Face to Face: December 2017

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Issue 52 / December 2017

Editor-in-Chief Javier González Lagunas

Assistant Editor Deepak Krishnan

Graphic Designer María Montesinos

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

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

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

Committee Chairmen Rui Fernandes, Education Committee Joseph Helman, Research Committee Deepak Krishnan, IAOMS NextGen Committee Steve Roser, COGS Committee Fred Rozema, IT Advisory Committee Mark Wong, IBCSOMS Representative Alfred Lau, Membership and Communications Committee Alejandro Martinez, Governance and Ethics Committee Luiz Marinho, 24th ICOMS-2019, Brazil David Koppel, 25th ICOMS-2021, Glasgow CONTACT US IAOMS

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

Letter from the Editor HOW I SEE IT


am absolutely convinced that oral and maxillofacial should expand to new horizons. I had that belief before ICOMS Hong Kong, but Dr. Rui Fernandes´s presidential lecture had a deep effect in my thoughts. Thinking outside the box and thinking laterally are the strategies that will allow us to take giant leaps in the evolution of our speciality.

Managing the beauty of our patients through the different techniques of cosmetic medicine and esthetic surgery is a natural step for maxillofacial surgeons. And it is a very simple way to expand your practice. But esthetics should not be considered an enclosed area where some particular techniques are performed. Think about QUALITY in any business: quality should not be only the name of a department. In order to be effective, quality should imbue all the activities of that particular company, from the CEO to the last intern. The same happens with esthetics and our specialty. Knowing and applyng basic concepts and techniques of esthetics in all areas of our speciality will make the difference Again FACE TO FACE travels the globe. We have invited a group of young surgeons from US, Oman, Iraq, Chile and France to share their projects, thoughts, hopes and fears with us. I look forward to see the results of the collaboration between Madmax and Nextgen in the near future. Both initiatives have communicating vessels that can only improve our global network of maxillofacial surgeons. Read the fantastic paper of Dr. Sillifant’s about his new life in Tasmania. Don´t you all want to apply for a job with Paul?

“Managing the beauty of our patients through the different techniques of cosmetic medicine and esthetic surgery is a natural step for maxillofacial surgeons.”

We have published already 8 issues since we greeted the arrival of Julio Acero to the Chair of IAOMS. Read his farewell text and you will be aware of the hectic activity of the man in the last two years. But read also Rui´s paper. It exudes friendship and a well deserved recognition. Dear Julio: Good bye and thankyou very much for your endless work and permanent endeavour for the association. Dear Alexis: Welcome and good luck during your tenure. We have full confidence in your leadership and projects. And finally, dear members of IAOMS, dear future members of IAOMS: MERRY CHRISTMAS AND A HAPPY 2018!! Javier González Lagunas EDITOR IN CHIEF

CONTENTS December 2017 10 SPECIAL REPORT Aesthetics

A PERSPECTIVE ON... 15 Julio Acero

18 SO, YOU WANT TO WORK... In kenya

WOMEN IN IAOMS 20 Paving the road for future female Maxillofacial Surgeons in Oman

22 FROM PROUST TO PIVOT Alexis B. Olsson

COPY ME 24 Open Structure Rhinoplasty


NEXT GEN 30 The Challenges of Effective Communication


A Maxillofacial Resident in Chile FELLOWSHIP 34 Ahmed Maki


WHERE ARE YOU NOW? 38 John W. Curtin


The Economy of Aesthetics



was privileged to join Drs. Julio Acero and Alexis Olsson at the 62nd Congress of the Japanese Society of Oral and Maxillofacial Surgeons in Kyoto last month, where we had the official ceremony of passing the IAOMS Presidential Chain from Dr. Julio Acero to Dr. Alexis Olsson, who will assume the Presidency of the IAOMS on January 1. Our hosts, Dr. Kenichi Kurita, IAOMS Regional Representative for Asia and JSOMS President Mikihiko Kogo, provided delegates not only with a great scientific meeting, but also extended their warm hospitality to us. The experience left me thinking about leadership, partnership and family – three concepts central to the IAOMS. Leadership In this “year-end” column, there are many individuals and organizations to thank for their leadership as well as for helping the IAOMS be the leading global home for OMF surgeons at every stage of their career. While I could take up this entire issue of Face to Face, with thanks, I especially would like to thank our Executive Committee, Board of Directors, National Presidents and Councilors; funders such as KLS Martin, Elsevier, Straumann, Zimmer Biomet and DePuy Synthes and as importantly, every IAOMS member – from Trainees to Fellows and Life members. In particular, there is one leader who has had the vision and the energy to move the IAOMS forward: Dr. Julio Acero, who in a couple of weeks time, will assume the role of Immediate Past President. It has been a great pleasure to work closely with Dr. Acero. Together, along with our volunteer leaders, we have many accomplishments for which we all can be proud – and I would like to share a couple with you. Together, we have: • Strengthened the financial position of the organization, with the help of Treasurer Dr. Arthur Jee, who has helped the organization focus on best practices in financial management. • Increased membership growth by 10 percent over last year and reversed a membership decline; planned to develop a member retention plan with a goal of achieving 85% member retention. •D eveloped and approved a multi-year, strategic plan to ensure the continued growth of the IAOMS and anticipate (and meet) member needs. •R aised more money for the IAOMS Foundation than in the last two years combined and built upon the success of the Laskin Legacy Society, (a giving society to honor Dr. Daniel

Laskin, a living legend), through the addition of 11 new donors. Additionally, we have secured multi-year gifts and attracted new corporate funders. • Professionalized and optimized the marketing, communications and administrative functions according to best practices. • Launched the IAOMS NextGen Council. Our leadership extends to education – where we held our signature event, ICOMS2017, in Hong Kong this past spring with the Hong Kong Association of Oral and Maxillofacial Surgeons. We introduced a new webinar series, Next Level Forum/Digital, focusing on issues and trends in leadership and management. Additionally, we continued our Scientific Webinar Series and continued to provide education through the “Gift of Knowledge” Program. Finally, more than 80 trainees applied for the IAOMS Foundation Fellowships. Partnerships In addition to working with various individual leaders, the IAOMS partners with organizations to reach IAOMS members “closer to home” and to help strengthen other organizations. Through our support of IBCSOMS, we help promote its mission of advancing minimum standards of care globally. IBCSOMS has offered international board certification for eligible surgeons, thus enhancing the quality of training and the delivery of patient care. Partnerships and partnering characterize how IAOMS works with volunteer leaders and other organizations with the goal of advancing our mission. Family Finally, family is at the heart of the IAOMS and our four core values guide how we operate and interact with individuals and organizations. Specifically, we are committed to: • 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. With this culture, we will continue to recruit and retain a global membership. As we enter the holiday season, I wish all of you every joy that the season offers – and warm wishes for a happy and prosperous new year. With gratitude, Mitchell Dvorak EXECUTIVE DIRECTOR, IAOMS

Letter from the President TODAY, AS I WRITE THIS LAST COLUMN AS IAOMS PRESIDENT Dear Colleagues and Friends:


t seems like just yesterday when I set out to write my first column outlining my priorities during my Presidency: our membership (engaging members and maintaining/growing our base), increasing communications and presence of the IAOMS globally, strengthening our Chicago headquarters team, rationalizing the Association´s structure to increase efficiencies and continuing to focus on education – in all of its many forms. Today, as I write this last column as IAOMS President, I am humbled by the work we have accomplished together. My thanks to our members, Councilors, National Presidents, Executive Committee, Board of Directors, staff and corporate partners– each of you played a tremendous role in helping us reach this position of strength. It is my pleasure to reflect on a few highlights of our organizational successes. These are the result of teamwork – across the table, across languages, time zones, cities and continents. Working as a team, we: • Grew our membership by 10%, including introducing IAOMS NextGen, a special initiative to recruit Trainees and young surgeons. • Conducted a member survey to learn more about our members: their level of satisfaction, their educational needs as well as IAOMS Foundation programming. • Hired an outstanding Executive Director, Mitch Dvorak, who has convened an exceptional staff to professionalize every aspect of IAOMS – from strategic planning and operations to communications, education, fundraising, marketing, membership retention and recruitment; implemented changes in the IAOMS committee structure and in our Bylaws. My special gratitude and recognition to our excellent staff. • Conducted a strategic planning, “think tank” session in Madrid during a great Executive Committee Meeting which was followed with strategy meetings in London and Hong Kong. • Enhanced communications with our members and the global community of OMF surgeons, facilitating direct communications with our headquarters staff. We’ve introduced a YouTube channel and increased our social media presence (Facebook and Twitter). And FACE TO

FACE, under the direction of Dr. Gonzalez-Lagunas, continues to be an excellent window to our specialty worldwide. • Developed a procedure to update www.iaoms.org to make it more effective and responsive. The intense work of a Website Task Force (along with our staff) will conclude in a new site next year. • Provided IAOMS members with access to IJOMS directly through www.iaoms.org, and began sending monthly emails to notify members of the latest issue’s contents. Our Journal continues reinforcing its leadership as one of the Specialty’s best scientific journals. • Initiated, together with IAOMS Foundation Chairman Dr. Larry Nissen, our first Annual Appeal to benefit the IAOMS Foundation. As of this writing, we have raised $450,000 towards our $500,000 USD goal. Also, we have worked to make the Foundation´s structure more efficient as we’ve continued to professionalize the organization. • Introduced “Visiting Scholars,” a new IAOMS Foundation program which will facilitate brief educational visits of young colleagues to reference departments of the specialty.

• Launched IAOMS NextGen (and an accompanying Facebook page), to give voice to young Trainees, increase their participation in the IAOMS and develop a leadership pipeline. • Debuted a live webinar series – scientific as well as Next Level Forum/Digital, which explores issues related to leadership and management. • Expanded the IAOMS educational programs worldwide and approved the development of programs in Asia, Latin America and Africa. We launched the IAOMS Symposia with a first Symposium in Medellin, Columbia. The goal of these top-level scientific meetings is to contribute to educational exchanges in different parts of the world increasing collaboration with National and Regional Associations. My thanks to Dr. Rui Fernandes, Chairman of our Education Committee, for his commitment and great work. • Co-Hosted ICOMS2017, where we had about 1800 representatives from 70 countries participate in 135 sessions and launched “Next Level Forum,” to discuss best practices in leadership and management. Both the scientific program and the social events were excellent, which contributed to making a memorable ICOMS in Hong Kong. My thanks and recognition to Prof. Nabil Samman and his team for this great meeting. On a more personal note, it has been my true honor to represent all of you at national or international Congresses (and other important events as much as I have been able), in cities throughout the world as an IAOMS ambassador. And it has been my pleasure to travel and meet with IAOMS members in: • Bangalore: at the World Oral Cancer Congress • Beijing: while visiting the Oncology and Reconstruction Fellowship Training Center, Beijing University School and Hospital of Stomatology • Buenos Aires: at the XX CIALACIBU International Congress, where I was honored with an honorary membership from the Latin American Association •D ubai: at the AEEDC World Oral and Maxillofacial Conference where I also lectured • Hong Kong: at ICOMS 2017 • Kyoto: at the 62nd Congress of the Japanese Society (JSOMS) • Las Vegas, USA: at the AAOMS Annual Meeting (2016)

• London: at an IAOMS Board of Directors meeting, in conjunction with EACMFS • Madrid: at our IAOMS strategy meeting and the Ramon y Cajal International Symposium • Malaga: at the 24th Congress of the Spanish Society of Oral and Maxillofacial Surgery • Manila: at the 12th Asian Congress on Oral Maxillofacial Surgery (ACOMS) • Marseille, at the French Congress of Maxillofacial Surgery, where I was recognized with the Medal of the French Society • Medellin: where we collaborated with the Latin American Association (ALACIBU) and the Columbian Association and introduced our first IAOMS Symposium, which helped bring the IAOMS “closer to home” for some of our Latin American members • Nagpur, India: at the Inaugural Ceremony for the 42nd Annual Congress of AOMSI • Naples: at the Congress of the Italian Society of Maxillofacial Surgery • Queensland, Australia: at the ANZAOMS Conference, where I was honored to receive an honorary membership • San Francisco, USA: at the AAOMS Annual Meeting 2017 • Sri Lanka, where I participated as a lecturer in the IAOMS Regional Workshop • San Juan, Puerto Rico, at the 37th Annual Scientific Conference of the American College of Oral and Maxillofacial Surgery where I was presented with the ACOMS Humanitarian Award During these last two years, I represented the Association globally and met personally with as many colleagues and friends as possible to get to know them and express my support on behalf of the IAOMS. These years have been rewarding on so many levels and I thank you for the privilege of serving as IAOMS President. As I assume my new role as Immediate Past President, I look forward to working alongside you as an IAOMS member – and to seeing you – online and in-person -- at our upcoming events. My best wishes for a fruitful presidency to our next President, Dr. Alexis Olsson. The Association remains in good hands.

Kind regards, Julio Acero IAOMS PRESIDENT 2016-2017

special report

s c i t e h Aest 01

Oral and Maxillofacial Surgery & Facial Plastic Surgery: Maximum compatibility By Blas GarcĂ­a Advanced facial plastic and maxillofacial surgery. Tenerife (Spain)


n recent years, aesthetic surgery procedures of the face have increased at an exponential rate. Social changes, the way we relate to each other, work pressure, the development of technology, social networks and and the existence of less invasive and better tolerated materials and instruments, among others, have contributed in part to the substantial increase in the different procedures in aesthetic surgery. 10 iaoms.org

However, the main advance of facial aesthetic surgery in recent years is due to the fact that a large number of specialties have incorporated competencies in facial aesthetic surgery in their residency training programs. That is why, all those medical specialists who perform facial surgery, especially the younger ones, such as dermatologists, ENTs, ophthalmologists, general plastic surgeons and oral and maxillofacial surgeons, have December 2017

more and more interest and dedication in learning and be trained in aesthetic facial surgery. In most of these specialties, aesthetic facial surgery procedures are an important part of the resident’s training programs and they are part of their board exams. No contemporary surgeon admits today that aesthetic facial surgery is the exclusive competence of a single specialty. Having said that, it is possible to affirm that of all these specialties described, maxillofacial surgery is undoubtedly the most qualified specialty to carry out in an integral way, facial aesthetic surgery procedures. No other specialty knows the facial surgical anatomy so thoroughly, nor does it have such an advanced level of experience in soft tissue surgery of the face and craniomaxillofacial bones. As an example, for a surgeon who performs parotidectomy procedures, it will be very easy to approach a facelift surgery. In the same way, a surgeon who performs orbital or nasal fractures approaches will easily learn the different procedures of blepharoplasty and rhinoplasty, respectively. Surgeries for the treatment of upper third fractures, which require a coronal approach, will simplify the training to perform a forehead or a browlift and likewise, we could set an example of many other procedures. WITH THESE ARGUMENTS, one might think that maxillofacial surgeons are the reference surgeons to perform a procedure of facial aesthetic surgery of the face. However and unfortunately, this does not happen for various reasons:


The majority of University Hospitals, mainly in Europe and the United States, do not include pure facial aesthetic procedures within their services portfolio.

2 3

Many educators in maxillofacial surgery have got very little knowledge about aesthetic facial surgery.

A lot of residents of maxillofacial surgery, mainly in the United States, come from a previous dental degree that determines in many cases, the future of the residents, focused much more in the field of oral surgery and dentistry.


ral and maxillofacial surgery presents a O situation of greater weakness because there is a much smaller number of specialists in

“All those medical specialists who perform facial surgery, especially the younger ones, such as dermatologists, ENTs, ophthalmologists, general plastic surgeons and oral and maxillofacial surgeons, have more and more interest and dedication in learning and be trained in aesthetic facial surgery.”


oral and maxillofacial surgery compared to the rest of the specialties that can perform aesthetic facial surgery procedures (ENTs, dermatologists, general plastic surgeons and ophthalmologists).

A large number of National and International

Societies of oral and maxillofacial surgery have not actively sought to claim for themselves of what rightfully belongs to them.

In fact, other specialties such as ENT or ophthalmology have for years, official sub-specialties in facial plastic surgery and call themselves “facial plastic surgeons” with the opportunity of to be eligible to take the examination for certification by the American or European Board of Facial Plastic and Reconstructive Surgery. In addition, these specialties also have a large number of fellowship programs in facial plastic surgery that do not allow access to specialists trained in oral and maxillofacial surgery. For all this, from all the institutions and societies that represent the specialty of oral and maxillofacial surgery, it is urgent to develop different strategies to avoid the amputation of a part of our specialty. ■

special report


30,000 feet view - Facial Aesthetic Surgery in the USA

By Faisal A. Quereshy Associate Professor -Tenure / Residency Program Director Oral & Maxillofacial Surgery. Case Western Reserve University


aving been involved in the field of Cosmetic Surgery since 2000 i would like to share my perspective on the growing interest in performing facial cosmetic procedures in our specialty of Oral and Maxillofacial Surgery in North America. As I have trained over 50 all Maxillofacial surgeons in my 18 year years of academia, I have seen the growing interest in bright eyed surgeons looking for expanded scope of practice. What better specialty to perform soft tissue rejuvenation procedures in conjunction with other reconstructive surgeries. An OMS is unique in that we have a strong understanding of hard tissue anatomy, and reconstruction of form and function that can allow the OMS to fully take care of their patients desires. The growing interest to perform minor surgical procedures has exploded with the common use of Botox and soft tissue fillers. The more advanced surgical techniques and treatments tend to require a longer recovery period, with potential life altering healing times, have forced facial surgeon specialists to become familiar with the adjunctive therapy is to provide facial rejuvenation. The implementation of in office technologies including nonsurgical lasers have become almost apparent to stay current in today’s marketplace. Unfortunately the field the facial cosmetic surgery has become one of a competitive market space with other surgical specialties including dermatologic surgery and ophthalmology offering similar services, not to mention our general dental colleagues now offering “Dental Spa” services. The national campaign of seeking board-certified surgeon’s in the field official Cosmetic Surgery has also created an uprising in the board certification process across specialties. With a “buyer-beware” mentality, our specialty must seek credibility to perform these procedures and it may lie in the hands of our parent board organization with including “Certificates of Added Qualifications”. 12 iaoms.org

“The field the facial cosmetic surgery has become one of a competitive market space with other surgical specialties including dermatologic surgery and ophthalmology offering similar services” December 2017


The Quest for facial harmony or in other words: don’t forget the “Facial” in Maxillo-Facial! By Henri Thuau Center For Jaw Surgery And Facial Plastic Surgery. Mellingerstrasse 2A, 5400 Baden, Suiza

Beauty is considered to be skin deep. Maxillofacial surgeons however know that it is both skin and bone deep….

As I enter my third decade of practice, I feel that to maintain the presence in the community to perform these procedures will require the addition of med spa services with additional of esthetic personnel creating a holistic approach to the facial cosmetic surgery patient. In the educational realm, it is important that we continue to offer courses, workshops, and Didactic instruction to our colleagues to allow them to be equipped to pursue additional training if required to stay current in their communities and market space. As an oral maxillofacial surgeon I am not preaching to the choir, but I definitely feel our specialty ARE “the experts in all things face”. ■ December 2017


istorically, OMS focused on the bony structures of the face. Pioneers such as Hugo Obwegeser opened new horizons in the management of facial deformities. Having been initially trained in Zurich, I vividly recall the principles of orthognathic planning I was then taught: these were based on the ¨construction¨ of an ideal facial profile, rather than an ideal cephalometric ensemble. At that time, it was something totally new! Bimaxillary osteotomies, jaw distraction, onlay recontouring have become routine tools used to optimise jaw relations. Maxillofacial surgery towards the end of the 20th and the beginning of the 21st century has blossomed as a specialty, thus including Head& Neck surgery as well as Facial Plastic Surgery. iaoms.org 13

special report The in-depth knowledge of the Maxillofacial surgeon enables him/her to accurately assess a face, understand hard/soft tissue development and resulting contour, statics and dynamics of the soft tissue envelope, both from a qualitative and quantitative perspective, as well as the intricate interaction between the hard scaffold and the mobile surface (via muscles, ligaments or loose connections). There was a time when we were taught that optimisation of facial bony contour was the key element leading to facial beauty. Many of our teachers believed that soft tissue contour was more or less passive and matched the shape of the underlying bone. In parallel, other specialties ignored bone, considered more or less irrelevant, and focused exclusively on soft tissues. We know today that this is a discipline-related tunnel

vision, which misses the point. Hard and soft tissues do coexist with marked differences, both at rest and during function. Striving to improve facial harmony will nearly always require intervention on both. FACIAL SURGEONS FACE MANY CHALLENGES IN GENERAL. One of them is related to the communication with the patient about facial aesthetics, and this because of the progressive “blending” of facial characteristics (we could say blurring of anthropometric standards). Globalisation has not only affected the world economy, it has also affected our (and our patients’) understanding of beauty. The face that has become a reference is a “fusion face”: Indo-European contrast, AfroCaribbean lips and ears, middle-eastern / Asian “fusion” eyes, oriental / Latin American fusion skin.

This is sufficiently complex, if there was not another relatively recent parameter: the medial projection of an enhanced reality. The reality we think we perceive is in fact a magnified reality - enhanced facial contour, sharp jaw line, balance between concavities and convexities, demarcation between face and neck. 3D TECHNOLOGY (facial capture, matching with 3D skeletal depiction) are therefore a useful tool enabling the maxillofacial surgeon to establish a meaningful conversation with the patient. Functional and anatomical considerations, identification of “key links” in facial balance and contrast, will enable the clinician and the patient to grasp the aesthetic convergence for each individual case. The Maxillofacial surgeon is therefore the specialist par excellence capable to understand the face globally and intervene specifically at each level.

The armamentarium in Facial Plastic Surgery is growing every day, and current research predicts the emergence of exciting new techniques and materials aiming to recontour, rejuvenate and enhance the face. Combining these with traditional maxillofacial techniques opens unlimited perspectives. The capacity to correct bone deformity and address soft tissue imbalances or age-related changes is a unique opportunity offered to our trainees. I urge our younger colleagues to engage in this exciting field and push the boundaries of our specialty further. The quality of the care provided will gain tremendously from this and the developments will be considerable! As somebody else said: just do it! ■


THE MAN WITH AN INEXHAUSTIBLE ENERGY… THE “ENERGIZER BUNNY” OF ORAL & MAXILLOFACIAL SURGERY By Rui Fernandes Department of Oral and Maxillofacial Surgery University of Florida, Jacksonville (USA)


e all know someone who is the consummate hard worker. He is the first one at the office and the last one to leave. You can always count on him to respond to your email, even at 3 am, no matter what time zone he is in. He brings energy and enthusiasm to any task and always hits the ground running. This truly describes Julio Acero, but to call him a hard worker only scratches the surface of who he is. I first met Julio about ten years ago at the ALACIBU meeting in Brazil. He was busy going from lectures to meetings and back to lecturing. However, I noticed he was never too busy to stop and chat with a young resident, faculty or an old friend. From the start, I could tell that he was not only a hard worker but also a nice guy. Over the years we have crisscrossed the globe together and have traveled to almost every continent. The work we have done on these trips has not only been rewarding, but also fun. I would like to highlight some of the experiences we have shared. December 2017

South America: Paraguay

The IAOMS course in Encarnacion, Paraguay was the first time Julio and I worked together. As usual, the day before the course began, all of the faculty met at the hotel. Most of us arrived that afternoon, but Julio came in early evening as he had a transcontinental flight from Europe. He quickly settled in and then joined us for the faculty dinner to discuss the next day’s outline. We returned to the hotel at about 10 pm and everyone went straight to the rooms to rest. The next morning at breakfast, Julio told me that he had set his alarm to wake up early to work on his lectures. When his alarm went off at 6:00 am, he got up, took a shower and proceeded to get dressed for the day. It was a few minutes later that he realized the time on his cell phone was still set for the time in Madrid. Instead of waking at 6:00 am, he had actually awake at midnight in Encarnacion. He decided that since he had already showered and was dressed, he would stay up for the rest of the night and work on his lectures. He is like the bunny from the Energizer battery commercials, he just kept going and going. iaoms.org 15

Asia: The Philippines

Africa: Nigeria

I knew Julio was an energetic person, but on our trip to the Philippines, he took it to a whole new level. We landed in Manilla at about one in the morning and had a one hour car ride to the hotel. When we finally arrived, my main priority was getting a few hours of sleep before we started conference at seven in the morning. Julio on the other hand stayed up all night putting final touches on his lectures. We lectured the next two days non-stop, only leaving the hotel to go to dinner in the evening. After being in Manilla only 36 hours, we departed, again in the middle of night (we never saw daylight during our entire stay). I was exhausted, but Julio was energized. He was excited about the program and the trajectory of the IAOMS course.

Europe: Spain

One of the best experiences I had with Julio during the last six years was the Microvascular program in Nigeria. We traveled to Lagos Nigeria every six months for three years and enjoyed great hospitality from our Nigerian colleagues. I was always impressed with Julio’s dedication to the project, his positive outlook on the success of the program and his commitment to ensure that the surgeons learned the procedures. Once, while Julio was doing a cadaveric dissection, the electricity shut off in the middle of his demonstration. Ever the professional, he never missed a beat and continued to dissect while I used the flashlight on my cell phone to illuminate the surgical field until the power was restored. Julio knew we didn’t have any time to spare and we had to keep going to get the job done.

I have had the pleasure of visiting Julio in his home city of Madrid many times over the years for various educational and IAOMS related activities. As you might imagine, Julio is the ultimate host and goes above and beyond to ensure that everyone feels welcomed and looked after. During my first visit to Madrid, Julio was determined to show me around the city, even though I only had about 6 hours before my flight. Unfazed, he set out a plan that would take us to sample some of the local cuisine, see the main sites in the city including a short but intense visit to the Prada museum. As usual, he accomplished the task and we had fun in the process. 16 iaoms.org

December 2017

Australia: Melbourne

North America: USA

As we all remember, the ICOMS meeting was recently held in Melbourne. The meeting was one for the books, both from a scientific perspective as well as a social one. As could be expected, Julio was inundated with board meetings and lectures. Every time I ran into him he was either on his way to give a lecture or to go listen to one. It never mattered if it was one given by a prominent surgeon or one given by a resident, he was and is always committed to supporting colleagues and to his own learning as well.

Since the IAOMS headquarters is in Chicago, Julio is a frequent visitor to the USA. Several years ago, Julio was the Keynote speaker for the Oncology and Reconstructive Program for the AAOMS annual meeting in Philadelphia. Although this was his first time lecturing at AAOMS, he knew all of the surgeons involved and was already known by nearly all in attendance. Once again, he did a fantastic job with his lecture and in keeping with his typical schedule, the trip was less than 48 hours. Although his time was short, he still managed to see the Liberty Bell, visit museums, and taste an authentic Philly cheesesteak sandwich. Over the past decade, and particularly in the last 6 years that I have served as the chairman of education for IAOMS, I have gotten to know Julio well. He is a master surgeon, an unmatched ambassador for our specialty, a devoted family man and a great friend. If I did not know him better I would say that he is off to get some rest as he passes the baton of President to Alexis Olsson. However, I know better than to think that. He is off to being the Immediate Past President of IAOMS, the President–Elect of the European Association of Craniomaxillofacial Surgeons, the world’s greatest Grandpa, and the ever-present friend.

. e n o d ll e w b o j a , To Julio

HOW MUCH WILL IT COST? To have a dental implant installed by a maxillofacial surgeon..

US $1256



ARGENTINA 850 USD December 2017

iaoms.org 17




So, you want to work...


By James Kirimi Mung’atia Consultant Maxillofacial Surgeon, Meru (Kenya)


enya, officially the Republic of Kenya, is a country in Africa and part of East Africa and the Great Lakes Region. Kenya’s territory lies on the Equator. It is bordered by Tanzania to the South, Uganda to the West, and to the North from West to East are South Sudan, Ethiopia, and Somalia. Kenya covers 581,309km2 (224,445 sq. miles) making it the forty-seventh largest country by size. As of January 2017 Kenya had a population of 48 million people, with over 70% under 30 years. The capital Nairobi, is home to 4 million inhabitants and is a regional commercial hub. The GDP of Kenya is the largest in East and Central Africa.


Kenya has a warm and humid tropical climate on its Indian Ocean coastline. The climate changes to temperate inland and then to arid and semi arid in the north and north east parts of the country. Kenya receives a great deal of sunshine every month throughout the year; summer clothes are worn all year. The average annual temperatures are a maximum of 34.8° Celsius in the north to a low of 9° Celsius in the coldest parts of the Kenyan highlands. Since Kenya lies on the equator sunrise and sunsets happen at the same time respectively throughout the year.

In Kenya Maxillofacial Surgery is a recognized dental specialty. Specialist recognition is granted by the KMPDB and the regulations can be found on: www.medicalboard.co.ke www.health.go.ke

18 iaoms.org

All doctors are registered and licensed by the Kenya Medical practitioners and Dentists Board (KMPDB). Licensing regulations are passed by the Kenyan parliament and policy guidelines are provided by the Ministry of Health.

December 2017

Kenya is known for its world famous athletes, white sandy beaches, and diverse landscapes peppered with immense herds of wildlife. The country has a considerable land area dedicated to wildlife habitats. The “Big Five” game animals of Africa, - lion, leopard, rhino, elephant and buffalo, can be found in Kenya. There is also a huge bird population (over 1,000 species) including both resident birds and immigrants making Kenya an important birding area in the world.

The official languages in Kenya are English and Kiswahili. In addition, there are over 42 tribal languages spoken over different regions in the country. The urban populations are cosmopolitan and both English and Kiswahili are spoken in the workplaces.

s Regional Association The East African Association Oral Maxillofacial Surgeons (EAAOMS) is the regional association for surgeons in East Africa. It is headquartered in Nairobi, Kenya and a a vibrant calendar of activities including workshops, seminars and conferences. The EAAOMS is affiliated to the African Association, AfCOMS, and the international body, IAOMS.

OMS Demographics in East Africa Kenya has the highest number of OMS specialists at twenty-five followed by Tanzania (≤15), Uganda (≤10), and Rwanda (1). Training programs in OMS are available in Kenya, Uganda and Tanzania. All these programs are relatively young having been started in this millennium. A good majority of the OMS specialists in Kenya trained in the UK and USA and have dual qualifications. The majority of the OMS specialists in Kenya are based in the capital city Nairobi. Here they work in both public service as well as private practice. In terms of gender, there more male OMS than females (5:1) in Kenya.

One is required to have practiced for 2 years in a hospital setting post specialist qualification to be recognized as a specialist OMS. Specialists from the East African countries are exempted from seeking work permits while those from outside East Africa require to have valid immigration status as well as work permits. More information can be found at: www.immigration.go.ke https://fns.immigration.go.ke

December 2017

✔ 7 at the University of Nairobi and part time private practice in Nairobi. ✔ 7 based in regional/county referral hospitals outside Nairobi. ✔ 7 at the two national referral hospitals (Kenyatta National Hospital and Moi Teaching & Referral Hospital) and part private practice in Nairobi and Eldoret. ✔ 2 with the military/defense forces hospital in Nairobi. ✔ 2 full time private practice in Nairobi. With a combined population of over 150 million and less than sixty OMS specialist the East African region welcomes you to come visit and work here and enjoy our flora and fauna as well as the immense cultural diversity. We are home to some of our planet’s most striking landscapes and wildlife. This is (East) Africa! ■ iaoms.org 19

Women in IAOMS

PAVING THE ROAD FOR FUTURE FEMALE MAXILLOFACIAL SURGEONS IN OMAN By Noor Jabbar Resident Oral and Maxillofacial Surgery, Oma medical Speciality Board. Oman Medical

THROUGHOUT HISTORY, women have fought bravely to assert themselves as individuals and as experts in their fields. They have inspired generations and proved to the world their capabilities, potentials, strength, and vision in many famous figures. Women are still fighting for their rights in many nations. However, as long as there is determination, there will always be a way to justice and equality. I have been raised in a society, where gender equality is favored and supported by the leader of the country - A country in which men and women rights and opportunities are equal, and gender discrimination is not acceptable. This country is the Sultanate of Oman, a beautiful coastal country, ruled by his Majesty the Sultan Qaboos bin Said, a man of wisdom who is proclaiming peace, justice and equality in the society. He once said “Taking the challenge “Women are half and becoming young of the population, surgeons today will not be an their success is accomplishment for ourselves only, our triumph”, as well as in it will be a seed planted in many a remarkable souls to take a step further in a speech in the world full of opportunities.” Omani women’s day, he also said “… the country, needs 20 iaoms.org

December 2017

“Women are half of the population, their success is our triumph”

both men and women because no doubt it resembles the bird in relying on both its wings to fly high on the horizons of the sky. How can this bird manage if one of its wings is broken? Will it be able to fly?” NEVERTHELESS, Oral and Maxillofacial Surgery (OMS) has always been a male-dominant specialty in Oman, until few years ago, when this took a shift and women were warmly welcomed to specialize and join. I am considered one of three females to specialize in this field in the whole country. My senior colleague specialized few years ahead of me and became the first Oral and Maxillofacial female surgeon in the country, subsequently myself; as I am almost graduating and then my junior colleague who is currently in her third year of residency. Being the first three ladies to join the program has opened an additional field where Omani women proved their capabilities and excellence. It was not difficult to prove ourselves and get accepted by the OMS Residency Program in Oman Medical Specialty Board, yet being a female in a male dominant field has always been a challenge taken happily by us. Our teachers, who are all men, never showed discriminations to their residents and we ‘females’ never felt odd working along. However, as we are competing with macho colleagues, subconsciously, we wanted to excel and prove ourselves further. JOINING the residency program and the specialization was not our only achievement; we are outstanding further by participating in associations and scientific programs. Our senior colleague is the 1st female December 2017

to head a committee in the Oman Dental Society, by being the Head of the Scientific Committee. She is also one of the directors of the Study Club - Muscat of International Team of Implantology (ITI). Additionally she is one of the elected individuals for Young Podium in ITI - Middle East Section, and one of the task force of the upcoming Advance General Dentistry Residency Program in the Oman Medical Specialty Board. Recently, she became a reviewer in The Sultan Qaboos University Medical Journal and was elected as an associate faculty in Oral and Maxillofacial Surgery Residency Program, being again the 1st female to join the faculty. On the other hand, my other colleague and I were the first females to graduate from Oman and join the program directly, which makes us completely homemade! And that was a booster to the dental students in our college and specially the females. We both represented our country in many national and international conferences and workshops. One of them was the latest International Conference of Oral and Maxillofacial Surgery (ICOMS), where I was awarded for Best Future Surgical Instrument Design and was also elected as a member of the NexGen committee as Asia representative. Furthermore, we published a couple of scientific papers and working on more, with ongoing research projects while we are still residents. All of this has taken the Omani female OMS leadership to a completely different level and we are honored to be the ones representing our country. IT WAS ROSA PARKS WHO ONCE SAID ‘memories of our lives, of our work and our deeds will continue in others’. Taking the challenge and becoming young surgeons today will not be an accomplishment for ourselves only, it will be a seed planted in many souls to take a step further in a world full of opportunities, to be fearless and to excel in any field. We are proud of what we have achieved so far and we are hoping and aiming to be inspiring figures and good role models for women in Oman and worldwide one day. ■ iaoms.org 21

From Proust to Pivot


t n e id s e r P w e n r u o t ee M Dr. Alexis B.


Northwestern University Feinberg School of Medicine. Chicago (US)

What is your favorite word? Yes. What is your least favorite word? Never. What is your favorite drug? Wine. What sound or noise do you love? A waterfall. What sound or noise do you hate? Anything that is off tune. What is your favorite curse word? WTF. Who would you like to see on a new banknote? A Viking. What profession other than your own would you not like to attempt? A Herpetologist. If you were reincarnated as some other plant or animal, what would it be? A Sequoia Tree or a Ram. If Heaven exists, what would you like to hear God say when you arrive at the Pearly Gates? My goodness, they’ll let anyone in nowadays.

What is your idea of perfect happiness? Freedom from everything.

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

What is your greatest fear? Running out of time in life.

Which living person do you most admire? My father.

What is the trait you most deplore in yourself? Being pedantic.

What is your greatest extravagance? Private golf club membership.

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December 2017

What is your current state of mind? Anticipatory.

Which talent would you most like to have? To be a painter

What do you consider the most overrated virtue? Righteous.

If you could change one thing about yourself, what would it be? To be more patient

On what occasion do you lie? Hurtful truths. What do you most dislike about your appearance? What has happened in 35 years. Which living person do you most despise? The two faced politician. What is the quality you most like in a man? Dependability. What is the quality you most like in a woman? Loving. Which words or phrases do you most overuse? Wanna bet? What or who is the greatest love of your life? My wife and kids. When and where were you happiest? The top of Piz Nair, Switzerland, Christmas, 1986- 3 feet of fresh snow- off piste. The world by its tail.

What do you consider your greatest achievement? My children If you were to die and come back as a person or a thing, what would it be? Stan Getz. Where would you most like to live? The Rockies. What is your most treasured possession? My grandfather’s pocket watch.

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

What do you regard as the lowest depth of misery? Emptiness.

Who are your favorite writers? Robert Ludlum, Charles Krauthammer.

What is your favorite occupation? Fighter pilot.

Who is your hero of fiction? James Bond- but is he really fictional?

What is your most marked characteristic? Persevearance.

Which historical figure do you most identify with? Gustaf II Adolphus. Who are your heroes in real life? Those who put their lives on the line to protect us. What are your favorite names? My daughters names Katherine and Kristina. What is it that you most dislike? Failing. What is your greatest regret? I try not to. How would you like to die? Quickly. What is your motto? Carpe Diem.

December 2017

iaoms.org 23

Copy Me OPEN STRUCTURE RHINOPLASTY In an issue dedicated to Facial Esthetics, it seemed natural to talk about rhinoplasty. We have one of our best-knowned experts sharing with us some tips in “open-structure rhinoplasty”. This surgical approach has a key role in teaching rhinoplasty to our trainees. TIRBOD FATTAHI, MD, DDS, FACS Professor & Chair. Department of OMS University of Florida, Jacksonville


Outline of bilateral marginal incisions connected to an inverted “V” transcolumellar incision.

24 iaoms.org


Incision along the caudal edge of lateral crus.


Degloving of nose in a subperichondrial fashion.

December 2017



Endoscopic view of septal harvest preserving the 1.0 cm “L” strut at the caudal edge.

Placement of bilateral spreader grafts in order to manage the mid-vault.

December 2017


View of nose after harvesting of septum; the “L” strut is clearly visible.


Harvested septum; will be used to create graft material.

8 iaoms.org 25

Cadaver demonstration of a High to Low to High lateral osteotomy.

Copy Me


Intraoperative view after bilateral cephalic trim.


Placement of a tip “shield� graft.


Creation of a pocket for placement of a rim graft.


Single intra-domal suture placed in right dome in order to narrow the tip.

14 Before and after photographs following open structure rhinoplasty. 26 iaoms.org

December 2017


Placement of columellar strut graft.



A bi g



yo u

Dear Friends, Happy Holidays from the IAOMS Foundation!

2017 has been an amazing year – for the IAOMS Foundation as we have experienced unprecedented success, for the IAOMS as membership, communications, and the vision of the organization, and for our specialty internationally, as ICOMS in Hong Kong was the highlight of tremendous educational and networking opportunities. At the beginning of this year, the Foundation set out toward an ambitious goal. We believed we could grow our impact and educational reach around the world through a formalized fundraising and partnership program. With this goal in mind, we set out to raise $500,000 USD this year. As of this writing, we have raised nearly $450,000 USD. First and foremost, I want to say THANK YOU to all who have participated in this effort. We’ve had 115 individuals contribute a total of more than $175,000 USD. We’ve had seven regional OMS organizations contribute more than $120,000 USD, highlighted by a historic $50,000 USD commitment from AAOMS. And our corporate partners have committed $130,000 this year as well. Special thanks to our good friends at the KLS Martin Group, who once again this year have matched our individual giving with an $80,000 gift. Friends, we are nearing our goal, but we need your help to cross the finish line. On behalf of the IAOMS Foundation Board, I’d like to ask you to join us right now. If you are able, will you consider joining our “Advocate Circle” with a gift of $1,000 USD? This comes out to about the price of a small coffee a day for the year, and will help us reach our goal of transforming OMS education worldwide. Please know that we appreciate each and every gift at a level that is appropriate for you. We will be recognizing your support on our website, in digital mailings to our global membership, and in IAOMS publications. We hope to be able to acknowledge each and every one of you for your generous support. To make your commitment today, visit the Foundation’s giving page. https://iaoms.site-ym.com/ donations/donate.asp?id=13705) Thank you all for your continued support of the IAOMS, and of the IAOMS Foundation. We wish you a wonderful year-end season, and we look forward to celebrating the success of our Annual Appeal together with you. ■

Larry W. Nissen IAOMS Foundation Chairman December 2017

iaoms.org 27



“My obsession for face drawing, and my interest in trauma and reconstruction leads me naturally to Maxillofacial Surgery”

I studied and trained as intern in Marseille, in the Departments of Maxillofacial and Plastic surgery. During my internship, I made a short rotation in Children Hospital of Los Angeles. I improved my skills in trauma care in Grenoble (France) and Genève (Switzerland). Since my childhood, I have always wanted to be a surgeon. But personal issues imposed me a long break at the very beginning of my medicine studies, so I turned myself into fine arts, especially portraits painting! Finally, I came back to surgery. My obsession for face drawing, and my interest in trauma and reconstruction leads me naturally to Maxillofacial Surgery.


“Maxillofacial Surgery isthe only field that would allow me to combine the practice of amazingly beautiful surgical procedures”


I studied medicine at the Pitié-Salpêtrière Hospital in Paris. I completed my surgical training first in Nantes, in the Department created by Prof. Delaire, and then in Paris at the PitiéSalpêtrière Hospital and at Necker Hospital. I also did a PhD in craniofacial development at King’s College and a pediatric plastic surgery fellowship at Great Ormond St. Hospital, both in London. Since medical school my clinical and scientific goal has always been to understand and treat craniofacial developmental and growth anomalies. I quickly realised that Maxillofacial Surgery isthe only field that would allow me to combine the practice of amazingly beautiful surgical procedures and a proper overview of all the components that contribute to craniofacial development and growth, from the tongue and teeth to the brain and the skull vault!



RH KHONSARI: We created MadMax with Dr. Jean Marc FOLETTI under the leadership of Pr. Cyrille Chossegros, the current president of the SFSCMFCO (French society for OMFS [site internet]). MadMax is here to help OMFS residents and fellows interested in research and considering pursuing an academic career. More precisely, our aim is to help our younger colleagues to strengthen their research and teaching portfolio. MadMax will bring together senior consultants from our three national associations (SFSCMFCO, AFCF and AFJCMF) and the College des Enseignants (which includes all the French OMFS associate and full professors), as well as representatives of residents, consultants and academics.



JM FOLETTI: Hossein and I have both been appointed associate professors earlier in 2017, Hossein in Paris (at Necker University Hospital), and myself at the University Hospital of Marseille. In France, University Hospital teachers are appointed after a national competition. Thanks to our recent experience, we know very well how difficult it is to combine clinical practice with research and teaching - while being a good surgeon, an innovative biologist and an appreciated teacher! RH KHONSARI: Young surgeons interested in research and innovation are required to conduct projects and publish their results without the benefit of having any dedicated, protected time. On top of this, they have to pursue their surgical training, regularly be on call and manage a large amount of administrative issues. All this sounds like an impossible mountain to climb.


to organize their curriculum or about which research topic to focus on. These meetings will also include presentations from Editors of major OMS journals and from surgeons with established academic backgrounds. The first MadMax meeting will take place in Paris the 8th February 2018 2. Rewards for outstanding oral presentations With the support of the SFSCMFCO, we awarded a total of 5,000 euros to the 3 best oral presentations by young surgeons at the 53rd French conference: Dr. Jebrane Bouaoud for a clinical study on osteosarcoma, Dr. Jean-Philippe Foy, for a molecular biology study on squamous cell carcinoma and Dr. Alexandre Debelmas for a biomechanical investigation of the mandibular periosteum. Further awards will be available for our 54rd conference as well as for the EACMFS congress in Munich in 2018. 3. Research project database We are currently building an online database of Masters and PhD projects suitable for maxillofacial surgeons across France. We hope that this tool will help residents working in units linked to smaller universities to find research programs and facilities in their field of interest. 4. International Section Spending one year abroad is strongly recommended in the academic portfolio of the applicants for associate and full professorship positions. MadMax will help residents and young consultants to find suitable clinical and/or academic departments in Europe and beyond, with the help of the senior members of the SFSCMFCO. RH KHONSARI: The 5th focus of MadMax will be Research valorization. I have some personal experience in the design and production of a simple medical device. This project combined both a valorization approach and an international experience, as I developed the device with Dr. Alexander Ivanov, from Moscow. Thanks to this experience, I would like to help and support younger surgeons who would like to launch similar projects.



JM FOLETTI: In brief, we defined five major axes within MadMax. The first four of these axes are: 1. Support for scientific publication We plan to organize informal seminars where MadMax members will interact and ask practical questions to the senior staff, for instance about how December 2017


RH KHONSARI and JM FOLETTI: It’s a work in progress. Our approach is to listen to the practical issues encountered by our younger colleagues and adapt what we can offer to their needs. Above all, we are open to establish links with similar structures in other countries where we are convinced that residents are confronted to similar issues when trying to combine surgery and science! ■ iaoms.org 29


The Challenges of Effective Communication

FACEBOOK AND BEYOND of Oral Maxillofacial Surgeons (ROAAOMS) a few years ago, as the largest obstacle we faced at that time was also finding the most effective means of communicating with both fellow trainees and predoctoral students throughout America. With the help of the ROAAOMS Executive Committee and our ROAAOMS advisor Mary Allaire-Schnitzer, we assembled a subcommittee to solely focus on communication, which led to our successful advent of our national Facebook page.

By Payam Afzali Oral & Maxillofacial Surgery Ann Arbor, MI (USA)


had the pleasure to be introduced to the passionate and energetic IAOMS NextGen Council at the 23rd Immediately after the ICOMS meeting in Through International Conference on Hong Kong our NextGen council started our discussions Oral and Maxillofacial Surgery in familiarizing ourselves with each other with our council it Hong Kong. and spreading ideas via the cell phone was soon apparent that communication application WhatsApp. utilizing the present tools Since the meeting, I have come Who would have thought just about of social media would be to realize the breadth and reach 10-15 years ago not owning a cell phone the best avenue to reach of the past NextGen Council, was a possibility, in contrast to today’s the most people in and how, most of my American world which more people in the world our generation colleagues weren’t even aware of these statistically own a cell phone than even a extraordinary efforts. It reminded me of toothbrush (Consumer Technology Association, the similar experience we went through with 2015). Through our discussions with our council it the Resident Organization of the American Association was soon apparent that utilizing the present tools of 30 iaoms.org

December 2017

We hope our fellow international young surgeons will get involved, share their global ideas for new projects and assist in expanding our worldwide knowledge base

social media would be the best avenue to reach the most people in our generation. We quickly agreed to rejuvenate our efforts on the social media giant… Facebook. This multibillion dollar social networking service has evolved into virtually the norm in the world today, utilized worldwide through all age groups from our grandparents to our young kids. Facebook was founded just about 11 years ago, already has over 2 billion monthly active users, with a 16% user increase annually (Facebook, 11/01/17). We agreed that this social media tool would be ideally suited for exchanging ideas, knowledge, upcoming events, research, networking and more, not only throughout all regions globally, but also between the generationally diverse members of our profession. We proposed the idea of the NextGen Facebook Page to the IAOMS Board of Directors. With the support of the IAOMS Board and staff, our current NextGen Facebook page successfully launched this past August. December 2017

Currently our page consists of the IAOMS mission, contact information, upcoming trainee events, possible funding/fellowship opportunities, webinars and numerous other professional resources. Our council is currently working on multiple potential projects to propose to the Board to utilize on our new Facebook page, including mentorship programs, research, global outreach opportunities, and interactive education tools such as e-journal clubs and monthly quizzes on topics facing our profession today. As ideas are constantly shared amongst our group, the possibilities appear to be endless as we each expand our regional ideas and adapt it internationally. We hope our fellow international young surgeons will get involved, share their global ideas for new projects and assist in expanding our worldwide knowledge base. Now we have the means to spread our ideas, share our talents and hopefully unify the next generation of surgeons in our profession. What’s next… Instagram? Twitter?…. soon to come... ■ iaoms.org 31


e l i h C in

By Andres Teare Hospital Luis Calvo Mackenna, Santiago de Chile


hile I was on my fourth year getting my DDS degree, I realized I wanted to become an Oral and Maxillofacial surgeon, so I started to focus on achieving my goal. As soon as I graduated from Dental School, I started working in the Chilean Air Force Hospital. There I met a great maxillofacial team, and I was even more encouraged to achieve my objective. In 2015, I applied to the Oral and Maxillofacial program at Mayor University and got accepted. At the moment, I am a second-year resident. The program consists of a 3 years curriculum and I have six other classmates. We are all sent to different hospital across Santiago de Chile, and rotate every six months. Besides all the work from each hospital we still have courses to complete from the University, so we have to attend to classes and prepare workshops on a weekly basis. We see each other very often and by now we are a close group of friends. Currently, I am in my pediatric rotation in Hospital Luis Calvo Mackenna. It is a high complexity hospital, which receives cases from all around Chile. It has one of the best Cleft Lip and Palate multidisciplinary team and it includes Plastic surgeons, Oral and Maxillofacial surgeons, Nurses, Psychologist and Speech Therapists. My week consists of the following: on Mondays and Fridays we have Maxillofacial clinic in the morning, where we do oral surgery procedures, pre-op evaluations and post-op follow-ups. And on the afternoon, there is designated operating room for plastic surgery procedures. On Tuesdays and Wednesday, we have Plastic surgery clinic, for pre-op and post op follow up. 32 iaoms.org

On Thursday, there is Maxillofacial designated operating room, for procedures under general anesthesia, all day long.

5:30 am

Monday, I’m starting a new week, hopefully it will be a good one, since there is a holiday on Friday. Every day I work out before going to the hospital. Otherwise I feel sleepy all day, have breakfast, take a shower and get my stuff ready to go.

06:50 am

Get into my car and put on some music, or listen to the local news, and think about what challenges I have on this day.

07:30 am

I arrive at hospital, head to the third floor and find out if there are any new patients that were admitted, their condition, and prepare to present the patients to the staff surgeons.

08:00 am

I meet up with all the staffs, and round the floor while presenting the new cases, to decide the next action to take, and reviewing the hospitalized patients to get them ready to discharge. Afterwards we head to the December 2017

clinic where I have to present all the cases that are going to the OR this week, the patients we operated last week and the ones that are going to the OR on the week to come, plus some special topics that we mioght have discussed.

09:00 am

The clinic starts, generally we have a list of around 25 patients, plus the emergencies that might pop up. We start seeing patients with different needs, postop controls, pre-op evaluations, new evaluations, I am running around taking medical histories, taking pictures, evaluating X-rays or CT scans, taking models for future surgery planning, and getting all the paperwork done to schedule new surgeries.

13:00 pm

Finally, a break. Lunch break generally means eating something quickly, and use the rest of the time to do the finishing touches for the seminar in the afternoon. Then head to the OR

14:00 pm

After the anesthesiologist has evaluated the patient and everything is in order we head to the operating room, choose some music that everyone likes, and then the fun part of the day begins. On Monday December 2017

afternoons we have minor surgery lists, so the mood in OR in more relaxed.

17:00 pm

After surgery, I head to the third floor to do a round on the patients that are still in the wards and check everything is under control. Then head to the laboratory to start doing model analysis and planning to program further surgeries.

20:00 pm

As part of the Maxillofacial program, we have seminars and classes alongside the residencies at the different hospitals. Today my seminar is a crossfire between treatment on open v/s closed comminuted fractures. After a good discussion it is time to go back home.

23:00 pm

I finally arrive to my place, grab some food before going to bed, review my day, think about the good, the bad and the things that I could improve to make my life easier, download and organize the different cases of the day, and prepare for tomorrow.

00:00 am

Go to sleep, so tomorrow can be another great day. â– iaoms.org 33


Do you remember Ahmed? One year ago we asked him about his IAOMS fellowship in India. Today he looks back and tell us how that experience changed his career.

BACK HOME By Ahmed Maki Alkarkh General Hospital. Baghdad- Iraq


recently completed a fellowship in craniofacial and cleft lip and palate surgery offered by the International Association of Oral and Maxillofacial Surgery. I am now back home in Iraq. As I begin my professional life here, I am confronted by a variety of cleft cases of varying severity. I find myself falling back on the confidence and the skills I learned from my mentors - Drs. Krishnamurthy Bonanthaya and Gosla Reddy. They had so unselfishly taught me every step in the whole spectrum in the treatment of clefts. What is unique about this cleft fellowship is that it offers an unbridled opportunity to create a smile on the face of a child, many a child, and you realize that your life changes when you see that smile - (Rumi said: “I learned that every mortal will taste death, but only some will taste life”).

“Rumi said: I learned that every mortal will taste death, but only some will taste life.”

The opportunity also introduced me to India, an amazing country which has a great diversity in its culture, traditions and cuisines; my oneyear journey was like a page out of the stories of The Arabian Nights. Now I am back in Baghdad, working my way in, step by step in my hospital, to raise the standard of care in the management of clefts and to pass on what I learned through my year of training to my colleagues here. ■ 34 iaoms.org

December 2017



By Paul Sillifant Oral & Maxillofacial Surgery. Hobart (Australia)


had wanted to be a surgeon since sitting and watching my grandfather blowing smoke rings, which thrilled me as they sailed high above his arm chair... while the rest of the family ribbed him for his enormous large nose, causing me anguish that my hero was being so teased. In retrospect it was obviously rhinophyma. I would protest, and mum would say “when you are a surgeon, you can fix grandad’s nose”. This led me into my many years of dentistry and medicine and then surgical training to eventually arrive as an Oral and Maxillofacial Surgeon with a Head of Department job in the adult hospital and a Consultant position at the Children’s Hospital in Perth, Western Australia. However, many years ago, my wife and I were on a holiday together in Tasmania in 1998. We were fortunate enough to do the iconic Overland Track – a 7-day bush walk from Cradle Mountain to Lake St Claire in the Tasmanian World Heritage area. Staring across Lake St Clair, looking at the jagged snowcapped peak of Mt Olympus, a seed was planted, It nagged and grew in me as I trained in maxillofacial surgery, this affinity for Tasmania. I had trained in Perth and Liverpool, UK finishing with a craniofacial fellowship at Alderhey Hospital. This had been a tightly subspecialized fellowship in paediatric cranial vault surgery and ear reconstructions with David Richardson. December 2017

Witnessing his meticulous attention to detail as he fashioned the cartilage constructs late into the evening was an experience I will never forget. Then returning to Perth after all those years of training and finding that the dominance our specialty had gained in the UK was not the same in Australia and the stronger specialties of plastics made it very difficult to be involved in paediatric craniofacial surgery. The little seed of Tasmania started to grow my discontent and when I spotted a farm for sale a mere 45-minute drive from Hobart, on the stunning river Derwent with a history dating back to 1827 and a newly planted vineyard, my wife and I fairly quickly made the move with our 4 young boys. This I thought was my ‘sea change’ or more commonly called a ‘tree change’ as Tasmania has some of the largest tracts of protected temperate rainforests left on earth. Truth be told I was nervous about farming but I felt confident I could repair a fence after all my years of putting on archbars for fractured jaws. Our first months on the farm were full of new experiences for the family – I think we spent our entire first weekend herding our sheep who had escaped because of a fallen tree across a fence. Sheep are not that smart and were a cause of huge frustration when, as usual, they would iaoms.org 35

WORKING IN PARADISE take the least predictable path leading me to yell instructions to my children to chase down the wayward animals. (I am relieved our neighbours were some kilometres away and still cannot believe we attempted this without dogs or motorbikes!) NOW 4 YEARS ON we have all settled into the running of the property and balancing it with our “city” life. The most exciting time of the year is harvest, usually in March to May when we pick our Pinot Noir and Chardonnay grapes to be made into sparkling wine. The Derwent Valley in Southern Tasmania is renowned for being an ideal site for premium quality sparkling wine due to a long growing season and cool nights allowing a perfect balance of crisp acidity and sugars to balance the sparkling palate. Picking days start early before the sun is up and it is all hands on deck - our 4 children have the week off school and bring along their friends to help pick the grapes, alongside around 35 backpackers and other seasonal workers. The grapes are picked into buckets and collected by our oldest son driving the tractor. At the end of each day around 15 tonnes of grapes are loaded onto the truck and we can finally relax… at least until the next day when we do it all again. The satisfaction comes from seeing our previous 12 months of work being brought to fruition.

The lasts days’ picking is marked by a bonfire and this vintage I joined my children in stomping the last of the pinot to make our own family batch of wine. Our other great love on the farm is our herd of around 100 Aberdeen Angus Cows. They are the allblack cows and are heavily matriarchal and amazingly protective mothers. I have had at least 2 cases of severe facial fractures in the last 2 years at the Royal Hobart Hospital of a farmer getting too close to a new calf and coming off second best when the cow is protecting its baby. What delights us to witness is the complex nurturing community the cows have. When there is no danger, one or two of the mother cows will look after all 30 to 40 calves while their own mothers feed and rest. When danger is sensed a loud ‘moo’ is announced and all the heard will gather round to show the herds strength and deter the threat. When I moved to Hobart I had thought that my surgical career would be of secondary focus to my farming time and I would be mostly doing relatively simple dentoalvelolar surgery. However, fortune has favoured our move here and as Austin Powers would say I have got my Mojo back for operating. The smaller size of Hobart encourages my general maxillofacial surgery away from the subspecializing and although I will probably never do a paediatric

“Its not all smooth sailing taking on a farm - we have had floods which have washed dams away, frosts which have taken 70% of our crop, escaped long horn cows treating our vineyard as a rodeo ring leaping the vineyard rows and the odd heart attack while watching children crash their motorbikes at speed…. and all the while thinking back to when we lived a calm, predictable, suburban life in the city! But at this moment in time we wouldn’t change a thing and relish every new experience this adventure has given us.”

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cranial vault remodeling largely due to the lack of adequate paediatric neurosurgical and anesthetic interest, we get to do pretty much everything else in our field just not in large numbers.

Our first months on the farm were full of new experiences for the family

watching children crash their motorbikes at speed…. and all the while thinking back to when we lived a calm, predictable, suburban life in the city!

But at this moment in time we wouldn’t change a thing and relish every new I think farming makes me a better surgeon as in experience this adventure has given us. Moving farming, nothing is predictable because of the to Tasmania and taking on the farm has huge number of variables (think Tasmanian renewed my enthusiasm for surgery. I find Moving weather!) and most of your day is spent that after the stress of 4 days surgery each to Tasmania fixing things and problem solving. week, I then spend Friday on the farm and taking on the getting covered in mud which ends up farm has renewed Its not all smooth sailing taking on a farm deep up under my fingernails, sorting out my enthusiasm for - we have had floods which have washed the cows or the vines or the pumps or surgery dams away, frosts which have taken any other number of problems the week 70% of our crop, escaped long horn cows has brought. And in doing so the stress of treating our vineyard as a rodeo ring leaping the surgical week are way behind me and I am the vineyard rows and the odd heart attack while content. ■

IAOMS Sign course

Pre-Congress Cadaver Workshops of the SASMFOS, endorsed by the IAOMS September 2017 in Cape Town

Recently two high profile courses were held at the Department of Anatomy, Tygerberg University, in Capetown, South Africa, organized by Prof. Jean Morkel and team. The first course was a Surgical free flap reconstruction course, the third of its kind organized by the same group. This course was led by Prof. John Langdon, with Martin Danford and Bhavin Visavadia serving as international faculty. The President of the SASMFOS, Greg Boyes-Varley served as local faculty. The course was a combination of didactic lectures followed by a hands-on workshop on techniques learnt. On the 12th September, a pre – congress cadaver course in Orthognathic Surgery was conducted at the same venue, under the guidance of Prof. Reyneke and Prof. Sullivan, with lectures, transmitted live surgery and hands on workshops offered to the attendees. The

anatomical lab had highest standard and the technical equipment provided by Zimmer Biomed and Stryker surpassed all expectations. As the evaluation forms and feedback of attendees proved, both cadaver courses were highly esteemed and the IAOMS wants to congratulate all organizers, teachers and attendees on the academic success. These pre-conference courses were followed by the National Congress of the SASMFOS. The highlight of this congress was the Master Classes in Orthognathic Surgery - organized by their ambassador Prof. Johan Reyneke and his panel of an international super league of legendary in Orthognathic Surgeons. ■


TodDr.ayJohn W. Curtin By Deepak Krishnan Assistant Professor of Surgery, UC Health. Cincinnati


ear Dr. Curtin

How do you spend your days now? I retired in February 2016 just following the very successful ICOMS 2015. Just prior to that I had a nasty pneumonia with ARDS so retirement was inevitable. Following this we “downsized” as we say in Australia and sold our family home and moved to our beach house near the Great Ocean Road, whilst we awaited completion of our new home. As I write this we are ready to move back to our old suburb of Kew, just outside Melbourne. So since I have retired I have spent a large amount of time regaining my health, meeting a number of my medical colleagues, but this time as a patient! Together with my wife Mary, we have visited Melbourne every 2-3 weeks to visit family check the progress of our new home. But most importantly we cared for our two grandchildren, Annabelle and Patrick. We very much look forward to moving back to Melbourne where we have more time with them.

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What do you read in OMS literature these days that fascinate you? Currently I subscribe and read the IJOMS, JOMS and the Australian Dental Journal. I like to read articles from all areas especially from my ANZAOMS Colleagues, particularly articles on new techniques like the advancements in Digital Radiology and 3-D printing. Over the years one has seen how the speciality has advanced and broaden the areas into Surgical techniques previously not undertaken by OMS such as Orbital Surgery, Head and Neck Surgery and Trauma. What do you consider the single most meaningful contribution you made to the Speciality of Oral Maxillofacial Surgery? Apart from caring for my patients, I have been involved at all levels of ANZAOMS, on the Board of the RACDS and reached the level of Oceania Representative on the Executive Committee of the IAOMS. More recently I have been on the Fund Raising Committee of the IAOMS Foundation. I see my contribution to the Speciality as being involved with the setting up and initial funding of the ANZAOMS Research and Education Foundation in 1993. The Foundation now is well established and is actively funding Research and Education in our region. At the ICOMS2015 under the Chairmanship of Mr David Wiesenfeld we held a very successful series of events for the Foundation. The Foundation luncheon, Golf Day, a tour of Melbourne on a Restaurant Tram and a visit to an Art Gallery inside a Private Home. What is your perception of how the speciality has changed from when you started to now? The Speciality has undergone incredible changes since I commenced in 1980’s. The list is long. Rigid Fixation and developments in Digital Radiology to give us a better 3D perception of Developmental Defects, Trauma, Implant Surgery and even in routine dentoalveolar surgery where localization of the nerve has avoided many operative issues. What do you miss about work? I have missed the friendship of my colleagues, my

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staff and the staff of the Hospitals I worked in. My anaesthetist’s were also great support and I admired their expertise. One does miss the patients and solving their problems. What do you not miss about work? That’s easy any late night calls, my 5.45am Alarm Clock and Melbourne traffic. Do you keep in contact with former colleagues? Living out of Melbourne in the past year has been tricky. But I have met a number for the occasional meal in Melbourne during our visits. I also keep in contact with a number of colleagues through telephone and email. But we do look forward to moving back to Melbourne. My colleagues and friends were great support during my illness and retirement. What would you change about your career path if you could go back and do so? After completing my dental degree, I should have continued straight on and complete a medical degree, then commenced my training. In time this is how our training programs have evolved over the years. It would have been nice to complete a non-OMS degree like Law, but there is only 24 hours in a day! Which technological advance in the Speciality made a difference in your surgical activity? As I said previously Rigid Fixation, better drills, advances in Anaesthetic Drugs especially for pain management and advances in Radiology, with the introduction of OPG and Cone Beam CT technology, the CT and MRI scans. All these advances improved the delivery of our services to our patients. What advice do you have for the OMS Trainee starting training in 2017/2018 First select the best training programme and complete your training. Whilst training, get a senior person to mentor you through your training programme. And then post training have a mentor to discuss difficult patients. Keep a good work/life balance as it can be a time-consuming speciality training programme. Upon completion, travel overseas to round up your experience. Then join your local Association and get involved in the various activities provided. Also join the IAOMS and attend ICOMS. Through these, you will make life long friends as I have done. If you live in Australia or New Zealand donate generously to their Foundations. You will be living and practising in area of the world where our Health system is First Class – you are very lucky. Then donate generously to the IAOMS Foundation where you will assist Education and Training in areas where access to treatment is not as good as in your region.

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How do you reflect on your involvement in the IAOMS? How important was the Association in your career? Being involved in the IAOMS allowed me to travel to various parts of the world like Panama, China, India and of course Chicago – the IAOMS headquarters. I made a number of friends, but sitting around tables watching and listening to OMS Specialities leaders like John Williams, John Helfrick, Larry Nissen, Piet Haers and others, I learnt a lot. Also we were fortunate in Melbourne to have world-class leaders. Bob Cook was IAOMS President from 1992 to 1995. More recently we have had ICOMS2015 led by David Wiesenfeld and Professor Andrew Heggie. Younger members, like Associate Professor Jocelyn Shand, who is currently the Oceania Representative on IAOMS. But over the years Australia and New Zealand has punched above its weight with around 220 members plus trainees; we have produced two IAOMS Presidents, held ICOMS twice and had senior members on the Executive Committee like Professor Alaistair Goss and Paul Sambrook from Adelaide. So my involvement with IAOMS was very rewarding by making some wonderful friends and assisting the development of the Speciality in the Oceania Region. What are the qualities you most value in a career academic surgeon? High quality surgical leadership, excellent people handling skills, patience and compassion. Also they need to stimulate and encourage research and education. Being involved in the politics of the University and the Speciality. All in all, a super-person, which would be hard to find. What are you currently reading? Secret Wars on espionage in World War 2 by Max Hastings, Prince Charles Biography by Sally Bedall Smith, The Mathematics Book by Helen Prochazka, Raoul Wallenberg Biography By Ingrid Carlberg. ■

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Beyond O.R.

The Economy of Aesthetics By Javier González Lagunas (follow me on



esthetic surgery has increased exponentially in the last few decades. It is a world wide phenomenon, and according to Forbes it is leaded by the US, Brazil and South Korea. As a matter of fact if we adjust numbers by population size, Brazil and South Korea widely surpass the US in many categories. Approximately ten percent of all aesthetic procedures in the world happen in Brazil. India, Mexico and Germany are the next on the list.

I want to share you with you some facts about aesthetic surgery (source ISAPS 2015) It has been steadily increasing in the last decades: the number of cosmetic procedures increased from 2.1 million in 1997 to 9,2 million in 2011 and to 21 million in 2015. Surgical procedures increased by 73%, but the increase of non-surgical procedures was 365%!. Around 10 billion dollars were spent in cosmetic procedures in 2011. There are obviously gender differences in aesthetics. While for women eyelid surgery is only the fourth most common procedure, for men, nose surgery stands in the second position, eyelid surgery is third and facelift is fifth on that list. Non-surgical procedures are more popular among women. Botox injections (86,5%), dermabrasion (80%), chemical peels (88%), or hyaluronic acid (88%) have their objective target in the female sector of the population. Men are not far behind in vanity either: they are starting to invest in cosmetics, and from 40 iaoms.org

1997 to 2013 there was a 273% increase in men receiving aesthetic surgery. If we consider non-surgical cosmetic procedures, Botox is still the unbeatable leader (38% of total), followed by dermal fillers (23%), chemical peels (4,5%), laser resurfacing and dermabrasion(4%). That makes a total of more then 11 million procedures yearly. Oral and maxillofacial surgeons have the skills and knowledge to improve facial aesthetics,. Aesthetic surgery of the face is taught in many training programs around the world, it is included in the logbook of residents and should be a a fundamental aspect of modern maxillofacial surgery. The Spanish Association of Oral and Maxillofacial Surgery is launching a pathway to Specialization in Aesthetic Medicine and Surgery of the Face, next year and I am sure many others will follow. You are going to have to be involved in it. Patients demand it. You have the skills and the regional knowledge, You need to learn and improve particular techniques, you will need to change the structure of your practice, and to buy new tools. But most of all you will need to internalize the “aesthetic concept” in all procedures that you make in the faces of your patients.■ December 2017

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