Face to Face from the IAOMS

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Issue 51 / October 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 Javier Gonzรกlez Lagunas EDITOR IN CHIEF

Face to face wants to pay a tribute to IAOMS Foundation, a keystone of the educational activities of our association.


Educational Programs. Past, present and future SO, YOU WANT TO WORK... 18 In Mexico


Maxillofacial Surgery: my passion and commitment FROM PROUST TO PIVOT 22 Dr. Sanjiv Nair


Maxillary distraction in cleft patients

NEXT GEN 30 Our big Band TOMORROW!

32 WORKING IN PARADISE Mahdia, Tunisia

WHERE ARE YOU NOW? 34 Dr. Jose Luis Ferreria

36 BEYOND THE O.R. Blue or Red?



t’s the end of summer in much of the world and a time when students head “back to school.” In the first few days, they often talk about what they did on their summer holiday. With that in mind, I’m pleased to update you on what the IAOMS headquarters team has been working on this summer – including how we’re advancing a key pillar of the IAOMS mission: education. I joined IAOMS President Dr. Julio Acero at the CIALICIBU Congress in Buenos Aires in August. While there, we met with the ICOMS 2019 Rio team, chaired by Dr. Luis Marinho, who is working diligently to deliver a world-class roster of speakers and presenters at our signature conference. Registration will open soon and abstracts will be accepted beginning on May 1. You can find other information on ICOMS 2019 at its website. We will share more details as they become available. And I, along with the IAOMS leadership and our headquarters team, look forward to welcoming you to Rio in May of 2019. My thanks to Face-to-Face Editor-in-Chief Dr. Javier Lagunas for shining a spotlight on the IAOMS Foundation in this issue – as well as a big thank you to Dr. Larry Nissen for his vision and leadership as Foundation Chair. One particularly terrific educational opportunity the IAOMS offers is the IAOMS Foundation Fellowship. Applications are available online until November 1 and I encourage you to apply and share the information with colleagues who may be interested. Special thanks to KLS Martin for its ongoing support of this educational opportunity. NEW LEARNING MANAGEMENT SYSTEM AND “FIRST-EVER PROGRAM” I am excited to announce that we will introduce a new Learning Management System this fall to help members access training and educational materials with ease on their mobile, tablet or desktop devices. We are working on updating and developing programming that we will add to our current offering (which also includes our monthly scientific webinars and our Next Level Forum/Digital series). We will email you with dates and topics for those upcoming webinars in the next couple of weeks and I hope you will take the time to join us. To round out the IAOMS educational offerings, we will introduce two new programs through the IAOMS Foundation. The first program will focus on basic and clinical research – the first program of its kind in the

Foundation’s history. And through the Visiting Scholars program, early-career IAOMS members will have an opportunity to experience shorter, targeted training opportunities at learning destinations around the world. We are also working with some of our affiliated associations to co-sponsor conferences such as the IAOMS- AÇBID 12th Joint International Congress on Oral and Maxillofacial Surgery in Antalya Turkey (May 9-13, 2018), where we are proud to be a first-time co-sponsor. IAOMS will have a presence at the 62nd Congress of the Japanese Society of Oral & Maxillofacial Surgeons (October 20-22, 2017) in Kyoto, where we will be honored to transfer the Presidential Chain from IAOMS President Dr. Julio Acero to President-elect Dr. Alexis Olsson during a special ceremony. Additionally, we will have a presence at the 22nd UAE International Dental Conference (February 6-8, 2018) in Dubai; at ACOMS (the Asian Congress of Oral and Maxillofacial Surgery) in Taipei, Taiwan (November 8-11, 2018) and we are developing a conference in the Dominican Republic. All of these events demonstrate our ongoing commitment to maintain a presence in every region of the world. In addition to these educational opportunities, other highlights from our summer include: • Launching the NextGen Facebook page •O ngoing work to select a vendor/partner for the IAOMS website redesign • Encouraging new donors to support the IAOMS Foundation to help us reach our Annual Appeal goal of $500,000 USD (we have raised approximately $350,000 USD) And we look forward to a busy fall which will include participating at the AAOMS 99th Annual Meeting in San Francisco in October and kicking off our membership renewal campaign. At IAOMS, education always will be a central focus. Improving the quality and safety of health care worldwide through advancing patient care, education and research is how the IAOMS helps you build your practice and our profession. With thanks for your membership and support of the IAOMS Foundation. Regards, Mitchell Dvorak EXECUTIVE DIRECTOR, IAOMS

By Luiz Marinho

1 2 3 4 5

Best scientific program ever!

Stroll in Ipanema and sing “Girl from Ipanema” Where diversity meets and celebrates the diferences… Beach and tropical rain forest just a stone’s throw away. Take pictures near to the sky at the Sugar Loaf and try an original Brazilian coffee.

Letter from the President


t is especially emotional for me to have been invited to write this column as the President of the IAOMS in this issue dedicated to the activities of our Foundation, since much of my life has been dedicated to teaching and because I initiated many of the educational projects the Foundation has developed and supported throughout the years. First as the Chairman of the IAOMS Education Committee, then as Director of the Fellowship Program and finally as President of the society, I have been involved in the development of many Foundation activities and programs. I remember well when in 2003 Nabil Samman, at that time Chair of the Education Committee, proposed to me that I become Chair. While I had experience planning and managing many European educational projects, the challenge of assuming the chairmanship of the IAOMS Education Committee was a major task due to the responsibility of expanding the programs globally that Dr. Samman started in Thailand in 2002. During my tenure as Education Chair, it was an exciting experience to learn about the issues our colleagues working in different parts of the world confront “in the field” frequently. As Committee Chair, I received much more from the experience that I could have given. The first program in Latin America was held in Lima, Peru between 2004-2006. Given the success of the program, we expanded programs throughout the continent in Paraguay, El Salvador and Panama. In Africa, we started in 2007 with the Eastern Africa program, an important program planned during the presidencies of Dr. Paul Stoelinga and Dr. John Williams and based in Nairobi, Kenya and Dar es Salaam, Tanzania. In this project, we incorporated attendees from all East African countries. Subsequently, the Nigerian program had a new concept: training the trainers at the highest level of reconstructive surgery. Dr. Rui Fernandes, current Chair of the Education Committee, and I participated in the every course of this popular successful program, which concluded in 2015. During the last course, Dr Fernandes and I were happy and proud to assist the local surgeons in complex microvascular reconstruction operations. In Asia, following the Thailand program, we continued organizing courses in Indonesia, Malaysia, the Philippines and Sri Lanka. All of these IAOMS Foundation programs had a very important impact, not only in the country where the project was

developed but also in neighboring areas. I have the pleasure to announce that we will continue developing educational programs at a global level, having recently approved a new project in the Dominican Republic, focusing on the Caribbean region, another in Myanmar (Asia) and we are considering a new program in Africa. The IAOMS Fellowship Program was launched in 2009 with the intention of offering young surgeons advanced surgical training and surgeon-to-surgeon exchange within the specialty. The Foundation annually funds up to three advanced Fellowships in Oncology and Reconstructive Surgery and Oral Lip and Palate/Craniofacial Surgery. To date, 21 surgeons have participated in this program. I was happy to serve as the Director of the IAOMS Scholarship Program for four years after my term as the Chairman of the IAOMS Education Committee, an experience that was very gratifying. Today, I am pleased to announce the creation of a new scholarship program designed especially for young colleagues visiting foreign hospital centers for short periods. I have dedicated significant time and effort to the Foundation’s teaching and humanitarian activities for many years and I encourage all of our members to participate in these activities as volunteers as well as to support the Foundation financially. Every gift to the Foundation – large or small – makes a difference and helps us provide training to OMF surgeons throughout the world. I am pleased to report that the entire IAOMS Board of Directors has contributed to the Foundation. Finally, I want to acknowledge and thank IAOMS Foundation Chairman, Dr. Larry Nissen, for his leadership and commitment. With his vision, we are making the Foundation an even more professional and efficient organization, ensuring the sustainable development of more and more continuing education programs worldwide with the goal of advancing the specialty, developing young colleagues and creating humanitarian projects to serve communities. My gratitude to everyone who is involved in the Foundation – past, present and future! Sincerely yours,

Julio Acero IAOMS PRESIDENT 2016-2017

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l a n o i t a c u Ed s m a r Prog Past, present and future 10 iaoms.org

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IAOMS foundation educational programs By Larry Nissen

IAOMS Foundation Chairman


he mission of the IAOMS is to “elevate the quality of healthcare worldwide through the advancement of the art and science of oral and maxillofacial surgery”. As the philanthropic and funding arm of the organization, the IAOMS Foundation has, for years, worked alongside the IAOMS to support numerous educational throughout our organization’s history to a broad spectrum of audiences. The first stand-alone educational program of the IAOMS (outside of the ICOMS) was held in Hat

Yai, Thailand from 2002-2005, and was the result of two years of planning led by IAOMS President Paul Stoelinga, in cooperation with the Thai Association of OMS, the Prince of Songkla University in Hat Yai, and the IAOMS Foundation. The location was chosen to facilitate involvement of surgeons from neighboring countries, particularly Indonesia. OVER THE COURSE OF THREE YEARS, experts in the specialty from Europe, Argentina and the United States presented a series of in-depth lectures, covering the entire scope of the specialty,

special report enhancing the knowledge base of the participants. Approximately 150 young surgeons from Thailand and 7 neighboring countries participated in this unique educational experience – bringing knowledge to developing regions that need it most.


THIS “THAI PROJECT” BECAME the blueprint on which the IAOMS and its Foundation will have completed 12 of these programs by 2019, typically with two series in process at a given time, spanning various corners of the globe. They have been held in Asia, Africa, Central and South America. Previously known as the “Surgeon to Surgeon” program, they have been renamed the “Gift of Knowledge” program – as there is no tuition or fee charged to the participants; the host university provides the lecture facilities, speaker housing, and meeting logistics. Lecturers receive no honorarium, and travel expenses are provided by the IAOMS Foundation or through the generosity of various regional or national associations. It is estimated that over 1,500 OMS surgeons have received the benefit of these programs; a tribute to past leaders of our specialty recognizing the value of longitudinal education in developing countries to benefit the specialty and improve patient care. *(Information from 50 Years of IAOMS – The Development of the Specialty, Paul J.W. Stoelinga and John Ll. Williams, 2012.)

The mission of the IAOMS is to “elevate the quality of healthcare worldwide through the advancement of the art and science of oral and maxillofacial surgery” IN ADDITION TO THESE BASIC OMS EDUCATIONAL programs, the Foundation developed a dedicated Fellowships program in 2010. During Nabil Samman’s presidency, Foundation leaders realized that advanced educational opportunities existed at regional centers of excellence in the areas of Oncology/Microvascular Reconstruction and Cleft/Craniofacial Surgery. It was determined that these Fellowships would span one year, and that we would award two per year in Oncology, one in Shanghai, China and one in Beijing, China. In addition, the Cleft Fellowship would accept one person annually and originally included rotations in Orlando, Florida, Indonesia and Pretoria, South Africa. Currently, this program includes six months in Bangalore, India and six months in Hyderabad, India.




FIFTEEN SURGEONS HAVE COMPLETED OR are currently in training in Oncology, and six in Cleft areas. These Fellows have come from 16 different countries. This extensive training has allowed the Fellows to return to their home countries to teach local colleagues these procedures, in addition to expanding patient care in these critical areas of our specialty. For the past two years, over fifty applicants have sought these positions from across the globe, demonstrating the demand for these advanced educational programs. A generous challenge/match grant from the KLS Martin Group provides the funding for one of the Oncology/ Microvascular Reconstruction Fellows in perpetuity. Other corporate donations from Zimmer Biomet and Synthes have also provided partial funding for the two other Fellows in various years.

“A tribute to past leaders of our specialty recognizing the value of longitudinal education in developing countries to benefit the specialty and improve patient care” IN 2018, THE FOUNDATION will begin two new educational programs to augment opportunities for trainees. The first Research Fellowship will be offered at the University of Michigan in either basic or clinical research and will be a year-long program. This the first time that funding has been available for research from the Foundation and is possible through a grant from Elsevier publishing, as a part of the International Journal of OMS contract. A Visiting Scholar program will also enable two senior trainees or new graduates to spend two to three weeks in various volunteer training centers around the world, further expanding the global educational outreach of the IAOMS and its Foundation, key to their missions. DESPITE THE LIMITED FUNDS that have been available in the past, the Foundation has provided an extensive array of programs that have served the specialty well and improved patient care. Generous donations of money, time, and travel expenses from members, corporate partners and regional and national associations and other friends have made this possible and are greatly appreciated. In 2017, the Foundation has undertaken a bold, proactive initiative to greatly increase the ability to further expand the educational opportunities within our specialty. With increased funding, the Foundation CAN and WILL do more. ■ October 2017

02 Building for the Future: The IAOMS Foundation’s Evolution in Fundraising By Mitch DvoraK Executive Director, IAOMS


hen I joined the IAOMS a couple of years ago, I joined a landscape of engaged members with enormous potential for growth, and a compelling vision for the future. Now, in 2017, that future is starting to take shape. The international conference continues to grow, our educational programs continue to expand, and there are exciting new technological platforms on the horizon. Of course, alongside the IAOMS, sits the IAOMS Foundation. For over 20 years now, the Foundation has worked to raise funds to support educational opportunities around the world – including fellowship awards, and dedicated training programs in developing countries. In recent years, under the leadership of Dr. Larry Nissen, the Foundation’s Chairman, it has become a formidable organization that has impacted millions of lives through its activities. IN 2016, Dr. Nissen and I took a long look at the Foundation’s potential. We asked the question – ‘How can we take this to the next level?’ Even with iaoms.org 13

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a strong fundraising year (the IAOMS Foundation raised over $180,000 from corporate partners and individuals in 2016), we knew there was room to do more. But we knew we needed to validate the opportunity. SO, IN THE LATTER PORTION OF THE YEAR, we engaged a strategic partner to organize a formal assessment of the Foundation’s fundraising activities and potential for growth. Together, we held nearly 50 formal discussions with IAOMS leaders, fellows from around the world, corporate constituents, and others. We asked the tough questions: What should the Foundation be funding? What would motivate others to give? How can we best serve the international specialty? And, will you help us lead this effort? 14 iaoms.org

WHAT WE FOUND THROUGH THIS ASSESSMENT WAS TREMENDOUS POTENTIAL to grow the IAOMS Foundation into an even greater catalyst for the OMS specialty. And so, in January of this year, we launched the Foundation’s first official Annual Appeal with a goal to raise $500,000. While this certainly was an ambitious goal, we wanted to set the bar high. Thanks to Dr. Nissen’s continued leadership, the IAOMS Foundation Board of Trustees’ support and advocacy, and the Appeal Development Committee’s efforts, we are on pace to reach our goals. As of early August, the Foundation has raised nearly $350,000 toward our goal. Already, this represents nearly double the funds raised in 2016 – a truly historic accomplishment! October 2017

In the coming months, the IAOMS leadership and I cannot wait to see the Foundation reach its goals, so that we can talk about what is next.

You can support the Foundation’s Annual Appeal here: https:// iaoms.site-ym.com/ donations/donate. asp?id=13705

MOST IMPORTANTLY, on behalf of the Foundation’s staff and volunteers, I’d like to say thank you. Thank you to Dr. Nissen and his tireless work to drive the organization forward. Thank you to our Development Committee for advocating the Foundation’s work to others. Thank you to our corporate partners, who have made our work possible over the years. And, thank you to all of the individuals who have given generously, both this year, and in the past. These are exciting times. If you haven’t had a chance to support the IAOMS Foundation’s Annual Appeal this year, now is the perfect time to jump on board! ■ October 2017

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IAOMS in first person Dr. Knips

Jill, what are some of the key skills/lessons you learned during your Fellowship year? From the professional point of view, I learned many cleft related procedures such as lip repair or labioplasty in different techniques, palatoplasty in different techniques, columella lengthening, velopharyngoplasty, bone augmentation, how to arrange a cleft center and how to organize surgical charity trips. 

From a personal point of view, I learned that it is much more challenging to be part of a different culture than I expected and very hard to learn new social “soft” skills. It’s difficult to understand, live and respect another culture and be accepted as part of a team. How did those skills/lessons improve your ability to help patients? The techniques help me offer my patients different treatment options and explain more clearly advantages and disadvantages of different surgical procedures. 

Please discuss one or two specific examples of how you were able to help a patient because of the training you received. I treated a patient with a sub-mucose cleft palate, a 33 year-old woman, whose cleft had never been diagnosed. Due to her velopharyngeal insufficiency, it was difficult to understand her speech and because of that, she lost her job, one after another. She was very happy when her speech was improved by a combined cleft repair with pharyngeal flap. 

“The techniques help me offer my patients different treatment options” “It’s difficult to understand, live and respect another culture and be accepted as part of a team”

Also, I treated a 6-month old baby with a cleft palate. The mother had problems feeding her baby. But two weeks after the cleft repair, the baby was able to take all the milk in five meals a day instead of eight meals a day. Have you been able to share the knowledge you gained with other OMF surgeons in your hospital? I had to wait for two years before I was able to take over the cleft clinic in my Hospital. Now I am teaching dental students and OMF residents (There are 60 students and 12 residents at the moment). I give lectures to the dental students and they have to attend the OR. The OMF residents have learned how to reconstruct a soft palate trauma when they are on call in the emergency room. I am the only surgeon at the University Hospital Hamburg in my department who consults and operates on cleft patients. We have about 200-300 cleft patients and probably 75 cleft-related procedures per year. 

I have participated in five charity trips. For example, in Indonesia, we were a group of about 7-8 surgeons who travelled to a small village to perform surgery. The local dentist gathered about 20 patients with a cleft and asked the cleft foundation to send a team. 

Any final thoughts on the IAOMS? I have met some very impressive IAOMS members and I appreciate being able to contact members through the IAOMS network and consult with them. ■ 16 iaoms.org

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A bi g



yo u

Dear Friends, As we move into the final third of the year, I send greetings to all in the OMS community, on behalf of the IAOMS Foundation’s leadership. It is an exciting time for our specialty, and we thank you for the role that you play every day in advancing our profession in every part of the world. There is a lot happening at IAOMS. Under Mitch Dvorak’s leadership, and thanks to his staff’s good work, our membership is growing once again. New corners of the world are becoming more connected and engaged. Educational opportunities are being offered, both in person, and virtually, providing greater access to learning. And there are exciting new technological products coming soon. As the IAOMS develops, the IAOMS Foundation continues to work alongside it. As you may have seen, this year’s Fellowship Program applications opened on August 1. For the Program year (2018-2019), the Foundation will award two Fellowships in Oral and Maxillofacial Oncologic & Reconstructive Surgery (one in Shanghai and one in Beijing, China) and one in Cleft Lip and Palate and Craniofacial Surgery (in Bangalore and Hyderabad, India). Each Fellowship will run from September 1, 2018 to August 31, 2019. We give our special thanks to KLS Martin Group for its ongoing support of the Fellowship Program. Applications will remain open until November 1, so for those interested, act quickly! You can find program and application details here: http://www.iaoms.org/mpage/Fellowship We are also looking forward to announcing more information on two new programs: the Visiting Scholars program, which will provide young members with an opportunity to experience shorter, targeted training opportunities at learning destinations around the world, and the Research Fellowship program, which will provide a training opportunity focused on basic and clinical research – the first research activity in the Foundation’s history. Be on the lookout for more information. We are pushing forward with our 2017 Annual Appeal as well. With an ambitious goal to raise $500,000 in commitments this year, we have been working hard to engage individuals, corporate partners, and fellow associations. As of mid-August, we have raised nearly $350,000 toward this goal, with many more exciting conversations still in process. We need your help to push us toward our goal! Would you consider making a $365 commitment this year to support education, development, and opportunity for young OMS professionals internationally? With this commitment of just a dollar a day, together we could make a huge difference. If just a small percentage of our community of thousands make this commitment, we will meet our goal. Please visit the Foundation’s giving page to make your commitment: https://iaoms.site-ym.com/donations/donate.asp?id=13705 On behalf of the IAOMS Foundation Board of Trustees, thank you for your support. We look forward to sharing more exciting progress with you soon! ■ Larry W. Nissen IAOMS Foundation Chairman October 2017

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So, you want to work...


By Cesar Villalpando President of the Mexican Association of Oral and Maxillofacial Surgery. Monterrey


exico is located in the American Continent, in the southern portion of North America. It is bordered to the north by United States; to the south by Guatemala; to the east by the Gulf of Mexico and by the Pacific Ocean in the west. Mexico is composed of 32 states and together they make up for a democratic system of government. At present, the population in our country is over 130 million in a territory spanning 1964 million kilometers. Spanish is the official language, but we also have 68 different indigenous dialects. However in the states where industry and tourism are relevant, like Mexico city, Guadalajara and Monterrey, English is the second language spoken. The main economical activities are agriculture, cattle raising, manufacturing, oil production and tourism. The Gross Domestic Product (GDP) in 2016 was $1046 billion USD. We have signed 12 free trade agreements with 45 countries. Our population is composed of 30% of young people with a mean age of 27. Around 55% of the population is economically active and our Currency of Exchange is the Mexican Peso. The Health Secretary (Secretaria de Salud) is the governmental agency that controls the medical population and also all the drugs for medical use. 18 iaoms.org

gulate Institutions that re the specialty of Oral and Maxillofacial Surgery. Mexico boasts of two institutions that regulate the specialty of Oral and Maxillofacial Surgery. The Mexican Association of Oral and Maxillofacial Surgery, was founded in the year 1954 with the objective of educating maxillofacial residents. The Mexican Council of Oral and Maxillofacial was found in 1980 with the main goal of certification of the Oral and Maxillofacial specialists for their surgical skills and knowledge. The re-certification is required every five years. This council is recognized by the National Council of Medical Specialists and by the National Academy of Medicine. October 2017

In Mexico, the first academic requirement to apply for Oral and Maxillofacial Surgery is Doctor in Dental Surgery (DDS). We have 16 training programs, in various General Hospitals and Army Force hospitals recognized by prestigious universities such as Universidad Autónoma de México and Universidad Autónoma de Nuevo León.


FOR ACCREDITATION OF INTERNATIONAL ORAL AND MAXILLOFACIAL SURGEONS IN MEXICO: 1. Study revalidation of the Dental degree and the speciality in Oral and Maxillofacial Surgery by the Secretary of Public. Education Education in order to expedite a professional ID. 2. Exam approval of certification by the Mexican Council of Oral and Maxillofacial Surgery.

The first stage of selection is a national general dental science exam, followed by the second stage being a propaedeutic course for hospital concretization. The third and last stage of selection is a psychological test. Training occurs in an academic medical environment for four years,

The Data Around the country, there are 720 Oral and Maxillofacial Surgeons, with the highest concentration in Mexico City. Mexico City also leads in the number of training programs. We estimate that there are also about 12 international Oral and Maxillofacial surgeons working in Mexico. The medium income in a public hospital is around $2500 USD. October 2017

3. Legalize the labor status in the National Migration Institute. 4. Become member of the Tributate Administration Secretary (SAT) for income registration.

The scope of practice of majority of Oral and Maxillofacial Surgeon in Mexico are: ✔M inor surgical procedures such as wisdom teeth surgery and Oral Implantology. ✔ Orthognathic Surgery. ✔ TMJ Surgery. ✔ Maxillofacial Trauma. ✔ Surgical Pathology. ✔ Lip and Cleft Palate Surgery. ■ iaoms.org 19

Women in IAOMS


My passion a By Laura Leticia Pacheco Ruiz Oral & Maxillofacial Surgeon Centro Médico Nacional 20 de Noviembre ISSSTE Mexico, City

UPON COMPLETION OF TODAY’S CASE, I took a few minutes to think deeply on what we just achieved. A few thoughts later, I ended up outlining everything we have been able to accomplish as a specialty, not only in this specific case, but in all the surgeries and treatments that our specialty has been able to carry on. This was a multidisciplinary surgery involving three different surgical specialties where all of us were contributing our best to support a human being to obtain the best in life. As I observed my residents, I was wondering if they were conscious of how long did it take to our specialty to be in an operating room like we did today? I wonder if they had ever thought about all the efforts put in by those premiers in our specialty to be able to get us where we are today. I questioned if in the madness of the surgical circus and their training, they had ever had the chance to meditate about the surgeons who

had dedicated their lives to Maxillofacial Research and about how much technology has been developed. Did my residents ever ponder about everything that allows us now to optimize our treatments and change old paradigms? Later, I began analyzing myself - I analyzed my own battles and challenges, the battles of a woman like me, that chose to believe that a better world is possible, that chose to follow others who pursued their dreams tirelessly, till they succeeded. I could write a lot about the challenges involved in being a woman in a man’s world. But I have decided to obviate that part to emphasize the idea, that all of us have a fight story, a progress story, the story of a dream we know we can achieve. I have learned that I would not compare myself to others, and that I would only compare myself to a previous version of me; that every time somebody told me I would not be able to do something, I was already sure I would be.

By Dr. Gabriele A. Millesi M.D., D.M.D. Vice President Elect of the IAOMS Assistant Professor Medical University of Vienna University Hospital for Cranio Maxillofacial and Oral Surgery

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Manuel Duarte, doctors par excellence, all of them believed in me. I recall an ocassion when Dr. Davila assigned me to present a project at the IAOMS meeting in Kyoto, Japan. There, he introduced me to Dr. William Bell. In 2009 I start working with Dr. Bell in a research project on Virtual Surgical Planning. To me, it felt like a dream! Dr.Bell was the most extraordinary human being I had ever met. He did not only taught about surgery, he embrace my humanism, and taught me the most trascendental lessons in life. I keep on trying to fulfill my dreams, I always try to help and to give back to my people and my country everything that has been invested on me.

I remember I always wanted to be a doctor, since I was a child. During Dental School at the National Autonomous University of Mexico UNAM in Mexico City, I found myself working and studying at the same time. It was during the fourth year of dental school, that I had the chance to see patients being prepared for orthognathic surgery. I remember asking an orthodontist if such corrective jaw surgery was performed by an oral & maxilofacial surgeon. His answer was: “None of them could do such things, that procedure is performed by a plastic surgeon”. That was the defining moment that I decided to become an oral and maxilofacial surgeon. As I started my residency progam, I could not fathom what I was about to learn, and the extraordinary people I would meet, who have been part of my life ever since. Apart from surgery, they have taught me the most important lessons of humanity - respect and love; many of those lessons did not come about the easy way. MY GREAT MENTORS, those who always managed to get the best out of me - Javier Davila, Molina Moguel, October 2017

MY ACADEMIC STORY STARTED with my residency in 1997, and the learning has not concluded. Every day I learn something new, from my patients, my residents and every circumstance related to patient care. I have worked in this hospital since 2001 and in 2003, was appointed Program Director. Furthermore, in 2011 I started leading the Surgical Coordination Department of my hospital, leading more than 200 residents from 18 different specialities. It is quite rewarding to see how little by little with great efforts, passion and compromise we, the women of our time have been able to grow and have the positions than in the past had been exclusive for men. I pride in being a part of such women leadership. Every day I work shoulder to shoulder with other women who are head of services, sub-directors and directors, who are movers and shakers of the mexican maxilofacial surgery. With Dr. Gabriela Milessi is now the vice-president of IAOMS, and Dr. Marìa Luisa Lòpez Salgado who in November this year, will be the new president of the Mexican Asociation of OMS as our flag bearers, we may say that we are a unified group of doctors where the gender barriers does not exist and where the only limit is the one that we create in our minds. I feel blessed to be able to have dedicated my work and career so I can give my patients what I consider the best gift of life - their good health. ■ iaoms.org 21

From Proust to Pivot


Dr. Sanjiv


Consultant Maxillofacial Surgeon, MDS, FFDRCS.

Which living person do you most admire? My Father.

What is your favorite word? Party. What is your least favorite word? Impossible.

What is your greatest extravagance? Travel. What is your current state of mind? Confused about retirement.

What is your favorite drug? Peace. What sound or noise do you love? The Train Horn. What sound or noise do you hate? Traffic din. What is your favorite curse word? Would not mention it. Who would you like to see on a new banknote? My Face. What profession other than your own would you not like to attempt? That of a Bus Driver. If you were reincarnated as some other plant or animal, what would it be? A Dog.

What do you consider the most overrated virtue? Ambition.

Dr. Sanjiv Nair If Heaven exists, what would you like to hear God say when you arrive at the Pearly Gates? Sorry, You are late. What is your idea of perfect happiness? Reading a book on the banks of a river. What is your greatest fear? Loosing my Kin. What is the trait you most deplore in yourself? Temper and Anger. What is the trait you most deplore in others? Indiscipline. 22 iaoms.org

October 2017

Team Maxfax with international fellow

On what occasion do you lie? Me never....oops. What do you most dislike about your appearance? My double chin. Which living person do you most despise? Autocratic politicians especially our head of government. What is the quality you most like in a man? Integrity.

My retirement destination

What is the quality you most like in a woman? Integrity.

With my family in Greece

Which words or phrases do you most overuse? My patient is my God. What or who is the greatest love of your life? My Family. When and where were you happiest? Now and in the present with my family. Which talent would you most like to have? Ability to sing.

If you could change one thing about yourself, what would it be? To be born a musician. What do you consider your greatest achievement? Compassion to my patients and my practice therefore. If you were to die and come back as a person or a thing, what would it be? A Musicia. Where would you most like to live? By the river in Kerala. What is your most treasured possession? My Family. What do you regard as the lowest depth of misery? Loosing a close kin or friend. What is your favorite occupation? Surgery. What is your most marked characteristic? Ability to communicate with my patients. October 2017

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What do you most value in your friends? Loyalty. Who are your favorite writers? A. J Cronin, Charles Dickens and R.K. Narayan. Who is your hero of fiction? Oliver Twist. Which historical figure do you most identify with? Mahatma Gandhi. Who are your heroes in real life? Azim Premji, The Indian version of Bill Gates. What are your favorite names? Vedanth and Advaith , Names of my sons. What is it that you most dislike? Hypocrisy. What is your greatest regret? Not being able to change the way people drive. How would you like to die? In my sleep. What is your motto Live and let live.

Copy Me MAXILLARY DISTRACTION IN CLEFT PATIENTS Maxillary hypoplasia is a common dentofacial deformity in cleft patients secondary to the the repair of such clefts and multiple subsequent surgeries to correct the associated deformities. The majority of the patients can be treated with orthognathic Surgery, but severe maxillomandibular discrepancies require

maxillary distraction to correct the jaw size discrepency and functional disabilities. 3D planning is very useful in order to predict the vector and positioning of the distractors and to achieve a good occlusal and aesthetic result.

JOSEP RUBIO PALAU Pediatric Maxillofacial Unit Hospital Sant Joan de DÊu (Barcelona Children’s Hospital). Chairman, Department of Oral Medicine & Oral Public Health, Universitat Internacional de Catalunya, Barcelona (Spain)

1 Preoperative images of a bilateral cleft lip and palate patient.



Intra-oral view.

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3D planning. Vector design, cutting and positioning guides according to the predicted final position of the maxilla with internal distractors.

October 2017




Cutting guides and 3D printed model.

Cutting guides. Note the drills in the splint in order to fix it to the brackets if needed. October 2017


Positioning guides and internal maxillary Zurich distractors placed according to the vector.

Placement of positioning guides. Note the drilling in the malar body to have more stability of the distractor and avoid its movement during the distraction.

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Copy Me

8 Placement of internal maxillary distractors.

10 9

Pre and postoperative frontal view.

Postoperative facial images after distraction and posterior BSSO, genioplasty and rhinoplasty.


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October 2017

Pre and postoperative lateral view.

Gradual maxillary distraction and orthognathic surgery.


Prof. Hugo L. Obwegeser By Dr. Robert Bruce Macintosh Bingham Farms. Michigan, USA

One of the most comprehensive, influential, and illustrious careers in the history of oral and maxillofacial surgery came to conclusion on September 2, 2017, with the death of Hugo L. Obwegeser, in Zurich. Professor Obwegeser had been in deteriorating health for most of the year, and succumbed to respiratory complications some six weeks short of his 97th birthday. This giant among men was born in Hohenems, Austria, on October 21, 1920, and in his near-century life span experienced dynamic times: Naval service in World War II, professional training in his impoverished homeland in the post-war years, establishment of a worldrenowned surgical center in Switzerland, introduction of new and refined surgical techniques, and enjoyment of universal recognition from every quarter. During the acquisition of his basic medical training at the University of Innsbruck, he gained six months general surgery training and, following graduation, an additional six months in the hospital in his home town. He subsequently completed two years of pathology training at the Rokitansky Institute for Pathology and Microbiology at the University of Vienna, under the renowned Professor von Chiari. Originally hoping to pursue internal medicine or gynecology, he was recruited to study dentistry and oral and maxillofacial surgery at the University of Graz by Professor Richard Trauner. During his six years in Graz, he gained his diploma in dentistry, his expansive training in oral and maxillofacial surgery, and further plastic surgery exposures in a year-long visit with Professors Eduard Schmid in Stuttgart, Germany, and Sir Harold Gillies at Basingstoke in England. Throughout his career, Professor Obwegeser was always quick to acknowledge his mentors, and, additionally, what he had learned from Paul Tessier and Norman Rowe. By the middle 1950s, Hugo Obwegeser was in Zurich and over the next twentyfive years developed an oral and maxillofacial surgery colossus in that city, attracting legions of visitors from every point on the globe. His main

emphases were orthognathic surgery, pre-prosthetic surgery, secondary cleft care, and the temporomandibular joint. He was one of the first surgeons to stress the significance of disc pathology in temporomandibular joint complaints, and wrote in later years that secondary correction of craniofacial cleft deformities represented his most significant successes. Obwegeser served as Professor of Oral and Maxillofacial Surgery at the medical school and Professor of Oral and Maxillofacial Surgery, Oral Pathology, and Oral Diagnosis at the dental school of the University of Zurich until his retirement in 1987. Hugo Obwegeser espoused strong opinions on fundamentals concerning the health of the specialty. He insisted on accurate detail in writing, honest attribution for previous accomplishment, and the necessity of formal medical education and legitimate dental training in preparation for a career in OMFS. He was not inclined to avoid argument, nor, on occasion, hesitant to start one! He carried these precepts into his efforts – with Franc Celesnik – to bring a united Europe and a common language, at least at the OMFS level, into the foundation of the EACMFS and its journal in 1970. Journal requirements demanded either original scientific investigation, truly new techniques, or a significant number of cases in clinical reviews. He served as first Editor of the journal as well as Founding President of the EACMFS. He also held the office of President of the Swiss and German Societies of Oral and Maxillofacial Surgeons. Obwegeser’s one hundred or more articles and his innumerable lectures brought him to prominence world-wide. Nowhere was this more evident than in the USA. His hallmark presentations in Washington, D.C. in June of 1966, particularly in the field of orthognathics, stimulated an explosive redirection of the American specialty which, within little more than a decade, evoked a change in its name from the American Society of Oral Surgeons to the American Association of Oral and Maxillofacial Surgeons. His recognition in the US is October 2017 iaoms.org 27

reflected in his Distinguished Civilian Service Award, Department of the Army, USA (for his training of American military residents), his First Award for Excellence in Oral and Maxillofacial Surgery, from the University of Texas Southwestern Medical School, and his Honorary Doctor of Science degree, from the University of Detroit. These citations were in addition to his earlier Down Surgical Prize, of the British Association of Oral and Maxillofacial Surgeons, his Medal of Honor from the Semmelweis Medicine University in Budapest, the designation of the Hugo Obwegeser Prize, of the Swiss Society of Oral and Maxillofacial Surgeons, and recognition through the EACMFS Obwegeser Traveling Scholarship. He maintained his status as an operating room observer until the last year of his life. Hugo Obwegeser was quite clearly the most influential oral and maxillofacial surgeon of our time. He was born a son of the Vorarlberg in Austria – he died a citizen of the world. ■


Walter C. Guralnick

Oral and Maxillofacial Surgery Loses One of its Leaders Walter C. Guralnick, DMD, died Wednesday, September 6, 2017 at the age of 100. Dr. Guralnick was a mentor and friend to many and had a lasting impact in the lives and careers of generations of oral and maxillofacial surgeons as well as many in others in the dental and medical world Dr. Guralnick, Professor of Oral and Maxillofacial Surgery, Emeritus, graduated from the Harvard School of Dental Medicine in 1941. After completing an oral surgery residency at Boston City Hospital, he spent four years in the military, serving in the 7th General Hospital in England during World War II. He returned to Boston in 1946 and started his own oral and maxillofacial surgery practice, later joining the Harvard School of Dental Medicine faculty in 1954. In 1966, he became Professor and Chairman of the Department of Oral and Maxillofacial Surgery at the School of Dental Medicine, a position he held until 1982. Under his leadership, the Faculty of Medicine at Harvard, in 1972 approved the Harvard Oral and Maxillofacial Surgery -MD program. This program was one of the first OMS/MD programs in the United States and has been a model for oral and maxillofacial surgery training in the U.S. since its inception. Walter Guralnick was a role model, teacher as well as an inspiration to all those that had the opportunity to know him. He was a visionary who instilled the love of the profession in countless students, residents and colleagues. He as an extraordinary surgeon who believed that surgery was a privilege granted to surgeons by their patients whose confidence was earned by being a lifelong student and always respecting that confidence. He taught us the value of listening which he did with uncanny ability to synthesize what was being said and propose solutions that were usually just right. Also in 1966, Dr. Guralnick was appointed Chief of the Oral and Maxillofacial Surgery Service at Massachusetts General Hospital, and became a founding member of what is now known as Delta Dental of Massachusetts, one of the first dental insurance plans in the

nation. He served as its president for 10 years while also contributing as a member of the Board of Blue Cross Massachusetts. His contributions in education and training were recognized with election to both the Institute of Medicine of the National Academy of Sciences as well as to the Royal College of Surgeons in 1996. He was also awarded honorary professorships at medical schools in Shanghai, Chengdu and Xian, China. In 1980, he led the first delegation of American dentists and oral and maxillofacial surgeons on a teaching tour of hospitals in China under a new exchange program. In 1985, Dr. Guralnick and a group of other dentists established the nonprofit international healthcare group Project Hope to create a program in dental surgery education, and later a program in preventive dentistry in China.

guidance on many subjects. In 2016 at his 100 birthday celebrations at Harvard School of Dental Medicine hosted by Dr. Donoff and MGH hosted by Dr. Maria Troulisin, Chief of the Oral and Maxillofacial Surgery Service, Dr. Guralnick gave wonderful and inspirational presentations. As part of those presentations he offered the reasons he came to work which included his desire to stay current about healthcare and to have the opportunity discuss this and other topics with those that visited with him. Also in 2016, at his 75th reunion, Harvard School of Dental Medicine established the Walter and Betty Guralnick Scholarship to benefit predoctoral students.

1n 1983 Dr. Guralnick stepped down from the position as Chief at Harvard-MGH and Dr. Bruce Donoff, one of his residents succeeded him. Dr. Guralnick became the Director of the Operating Rooms at MGH and continued as a full time faculty in OMS at MGH. In 1993, an endowed chair, the Walter Guralnick Professorship in Oral and Maxillofacial Surgery, was established in his honor at the dental school. In 1994, Dr. Leonard Kaban became the Chief of OMS at Harvard-MGH. Dr. Kaban was another resident mentored by Dr. Guralnick. In 2005, at the age of 89, he was honored with the Harvard Medal for Distinguished Service, only the second dentist to ever have received the prestigious award given by the Harvard Alumni Association.

Dr. Walter Guralnick was a great surgeon, a pioneer and leader in oral and maxillofacial surgery education, a leader in the delivery of dental care in Massachusetts and a leader in the MGH-Harvard community. His impact has truly been worldwide. He was a caring and generous man and true gentleman. It is sad that the future generations will not have the opportunity to know him personally. However, he will continue to inspire and shape the future through those that he inspired and shaped.

In 2009 Dr. Guralnick received the Arnold K. Maislen Award at New York University and was given the Gavel Medal from the Forsyth Institute. Dr. Guralnick continued to come to work at MGH almost daily until he was recently hospitalized. His door was always open to students, residents 28 iaoms.org October 2017 and colleagues who sought his advice and

Dr. Guralnick was predeceased by his wife, Betty Marson Guralnick, who passed away in 2010 at the age of 89 after 68 years of marriage. Betty Guralnick, like Walter, was a very generous and caring person. He is survived by his three children, Peter, Susan and Tom; five grandchildren and numerous great-grandchildren. ■

Report Meetings

Another succesful ALACIBU meeting By Mariano Botta Vicepresident Organizing Committee President SACTBMF


he 20th International Congress of the Latin American Association of Buccomaxillofacial Surgery and Traumatology (XX CIALACIBU) was held at the Hilton Hotel in Puerto Madero, Buenos Aires, Argentina from August 6-9, 2017. The Congress was attended by more than 1,000 participants (including some 250 residents) from the 31 countries representing the ALACIBU. A number of scientific events were held including, the 6th Meeting of Residents of ALACIBU (devoted to Orthognathic Surgery), the 2nd International Conference on Implantology, 2 pre-congress courses (sponsored by SORG and AO), 16 mini courses and 12 Symposiums. A total of 114 posters were presented. The international faculty included speakers not only from all over Latin America, but also from Belgium, Germany, Israel, Spain and the United States. IAOMS was represented by Professor Julio Acero, and its Executive Director Mitch Dvorak. A booth in the Exhibit Hall introduced the delegates to the activities of the association. Professor Adrian Bencini and his team made an extraordinary effort to organize a meeting that will be remembered for its excellent scientific programs and the camaraderie and networking opportunities its social events promised at the beautiful Puerto Madero. â– October 2017

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Our big Band TOMORROW!


By Alfred Lau Elected Chairman NextGen, IAOMS

ollowing the success of ICOMS 2017 held in Hong Kong, I am very glad that we have established the new NextGen Council. The selection was chaired by Dr. Gabriele Millesi of the IAOMS board of directors, and me and together we have appointed 12 young, smart and energetic representatives from six different regions, and we have seen their faces in the last issue. 30 iaoms.org

Nowadays, young surgeons and trainees face an entirely different world of challenges. They are confronted with rapidly changing technologies: sophisticated cone beam CT scanners, 3D printing and modeling, computerized planning with virtual surgery, CAD/CAM surgical guides and implants, navigation systems, 3D videography, virtual reality, augmented reality‌ and more. To cope with these ever-advancing medical innovations, the need for October 2017

a different training and education system is essential, starting with good communication tools.

surgical procedures are accessible from YouTube, we have to be careful of its contents. As a credible international association, we have the responsibility to keep all these Two decades ago we could hardly imagine people living in order, by providing high quality and reliable internet with smart phones. The information technologies have resources. Whatever the new tech is, be it 3D videoing, taken a huge leap and the usual medium of knowledge virtual reality, high quality tactile sensor devices, transfer has undergone complete revolution. There is robotic navigations, it needs to be incorporated into the no more physical and time boundaries to prevent future education system. What can be better than surgeons from communicating with each understanding anatomy, surgical procedures, other. Fingertip communication is a mere feeling the surgical sense of different THE VIRTUAL convenience. We have then to ask structures, simulated surgical outcomes WORLD CAN NEVER ourselves about how we could make and patient response, in a real-time and SIMULATE REAL LIFE good use of these revolutionizing 3-dimensional perspective right in front EXPERIENCES THAT technologies to facilitate our field of you? There are amazing and innovative REALLY SHAPE WHO in the future? Especially for the next free apps on smart phones that allow WE ARE OR WHO WE generation… you to do surgery simulations at your BECOME It goes to show how much technology has fingertips, guided precisely step by step, advanced over the decades, or the past few from draping to dressing. years, even. We are now in the era of social media and instant messaging. How we communicate These are all very good adjuncts to facilitate today has changed the way we interact with each other. educational growth in the field. However these types of Our NextGen committee has started to incorporate advancements should not stun us morally. We should these tools as one of our communication tools, so as to not forget the core values as a medical professional – the keep everybody instantly in the loop. We are trying to responsible attitude, a kind heart, a caring mind and high update the Facebook page so all the members can come ethical standard to patients. These values are difficult to together in the same platform, for knowledge transfer, learn from the internet, but are gained from good mentors casual chat, networking and social gathering 24/7. We and great teachers. The virtual world can never simulate will try to connect people around the world with regular real life experiences that really shape who we are or who and sustainable activities such as Q&A forum, monthly we become. quiz page, case presentation and discussion, activities reporting, ideas sharing and possibly a regular online publication for young people to engage in intellectual pursuits. I believe members will be curious to know what is happening on the other side of the world and share what is happening around them. Utilizing Facebook, Instagram and other social media sites mobile device communication apps young OMSs will be able to communicate from wherever you are. This is how we should start our networking foundation, and it’s not hard to imagine how powerful a tool it will be. Training and education has also been dramatically changing. We have incorporated web education programs, either live-feed or recorded. We are working to build up a library so clinicians can have a useful archive for their interest. Although a range of different

So please come and give us some ideas on how you would like your OMS community would be. Lets NextGen! Lets IAOMS! ■

WORKING IN PARADISE Tunisia By Montacer Bouzaiene

President of the Tunisian Society of Maxillofacial Surgery since 2013


s soon as I finished my training in SaintLouis Hospital in Paris in 1996, I came back to Tunisia with the intention of reintegrating the former team in the Department. A new proposal came from my professor to launch a core of Oral and maxillofacial surgery in my hometown, Mahdia. Starting from scratch, I was aware that it would be a hard task starting with a general surgery team especially when an ENT Department already existed at the university hospital. The idea of being the leader in oral and maxillofacial surgery in the region and the possibility of building up my own team filled me with motivation. Consequently, I had to strive in order to convince our colleagues to take up the responsibility of trainees and I increasingly struggled over the years to get the necessary equipment through endless negotiations with the administrative staff to attain the department’s full potential. Another obstacle was to work on climbing the academic ranks.

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Eventually, I got promoted from the position of Associate Professor to Professor in 2013. The historical features of Mahdia, rich with its touristic attractions played a significant role in my decision to work there. Mahdia, a city of such glorious past, was the first Fatimid Capital founded in the Tenth century. The entrance to Mahdia’s Medina (old town) is through the impressive Skifa El Kahla (Bab Zouila). This gatehouse, with its 44 metres, was formerly incorporated in the 175 m long town fortifications that surrounded the peninsula. The present gate is not the original Fatimid structure, having been rebuilt in 1554 using stone from the Fatimid fortress after the Spanish destroyed Mahdia. From the original round towers on polygonal bases, which stood at the north and south ends of the wall, only some vestiges remain at the north end.

October 2017

Wandering between the fortress Borj el Kabir and the lighthouse at the tip of the peninsula brings someone to the old harbor area with the gorgeously situated cemetery and some interesting scattered Versatility, ruins. Near the lighthouse variety and are a number of 10th enthusiasm are century Shiite tombs as the main motivators well as the remains of some of our proficient cisterns. The peninsula’s staff south side was the site of the old harbor, which was probably used as far back as the Punic Era. During Mahdia’s golden era under the Fatimid rule, two watchtowers (incorporated into the town walls and later linked by an arch) protected the narrow entrance channel.

number of marble columns, showed that that the ship came from Piraeus (now part of modern Athens in Greece). Our department’s working schedules are particularly loaded in summer. With the city being very busy and overcrowded, we see a number of road accidents resulting in complex craniofacial fractures. Alcohol and unsafe driving among youngsters is another strong factor.

The city is also a famous touristic site with great fascination due to its sapphire blue sea and its Versatility, variety and virgin white beach. Mahdia enthusiasm are the is Tunisia’s best spot for main motivators of underwater exploration and our proficient staff. fans of wreck diving won’t Making our specialty be disappointed. In 1907, Mahdia west side sea, down ancient be recognized in my sponge-divers discovered country took a lot of phoenician port of Mahdia the wreck of a Roman sailing time and large collective ship sunk in 86 BC - thereby proving the harbor had efforts from our side. Thank God, we have achieved been used from the classical age. Its cargo, which satisfactory results and we will continue to work included dedicatory reliefs from Piraeus and large hard to keep that flame burning bright. ■

October 2017

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ay Luis Ferreria TDr.odJose

“I’m doing quite a lot of things. I’m a part-time OMS in private practice, I’ve just finished writing my first novel and I’m immersed in the second one”

By Deepak Krishnan Assistant professorof Surgery, UC Health. Cincinnati


ear Dr. Ferreria

How do you spend your time these days? I’m doing quite a lot of things. I’m a part-time OMS in private practice, I’ve just finished writing my first novel and I’m immersed in the second one. I live half the week at our country home with Iris, my wife, where I go cycling and horse riding and do gardening and, above all, cooking. When we´re in Buenos Aires, we go to the opera. What do you read in OMS literature these days that fascinate you? To tell you the truth, I read very little about OMS these days, but I read a lot of general literature: novels, essays, philosophy and sociology. 34 iaoms.org

What do you consider the single most meaningful contribution you made to the specialty of Oral Maxillofacial surgery? I feel that I finished what Paul Stoelinga and John Williams started. The African OMF Association was founded during my term as IAOMS President. As a result, all the continents are now integrated in the International Association. What is your perception of how the specialty has changed from when you started to now? It has changed in many respects and you can be sure that IAOMS was the leader of these processes. The scope has widened greatly. Globalization and social networks have had an enormous influence on research and practice in our specialty. What do you miss the most about work? Teaching. October 2017

What do you not miss about work? Stress. Do you keep in touch with former colleagues? Yes, through academic and institutional work. What would you change about your career path if you could go back and do so? Almost nothing. But I would have loved to do research full time. Which technological advance in the specialty would have made a difference in your surgical activity? Laser surgery, endoscopy and minimal invasive surgery. Robotic surgery. What advice do you have for the OMS trainee starting training in 2017? Commitment, a passion for truth, patience and tolerance. How do you reflect on your involvement in the IAOMS? How important was the association in your career? I was involved in the IAOMS Executive Committee for 19 years. My involvement started with the 1989 ICOMS in Jerusalem, Israel, where I was Chairman of the Organizing Committee of Argentina’s ICOMS. My participation continued uninterruptedly until the 2007 ICOMS in Bangalore, India. I became President Elect in Durban, South Africa, in 2001 and my term as President started in Athens, Greece, in 2003. John Williams took office in Vienna, Austria, in 2005 and I continued for two more years as Past-President. Being involved in IAOMS affairs for so many years had a profound impact not only on my career but on my whole life. I was fully committed to the job, so much so that two weeks after handing over to John Williams I had a coronary event and four stents placed. I am very proud of having served on the Executive Committee, but most of all, of the many, many friends that I made all around the globe. What are the qualities you most value in a career academic surgeon? To be open minded, to teach young colleagues surgical skills and knowledge together with respect and consideration for the suffering of others. October 2017

“Globalization and social networks have had an enormous influence on research and practice in our specialty”

What are you currently reading? I am reading Truman Capote’s “Short Stories”, Joseph Campbell’s “The Power of Myth” and Abraham Eraly’s “Gem in the Lotus”. Some years ago I developed the habit of reading more than one book at the time. ■ iaoms.org 35

Beyond O.R.

Blue or Red? By Javier González Lagunas (follow me on



o, I do not intend to talk about American politics (or maybe I should?). This time I am talking about marketing strategies.

Imagine a sea full of fish. You are a young fisherman, you move to the nearest harbour looking for your share of the catch, only to find out that dozens or hundreds of other fishermen occupy “your” space: young and old, experienced and novices, good and bad, they all had the same idea. Working there will become a nightmare. Too many hunters, too little to hunt. The spilling of blood will taint in red the ocean’s waters, because of the fierce competition. The Blue Ocean Strategy presented in 2005 by W. Chan Kim and Renée Mauborgne will want to make you rethink your business. Both authors are reputed professors of Business Strategy in INSEAD, one of the prestigious Business Schools in the world. Blue Ocean strategy is based on renewing the idea of the situations of competition among the companies in an innovative way, with an emphasis in breaking the traditional rules of business. In addition, its main drive is the motivation to create new markets and generate value in an innovative form. It tries to align innovation with utility, price and cost and suggests that both service differentiation and lower costs are achievable simultaneously. It consists of dividing the market in a Red Ocean and a Blue Ocean with differences among them: the Red Ocean is a crowded marketplace: it competes in the existing market space, it challenges the competition, exploits the existing demand, and obliges to choose between differentiation and low cost. On the other hand, the Blue Ocean creates a new market space without competence, so that the competition becomes immaterial and irrelevant, creates a new demand, breaks the value cost of trade off and finally the whole system aligns to achieve differentiation and low cost simultaneously.

controversies regarding animal abuse, and a dramatic decline of people attending the shows. They created a market totally alien to the traditional circuses, innovating shows full of music, dance, color and artistes, thus converting circus to a show for adults. So, rethink your practice and lead your practice or department to an ocean where your patients feel there is an added value, and your service is unique. Its application in medicine is not easy, because health professionals are not keen to disrupt the status quo. Think for instance on the introduction of the Da Vinci Robot in surgery. Kim and Mauborgne describe different steps in global strategy. For instance, The Four Actions Framework and the ERRC grid: ✔ Eliminate. Which factors that the (health) industry takes for granted should be eliminated? ✔ Raise. Which factors should be raised well above the (health) industry standard? ✔ Reduce. Which factors should be reduced well below the (health) industry standard? ✔ Create. Which factors should be created that the (health) industry has not seen before? Or, four key organization hurdles to overcome: political, motivational, resources and cognitive. If your goal is to create and retain customers in your practice, you will need to adopt some marketing strategy. Blue Oceans offers value through innovation in a new market with limited competition. A good Blue Ocean strategy is the one that is difficult to imitate. Definitely a book worth reading to open your mind. ■

A classic example of the Blue Ocean strategy is Cirque Du Soleil, the Canadian company that challenged the industry of the circuses. It was a difficult time for the circus houses, with 36 iaoms.org

October 2017

2017 Annual Appeal Investing in Our Specialty’s Future

The Foundation has raised nearly $400,000 toward our 2017 goal of $500,000. Your gift can help us get there. Join us today! Visit www.iaoms.org/foundation or email donate@iaoms.org to make a gift.

Advancing global care standards through education and training. October 2017

IAOMS Foundation 8618 W. Catalpa, Suite 1116 Chicago, Illinois 60656 USA

iaoms.org 37

Phone: +1.773.867.6087 www.iaoms.org/foundation

Everyone has something to share... What’s your OMS story?

8618 W. Catalpa Ave., Suite 1116, Chicago, IL 60656 U.S.A. www.iaoms.org 38 iaoms.org

October 2017

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