to be operated in their hometown, although the majority of patients would rather undergo surgery here and go back home as if they hadn´t had any problem during their vacation. I am not sure wether I am working in paradise or not, but there is one thing I know: I will never regret accepting this position, as I found a thrilling job, new friends, love and a second home. ■ iaoms.org 33
ultimate guide to E
RAGAMA (SRI LANKA) 27-31 July 2016
LONDON IAOMS symposium in EACMFS meeting: skull base surgery
PANAMA (PANAMA) September 1-2, 2016 MEDELLIN (COLOMBIA) October 14-15 2016 DOHA (QATAR) October 2017 SAO PAULO (BRASIL) 2017 LONDON IAOMS symposium in EACMFS meeting: skull base surgery
PANAMA (PANAMA) 1-2 Sept. 2016
MEDELLIN (COLOMBIA) 14-15 October 2016
MANILA IAOMS symposium in ACOMS meeting: New technologies CAIRO IAOMS symposium in Panafrican meeting: Pushing the edges 34 iaoms.org
SAO PAULO (BRASIL) 2017
Education Committee activities
MANILA IAOMS symposium in ACOMS meeting: New technologies
DOHA (QATAR) October 2017
CAIRO IAOMS symposium in Panafrican meeting: Pushing the edges
RAGAMA (SRI LANKA) 27-31 July 2016
To tweet or not to tweet By Javier González Lagunas (@golagunas)
our are a busy surgeon and like me, you are still wondering if there is a real need to become an active member of the Twitter community.
What is Twitter? It is an online social network that allows members to send and receive short messages with a limit of 140 characters (the so-called “tweet”). It all started in 2006, and today there are 1300 million registered users, 310 million users, and around 100 million daily active users. Not bad at all for 10 years! I think that Twitter is extraodinary and underutilized tool for doctors to communicate with patients, prospective patients and other healthcare stakeholders. But, obviously the use of social networks is not compulsory. It depends on the profile you want to keep: do you want to stay in the shade or do you prefer to be in a position of leadership? Do you want others to know your opinions? ...on what? ...medical science? ..on professional issues? Do you want to be a resource for patients? Are they Baby -boomers or Millennials? Or maybe you want to be the first one to communicate with the post-millenials, the Generation Z. They are the first generation born and raised with an smartphone.
professional issues. So you will not be the last one to discover what is going on with the training or organization in your speciality. You are are lucky to be a part of IAOMS, an association that is active in the net, and that wants to go even further in this particular aspect. Third, the contact with other professionals, will amplify exponentially your network, and you not only benefit from the contributions that these professionals make but those of your contacts, too. Fourth and final. You might feel that you have nothing to say in Twitter. You can stay silent for a while, but follow the opinion of your leaders: it will definitely enrichen you The limit of 140 characters per message is the central characteristic of Twitter, but also its main danger. That limit helps you write simply and efficiently. But also, the message cannot exactly clarify your position and sometimes can give a wrong or at least limited view of your opinion. The wise use of links to external URLs will give a better understanding of what you want to transmit. ■
Is Twitter a waste of time, or a time-investment? I am going to give you four reasons to be professionally engaged with Twitter. First, Twitter enables surgeons to share updated information about health issues. We can offer an educated sieve, selecting reliable information. Probably this will lead to a more “horizontal” health care system, between the caregivers (us) and the care-receivers (them). Second, the immediate contact with scientific associations allows you to access in real time to the latest medical knowledge and advances presented at the meetings of these societies. Well-organized associations will also keep you updated about 36 iaoms.org
Invest in your future. Join now at iaoms.org