IAOMS Face to Face Issue 41

REGISTRATION NOW OPEN We are pleased to announce that registration is now open for ICOMS 2015.

The Conference will be held from 27 – 30 October 2015 at the Melbourne Convention and Exhibition Centre, located in the heart of the world’s most liveable city, Melbourne.

Visit the website (www.icoms2015.com.au) now for all the information you will need to assist in your plans – registration, social events, optional tours and accommodation. You don’t want to miss this experience.

Please find below an invitation message from the IAOMS President Piet Haers and the ICOMS 2015 Conference Chair David Wiesenfeld.

Early bird registration is available until 31 May 2015.

We look forward to welcoming you to Melbourne in October.

CLICK HERE TO REGISTER

PROGRAM A preliminary program for ICOMS 2015 is now available. The program is designed to assist with your travel plans and provide an overall view of the program which will showcase a variety of themes complemented by our invited speakers and free papers sessions. Please visit the website (www.icoms2015.com/program/) to view the preliminary program.

We are pleased to announce an outstanding faculty of national and international speakers for the Conference. Visit the website (www.icoms2015.com/invited-speakers/) for further information.

Pre-Conference Workshops supported by our Industry Partners will be held in the days immediately preceding the Conference. Further information will be available on the website (www.icoms2015.com/program/) shortly.

View the video below for an overview of the program highlights.

SOCIAL EVENTS To complement the outstanding scientific program, an equally outstanding social program has been developed to allow you the chance to relax, enjoy and experience genuine hospitality whilst you are in Melbourne. Please visit the website for more information (www.icoms2015.com/social-page/)

IAOMS FOUNDATION EVENTS The IAOMS Foundation events held during ICOMS 2015 offer you an outstanding experience whilst making a valued contribution to the Foundation and its programs.

Find out more about these events and book via the online registration form to secure your place. (www.icoms2015.com/iaoms-foundation-page/)

ACCOMPANYING PERSONS

We are delighted to invite accompanying persons to the Conference. For more information on the activities on offer please visit the website. (www.icoms2015.com/ registration/accompanyingpersons/ )

CALL FOR ABSTRACTS CLOSING 10 APRIL Abstracts are invited for ICOMS 2015, the premier international forum for research, theory and development related to Oral and Maxillofacial Surgery.

We invite your contribution to the program and encourage you to submit an abstract for consideration.

Accepted abstratcs will be included in an online supplement of the International Journal of Oral and Maxillofacial Surgery.

Please also visit the website (www.icoms2015. com/call-for-abstracts/#scholarship) for information regarding limited scholarship opportunities.

SPONSORSHIP & EXHIBITION ICOMS 2015 offers a prime opportunity for providers of services and equipment within this specialised field to establish new and consolidate and grow existing networks and relationships.

To find out more please visit the website (www.icoms2015.com/sponsorshipexhibition/)

WE ACKNOWLEDGE THE SUPPORT OF OUR VALUED PARTNERS: Platinum Partners ®

M a k e

Gold Partners

Silver Partners

The abstract submission will close on 10 April 2015.

PROUDLY SUPPORTED BY

CLICK HERE TO SUBMIT AN ABSTRACT

Please visit the Conference website for further information www.icoms2015.com, or contact WALDRONSMITH Management: 119 Buckhurst Street ❙ South Melbourne VIC 3205 Australia T +61 3 9645 6311 ❙ F +61 3 9645 6322 E ICOMS2015@wsm.com.au ❙ www.icoms2015.com

i t

S i m p l e

Issue 41 / March 2015

Editor-in-Chief Javier González Lagunas

Managing Editor Lisa Markovic

Executive Committee 2014 – 2016 Board of Directors Piet Haers, President Kishore Nayak, Past President Julio Acero, Vice President Alexis Olsson, Vice President Elect Robert T.M. Woodwards, Treasurer Larry W. Nissen, Foundation Chairman Pierre Désy, Executive Director

Members-at-Large Gabriele A. Millesi Sanjiv Nair Javier Gonzalez Lagunas

Regional Representatives Abdellfattah Sadakah, Africa Kenichi Kurita, Asia Henri Thuau, Europe Alejandro Martinez, Latin American Arthur Jee, North American David Wiesenfeld, Oceania

Committee Chairmen Rui Fernandes, Education Committee Joseph Helman, Research Committee Deepak Krishnan, IAOMST Committee Steve Roser, HADR Committee Fred Rozema, IT Advisory Committee Mark Wong, IBCSOMS Committee Juan Antonio Hueto Madrid, eLearning Sub-Committee

CONTACT US IAOMS

5550 Meadowbrook Industrial Court, Suite 210, Rolling Meadows, IL 60008 U.S.A. 1.224.232.8737 / communications@iaoms.org

Letter from the Editor How I see it

I

nnovation: The act or process of introducing new ideas, devices, or methods. Too dull of a definition? Let´s try this one then, “The practical translation of ideas into new or improved products, services, processes, systems or social interactions.”

Research (or investigation) is not the same as innovation. Advances in fundamental science represent important progress that may contribute to basic knowledge and stimulate further innovations.

Basic research is executed without a practical end goal, without specific applications in mind. Not requiring an immediate application, medical research is a different concept then medical innovation. But research can adopt more forms: it is not only the basic investigation on the biology of a disease, but also the evaluation of new technologies and new techniques in surgery.

Because of our work, we surgeons are accustomed to seeking new solutions to face challenging problems or situations. The coupling of new ideas and its clinical use is nuclear to surgery. It is in our DNA to explain the role of surgeons as innovators and the progress that their innovations have created in medicine as new technologies or techniques.

But on the other hand, the culture of the surgical profession is not realistically conducive to supporting research.

Here at IAOMS we think that we need to encourage oral and maxillofacial surgeons into this exciting and fundamental field. In the past a clinical methodologies/trials course was commended in Barcelona, in Chicago, an upcoming research summit will be held in conjunction with AAOMS, and in the future we will celebrate a new research symposium in Melbourne. So, our doors are wide open to stimulate young surgeons into this basic pillar of any medical specialty.

A final (and short) definition for innovation: fresh thinking that creates value.

So, my dear colleagues in maxillofacial surgery: INVESTIGATE, THINK and CREATE.

Javier González Lagunas Editor in Chief

“The coupling of new ideas and its clinical use is nuclear to surgery.”

contents March 2015 specials reports

The adventures of a rookie researcher. dustry and Working with in company. p u t r a t s a f o t developmen

Reserch in China

Our experience in China with Basic Research in Oral and Maxillofacial Surgery.

so you want to work...

ly? in Ita

herding cats

Attempting to harness the ‘NextGen’ OMS.

From Proust to Pivot Rui Fernandes OMS on a mission

Cleft lip and palate surgery.

copy me

Upper blepharoplasty.

24 hours

A day in the life of a maxillofacial registrar in Melbourne.

Obituary Dr. David Precious Trainees My experiences in the far east. beyond the or

Your staff, your practice, and your success.

Innovation and relevance Pierre Désy IAOMS Executive Director

“Creativity is thinking up new things. Innovation is doing new things.” Theodore Levitt

I

n the association world in particular, innovation refers to the development of a new or the significant improvement of a program, product, service, or process that adds value to our Fellows and Trainees. In a world that evolves at the speed of light, ongoing innovation is crucial for any association to remain relevant.

This year, IAOMS is innovating with education programs (eLearning webinars and SIGNs), increased foundation programs (Circles), improving internal processes, and other initiatives that are pertinent to oral and maxillofacial surgeons and the profession worldwide. An example of such an effort is the inaugural International OMS Day that was held on February 13, 2015. The International OMS Day is to celebrate the contributions oral and maxillofacial surgeons make to society around the world and to raise the profile of the specialty. The concept originated from the Association of Oral and Maxillofacial Surgeons of India where they conducted their first national celebration last year. This year, IAOMS has joined AOMSI and extended the effort globally. If you have not done so yet, you can visit the IAOMS

Webpage dedicated to the event to download videos, posters and stories that you can use to educate your community about the role of oral and maxillofacial surgeons.

The overwhelming response to the International OMS Day from our surgeons on social media pages around the world was a testament to the relevancy of the effort. The posts on the IAOMS Facebook page alone reached 37,114 individuals compared to our usual 4,000 people reached per week. Similarly, we recorded a 1,071% increase in the number of surgeons who liked our Facebook page compared to the previous week, and nearly 2,200 people engaged with our stories and posts (a 744% increase with the previous week). I invite you to go on to the IAOMS Facebook page to view photos and stories that your colleagues have posted in recognition of the Day. Watch our website and our social media pages for new ways IAOMS will be helping move the association forward with innovative thinking.

As always, thank you for reading this short piece!

Contact me if you have any questions or would like to discuss ideas you may have – pdesy@iaoms.org. ■

www.iaoms.org/membership/renew

Research, Innovation and IAOMS Piet Haers IAOMS President

T

his is another great issue of Face to Face with lively and fascinating contributions. I am in particular grateful to the editor, Dr. Javier Gonzalez Lagunas, for dedicating a large part of this new issue to interesting ideas on research and innovation. Innovation is a key component for IAOMS. Together, we have to reinvent our association and embrace innovations that bring us closer to you, the OMF Surgeons, and allow for increasingly active communication. Several initiatives that IAOMS has taken on are mentioned in the contribution of Pierre Desy, our Executive Director.

As is stated in our strategic plan, IAOMS also wants to promote research as one of the pillars of success of our profession. Our research methodology workshop in Melbourne is a unique opportunity providing in-depth courses presented by experts with a strong trackrecord in the fields of basic and clinical research. This methodology is a universal standard and not adhering to it may lead to poor or even flawed research. I therefore encourage you to join us for the upcoming research symposium during our ICOMS in Melbourne.

It will make you more successful in your endeavors, and strengthen your department.

Application of this scientific rigor and insights in clinical practice is equally important. Whereas ten years ago, the adagio was that “Every patient treated should be a patient studied,” today, this has rather become “Every patient treated should be a patient studied and DNA-analyzed.” Clearly new genomic insights will form the basis of new developments and better cures, be it for deformities, malignancies or other pathologies.

Correlating clinical outcomes with this analysis involves us as surgeons in that clinical data have to be collected of all patients in a meaningful way. And here as well as in many other areas of research and innovation that we do not necessarily conduct ourselves, we are essential partners in the translational communication to indicate where engineering of all kinds can be meaningful.

Which brings us to the fascinating role that IAOMS can play in these innovations. As an international association, representing fellows, researchers and OMF Departments from 106 countries, IAOMS is in the position to make a unique contribution. We can with the collaboration from colleagues worldwide, set up relevant and sustainable clinical databases that cover

patients groups worldwide to increase our insights in specific conditions. Those insights in return can initiate new research and innovation. Dr. Fred Rozema, Chair of the IT Committee, is currently looking into if we could pilot this idea and what it would involve. One of the first topics considered is international data collection relating to BRONJ (Biphosphonate Related Osteonecrosis of the Jaws), but many other ideas may be very meaningful.

What we need is increased corporate partnerships, manpower and expertise, active participation from you, rigorous data-collection and research of the data. I am sure that Dr. Rozema will appreciate your ideas, input and initiatives.

Setting up a start-up company often allows researchers to transform research into a translational project with the aim of focusing on “industrial development” which then ultimately leads to an available product for patients and clinicians. The importance of intellectual property as well as the rules governing this, the interaction with “for profit companies” versus the culture of research institutions and many other aspects may well be topics that deserve a specific symposium during our ICOMS in the future as well as dedicated online webinars. Let us know if you think that this is relevant to you.

Some years ago, well before easy access to social media, Skype and webinars, the IAOMS research committee tried to initiate a communication platform for announcing junior research positions, interaction between research teams and exchanges of young researchers. Now, with better communication technology and an increasingly strong team at IAOMS headquarters, we could give this idea a new start.

Ideas are the beginning of innovation. They then need lots of conviction and efforts to become reality. Only with an increasing and participating fellowship can we achieve that.

And then of course, there is the IAOMS biennial conference, the22nd ICOMS in Melbourne, Australia.

What better opportunity to attend in person an outstanding symposium presenting the latest findings of clinical and translational research, meet with speakers, colleagues and friends, exchanging your ideas for our future. Call it the human dimension of discussing research and innovation. IAOMS also stands for this great value. See you in Melbourne! ■

The adventures of a rookie researcher Dr. Joseph L. Helman

C J Lyons Endowed Professor Department of Oral and Maxillofacial Surgery. University of Michigan

I

t was a very cold day in January 1984 when I was on the courtesy bus from my apartment building in Rockville, Maryland to the National Institutes of Health (NIH) in Bethesda. A few weeks earlier I had started my Fogarty International Center Training Fellowship in the Clinical Investigations and Patient Care Branch under the leadership and mentorship of Bruce Baum. Bruce was the Clinical Director at the National Institute of Dental and Craniofacial Research at NIH, a great mentor, a superb scientist and now a true loyal friend.

Yesterday and today Helman Professor with his invariable mustache.

The Fogarty Fellowship was a challenging experience, only a few months earlier I passed my Boards in Oral and Maxillofacial Surgery in Israel and suddenly I was being trained in a very different field. This was a new area that instead of patients and surgery involved rats, tissues, reagents, test tubes, isotopes, chemicals, centrifuges and incubators.

Now, let’s go back to the courtesy bus‌ There was an older gentleman who lived in the same apartment

building as me and took the bus as well. His name was Julius Axelrod. He had his left eyeglass covered with a patch and was dressed in a very humble way. He wore a corduroy jacket and pants with some areas covered with patches where the corduroy had worn away.

Initially we just had formal conversations about what type of research I was doing at NIH and the difficulties one encounters in the process of changing the focus from rudimentary clinical investigation to hypothesis based science.

My research focus was on neuro-receptor mediated events in salivary glands, and the messengers activated in the intracellular environment after the initial stimulation with a specific agonist. In the beginning, all my time was dedicated to trying to figure out how to avoid mistakes which may lead to wrong conclusions based on poor data resulting from a flawed experimental design. Or even worse, right results with wrong conclusions.

Here I have to add a little story which may explain the last statement: Once there was a scientist who was trying to identify patterns of behavior of flies. First he trained a fly to respond to his command.

First experiment – Control: He asked the insect standing on the palm of his hand to fly in a circle with a total diameter of 3 meters and return to his hand. As requested, the little insect performed the task in a perfect fashion.

Second experiment – The two front wings were removed from the insect. The scientist asked the fly to repeat the same trajectory. The fly complied and arrived back to the palm of his trainer’s hand with some delay and difficulty.

Third and final experiment – The last two wings were removed while the same orders were given, but the insect didn’t fly. In a louder voice the scientist again said: “Fly!!!”; Regardless of the request, there was no response. In a final attempt the scientist shouted: “FLY!!!”..... No reaction by the little fly.

After careful analysis of the data considering ‘P’ values, time response and the delta between the time passed between giving the order and finishing the established trajectory, the scientist arrived at his conclusion based on the evidence from the experiments: a fly without wings is deaf!

a Monday morning and I showed him the results of my experiments some of which were influenced in design by my neighbor, bus rider and coffee partner. At the end of my presentation, Dr. Baum said: “Not bad for a surgeon!”

For clarification to the readers, I have to mention that at top notch scientific institutions “surgeons” are considered individuals with two It was under the neurons (one in each hand) with one mentorship of amazing extra-cortical synapse connecting scientists like Bruce Baum, Julius Axelrod and the the two. influence of great minds I thanked Dr. Baum for his comments, like Albert Einstein that but I also told him that many of l reached a conclusion the ideas for the design of my which forged my support experiments came from my neighbor for research during my life: ‘friend’ during our bus rides. Dr. As clinicians and surgeons Baum asked me who he was, and I we are like firefighters, said “I think he is a technician at the we put out fires. We take care of a limited number National Institute of Mental Health”. of patients, we treat them “What is his name” asked Bruce Baum, and usually we are able and I candidly said “Julius Axelrod”. to help and cure them With a big smile on his face, Bruce of their maladies. As educated me and said: “He is the scientists, we can prevent 1970 Nobel Laureate whose work the fire, thus impacting led to the use of selective serotonin more individuals / patients reuptake inhibitors (SSRI’s).” than a single surgeon. We can change history… We can improve the quality and length of life of human kind!

JOSEPH L. HELMAN

The moral of the fly story is to caution the young investigators who may only look at the abstract and the conclusion of a study, without evaluating both the experimental design and the raw data.

Back to the story of the gentleman with the patched eyeglasses: While we were riding the bus to NIH every morning, he asked me about the notes I was writing. I told him I was trying to design my experiments for the day. A few times he gave me hints about how to bypass the neuro-receptors and try to mimic the effects of the second messengers. After the ride on the bus, we bought the newspaper. He bought the New York Times and I bought the Washington Post which at half the price of the New York Times, still stretched our family’s meager monthly budget. Then we had coffee at the cafeteria while reading the newspapers and we parted ways to our respective laboratories.

After my first three months at NIH, Dr. Baum asked me to present the data of my experiments. We sat on

I was humbled by discovering who was helping me and embarrassed for my assumptions that Dr. Axelrod was a technician. He appeared to be so simple, he was so kind, so unassuming!

A few days later I asked him about his experience through science and his discoveries, he said “It is all about finding a significant scientific question and answering with an honest, valid and properly designed experiment”.

Another researcher who I didn’t have the opportunity to know but I always admired once said: “Knowledge of the empirical world doesn’t yield us any knowledge of reality, knowledge of reality start from experience and ends on it”. He meant that empirical assumptions are not valid unless validated by proper experimental design and results. His name was Albert Einstein.

The take-home message of those statements is obvious: implement critical thinking with the integrity and rigor of science and the flexibility of re-examining the assumed circumstantial “truth” by a constant search for new horizons. ■

FOUNDATION ACTIVITIES FOR ICOMS2015 22ND INTE R N A T I O N A L C O N FE R E N C E ON ORAL & MAXILLOFACIAL SURGERY

MONDAY 26th OCTOBER

TOUR OF LYON HOUSE MUSEUM and Lunch Lyon house museum is a private home in melbourne with an extensive collection of australian contemporary art.

Cost: $150 pp, includes transfers,guided tour and lunch.

Time: 1130-1500 hrs -----------------------------------------------------------------------------------------------

THURSDAY 29th OCTOBER

IAOMS FOUNDATION LUNCHEON Proudly sponsored by

Time: 1230 -1400 hrs Melbourne Convention Centre Guest Speaker: Professor Robyn Guymer “THE BIONIC EYE-CAN WE SEE OUR WAY FORWARD?” Inclusions: Two Course Luncheon with wine/soft drinks and presentation.

Cost: $150 pp.

-----------------------------------------------------------------------------------------------

FRIDAY 30th OCTOBER

KLS MARTIN FOUNDATION GOLF DAY Proudly sponsored by

Time: 1145-1900 hrs Depart/Return Melbourne Convention Centre Cost: $400 pp Inclusions: Transfers, 18 holes Golf at the Victoria Golf Club,shot-gun start, lunch,closing drinks and snacks at 19th Hole.

-----------------------------------------------------------------------------------------------

FRIDAY 30th OCTOBER

MCG TOUR and WINE SHOWCASE

Tour of the Melbourne Cricket Ground and Sports Museum with a lunch hosted by a famous Victorian Winemaker,who will speak about her wines.

Speaker: Kate McIntyre MW. Moorooduc Wines.

Time: 1200-1615 hrs depart Melbourne Convention Centre.

Cost: $200 pp Inclusions: Transfers,lunch/ selected Victorian wines,meeting with winemaker and private tour of MCG. -----------------------------------------------------------------------------------------------

FRIDAY 30th OCTOBER

FAREWELL TO MELBOURNE ICOMS2015

DINNER ON THE COLONIAL TRAMCAR RESTAURANT Proudly sponsored by O`Brien Family Foundation Bid Farewell to Melbourne as you dine in one of Melbourne`s historic Colonial Tram Car Restaurants. Enjoy a 5 course meal and quality beverages as you cruise the streets of Melbourne -a unique experience.

Time: 2015 for a 2030 hrs departure and 2330 hrs return.

Cost: $200 pp

We encourage you to support the IAOMS Foundation www.icoms2015.com by attending the Foundation Activities at the 22nd ICOMS. Register now at www.icoms2015.org www.icoms2015.com

Working with industry and development of a startup company

Stephen E. Feinberg, DDS, MS, PhD

Professor of Surgery and Dentistry.

(University of Michigan).

Founding Member of Tissue Regeneration Systems (TRS) Inc. (http://tissuesys.com/)

D

ealing with the corporate world is mystifying to academics whose main training has been oriented toward research, teaching, and clinical duties. Alliances between universities and industry are playing an increasing role in facilitating cutting-edge basic and clinical research.

There are two basic approaches that one can pursue: (1) find and industrial partner and develop a synergistic relationship or (2) create a spin-off biotechnology company that you are a founding member and have financial interest in.

Industry sources may sponsor one’s research via a contract, gift, subcontract, grant, grant-in-kind, sponsored research agreement, collaboration agreement, clinical trial agreement, materials transfer agreement (MTA) or fellowship. It is important to note as you move forward with industry that between a contract, grant, and gift, a contract is the most

restrictive form of agreement and a gift is the least restrictive. One of the most important things to keep in mind when working with industry is you are interacting with, in most cases, a “for profit” institution. This means that your ultimate goals/ objectives might not necessarily be the same as that with a non-profit institution/foundation that primarily funds research.

“Having IP rights will enable you to earn recognition or financial benefit from what you/they invent or create. This should be determined before the project is initiated.”

A second very important issue that must be kept in mind is intellectual property (IP) rights. The definition of IP is “a work or invention that is the result of creativity, such as a manuscript or a design, to which one has rights and for which one may apply for a patent, copyright, trademark, etc.” If you interact with industry and the creativity and innovation for the project emanates from you it is imperative to make sure that if the project

is successful and an invention or technique is developed that you maintain a piece of the IP. Having IP rights will enable you to earn recognition or financial benefit from what you/they invent or create.

This should be determined before the project is initiated.

If one decides to create their own startup companies (Figure 1) than there are other issues that one needs to be aware of:

1

You will need to write a business plan.

The business plan details the market, operational structure, competitive positioning, product development, strategy, and finances of the company. This document is critical in communicating your business model to potential investors, and helps you fully research and understand the fundamental elements of your business.

or angel investors, can identify and connect you with the appropriate funding options available.

4

Have intellectual property rights to support the company. In order to be a successful start-up company it is important to have the IP to protect your idea to solve an unmet need that the company will pursue.

You will NOT obtain any financial support unless you have an appropriate portfolio of IP to protect your start-up company as it moves forward during its early developmental stages (Figure 2). It is important to note that if you pursue this venue history has shown that there is a good chance that you will fail so you must be pragmatic in your approach and expectations (Figure 3). â–

2

Form a start-up team. A start-up company requires diverse and experienced individuals to manage the business and to execute the plan. You will need the assistance of a Business Formation Specialist who can help build and develop the right team to manage the start-up.

3

Acquire financing and funding: Funding will allow the company to reach meaningful milestones and revenues. Business Formation Specialists, with access to venture capitalists and/

“Alliances between universities and industry are playing an increasing role in facilitating cuttingedge basic and clinical research�.

Our experience in China with Basic Research in Oral and Maxillofacial Surgery Shang Xie, Zhigang Cai Department of Oral & Maxillofacial Surgery, Peking University School and hospital of Stomatology, Beijing 100081, China

O

ral and Maxillofacial Surgery (OMS) is one of the important constitutes of health sciences and covers a wide range of topics on both basic and clinical research. With its promising future as a good career choice, oral and maxillofacial surgery attracts the attention of young dental school students in China. Unlike the western OMS system, OMS in China covers even boarder domains, such as tumor and reconstruction, trauma, dental and alveolar surgery, oral implant surgery, infections of oral and maxillofacial regions, diseases of the salivary glands, temporomandibular joint diseases, neural diseases, cleft lip and palate, tissue engineering, stem cell and more. Thanks to the generous investment of the Chinese government in past decades, doctors are now considering the importance of basic science research. The professors and doctors at the university

“Despite advances in treatment for oral cancers, the 5-year survival rate remains disappointing. Thus, exploring the mechanism of tumorigenesis and progression is imperative.” affiliated hospitals are one of the groups that are playing a crucial role in advancing research. Currently, we have numerous teams focusing on basic research (around 1,000 members) in China. Different research groups have different research areas. As an example, for our research group at Peking University, we have one leading scientist (professor), one associate professor and several PhDs and PhD candidates.

Generally, we do our basic research in our hospital central lab (Figure 1); however, we also have broader collaborations with other labs.

Here we have summarized the advances in our basic research areas including tumor and reconstruction, salivary glands diseases.

Figure 1.

Oral squamous cell carcinoma (OSCC) is one of the most common cancers in China. Its high mortality rate and the disfigurement that survivors may suffer, gives rise to a considerable public health burden as well as seriously affect the patients’ mental health. Based on this high demand, our groups pay a great amount of attention to the post-tumor resection patients’ functional reconstruction (Figure 2). With development of microsurgery and digital surgical systems including

Figure 2.

Figure 3.

Figure 4. B

Figure 4. A

surgery navigation and robotic surgery and so on, patients’ postoperative deformities have been improved greatly.

Despite advances in treatment for oral cancers, the 5-year survival rate remains disappointing. Thus, exploring the mechanism of tumorigenesis and progression is imperative. In recent years, our groups have done a lot of work on research in this field and further studies are ongoing. Figure 3 shows a part of our research result. The transcriptome sequencing analysis of oral lichen planus (OLP) and OSCC indicates that several miRNAs might be potential biomarkers for the oral lichen planus (OLP) and its malignant transformation.

Salivary gland diseases are also common diseases in clinics and numerous

investigators have been dedicated to its basic research. Not only are they devoted to the basic research to gain understanding about the salivary gland diseases mechanism, but we are also researching some of the pioneer clinical trials.

For example: using submandibular gland transplantation to treat severe xerophthalmia and using Know that... botulinum toxin type A (BTXA) to “Unlike the western treat excessive glandular secretion, OMS system, OMS in including epiphora, Frey’s syndrome China covers even and so on. We have currently, boarder domains, gained good clinical outcomes with such as tumor and this research with additional basic reconstruction, investigations on the way. Figure trauma, dental and 4 shows a part of research wok in alveolar surgery, this area. BTXA induced apoptosis oral implant surgery, in SMG (TUNEL staining, Figure infections of oral 4A) and affected AQP5 mRNA and maxillofacial distribution in SMG (Figure 4B). regions, diseases of These investigations indicate that the salivary glands, BTXA injection could decrease temporomandibular the saliva secretion from SMGs. joint diseases, neural BTXA might be effectively used to diseases, cleft lip treat symptoms related to salivary and palate, tissue secretion such as drooling and engineering, stem epiphora after autologous SMG cell and more.” transplantation. ■

In ral Italy o ial fac maxillo not a y is y. surger pecialt s e u q i un e two r a e r e s: Th ecialtie p s t c y distin surger l a i c a f maxillo l surgery. and ora

By Piero Cascone

F

or anyone who wants to work in Italy as a maxillofacial surgeon, it is mandatory that you are a graduate in medicine and surgery with a specialization in maxillofacial surgery. The number of maxillofacial surgeons in Italy is around 700800, for a population of 60 million people. The training program for the oms specialty is 5 years, and around 50 new residents enter the system every year.

The procedures for the recognition of non-Italian qualifications are different for the European Union(EU)

BIOBIO

Associate Professor of Maxillo-Facial Surgery. “Sapienza” Università di Roma School of Medicine and Dentistry.

Director of the Unità Operativa Complessa. Chirurgia Maxillo-Facciale Policlinico Umberto I Roma.

Member of the Board of Directors of the Italian Society of Maxillo-Facial Surgery.

So you want to work...

...in italy?

If you are a medical doctor and want to specialize in Italy you can find detailed requirements for admission to schools of specialization in maxillo facial surgery at http://www.universitaly.it

Remember that all foreigners that are non-EU

intending to enter Italy must provide the documentation required to justify the reasons and duration of their stay. In some prescribed cases, the availability of adequate economic means and lodging.

Applications can be completed at the Italian Diplomatic and Consular Representations in your country of residence. http://www.esteri.it/ visti/index_eng.asp

citizens and non-EU citizens as well as for title awarded in EU and non–EU countries. For EU titles awarded-EU citizens: The recognition process consists of a verification of validity of the documentation presented. For EU titles awarded non-EU citizens and non-EU titles awarded: It’s mandatory to submit an application for recognition of the degree even if already recognized in another EU country. In this case, the Ministry of Health takes into account any additional training and professional activities. You can find detailed requirements at www.salute.gov.it

For anyone who wants to work in Italy as an oral surgeon it’s sufficient to have a dental degree, legally recognized in Italy- www.salute.gov.it Currently in Italy it is not easy to find a job for maxillofacial surgeons. It is easier to come to Italy for academic purposes, postgraduate or invited professors programs, which offer the opportunity for financial support and easier regulation and authorizations.

Earnings and salaries in Italy are variable both for surgeons and dentists. It is possible to work in private and/or public structures, with different kinds of contracts. Earnings may start at 1500 euro and may be higher, based on the personal career. ■

herding cats

Attempting to harness the ‘NextGen’ OMS Dr. Deepak Krishnan

H

ere is an after-thought, “Now I am thinking, “What was I thinking?”…”

The task at hand is a bit ambitious. How to captivate the attention of millennials, the next generation of oms?

One of the main challenges is to identify who are actual OMS trainees? Our numbers suggest that we currently have 269 trainee members from 66 countries. But, would a general surgeon in Burma who is spending that extra year training in the oral cavity, head and neck be considered an OMS trainee? Does the Australian student that has been in training for a decade be considered a trainee? What about the Pakistani registrar in the UK, who was a consultant in Lahore, but now in training for a millennia, (and has his daughter in her first year of medical school) be considered a trainee? Oh my, how do I validate if a listed dental school in Tanzania is indeed an existing dental school?

Another challenge is how in the world are we going to congregate them?

What student OMS can afford a trip to the other corner of the world to attend a bi-annual ICOMS regularly? Not my residents!

“Must think outside the box! The only probable way to bring together the talent of the next generation of Oral and Maxillofacial Surgeons is virtually”.

I have had many a life! I was an OMS apprentice in India, I spent time in Kenyatta Memorial hospital learning reconstructive surgery from Kenyan surgeons, I moved to the US to be an OMS intern, a resident, and then to Canada for a fellowship in orthognathic and reconstructive surgery and finally reincarnated as a teacher, clinician researcher in Midwestern Ohio. In between, I had a unique opportunity to represent the OMS resident in the American Association of Oral and Maxillofacial surgeons (AAOMS). I have been fortunate to travel the world and interact with the average OMS resident in different parts of the globe.

The more I meet oms trainees through my travel, the more I realize that there is a common thread among the student of oral and maxillofacial surgery – a certain character that is difficult to characterize – “the eye of the tiger”. It is focus, persistence, and commitment. There are leaders among those students that are destined with carrying that torch forward. There are scholars among them that will redirect our specialty. There is a need like never before to identify and commit them to our camaraderie.

This is a new world. We don’t need to define that OMS trainee by codes of institutional enrollment.

We don’t need to burden them with travel to the yonder. We have social media that will get the word out to unite. We have forums that are virtual to converse.

Must think outside the box! The only probable way to bring together the talent of the next generation of Oral and Maxillofacial Surgeons is virtually.

We must meet them at their meeting places – on Facebook, LinkedIn, Twitter and Instagram. We must offer them opportunities to meet others like them, whenever possible at an ICOMS, but also regionally, and virtually. We must engage them at their interests - scholarly activities, online journal clubs, research opportunities, and academic interactions. We must provide them access to world class journals, literature and serve as a portal for inter-institutional travel and training.

As the chairman of the IAOMS trainee section – IAOMS NextGen, the IAOMS-T, I am sincerely hopeful that this will be where we can converge unite all the OMS trainees of the world. While in the beginning, it did feel like herding cats, now it has taken on a life of its own, with pride. If you are not a trainee member of the IAOMS yet, join the IAOMS NextGen, the IAOMS-T and see and meet others like you – you there, with the eye of the tiger! ■

From Proust to Pivot An Apparently Innocent Questionnaire for Oral and Maxillofacial Surgeons

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ou’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 in 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 being oral and maxillofacial surgeons human beings as the rest, those questionnaites were a great method to let us know some personality traits of our interviewed.

Turn the page, enjoy, and discover how Rui Fernandes answers the IAOMS Proust Questionnaire. Enjoy, and compare their answers with those of celebrities!!!

The IAOMS Proust Questionnaire What is your favorite word? Yes What is your least favorite word? No What is your favorite drug? success What sound or noise do you love? Hearing my son’s laughter What sound or noise do you hate? Crying What is your favorite curse word? Don’t really have one, I use several…..

What profession other than your own would you not like to attempt? Television Pundit…

If you were reincarnated as some other plant or animal, what would it be? I would definitely be a Cheetah, the fastest but yet underrated animal in the savannah If Heaven exists, what would you like to hear God say when you arrive at the Pearly Gates? You did your best, now get some rest…

What is your idea of perfect happiness? Doing what you love and having a healthy and loving family to share in the success What is your greatest fear? Becoming Complacent What is the trait you most deplore in others?

Complacency What is your greatest extravagance? Collecting watches What is your current state of mind? At peace…

What do you consider the most overrated virtue?

Patience… ( Ask my residents and fellows, I often run short of it in the operating room) On what occasion do you lie? To please my wife…

What do you most dislike about your appearance?

My mustache…., just kidding, I like that the best, I was born with it…

Which living person do you most despise? Despise is a such a strong word… I have a number of people on my “S.it” list but none that I despise.

What is the quality you most like in a man? Strong work ethic What is the quality you most like in a woman? Their ability to forgive Which words or phrases do you most overuse? Sure…

What or who is the greatest love of your life? My family When and where were you happiest? Recent family trip to Europe

Rui Fernandes is a Board certified Oral and Maxillofacial Surgeon. He holds dual appointments in the Divisions of Oral and Maxillofacial Surgery and Surgical Oncology in the Department of Surgery at the University of Florida College of Medicine - Jacksonville.

Currently, he serves as Chief of the Section of Head and Neck Surgery, Director of the Microvascular reconstructive surgery fellowship and residency program director for Oral and Maxillofacial surgery.

What is your most marked characteristic? Hard worker What do you most value in your friends? Loyalty Who are your favorite writers? Dan Brown,

Which talent would you most like to have?

Photographic memory…

If you could change one thing about yourself, what would it be? To be able to turn off… I am usually thinking about work, working.

What do you consider your greatest achievement?

My Kids If you were to die and come back as a person or a thing, what would it be? I would come back as myself but knowing all of the things that I know now.

Where would you most like to live? Sunny Florida, just where I live now…

What is your most treasured possession? A healthy body and sound mind What is your favorite occupation? Surgeon

Who is your hero of fiction? Jason Bourne, from the Bourne Identity Which historical figure do you most identify with?

Haven’t really thought about this?... I am not that self absorbed.

Who are your heroes in real life? My Mother and Father What are your favorite names? Gabriela and Alessandro (my kids) What is it that you most dislike? Giving up and not trying….

What is your greatest regret? I have not lived long enough to have one How would you like to die? Peacefully What is your motto? “Be prepared” ■

OMS on a mission CLEFT LIP AND PALATE SURGERY: SECONDARY SEQUELS THE MOST DIFFICULT PART

By Dr. Rodolfo Asensio Marmol

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left lip and palate is the most frequent congenital malformation found throughout Latin America. It occurs one in every 700800 births. For this reason, the Government Health Systems have been forced to include protocols to diagnose and plan for comprehensive and multidisciplinary treatments. Many non-profit associations and institutions related to

“... the real purpose of these Surgical Missions is socially reinsert these children and ensure the same quality of life and opportunities that any other child would have.”

these programs are supporters of these protocols, and have helped to increase awareness over a larger area.

Even though more children can be treated nowadays, there is still much to be done. Many associations have advocated to help the cleft children, as well as to ensure the adequate development and health in Latin America. However, that being said, is that enough to ensure happy smiles on all these children’s faces?

The Antigua Pediatric Stomatology Center has been open for almost a half of a Century and from the beginning they have been dedicated to treating children with Clefts. Initially all newborns with virgin clefts were admitted to the Center and treated in stages until the patients completed growth and development. All surgical stages and multidisciplinary treatments were done at the center. As the Center became known throughout the continent, we have seen a high increase in major cleft lip and palate sequels. In reviewing the surgical past history on those patients, there was a constant; they were treated by “Cleft Lip and Palate Missions.”

Among these surgical consequences we found permanent esthetic, functional and speech deficiencies. These poor treatments are manifested in the improper growth and development of the facial skeleton, which makes it difficult to complete our systematic protocols and carry out the follow up surgical interventions needed to improve the facial balance, adequate speech and psychological limitations.

In our experience at the “Dr. Oscar Asensio” Pediatric Stomatology Center, we have registered a 30% increase in sequels, all of which were well documented. We were able to identify a poor surgical

The Data Cleft lip and palate is the most frequent congenital malformation found throughout Latin America. It occurs one in every 700-800 births.

technique execution, no follow-up protocols, and lack of multidisciplinary treatments. We can also add, an absence of the most basic principle of medicine “do not harm,” since in order to adequately complete a Cleft Lip and Palate treatment requires several surgeries and a multidisciplinary treatment throughout the growing years. It is not about flying in, perform a surgery, fly out, and leave the consequences behind.

es Happy smil

We participate in international medical missions, in collaboration with institutions that facilitate the entire pre-surgical and post-surgical process. These associations have the support of the governments and corresponding Health Departments. They have experience and a long history using systematic protocols, whereby they can guarantee the correct diagnosis, install treatment plans and conduct follow-ups on the children’s outcome.

I believe I speak for everyone when I say that, it is our duty to participate with the support of local institutions to improve the treatment of these children,

and in identifying and reporting these problems in our systems. We must insist that our health authorities control the aforementioned “Missions” to ensure the fulfillment of each country’s respective regulations. Only then, will these groups establish systematic protocols and follow up, as well as, interdisciplinary treatments, fulfilling the real purpose of these Surgical Missions, to socially reinsert these children and ensure the same quality of life and opportunities that any other child would have.

We must pass down the values of responsibility, ethics, and professionalism to future generations of surgeons, and insist on the importance of a complete, multidimensional, and interdisciplinary treatment for our patients. May our search always be to bring the power of a beautiful smile to all our Cleft Lip and Palate Children. ■

THE IAOMS FOUNDATION IN 2015

By Larry W. Nissen, IAOMS Foundation Chairman

This year is well on its way and although it is a time to reflect on the IAOMS Foundation accomplishments of 2014, we must also look ahead to 2015 and beyond. To say that 2014 was a “breakthrough” year for the Foundation is an understatement!

We received $80,000 in matching funds from the KLS Martin Group, the first year of a multi-year agreement of up to $400,000. The IAOMS Foundation raised over $90,000 in member donations, the most in a single year since the creation of this foundation. THANK YOU to our dedicated members, corporate partners, and national and regional associations for your generosity in achieving this important goal!!

As we look forward, our emphasis will continue to be on raising funds for the corpus of the Foundation to allow us to more predictably fund important projects of the IAOMS. Many of the 2014 donors pledged donations for the five years of the KLS Martin Group challenge. This will help us achieve our goal for the next four years, but it is important that we build on

issen Larry W. N

these gifts and encourage more to pledge for the future. If you haven’t yet made a contribution or pledge, please do so today.

Are you planning on attending ICOMS (http://www. icoms2015.com) in Melbourne this Fall? There are numerous events planned for the IAOMS Foundation.

A golf tournament, museum trip and city tours are planned as well as our signature event, an evening tour of Melbourne on board a luxury tram. Past Executive Committee member John Curtin has been instrumental in the planning of this day which will combine fun, food, camaraderie with raising funds for the IAOMS Foundation. Many thanks go to John and his team for their dedication to our cause.

The future of the IAOMS Foundation is bright and holds vast opportunities for the IAOMS and its projects. Don’t forget about our partnership with Change starts with you.

The IAOMS Foundation helps those in need by building a lasting AmazonSmile. If you shop on Amazon.com (http:// sustainable environment to improve the health and quality of life worldwide. Your donation will help surgeons learn new procedures simply to heal their countrymen and aid patients with no smile.amazon.com/ch/54-1825078) log-in and hope of healing without your gift. Imagine the difference. select the IAOMS Foundation as your charity of choice. A portion of your purchases will be donated to the IAOMS Foundation through the Amazon Smile program.

THANK YOU for your past donations and I hope you will continue to support (www.iaoms.org/foundation) the

With one mission in mind, “to advance the standards of care in our specialty through improved education and training,� the IAOMS Foundation has been focused on re-strengthening our vision. Thanks to supporters like you, we not only reached our goal in 2014, but we SURPASSED it! As we continue to build a stronger foundation, your continued support will mean more than ever. Learn more at www.iaoms.org/ foundation.

Thanks to these generous donors in 2014.

Akota Ilze Alejandro Martinez Garza Alexis Olsson Angelica Kopiczko Ann Collins Anthony DiMango Arthur C. Jee Arthur Helgerson Biomet Calandra Alfredo Rafael Changsirivatanathamrong Vacharee Chen Ping Zhang Christopher Muir Daniel Laskin David Friedman David Hoffman David Wisenfeld Deepak Gopala Krishnan Donald and Susan Booth Charitable Fund through the Essex County Community Foundation Donald Booth Edgar Harold Peacock Erik Evans Francis Connor Fued Samir Salmen G.E. Ghali

Gabriele A. Millesi Gary Ross Feldman Gary Werner Seldomridge Gerald Anthony Thurnwald Gerald Loboda Gerard Koorbusch Girtz Salms Glushko Alexander Gopal Krishna Mahapatra Bhardwaj Goutzanis Lampros Gregory Grantham Hector Olasoji Oladapo Heming Olsen-Bergem I. David Atcheson Ian G. Chambers In honor of Peter D. Waite In honor of Patrick Louis In honor of Victor J. Matukas In honor of Timothy A. Turvey In honor of George H. Blakey Janjatov Branislav V Javad Bigdeli Javier Gonzalez Lagunas Jay Malmquist Jeffrey A. Elo Jocelyn Maree Shand John Joseph Otten

John Llewellyn Williams John Thornhill Fisher John W. Curtin Jose L. Montes Herrera Joseph Helman Joseph Schoeners Juan Munzaenmayer Bellolio Julio Acero Sanz Kenji Yoshida Kishore Nayak Krishamurthy Bonanthaya KLS Martin Kursheed Moos Larry W. Nissen Mark Tucker Mark Wong Michael Abba Michael Shimizu Sho Mohammad Safeallah Madani Nabil Samman Neal Barnard Nicolas Perilla Patrick Hans-Heinrich Warnke Paul Stoelinga Petr Schutz Philip Jerome Nigel Pierre Desy

Piet E Haers Ramon Ruiz Richard Crinzi Richard Emery Rizk Girgis Robert Cook Robert TM Woodwards Rui Paulo Fernandes Rupa Brosseau Sanjiv Nair Scott Bolding Sofiyat Mustafaeva Spencer M. Daniels Stefan Hassfeld Stephanie Drew Stephen Alfed Schendel Stephen Sachs Steven Roser Surender Sodhi Suresh Shanamagonathan Susan Stucki-McCormick Terry and Barbara Slaughter Family Foundation The Markovic Family Thomas Lapp Wan Mahadzir Mustafa Werner Millesi Wynand J. Van Der Linden Yasuhiro Sakamoto

Copy Me Upper blepharoplasty In the last issue Dr Ilankovan described the basic surgical technique for lower lid esthetic correction. In this occasion, we move to upper lid blepharoplasty.

3 1

Markings for upper blepharoplasty.

2 Excision of hypertrophic orbicularis oculi muscle.

Ilanko IIlankovan is the current President of BAOMS, and one of the key figures to bring facial esthetic surgery to the first line of Oral and Maxillofacial Surgery. He works in Poole Hospital in Dorset, as well as in the Wentworth Clinic Excision of skin.

5

4

Orbital septum opened excess fat excised and contoured.

Midline anchor suture.

6 Skin closure.

7 8

Pre op.

Post op.

Hours A day in the life of a maxillofacial registrar in Melbourne

By Shiva Subramaniam (Perth, Australia)

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y name is Shiva Subramaniam and I was born and brought up in Perth, Western Australia, where I completed my dental degree at the University of Western Australia. My medical degree was completed at the University of Melbourne and consequently the vast majority of my training in Maxillofacial Surgery has been in Victoria. However, I have spent time training in Western Australia and Queensland, I am now in my last year of training and will sit my Fellowship exam in 2015.

Currently, I am the Senior Registrar at the Royal Melbourne Hospital (RMH), which is one of the biggest hospitals in Victoria. It has a 571-bed capacity and is a major trauma centre with one of the biggest Head and Neck Tumour Streams in the state.

The RMH is the largest Orthognathic Training Centre in Australia and is the home to the state wide Facial Prosthetic Service.

aniam is m a r b u S a iv Dr. Sh rar at the t is g e R r io n Se spital. o H e n r u o b l Royal Me

My working week varies depending on my weekly schedule, but the following is a rough outline of a day in my working life.

. m . a 5 4 : 6

Ward Round. I arrive at RMH and meet my co-Registrar and Fellow for a ward round of our inpatients. We generally have a variable mix of trauma, elective patients and oncology patients on the ward.

7:10 a.m.

Prof. Nastri in clinic.

7:45 a.m.

Head and Neck Tumor Multidisciplinary Meeting and Clinic. This meeting is where all of our oncology patients are presented and their investigations discussed.

Maxillofacial Surgeons, Otolaryngologists, Plastic Surgeons, Radiologists, Oncologists, Pathologists and a variety of allied heath and support staff attend . A/Prof David Wiesenfeld (Oral and Maxillofacial Surgeon) is the Head of this Tumour stream.

Facial Trauma Meeting. There is a facial trauma meeting that runs at the same time as the Head and Neck Oncology meeting and my co-Registrar and I rotate in our attendance at this meeting. We review all the radiology for our preoperative patients and audit the postoperative films from the previous week.

9:00 a.m.

Combined Orthognathic Meeting. Once a month the Orthodontic consultants and Post Graduate Students from the University of Melbourne come to RMH to discuss complex orthognathic cases. This meeting is very interesting and on occasion the differing opinions of the Surgeons and Orthodontists can lead to animated and sometimes heated discussions, which are always entertaining.

Orthognat hic meetin g in progres s.

9:30 a.m.

Maxillofacial Outpatients Consultant Clinic. Anywhere up to 40 patients will be seen in a morning. There are a variety of cases from dentoalveolar cases with complex medical histories to complex craniofacial deformity and oncology cases and everything in between. Clinic is hectic, however we have excellent nurses who make life much easier.

Expert advice from Prof Nastri in clinic (or more commonly he is discussing the fish he caught on the weekend on his boat or how he almost crashed his motorcycle after taking it off road).

Hours 12:00 p.m.

Registrar Clinic. Once all the histories from the morning’s clinic have been reviewed, we see patients from clinic that need biopsies, impressions, extractions or orthognathic work ups.

1:30 p.m.

Theatre. The list on Wednesdays tends to have a nice mix of orthognathics, craniofacial/dental implants, benign pathology and simple trauma. This is unlike the rest of the week where major trauma, complex dentofacial deformity and oncology tend to consume the majority of our operating time.

myself , o d r a c ic Mr Peter R Woods in nt and Dr Bre theatre.

5:00 p.m.

Post Op Ward Round. Postoperative ward round and review of any of the new referrals that may have been made that we have not been able to review during the day.

Oncall The oncall roster usually sees me doing oncall after hours one out of three weekdays and one out of three weekends. When oncall, I cover the RMH and the Royal Children’s Hospital. Oncall generally involves at least one trip to the hospital on a weeknight and several during the weekend.

6:30 p.m.

Home Time! Home for a quick bite to eat, prior to hitting the books for my exam.

There is usually a run slotted at some stage during the evening (usually as part of my procrastination from studying) around Princess Park or sometimes a quick beer at one of Melbourne’s many pubs (which we hope to take you to when you are visiting Melbourne for ICOMS this year).

Having a drink wi Consul th on tants M r. Timo e of my and D

r. Ja thy Wo ng the oth meel Kahderba i one of er train ees aft (bosses er work shout . of cou rse!)

T

raining in Melbourne offers a great mix of operating, research and teaching. There is exposure to all facets of Oral and Maxillofacial Surgery. We have an excellent Implant and Dentoalveolar rotation through the Royal Dental Hospital, general maxillofacial exposure at institutes such as RMH and an opportunity to gain pediatric experience at the Royal Children’s Hospital of Melbourne. We also have many other training posts in Victoria, which further enrich the training experience and offer us the opportunity to work with many different consultants. ■

In memoriam

Dr. David Precious

1944-2015

By Deepak G Krishnan, DDS

I

t’s snowing outside my window in Cincinnati as I write this. I sit sipping my poison staring at a coffee table book in my study titled, “Outstanding in Their Fields – Scarecrows of Nova Scotia – Elizabeth and David Precious” – a priced possession in my collection. It has been a week since Ben Davis had informed me of Dr. Precious’s passing. And I strive for a certain closure.

I cannot but help think of another time and place in my life – a year spent in training in Halifax Nova Scotia under DSP – David Stanley Precious. It snowed outside my window almost all of that year or at least felt like it. I remember meeting DSP (as he was known to us) on a snowy morning in early September in the OR lounge at the Victoria General.

He had just come back from India, operating and lecturing. Although it was our first meeting, he spoke with a sense of familiarity, a certain fondness and affection that I took a liking to him almost instantly.

I spent Wednesdays of academic year 2007-08 with DSP learning to do alveolar cleft repairs and orthognathic surgery among other things. I learnt from him how to enjoy a good glass of Bordeaux wine, and to pair it with the right foods, picked his brain on how he skillfully seem to balance the act of being the dean of a large dental school, travel, operate, on being the editor of an international journal among other things that he was. I searched the English literature and perused every script he had penned and felt disappointed and somewhat ashamed at not learning French to pursue his writings in that language. There was a sense of receiving a complete education, the kind that makes a man out of a boy, the kind that school alone cannot provide.

to the surgeon’s lounge where he would be pouring over ‘Globe and Mail’ the national newspaper in Canada or in a semi-animated conversation about some world crisis with a fellow surgeon or anesthesiologist. A man of many pursuits and interests, chatting with him was like being in conversation with a traveler who had sailed beyond horizons both figuratively and metaphorically, been on roads less travelled, seen sights no one else had ever - an effervescent and almost contagious sense of curiosity.

When at the end of my training in Halifax, I had gained among other things many friends and mentors. There was a sense of direction in my life that was new. Leaving Halifax, I packed with me his gift – a coffee table book he had co-authored with his wife on the Scarecrows of Nova Scotia, which has since travelled with me everywhere we have been.

Growing up in India, I was taught a student’s prayer to his Guru (the teacher).

Originally in the ancient language of Sanskrit, it roughly translates to -

g in “Outstandin ” their fields

Through the years, I have come to terms with the fact it is almost inevitable that even in social encounters, most of my surgeon friends tend to gravitate towards ‘talking shop’, in fact, many of them to a fault – this perhaps comes from the many years of focus and training in their specialty that many of them have never had the time or opportunity to ever pursue any interests outside of work.

It was always different with DSP. He broke that mould more than anyone I have known! Often, I would walk in

Lead me from the untruth to the truth Lead me from darkness to light Lead me from death to immortality (Brhadaranyaka Upanishad — I.iii.28)

While the first two lines are fairly self explanatory of a pupil aspiring knowledge, it is the last line of the verse that speaks of the true duty of a guru- the teacher. No guru can literally pass on the secret of immortality. It speaks of knowledge itself being passed on – an act that completes the guru and the student. Every time I teach a resident of mine how to perform a passive pterygoid separation in a maxillary osteotomy without using a curved chisel and every time I treatment plan an orthognathic case using a Delaire analysis, DSP live through me and the others that he has trained, remaining immortal among us...

This spring and summer as the scarecrows start popping up in the fields of Nova Scotia, I am certain that someone will travel a less travelled roads there, to ‘see where it went’ and click pictures for their coffee table books and hopefully pass them on for the next generation to admire and appreciate.

Thank you, DSP. Be immortal.

Trainees

My experiences in the far east

Kalfarentzos Evangelos MD, DDS, PhD Oral & Maxillofacial Surgeon IAOMS Fellow 2013-2014

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aving recently finished my Training fellowship in Oral-Head and Neck Oncology and Reconstructive Surgery I would like to share my experiences in the Far East with the rest of the international community. This is also a great chance for me to express my gratitude to everybody who has affected my professional advancement throughout the years.

By way of background I am a double qualified (MD&DDS) Oral and Maxillofacial Surgeon. I was trained in ‘Evagelismos’ University Hospital in Athens, Greece under Prof. Nick Papadogeorgakis.

His overall dedication to the specialty and specifically his passion for Oral-Head and Neck Oncology has always been an inspiration to me. I am truly thankful to him for broadening my way of thinking and supporting me throughout the years.

the joyful news of being selected as an IAOMS fellow for the Oral-Head and Neck Oncology and Reconstructive fellowship at Shanghai Ninth People’s Hospital in Shanghai, People’s Republic of China.

Upon reaching Shanghai I was impressed by the overwhelming hospitality of my Chinese colleagues which characterized the whole duration of my stay.

Everything I needed was already arranged for me so I adapted very quickly to my new way of life.

Exploring Shanghai and the Chinese culture was a very interesting and enjoyable way to spend my spare time.

For the next year I spent almost six days per week in the hospital, following the daily routine of my Chinese colleagues. Ninth People’s Hospital is an impressive

After completion of my core training program and having Oral-Head and Neck Oncology as part of my everyday residency life I developed a strong urge for further subspecialization and training in Oncology and Microsurgical reconstructive techniques. The IAOMS Fellowship program presented an excellent opportunity for me to train in a major and well organized institution. Almost one year ago I received

“As part of my training I was given the opportunity to observe, assist and perform numerous procedures related to Oral-Head and Neck Oncology & Reconstructive surgery”.

institution with Oral and Maxillofacial departments prevailing amongst the others.

The variety and number of cases is overwhelming and the level of experience and expertise of all the surgeons is very high. As part of my training I was given the opportunity to observe, assist and perform numerous procedures related to Oral-Head and Neck Oncology & Reconstructive surgery. After expressing my wish to engage on clinical and academic research Prof. Yue He was more than willing to help me by granting me access to all his work, and guiding me through the process with long discussions and debates. The weekly “Big Rounds’’ and Multidisciplinary tumor board discussions gave me new insight to the management of oncologic head and neck patients. Finally, to my astonishment, during

“Upon reaching Shanghai I was impressed by the overwhelming hospitality of my Chinese colleagues which characterized the whole duration of my stay.”

my stay in China I also had the opportunity to attend several Congresses, courses and lectures in English.

Another great benefit of this fellowship was the fact that I met many oral & maxillofacial surgeons from around the world. Apart from forming strong friendships with most of them, the constant exchange of experiences and ideas was a fruitful process that all of us has benefited from. I am sure that these friendships will serve as the starting point for future collaborations.

Overall the whole experience had a great IAOMS impact on me. Apart from Fellowship enhancing my surgical “I hope the idea and skills and revising my concept of these theoretical knowledge fellowships will I went through a life continue, expand and changing professional evolve in the future. experience. Although I believe that there I still have a long way are multiple benefits ahead of me I feel that deriving from this fellowship helped me such educational become more complete programs not as a surgeon by providing only for young me with more experience maxillofacial in Head & Neck Oncology surgeons but for and equipping me the progress of the with new free flap specialty as a whole reconstructive options in the long run.” and microsurgical skills.

All this could never be accomplished without the support of the IAOMS. I feel privileged to have been given this chance by the former Director of the IAOMS Foundation Fellowship Programs Prof. Julio Acero and the rest of the selection committee. I am truly thankful to them for giving me this opportunity and supporting me.

Most of all I would like to thank my Chinese Colleagues for accepting me as part of their team and being my friends. I would like to specially express my gratitude to Prof. Zhang Chen- Ping, Prof. Yue He and Dr. Chunyue Ma for being true mentors and tireless assistants during the whole duration of my fellowship.

I hope the idea and concept of these fellowships will continue, expand and evolve in the future. I believe that there are multiple benefits deriving from such educational programs not only for young maxillofacial surgeons but for the progress of the specialty as a whole in the long run. ■

Beyond OR Your staff, your practice

and your success

By Javier González Lagunas

Y

ou are a great maxillofacial surgeon, with extraordinary technical skills. You are also a great communicator and patients trust you not all only for your professional standards, but also because of your empathy and nearness. You work in a great hospital, with the best facilities, and with the best benchmarking results in your area. So you have it all to succeed!!

Are you sure about that? Don’t forget that you do not work on your own.

You have a medical staff working with you; you have scrubs, nurses and administrative staff, and some of them spend much more time with your patients then what you actually do.

Remember that your staff is also your internal customer. They must be satisfied in their work place to transmit the sensation of well-being to your patients.

They have to feel that your practice is definitely the best place to work.

What do we want from them?

Motivation, dedication, knowledge, satisfaction... the magic words, customeroriented staff!!

Are all of them rowing in the same direction? As a matter of fact, do they know what direction your practice is heading? How involved are they in the strategy of your practice? Do they know there is a strategy at all?

Staff management is one key factor for the success of your practice. It is one of the classical seven P’s of the marketing mix (price, place, promotion, physical environment, product, process, place and PEOPLE).

It is not only answering the phone with a smile, that´s just the skin of the process.

Do they know all the procedures you perform? Can they explain them clearly to the people visiting your practice?

Are they able to relax people when unexpected results occur? Do they function by standardized processes?

What are the columns for professional motivation? According to Daniel Pink (you definitely must read his book Drive), the 3 key factors are autonomy, mastery and purpose. Do not forget that there is also a previous basic requirement: their compensation must be adequate and fair. But once this economic threshold is achieved, more money does not generate a better behavior.

They probably know much better then you do how to organize their particular job, so, why don’t you let them develop their skills? It will be good for them, but also good for your team.

Taking care of your staff is not easy. You need time and expertise. But it is a must for the success of your professional career. ■

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