Face to Face® April 2021 by IAOMS

Issue 64 / April 2021

Editor-in-Chief

Deepak Krishnan

Assistant Editors Noor Al Saadi Lilis Iskandar

Graphic Designer María Montesinos

Executive Committee 2020-2021 Board of Directors

Gabriele Millesi, President Alexis Olsson, Past President Alejandro Martinez, Vice President Sanjiv Nair, Vice President-Elect Arthur Jee, Treasurer Larry Nissen, IAOMS Foundation Chair Mitchell Dvorak, Executive Director

Members-at-Large Piero Cascone

Rui Fernandes Fred Rozema

Regional Representatives

Imad Elimairi, Africa Tetsu Takahaski, Asia Nick Kalavrezos, Europe Leopoldo Victor Meneses Rivadeneira, Latin America Ian Ross, North America Jocelyn Shand, Oceania Nabil Samman, Editor-in-Chief, IJOMS

Committee Chairs

G.E. Ghali, Education Alejandro Martinez, Governance and Ethics Alfred Lau, Membership and Communications Sean Edwards, Research Paul Sambrook, IBCSOMS Representative David Koppel, 25th ICOMS-2021, Glasgow Ed Dore, 26th ICOMS-2023, Vancouver FACE TO FACE Registered in U.S. Patent and Trademark Office. ©Copyright 2018. I nternational Association of Oral and Maxillofacial Surgeons. Chicago, Illinois, USA. All rights reserved under international and Pan American copyright conventions. Cover image Adobe Stock

International Association of Oral and Maxillofacial Surgeons IAOMS Foundation 200 E. Randolph St., Suite 5100 Chicago, IL 60601 USA / communications@iaoms.org

A FOCUS ON VIRTUAL EDUCATION THANK YOU to all those that either joined or renewed their membership with IAOMS in 2021. IAOMS continues to develop educational programs that allow OMF surgeons to learn, connect and grow with one another from a virtual setting. We look forward to sharing some exciting news with you about upcoming education programs including brand new segments of the IAOMS Microlearning Series focused on cosmetics, and all new episodes of the IAOMS Podcast Series. The IAOMS Foundation will also release a special set of podcast episodes in honor of the 25th Anniversary of the IAOMS Foundation. But for now, we hope you enjoy some of our content available on-demand. Be sure to sign up for IAOMS communications and follow us on Instagram, Facebook, Twitter, and LinkedIn to be the first to hear the latest news from IAOMS.

CONFERENCES & E-LEARNING IAOMS/ALACIBU NextGen Online Conference: Thank you to all those that attended the IAOMS/ ALACIBU NextGen Online Conference. We are proud to share that over 1,000 participants from 69 countries attended the conference over the course of five days. We are grateful to the planning committee and to all the speakers and moderators who volunteered their time to build an engaging and dynamic scientific program. We would also like to recognize our emerald level sponsor KLS Martin Group for their support of this conference. If you were unable to attend live or would like to revisit the program, recordings of all sessions are now available on demand via www.iaoms.org under the e-learning portal. Participants will receive 2.5 CPD points per session. We hope you take advantage of this opportunity. IAOMS Virtual Conference in collaboration with Osteo Science Foundation: We are excited to announce that the IAOMS Virtual Conference in collaboration with Osteo Science Foundation will return for another year! Mark your

calendar to join us June 9, 2021. More details regarding speakers, moderators and topics for the conference will be announced in the coming weeks. Don’t forget – the 2020 IAOMS Virtual Conference in collaboration with Osteo Science Foundation is still available ondemand. We hope you catch up on last year’s scientific program presented by Dr. Sean P. Edwards, Dr. Nardy Casap, Prof. Shahram Ghanaati, and Dr. James C. Melville, and moderated by Dr. G.E. Ghali, Dr. Robert Sader, Dr. Majeed Rana, and Dr. Michael Markiewicz. We will see you in June for the next IAOMS Virtual Conference! On-Demand E-Learning Programs: Our robust catalog of e-learning programs is available on-demand 24/7. Visit www.iaoms.org to view the latest IAOMS Scientific Webinars, IAOMS Virtual Symposia, the IAOMS Microlearning Series and more available to IAOMS members and non-members. • IAOMS Scientific Webinar: “TMJ Ankylosis: Pathophysiologies and Treatments” presented by Dr. Joël Ferri (French) Members Only • IAOMS Scientific Webinar: “Artificial Intelligence in Surgery – Will a Computer Program Replace the Surgeon?” presented by Dr. Deepak Krishnan Members Only • IAOMS Scientific Webinar in collaboration with ALACIBU: “Paradigms in Dentofacial Corrections from Classic to Virtual Planning and Surgery” Open to All • IAOMS Virtual Corporate Symposia sponsored by AOT: “Cold-ablation Robot-guided Laser Osteotomy -First Clinical Experiences in Orthognathic Surgery-” Open to All

Mitchell Dvorak EXECUTIVE DIRECTOR, IAOMS

Letter from the President

Dear IAOMS Members & Friends, A warm welcome to all of you in a new year while we are still fighting with similar conditions as last year! Nevertheless, at least some of us had the privilege to receive the vaccination, and in combination with further testing and wearing masks, we all hope that we will get back some of our freedom. In the meantime, IAOMS is working hard to accompany you in our new normality by supporting you with information and educational programs. An absolute highlight at this start of 2021 was our joint venture with ALACIBU, organizing the IAOMS/ALACIBU NextGen Online Conference. This was put together with enthusiasm from leadership on both sides, as well as the strong support of our Headquarters. We would also like to thank our emerald sponsor, KLS Martin Group, for their support of this conference. Over the course of five days, the conference focused on different fields of our specialty, with presentations from senior surgeons and young surgeons, all of which are ALACIBU and IAOMS members. It was a harmonious show of scope of knowledge and expertise. This new format of engaging the NextGen community directly in an online conference was well received. We had over 1000 registrants and approximately 500 per day from all over the world! Thank you to all speakers, moderators and especially to

our participants! IAOMS is planning to repeat this successful format of a NextGen Online Conference with other regional associations in the future. On the 13th of February we all celebrated International Day of OMS. I want to emphasize that we all celebrated as it was amazing to follow the innumerable posts on social media with the logos and graphics and virtual pictures of our surgeons in the OR or with patients. This day mirrored all our enthusiasm for our great specialty of Oral and Maxillofacial Surgery! A day of purpose means

to encourage people to reflect and create understanding on their purpose. An even longer tradition is the International Women´s Day held on the 8th of March. Originally it was the National Woman´s Day, created by the Socialist Party of America in 1909. But since 1977, the United Nations have begun to celebrate the International Women´s Day as a reminder of what has been achieved successfully in the past for females, however still needs to be improved. As a further step to a balanced and equal professional

“An even longer tradition is the International Women´s Day held on the 8th of March. Originally it was the National Woman´s Day, created by the Socialist Party of America in 1909. But since 1977, the United Nations have begun to celebrate the International Women´s Day as a reminder of what has been achieved successfully in the past for females, however still needs to be improved.” future, I want to highlight that a Women’s Leadership Initiative was launched, affirmed by different associations such as IAOMS, AAOMS and OSF. NextGen and senior OMS speakers can register on the Women’s Leadership Initiative platform for the opportunity to be a speaker for future conferences. The platform is kindly provided by Osteo Science Foundation, but any registration is independent of any membership to any association. You can read more about the Women’s Leadership Initiative in this Issue of FACE TO FACE. I want to congratulate all our colleagues on a successful International Day of OMS and an International Women´s Day! To our members and friends, I want to wish you all sparks of joy, luck and health to you and your families! And do not forget, we are looking forward to meeting once again in person. With my warm regards,

Gabriele Millesi IAOMS PRESIDENT 2020-2021

CONTENTS April 2021 8

CHITCHAT 6 surgeons share their favorite procedures and... why they are so!

LIKE MOTHER, LIKE DAUGHTER...

COUPLE SURGEONS

3rd WOMEN IN OMS SYMPOSIUM

SPECIAL REPORT TRAIL BLAZERS Elaine Steubner, first OMS in the US. Irene Munzhulele, South Africa. Edvita Leibur, Estonia. Alicia Dean, Spain. Mª Luisa Lopez-Delgado, México. Ida Ayu Astuti, Indonesia. Debra Sacco, USA. Samira Mustafa Osailan, The Kingdom of Saudi Arabia. Ismat Ara Haider, Bangladesh. Chiara Copelli, Italy.

FROM ANZAOMS Women leadership extraordinaire!

THE NORDIC SUCCESS STORY Four women in Oral and Maxillofacial Surgery from four Nordic countries.

IAOMS PODCAST SERIES FEATURING SUZANNE MCCORMICK The opiod crisis and pain management across the globe.

A SLICE OF LEADERSHIP Women leaders in OMS organizations worldwide.

FOUNDATION CHAIRMAN REPORT

WOMENS LEADERSHIP INITIATIVE Be seen and have a voice.

HOW I DO IT Radial forearm flap.

NEXTGEN ALACIBU virtual meeting.

NEW PUBLISHING A Gift from AOMSI.

TAIL PIECE The truth about...

INSPIRE… THERE are many matriarchal cultures in the world. I was born into one such culture where my grandmother was the quintessential matriarch, owned all the wealth, called all the shots and while technically my maternal uncle would have been my guardian, I was born at a time when the winds of change were sweeping the sands of timehonored traditions from under that culture. I have always wondered about the factors that caused that cultural shift, why that matriarchy had to change. I remember my grandmother saying that one should never make any major decisions without having a woman at the table. And, I believe she was right. If only women wrote history…. Every tale and myth, every regime and power, every rebellion and war, and every religion and faith would probably have a different color and sound in the pages of humankind’s story. This issue of Face to Face is the story of women in OMS. We bring you trailblazers, who shattered every glass ceiling, swam against every tide and standing proud and strong as an OMS in different parts of the world. They represent various regions of the world. Our data suggests that the gender disparity in OMS is significantly varied across the globe. While most countries in South America have an average of 27% women surgeons (Nicaragua = 40%, Argentina =34.6%, Guatemala 7%, Costa Rica = 17.3%), North Americans lag behind under 10% women representation in our profession. Only about 31 % of Association of Oral and Maxillofacial Surgeons of India (AOMSI) members are women, despite having a spectacular number of women dentists in that country. Some European regions such as the Scandinavian countries have had a phenomenal success in attracting women to our specialty. You will find an article regarding their success featured in this issue and gives us all a lesson in how to improve gender diversity in our profession. I have called upon many friends and colleagues from all over the world to create content for this issue. One of the hardest features was finding mother-daughter surgeons

in our specialty. After searching high and low, we did find a few, and that page is a real treat. We also found several OMS couples on our globe trot and that was a fun picture album to create. Special credit to Elizabeth Gruber from London who shared pictures of their special wedding cake with drills and saws. My friend Stephanie Drew recalls a story from 2005, at the Vienna ICOMS. Serendipitously three friends, Drs. Gabi Millesi, Suzanne McCormick and Stephanie Drew were taking a break from the conference and sipping a few cocktails at a local restaurant and started talking about the challenges of being a woman OMS. They probably did not realize that, that afternoon, they formed an unofficial alliance of women thought leaders who have spearheaded a revolution in our profession, each of them making gender equality in OMS a mission of their lives. Within the next few pages, you will find reports on two startup movements that propels that mission further – the Women in OMS symposium and the WOMenS leadership initiative. These are both fertile grounds for new leaders who will change the landscape of our profession forever. Stephanie maintains notes she made on a paper napkin from that restaurant of that fateful afternoon as a blueprint and a memoir. Here is to hoping that these stories will inspire a generation of surgeon of all sexes, and my two daughters that a kind heart, selfless service and countless hours of training is what is most important to be called a surgeon, and that once you become a surgeon, that is your primary identity and privilege. Nothing else matters… Acknowledgement: Special thanks to Henry Garcia Guevara, Pritham Shetty and Stephanie Drew for their contributions to this column.

Deepak Krishnan EDITOR IN CHIEF

Sonal Anchalia INDIA

BIPLANAR DISTRACTIONS – slowly sculpturing and molding that callus over a month is so rewarding when you see the results and a grateful patient. Totally worth it.

Patricia Bordbar MELBOURNE, AUSTRALIA

I enjoy ALL ORTHOGNATHIC SURGERY, because they are not all the “S.A.M.E”

Indradewi Sutikno JAKARTA, INDONESIA

INTERPOSITIONAL TMJ ARTHROPLASTY, TMJ surgery is always difficult but always fun.

SURGEONS SHARE THEIR FAVORITE PROCEDURES AND...

Laura Pachecho Ruiz MÉXICO

re so! why they a

LEFORT I MAXILLARY OSTEOTOMY – the drama of the downfracture fascinates everyone, every time.

Jennifer Woerner SHREVEPORT, USA

CLEFT LIP REPAIR – a profound impact on the child, normalizes their face, makes care for the child easier, improved bonding and is the first step of my relationship with the family.

Noor Jabbar MUSCAT, OMAN

The beauty of POST-TRAUMATIC FACIAL RECONSTRUCTIVE SURGERY lies in hopes that come with restoring what have been lost in a sudden unfortunate moment.

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Patricia Cavalcante and Maria Aparecida Cavalcante. Rio de Janeiro, Brazil

Maria Carolina de Sousa Melo from São Paulo and Maria do Amparo de Sousa Farias Melo from Teresina. Piaui, Brazil

Dr Ermelinda Da Ponte and Dr Victoria A. Mañón. Kingwood Texas, USA

LIKE MOTHER, LIKE DAUGHTER two generations of women OMSs April 2021

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3rd WOMEN IN OMS SYMPOSIUM March 2021 By Elda Fisher Chapel Hill, North Carolina, USA

The Women in OMS Symposium, led by the Women in OMS Consortium through the University of Michigan, held its third Annual Meeting on March 5th-6th 2021. Over 250 participants attended this symposium, representing a broad demographic of women and men in all phases of their careers - from students to long time practicing surgeons. The theme of the meeting - this year held as an allvirtual symposium - was “Amplify”. Presentations focused on three areas for amplification of the woman surgeon: “Amplify Me”, “Amplify Her” and “Amplify Us.” “Amplify Me” focused on finding purpose and balance as a female surgeon. Speakers included women surgeons and life coaches for physicians and executives. Lead discussions aimed at refocusing on one’s goals, passions and commitments to personal life and surgery. “Amplify Her,” sought to focus on bringing others ideas to the table. Lectures included strategies for successful mentee/mentor relationships, sponsorship, and recognizing & effectively addressing bias in the workplace. The “Amplify Her” section featured keynote speaker Dr. Alison Davis-Blake, former president of Bentley University and renowned expert in leadership, strategic planning, and creating high-performance teams. Dr. Davis-Blake delivered a compelling talk on Leadership Development for Women.

took full advantage of small group discussions and the opportunity to pose direct questions to panelists.

The final conference section, “Amplify Us,” focused on career development in stages and specific arenas of surgery, including residency, private practice, academia, and within larger regional and national organizations. Throughout the symposium, attendees

The Women in OMS Symposium received gold-level sponsorship from KLS Martin, silver-level sponsorship from OMSNIC, Biohorizons and Stryker, blue-level sponsorship from Minne Ties and Geistlich, and symposium support from Osteo Science Foundation. ■

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(1) Alison Davis-Blake, PhD; (2) Janet Dombrowski, MHSA; (3) Robin Gallardi, DDS, MSc; (4) Rania Habib, DDS, MD; (5) Cathy Hung, DDS; (6) Antonia Kolokythas, DDS, MSc; (7) Erica Newman, MD; (8) Debra Sacco, DMD, MD; (9) Chi Viet, DDS, MD, PhD; (10) Ashleigh Weyh, DMD, MPH; (11) Niha Wunnava, MHSA, FACHE.

(1) Justine Moe, DDS, MD, University of Michigan. (2) Tara Aghaloo, DDS, MD, PhD, University of California, Los Angeles. (3) Carolyn Brooks, DMD, MD, Private Practice. (4) Elda Fisher, DMD, MD, FACS, University of North Carolina. (5) Sara Anderson, DDS, MD, University of Michigan. (6) Karen Carver, DDS, MD, MPH, Boston Children’s Hospital. (7) Kelly Sayre, DDS, MD, University of Alabama. (8) Catherine Haviland, DDS, University of Michigan. (9) Karen He, Harvard University

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TRAIL BLAZERS “A tribute to womens OMSs all over the globe who pushed the envelope for every little girl who wants to become a surgeon. Narratives from the heart, lessons to live up to…”

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ELAINE STUEBNER

United States

BLAZING TRAILS AND BREAKING GLASS CEILINGS The passions of a warrior for equality in Oral and Maxillofacial Surgery

By Stephanie J. Drew Atlanta, USA

LUCY HOBBS TAYLOR was the first woman to graduate from Dental school, and Dr. Emeline Jones was the first woman to obtain a license as a dentist in the USA. This was the time of Women’s Suffrage in the United States, and women would not be allowed to vote nor admitted to dental schools. Although they both studied dentistry, they had to become apprentices to practice. Dr. Jones finally established her dental practice in 1858, whilst Hobbs was not admitted to the college of dentistry and was not able to graduate until many years later in 1866.

1866

LUCY HOBBS TAYLOR

Almost 100 years later, DR. ELAINE ALICE STUEBNER graduated as the first female OMS from the Cook County Hospital oral surgery residency program. On October 1, 1960, she became a member of the American Society of Oral Surgeons (now known as American Association of Oral and Maxillofacial Surgeons (AAOMS)). She is also the first woman certified as a diplomate to the American Board of Oral and Maxillofacial Surgery (ABOMS). Dr. Stuebner’s career was full of leadership and teaching roles in our profession. After attending dental school at the University of Chicago, she served a one year internship at the University of Illinois research and education hospital, then the following year as a resident in the department of Anesthesiology. In 1957 she became an oral and maxillofacial surgery resident at Cook County Hospital training program.

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1960

ELAINE ALICE STUEBNER

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Dr. Stuebner passed away on June 28, 2007. Her obituary read as follows: No one can argue that Dr. Stuebner not only broke the glass ceiling, but she gave back to the profession through lifelong learning, mentoring and leadership. It is in her honor that the American College of Oral and Maxillofacial Surgeons (ACOMS) has created a scholarship for women.

After completing residency, she became full time faculty at the University of Illinois College of dentistry and trained and mentored both dental students and residents in both surgery and anesthesia. She was appointed professor in the department of Oral Diagnosis. Dr. Stuebner was very active in the dental profession. She was the second vice president of the American Dental Society of Anesthesiology. She was president of Upsilon Alpha. She was a member of Omicron Kappa Upsilon Honor Society and fellowship in the American College of Dentists. She also was elected as a distinguished practitioner of the National Academies of Practice. Dr. Stuebner passed away on June 28, 2007. Her obituary read as follows: No one can argue that Dr. Stuebner not only broke the glass ceiling, but she gave back to the profession through lifelong learning,

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mentoring and leadership. It is in her honor that the American College of Oral and Maxillofacial Surgeons (ACOMS) has created a scholarship for women. Change has been slow when it comes to increasing gender diversity in dentistry. As of 2020, there are 201,177 dentists practicing in the US, 34.5% are female. While dental school enrollment for women has equaled or passed parity in some schools, in the specialty of Oral and Maxillofacial surgery, we have a long way to go. Gender equality is not present yet in our oral and maxillofacial surgery residency programs. Less than 15% of the total OMS trainees in the United States are women. Although over sixty years have passed since Dr. Stuebner became an oral and maxillofacial surgeon, the number of women in our specialty has been increasing very slowly. In the United States, Women account for less than 10% of our specialty membership at AAOMS and 15% at the ACOMS. Women are leading on committees, in their hospitals and on various boards, as the students are more exposed to women in these leadership positions, perhaps they will inspire the next generation of women applicants to our training programs. Dr. Stuebner led the way, setting the example in mentorship, teaching and giving back. Now we need to follow her lead and continue to shatter a bit more glass. ■

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02 IRENE-MUNZHULELE South Africa THE TRAINING OF FEMALES as Maxillofacial Surgeons (MFOS) was a very rare occurrence in South Africa. This applied to all races: Blacks, Whites, Indians, and MixedRace citizens. When I started the training program, there was just one white woman who finished the training at the University of Pretoria (UP). I was born in a rural village of Venda, South Africa, and was the first generation in my family to go to a university. I was the first black female to qualify as a Maxillofacial Surgeon in South Africa in 2008, and was also the first black person to qualify as a Maxillofacial Surgeon with dual qualifications in both Dental and Medical degrees (BChD and MBChB).

only”, and “It is for individuals who are medically and dentally qualified only”. Even after I was finally given an opportunity, it was not an easy journey of breaking the barriers of gender, race, and prejudices. I am grateful for my mentor, the Head of Department (HOD), Prof K-W Butow, who believed in me. Just knowing that he believed in me propelled me to forge on under very difficult circumstances as a black female with a family and responsibilities thereof. During the eight-year of training, I acquired the MBChB as well as the MChD in MFOS. My mentor also encouraged me to take the college exams, through which I acquired a fellowship

of female MFOS with some ongoing female trainees in the program. Circumstances have improved for female specialists in the profession in all four institutions. However, room for improvement remains, especially in terms of gender equality. Despite all the challenges I faced to enter the field, now that I am in, the acceptance by my colleagues, both males and females across the racial divide is overwhelmingly positive, for which I am utterly grateful. Since the beginning of my career journey, I have accumulated several qualifications, which are BChD (Medunsa), DipOdont in Oral Surgery (UP), MBChB (UP), MChD MFOS

Reasons for my rejections include: “Specialization is for males only”, “It is for whites only”, and “It is for individuals who are medically and dentally qualified only”. Even after I was finally given an opportunity, it was not an easy journey of breaking the barriers of gender, race, and prejudices.

If I were able to choose, I would have liked to start my journey to specialize when I was younger. However, I was being overlooked, thus I started the specialization when I was already in my late 30s. Just getting into the program took me eight years of unsuccessful applications at four major institutions offering MFOS training in South Africa. Reasons for my rejections include: “Specialization is for males only”, “It is for whites

of MFOS offered by Colleges of Medicine of South Africa (CMSA). Following my qualification, I have worked as an MFOS specialist for the South African Defence Force and in private practice. I am also the first black Female HOD in our specialty at the Sefako Makgatho Health Sciences University (SMU), formerly known as Medunsa. Since serving as the HOD, I have trained a couple

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(UP), FCMFOS (CMSA). Recently, I have acquired a Teachers Diploma in Health Sciences Education (PGDHSE) from WITS University to align myself with the demand of academic teaching of both undergraduate and postgraduate students. I am committed to continue the journey of transformation for those who are deserving, so they too, may have the opportunities I have been given. ■

EDVITAR LEIBUR

a i n o t s E

EDVITAR LEIBUR is currently a professor emeritus at the University of Tartu in Estonia. She gives lectures in oral and maxillofacial surgery to the undergraduate and postgraduate students. Since 1975 she has been a staff member at the department of stomatology at the University of Tartu and a maxillofacial surgeon at the Tartu University Hospital. Between 1988 and 2003, she was a professor at the department of stomatology at the same university. Prior to starting academic career, she worked as a stomatologist surgeon at the regional hospital of Tartu/ Elva for 15 years. During that period, she moved to India with her family for two years (1969 – 1970) where she worked as an honorary dental surgeon and researcher at the medical institute of Banaras Hindu University. She was also working at Maxilla private clinic since 1989. She has performed various administrative activities as a vice dean and council member of the faculty of medicine at Tartu University, councillor and member of the European Association of Cranio-Maxillofacial Surgery and a president (1997 – 1999) of the Baltic Association of Maxillofacial and Plastic Surgery. She has been principal investigator of several grants financed by Estonian Science Foundation and a supervisor of six PhD thesis. Prof. Leibur completed her PhD thesis in 1973 at the Medical Institute of Riga, and Dr. med. Sc. thesis in 1987 at the Sankt-Petersburg´s Ist Medical Institute. In total, she has around 180 publications. In the last few years, her researches were dedicated on temporomandibular joint disorders and salivary glands pathosis. Facial And Mandibular Lesions University of Tartu, 2005.

She has two sons (violonist and surgeon) and nine grandchildren. ■

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04 ALICIA DEAN FERRER

Spain

I STUDIED medicine at the University of Navarra’s School of Medicine, Pamplona, Spain. My residency training in Maxillofacial Surgery was in the Department of Oral and Maxillofacial Surgery, La Princesa University Hospital, Madrid, Spain. I completed several fellowships in Switzerland, Germany and Belgium. I am also a fellow of the European Board of Oral and Maxillofacial Surgery since 1998 and Master in Research Methodology in Health Sciences. I lead the Department of Oral and Maxillofacial Surgery, Reina Sofía University Hospital, Córdoba, Spain since 2008 and serve as the Head and Director of the Head and Neck Cancer Clinical Committee of the

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same university since 2005. The University Hospital Reina Sofía is a leading and reference hospital for organ transplantation in Spain. At the Medical School of that university, I teach OMS as the Associate Professor of Surgery, and I have been in charge for the Maxillofacial Surgery Training Program. I have published numerous research articles and several book chapters on OMS. I was the President of the National Congress of the Spanish Society of Oral and Maxillofacial Surgeons (SECOM) in 2013. I currently serve as the Associate Editor of the Spanish Journal of Oral and Maxillofacial Surgery (Revista Española de Cirugía Oral y Maxilofacial).

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I am a Member of the European AO-CMF Faculties since July 2003, and have participated as a Faculty in several AO courses all around the world. I have been the Director of several AO courses, such as a Principles course in 2008 and an Advanced Course on Virtual Planning and Surgical Navigation in 2017.

I have also served as an examiner for the European Board of Oral and Maxillofacial Surgery. My fields of interest are reconstructive surgery with special interest in microsurgical reconstruction, traumatology and oncology. I have also developed special techniques in surgical planning and navigation applicable in oncology, reconstructive, traumatology, skull-based, temporomandibular joint, and orthognathic surgeries. In Spain, our department is the pioneer in the development of these new technologies in maxillofacial surgery.

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I have a great interest in research and education, and wish to improve the knowledge and skills in microsurgical reconstruction of the head and neck cancer patients in order to improve the results and quality of life of the patients. Besides being the Head of Department, I am a devoted housewife with four daughters to take care of, and a husband who shares with me the passion for Oral and Maxillofacial Surgery (and I am his boss!). ■

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Mª LUISA LOPEZ SALGADO

Mexico

I DISCOVERED Maxillofacial Surgery in the second year of dentistry during my visit to the Children’s Hospital in the city of Toluca. When I saw a cleft lip surgery for the first time, I realized what I wanted to do in my professional life. After my training in Maxillofacial Surgery at the National Medical Center XXI Century Specialties Hospital (IMSS) and being a visitor at the University of Northwest in Chicago and Case Western Reserve University in Cleveland, Ohio, I had the opportunity to enter the Children’s Hospital in Toluca, Mexico State as an assigned physician. Having performed pediatric maxillofacial surgery, either in cases of facial trauma, pathology, or cleft lip and palate deformity, I found that there is no greater satisfaction than the smile of a child. The resilience of pediatric patients is extraordinary and continues to amaze me to this day. I have had the honor of being part of the group of professors in charge of training new maxillofacial surgeons from different national and international training centers since 2000. The satisfaction of being able to sow a small seed in the future of these young generation is invaluable. I have been honored to be invited by the directive committees of different associations and schools as part of their committees. Being the first woman president of the Mexican Association of Cleft Lip and Palate and Craniofacial Anomalies A.C. from 2014 to 2016 was particularly special. I worked in a multi-specialty association together with plastic and pediatric surgeons. It was a challenge to break the paradigm in leading this association. It was my honor for having had the opportunity to highlight the importance of our specialty during my role in directing the Mexican Association of Oral and Maxillofacial Surgery, College from 2017 to 2019. I am also delighted to serve as the Editor of the Journal of Oral and Maxillofacial Surgery since 2002.

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"Having performed pediatric maxillofacial surgery, either in cases of facial trauma, pathology, or cleft lip and palate deformity, I found that there is no greater satisfaction than the smile of a child." One of my satisfaction is having been able to participate in the cleft lip and palate surgical programs, both in Mexico and in some Latin American countries, through which I shared with a group of excellent surgeons, anesthesiologists, nurses, and local volunteers. For me, professional development in any discipline means always striving at the forefront. I never considered that being a woman in the world of maxillofacial surgery was a limitation to develop my professional skills; Today more and more women fight, prepare and participate successfully in a number of disciplines, transcending the prejudices with dedication, effort and commitment. We are now fortunate to have the privilege to pursue our passion and dedication. May this momentum bring satisfaction and a big smile to everyone at the end. ■

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IDA AYU ASTUTI

Indonesia

DR. ASTUTI is one of the first female OMS in Indonesia who serves as a lecturer in the Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Padjadjaran University, Bandung, West Java since 1981. She is also a lecturer and instructor on orthognathic surgery at the Faculty of Dentistry, North Sumatera University since 2006. She is the Head of the Indonesian Cleft Center since 2006 and the Head of Indonesian Cleft Foundation since 2014, as well as one of the councilors in the International Cleft Foundation. She is also the Vice President of Indonesian Society for Special Care Dentistry. She was the former Head of Department of OMS in Padjadjaran University/

Hasan Sadikin General Hospital (1998-2006), former President (2008‑2011) and former General Secretary (2000-2004) of the Indonesian Association of OMS, as well as former Chairperson of the Committee of National Examination at Indonesian Collegium of OMS (200-2008). Together with her mentor, Prof. Tet Soeparwadi, they have contributed to the establishment of OMS in Indonesia and engaging the global community in research and education. Prof. Soeparwadi and Dr. Astuti have been duo role model figures to Indonesian female OMS.

SMALL STEPS TOWARD THE FUTURE AS the Indonesian Association of Oral and Maxillofacial Surgeons was founded, there was no formal education yet. Members are called "oral surgeons" based on different amount and kind of experience through exposure to the oral surgery cases. It is not until 1979 where a formal postgraduate study program on OMS was first established in Padjadjaran University, Bandung, West Java. Professor Tet Soeparwadi was among the founders and first students of OMS residency. She set a milestone for the existence of OMS in Indonesia.

In 1979, I graduated as a dentist and was working and teaching at the Faculty of Dentistry, Padjadjaran University, a junior to Tet Soeparwadi. I have had the opportunity to observe, learn and follow her lead to be very determined and to stand up for the goal of achieving the competence as an OMS.

Ida Ayu Astuti, Tet Soeparwadi, Lois Greenwood (was the Director of Smile Train - one of major donors for the cleft foundation).

Even in 1986, as I finished the OMS postgraduate program, the struggle for existence, to work in a main hospital, in the OR, to be included in the interdisciplinary team, even to participate in some meetings was still very tough. The hardest challenge is not from the outside, but rather from fellow Indonesian OMS who are reluctant to touch the overlapping competence with other scalpel-holding professions. Tet Soeparwadi held the most significant role in the set-up of a complete and modern operating theatre in Hasan Sadikin General Hospital, Bandung. Through a grant from Japan International Cooperation Agency (JICA), she supplied various equipment needed in the OR, including the hand instruments for major oral and maxillofacial surgery,. This was the first major step in establishing the OMS facility in our center. The second essential step in establishing Indonesian OMS specialty was ensuring the supply chain of patients. For cleft cases, the Indonesian Cleft Center has been facilitating pro bono surgery performed by the OMS in Hasan Sadikin General Hospital which enables us to prove our skills and knowledge. During my service, the OMS health service in the Hasan Sadikin General Hospital, which was once a section under Dental Policlinic, was incorporated into the Department of Oral and Maxillofacial Surgery, and has gain more access to in-patient, ER and OR cases. After a substantial rebuilding of the hospital, we are now allowed to occupy two ORs.

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Unfortunately, the three other centers of education for OMS face much more complicated matter which hinders us to exchange residents among the four centers. The third, and ongoing step to be taken is the standarization of the OMS competence through education. On behalf of the Indonesian Association of Oral and Maxillofacial Surgeons, I propose to the Educational Foundation of IAOMS to provide short courses by international experts to help us meet the international standard of basic knowledge in the field of neoplasm, trauma, orthognathic surgery, and cleft lip and palate in Jakarta and Bandung. ■

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07DEBRA M. SACCO

United States “Dr. Sacco currently serves as a Trustee for AAOMS. She is the first and only woman to have held that position.”

DR. SACCO grew up in New York and spent her last thirty years in Chapel Hill, North Carolina. An early interest in medicine led her to volunteer in one of the local hospitals during high school, during which she shadowed an Oral and Maxillofacial Surgeon who was regularly performing orthognathic surgery. This spurred her interest in exploring OMS further. Thus, after graduating from SUNY-Binghamton, she attended the University of Connecticut School of Dental Medicine and UNC School of Medicine where she completed her internship in general surgery and residency in Oral and Maxillofacial Surgery. Thereafter, she was hired as a full-time faculty member at UNCChapel Hill. She enjoyed mentoring dental students, teaching residents, and was involved in research studies involving orthognathic surgery, erythropoietin, implants, and growth factors for bone graft reconstruction. Currently, Dr. Sacco continues to perform bone grafting, implant therapy, and orthognathic surgery in a group practice in Chapel Hill, North Carolina.

Dr. Sacco has served as an examiner for the American Board of Oral & Maxillofacial Surgery. She has lectured nationally and internationally on implants and medical issues in dentistry. During her membership and being the chair of the Committee on Practice Management and Professional Staff Development, she instructed surgical assistants in AAOMS courses. She also has served the specialty through participation and chairing numerous committees for the American Association of Oral and Maxillofacial Surgery (AAOMS), UNC and Duke Regional hospital, and OMSNIC. The desire to serve the specialty began during her residency where she was part of the founding executive committee of ROAAOMS and was elected as the vice president during the first meeting of this group. Dr. Sacco currently mentors residents through the Osteo Science foundation, serves as

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District III trustee for the AAOMS, and is the Chief of OMS at Duke Regional Hospital. Whether caring for patients, mentoring students, or spending time with family, she loves to connect with others. In her spare time, Dr. Sacco enjoys yoga, rhythm tap dancing, and reading. When traveling to attend OMS meetings, she will often pack her tap shoes and find a local class to attend. She and her husband, of thirty years, are fortunate to have two lovely daughters: Emma is 22 and has just graduated from The Fashion Institute in New York, while Alaina, 17, is a high school senior excited about entering college next year for biomedical engineering. ■

SAMIRA MUSTAFA OSAILAN

The Kingdom of Saudi Arabia I WAS BORN IN AlMadinah AlMunwara and undertook my secondary school education in my hometown. I obtained my bachelor of dental surgery from King Saud University in Riyadh, as was my Master’s and residency training in Oral and Maxillofacial Surgery in 1996. I was the first Saudi female OMF surgeon. In 1997, I got my licence as OMS specialist and started working at one of the Ministry of Health hospitals. I was the only female at my department and had few females juniors who where inspired by me to become surgeons (I only knew that later). Then I got married and had my first baby. In 2001 I travelled to the UK and studied at Kings College London (KCL) Dental Institute, from which I obtained my PhD as well as my fellowship from the Royal College of Surgeons. That same year, upon completion of the PhD, I was offered a job at KCL as a lecturer

in the Oral and Maxillofacial Surgery department. I went on to work there for seven years, during which I also achieved a Master’s degree in education. In 2010, I was appointed as the Head of Undergraduate Teaching in my department with 25 supervising members of staff. Being in that role, I developed the teaching strategy in my department and established a standardized structure, which is still followed to this day. In 2012, I was recruited by the Dean of the Dental School at King Abdulaziz University in Saudi Arabia and joined the university in 2013. I was appointed as the Postgraduate Director and was an executive member in many committees. I introduced the OSCE clinical examination to the school and I was the main organiser. I recently established the University Dental Hospital CPR centre and am currently the Director. Additionally, I am the Head of the Supervising Committee of Health Colleges for clinical skills centres and simulation in education.

I was the first Saudi female OMF surgeon. I was the only female at my department and had few females juniors who where inspired by me to become surgeons... April 2021

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I was elected twice in 2015 & 2018 to be an EC board member and the head of the Western Region Committee for the Saudi Dental Society. My stay in the UK has helped me ensure that I fulfil this role to my maximum potential through training in leadership, professional communication, public relations and media talk. ■

OBSERVING first hand from a very young age the hundreds of lives my father touched as a Doctor inspired me to pursue this noble profession. I grew up in Bogura, Northern Bangladesh, and after graduating from Govt. Azizul Haque College, I began my medical school journey after my eldest brother who is a Dental Surgeon compelled me to participate in the admission test for the Dhaka Dental College. I was admitted as a student of the 1984 Batch. Afterwards, I passed the Bachelor of Dental Surgery (BDS) Examination in 1989.

09 ISMAT ARA HAIDER Bangladesh I never imagined myself as a surgeon. I always thought that in a patriarchal society like Bangladesh, I would never be able to go beyond the duties of an Orthodontist. However, I allowed my passion for surgery, strong will and perseverance to continuously challenge myself and guide me towards becoming a Maxillofacial Surgeon.

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During that time, the opportunity for postgraduate study was not available in Bangladesh. Thus, I enrolled in a Diploma in Dental Surgery Course in 1995 and joined a Master of Surgery Course in 1998. Afterwards, I joined Dhaka Dental College as an Assistant Professor. Alongside my father and eldest brother, my senior teachers were invaluable pillars who supported and nurtured my endeavors and aspirations. Their contribution allowed me to excel and I was promoted to the position of Associate Professor and Professor in 2008 and 2015, respectively. Since 2013, I have been working in the Oral & Maxillofacial Surgery Department of Dhaka Dental College as the Head of the Department.

April 2021

I never imagined myself as a surgeon. I always thought that in a patriarchal society like Bangladesh, I would never be able to go beyond the duties of an Orthodontist. However, I allowed my passion for surgery, strong will and perseverance to continuously challenge myself and guide me towards becoming a Maxillofacial Surgeon. I knew from the very beginning that there would be insurmountable obstacles to cross as a woman in this profession, but I also knew that I had to go on no matter what. In 1993, I got married and I was extremely fortunate as my partner who was not a medical professional supported me unconditionally and sacrificed immensely in order for me to reach my aspirations. My husband, inlaws and my two sons became pillars for my success. I still fondly remember those days when my eldest son would wake me up very early in the morning and ask, “Do you not have surgeries today?” Even at my work station, my colleagues were exceedingly supportive due to my sincerity and aptitude for hard work. My support and love from my family and colleagues as well as my dedication kept me so occupied with my work that I was even able to perform quite a few surgeries even before my second child was delivered. My love for extra-

Picture by Shah Imran Sheikh

second home. I get inspired everyday interacting with my students, colleagues and patients. Even after all these years of practice, every time I see a girl dreaming about becoming a surgeon, I get validation for each and every decision I have taken towards my career. I have no words to express my sentiments when I hear a female student saying, “Ma’am, we get the courage to come to the surgery after seeing your name.” Nowadays, the number of girls in OMS is increasing as

I have no words to express my sentiments when I hear a female student saying, “Ma’am, we get the courage to come to the surgery after seeing your name.”

curriculars, especially sports led me to become the vice president of the National Women Sports Association of Bangladesh. Fast forward to 2021, I can confidently say that the quality of treatment at my workplace, The Dhaka Dental College & Hospital is on par with the numerous dental hospitals in more developed nations. However, our main issue has always been with receiving adequate logistical support. Even then, we strive to provide the best service to our patients no matter what socioeconomic background they come from. The Oral & Maxillofacial Surgery Department is also my

April 2021

well. Most girls are also able to successfully continue with her career while assisting their families. My only suggestion for female Dental Surgeons is that they should continue pursuing their ambitions and developing their careers through sincerity and hard work. My hope for the next generation is that they will take maxillofacial surgeries in Bangladesh to new heights. My overarching dream is to build a full-fledged institute of Oral & Maxillofacial Surgery specializing in the treatment of cancer, trauma, orthognathic surgery & all sorts of oral surgery. This is how I want to continue serving my patients and country. ■

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COPELLI 10 CHIARA aly

CHIARA COPELLI is an Associate Professor in Maxillo-Facial Surgery. She is currently working at the Hospital Molinette and at the School of Medicine and Surgery of the University of Turin, Piedmont, Italy. Chiara graduated in 2006 and completed her residency program in Maxillo-Facial Surgery at the School of Medicine of Parma (Head: Prof. Enrico Sesenna). During her studies, she attended the Department of Otolaryngology-Head and Neck

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Surgery of the University of Washington Medical Center (Seattle, USA) and the Department of Cervico-Facial Surgery of the Institut de Cancérologie Goustave Roussy (Villejuif, Paris). From 2011 to 2020, Chiara worked at the MaxilloFacial Surgery Unit (Head: Dr. Roberto Cocchi) of the IRCCS Casa Sollievo della Sollievo della Sofferenza, San Giovanni Rotondo (Foggia, Italy), where she was the head of the Reconstructive Surgery Unit. To date, she has carried out more than

April 2021

1,500 surgical procedures, mainly related to head and neck oncologic and reconstructive surgery. She is a member of the SICMF (Italian Society of MaxilloFacial Surgery) board since 2015. Chiara has been involved in numerous research activity, mainly in the oncologic field, has been playing

publications in international peer-reviewed journals and participated as the speaker to 95 national and international congresses. Chiara joined various humanitarian missions organized by the “Sol y Luna” non-profit association in Colombia and Perù working as surgeon on the treatment of pediatric facial malformations. Regarding her experience as a woman in surgery she says: “During my studies and my professional career, I have learned the importance of having a strong scientific mindset and technical skills, of studying, of seeking continuous improvement and excellence, and of setting long term goals. Work ethic goes beyond genders. Motivation, determination, dedication, expertise, and knowledge make both women and men real specialists. I had the opportunity to observe other working contexts in different countries and I always felt proud of the Italian healthcare system. We have a great education system, a deep knowledge and the potential to provide for the ‘optimum’.

Be unstoppable and selfdriven. Do not let anyone undermine your confidence by telling you ’it is not possible’, ’it is too difficult’, ’you will not make it’.

a key role in several international projects, such as: the "Neomark project: Risk prediction tool for Oral Cancer" - Seventh Framework Programme - European Community, InterReg Italy-Greece project MICRO "A cross-border microsurgery center of excellence for the promotion of research, training and education”, and “BD4QoL – Big Data Models and Intelligent tools for Quality of Life monitoring and participatory empowerment of head and neck cancer survivors” – Horizon 2020. She has authored and co-authored 71

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To women undertaking the journey in the surgical career, I feel like saying: be unstoppable and self-driven. Do not let anyone undermine your confidence by telling you ’it is not possible’, ’it is too difficult’, ’you will not make it’.

It is a job that certainly requires sacrifices. There will be times when doubts will arise, when life and choices will make you feel like you are drifting away from your goals and ambitions. Do not fear when opportunities seem to vanish. This will only open to new challenges and horizons which were not foreseeable or coinceivable. Be ready to grab them.We must dare to travel, experience, meet different people, see other realities and, above all, study and always improve our professional skills”. ■

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FROM ANZAOMS

Women leadership extraordinaire!

ANN COLLINS

JANET SCOTT

Ann was the first female President of ANZAOMS, being elected by the full membership. She served on many committees, and the most notable was as the long-term chair of the Research and Education Foundation. She organised several conferences held in New South Wales and organised over twenty annual Westmead conferences for advanced trainees. She was a visiting consultant to Westmead Hospital and is in private specialist practice.

Janet Scott was the Commanding Officer of the 3rd Health Support Battalion, the first non-medical officer and only the second female to hold the position. Having been an active member of the Army Reserve for nearly 30 years and having commanded the 3rd Health Support Battalion, Dr Scott has seen overseas service in Bougainville and provided an active service in East Timor. She considers the opportunity to help those less fortunate as an honor, such as when she volunteered in Vietnam performing minor surgery and extractions for orphans in Vung Tau and underprivileged schoolchildren. Her most recent task during her service on the Council of the Australasian Military Medicine Association has been to rewrite the Infection Control Manual for the Defence Dental Services.

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BARBARA WOODHOUSE

CAROLINE ACTON

JOCELYN SHAND

Barbara Woodhouse is the recipient of The University of Queensland's Vice-Chancellor's Alumni Excellence Award 2018, a surgeon, mentor, and Lieutenant Colonel Consultant to the Australian Army. Dr Woodhouse has made significant contributions to the professions of dentistry and medicine both nationally and internationally. She served eight years as the chair of the Overseas Aid Committee, coordinating the training of local surgeons in Bangladesh, Fiji, Tonga, Vietnam, Papua New Guinea, Cambodia, and Vanuatu, and continues to undertake humanitarian work internationally and is a recent recipient of a Distinguished Service Award from ANZAOMS.

Caroine Acton has spent 27 years as Maxillofacial Surgeon at RBWH, mainly associated with the Multi– Disciplinary Head and Neck Clinic including caring for patients suffering long-term effects of radiotherapy. Concurrently, she also works in a private practice. In 2012, She got the Order of St John award, recognizing her contribution to St John QLD through the Training Branch Committee and Deputy Chairperson Role. She was the Past President of Kidsafe QLD and publisher of many papers relating to injury prevention in Children. She has undertaken overseas aid work in Cambodia and Uganda.

Jocelyn Shand became the VicePresident of the Australian & New Zealand Association of Oral & Maxillofacial Surgeons in 2007, and then the President in 2009. She is a member of the Board of Studies in Oral & Maxillofacial Surgery and the current Chair of the Standing Committee. She is the Director of OMS Training for Victoria & Tasmania and sits on the Regional Surgical Committee. Dr Shand was the Chair of the Basic Surgical Training Committee and a member of the BST Examination Panel. She has published a number of scientific papers and a book chapter, and is on the editorial board of the International Journal of Oral & Maxillofacial Surgery.

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THE NORDIC SUCCESS STORY Four women in Oral and Maxillofacial Surgery from four Nordic countries

Norway

HERITAGE from the Viking era with female rulers tributed by impressive graves, initially misinterpreted by archeologists as being males, may have paved the way for women’s strong position in the Nordic countries. The challenging Nordic climate and geography likely provided traits of necessity such as diligence and endurance. The hard work under harsh conditions is sometimes given the explanation for what we call a favorable “cultural capital”. A term that seeks to explain why some nations do better. This favorable cultural capital is based on values such as trust, inclusion, and cooperation.

Capitol: Oslo Inhabitants: 5.3 million OMS total: 112 Female OMS: 35 % (n=29) Female DQ: 7 % (n=2) Female SQ: 32 % (n=27) Professors: 6 (4 female)

As our societies became more complex, the aforementioned traits were hugely important in creating wealth. This newfound wealth and traditional values of tolerance gave the lawmakers free reins to implement policies aimed at leveling the playing fields for women who want to pursue both family life and careers. Parental leave is generous, which either parent can use, daycare is available for everyone and education is free of charge. The harshness of early human existence in Nordic countries is largely forgotten by the new generations, which now rejoice in mastering the elements through play, be it skiing, skating, sailing, hunting, hiking, kayaking, biking, and camping. Equality is a key word and does not only apply to gender aspects but also in terms of culture, religion, ethnic origin, age, and sexual orientation. Despite this, women are clearly underrepresented in oral and maxillofacial surgery (OMS) in the Nordic countries although they are the dominating gender in undergraduate training both in medicine and in dentistry. This indicates a remaining gender selection for OMS (Fig. 1). Today three of the five Nordic countries, are ruled by female prime ministers. Perhaps by coincidence, these are among the most egalitarian, happy, healthy, wealthy, and peaceful countries in the world.

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Denmark Capitol: Copenhagen Inhabitants: 5.8 million OMS total: 66 Female OMS: 32 % (n=21) Professors: 2 (1 female)

April 2021

Finland

Sweden

Capitol: Helsinki Inhabitants: 5.5 million OMS total: 214 Female OMS: 29 % (n=61) Female DQ: 30 % (n=6) Female SQ: 28 % (n=55) Professors: 4 (2 female)

Capitol: Stockholm Inhabitants: 10 million OMS total: 153 Female OMS: 26 % (n=40) Professors: 3 (1 female)

**Abbreviations OMS, oral and maxillofacial surgeon; DQ, double qualified; SQ, single qualified.

DENMARK ELSE MARIE PINHOLT

PROFESSOR Else Marie Pinholt, DDS,MSci, dr.odont. (DOS) trained abroad as a resident at the Department of OMS, University of Minnesota, Minneapolis, USA (where she obtained a master’s degree) before returning to Europe for training in traumatology in Bremen, Germany. She was a research fellow for four years at the University of Oslo, Norway (her dissertation focused on bone substitutes in alveolar ridge augmentation procedures), before returning to Denmark to serve as an associate professor at the Dental School, University of Copenhagen. She then went out to hospital setting as a chief consultant surgeon performing orthognathic surgery for 15 years. In 2007, she was appointed professor and chair of the Department of OMS in the Dental School of the University of Copenhagen. As a Co-PI, she collaborated in the Excellence program CoNEXT. After seven years at the UCPH, she was appointed professor and research leader at the

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University of Southern Denmark and returned to University Hospital setting at the University Hospital South West Jutland. Research interests: 3D virtual planning and research within orthognathic surgery and on high resolution evaluation of dental implants osseointegration in reconstructed bone using stem cells evaluated by synchrotron radiation microCT (SRuCT). She is a Co-PI in the EU H2020 grant MAXIBONE. Recreation and inspiration: Else spends time on the families sailboat and kayak, in the woods of the familyhome, grandchildren, embroidery and training her Truffle dog, the Lagotto Romanoglo Nynne. ■

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FINLAND RIITTA SEPPÄNEN-KAIJANSINKKO (SUURONEN)

PROFESSOR Riitta Seppänen-Kaijansinkko (Suuronen), MD, DDS, PhD, CVM, FEBOMFS, Dr.Tech (h.c.). Riitta was the first Finn to acquire FEBOMFS title from UEMS. She has also studied veterinary medicine for 4 years before she had to quit because of severe allergies. Her PhD thesis (1993) was the first OMFS thesis on biodegradable plates and screws in maxillofacial fracture fixation.

In 2015, she was appointed as a full professor of translational research on OMF (University of Helsinki and Helsinki University Hospital), and the research group had to be formed again from scratch to study extracellular vesicles, the “secret messengers” which transport information (RNA, DNA, proteins) from cell to cell. Currently, the research is focusing merely on osteosarcoma. The research consortium led by Riitta is multidisciplinary and multinational, consisting of clinicians, engineers, psychologists, geneticists, virologists, bioinformatics, among others.

Later, in 2003, she was invited for a full professorship in Tissue Engineering Regea in the University of Tampere. Research was carried out there and the center grew from one person to nearly 100. In Tampere, research was multidisciplinary and one of the results was published in IJOMS in 2009 (Mesimäki et al), where a large maxillary defect was treated successfully with adipose-derived stem cells. Thanks to this multidisciplinary team, a smart needle (IQ Needle) was also invented and later commercialized by Injeq Ltd.

Recreation and inspiration: Riitta and her pyrenese shepherd Milli enjoy Koli, a famous natural park, where hiking is very popular. Besides enjoying the nature, golf is a dear hobby, helping her to relax. ■

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NORWAY BENTE BROKSTAD HERLOFSON

PROFESSOR Bente Brokstad Herlofson is a single-qualified DDS OMS, full time professor and consultant at the Department of Oral Surgery and Oral Medicine, Faculty of Dentistry, University of Oslo and the Unit of Oral and Maxillofacial Surgery, Department of Otorhinolaryngology -Head and Neck Surgery, Division of Head, Neck and Reconstructive

more than 1700 MRONJ cases have been enrolled and registered with the assistance from OMS in Norway, Sweden, and Denmark. The initial purpose of the cohort study was to support a regulatormandated post-authorization safety study on Denosumab and Zoledronic acid in cancer patients in the three countries.

Her operating theaters, managing a carbon oar with the precision of a scalpel.

Rocksolid attachments, starring Otrøya and Daniel Laskin.

Surgery, Rikshospitalet, Oslo University Hospital. She has been the president of the Norwegian Association of Oral and Maxillofacial Surgeons from 2006-2012, a member of the University Faculty Board 2013-2020, and the Norwegian councilor for IAOMS several terms from 2006 until present. She is part of a European expert group on MRONJ (medication related osteonecrosis of the jaws) and the research investigator and national coordinator for Norway on the Scandinavian ONJ cohort study. From 2012 until the end of 2019,

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Research interests: oral morbidity and late effects in cancer, quality of life, bone pathology with specific interest in cancer and osteoporosis patients, osteonecrosis of the jaws related to medication and radiation, bone pathology in West Africa, transplantation of teeth, and implant surgery. Recreation and inspiration: Bente has a passion for kayaking, hiking, skiing, guitar playing, ideas from Sam Harris and her family with two fantastic grandchildren. ■

April 2021

SWEDEN BODIL KRISTINA LUND

PROFESSOR Bodil Kristina Lund is originally from Sweden, where she trained to be an OMS at Karolinska Institutet and at Karolinska University Hospital, Stockholm, Sweden. She is professor and senior consultant in OMS working as the Head of the Department of

Clinical Odontology, Faculty of Medicine, University of Bergen, and as OMS at the Department of Oral and Maxillofacial Surgery, Haukeland University Hospital, Bergen, Norway. She is also professor in OMS at Karolinska Institutet in Stockholm, Sweden. Currently, she is president of the Scandinavian Society of Oral and Maxillofacial Surgeons (SFOMK), chairman of the Swedish strategic program against antibiotic resistance in dentistry incorporated in the Public Health Agency of Sweden, expert advisory for guidelines on antibiotic use, Antibiotic Center for Primary Care at Norwegian Directorate of Health, co-founder and chair of board of Swedish national register in orthognathic surgery, member of ESTMJS, and chairman of National Board of Odontology Education and Research in Norway. Research interests: antibiotic resistance with special emphasis on utilization, attitudes, efficacy and safety, health technology assessment, and temporomandibular joint disorders in terms of patient characteristics, diagnostics, and predictors for surgical outcome. Recreation and inspiration: Bodil have a passion for running, hiking, Dobermann dogs, and quality time with family and friends. ■

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IAOMS PODCAST SERIES FEATURING SUZANNE MCCORMICK shares insight on her research regarding THE OPIOD CRISIS AND PAIN MANAGEMENT ACROSS THE GLOBE. 38 iaoms.org

April 2021

A SLICE OF LEADERSHIP

Women leaders in OMS organizations worldwide

STEPHANIE DREW

PATRISHIA BORDBAR

TARA RENTON

MARY ALICIA DELSOL

GABRIELE MILLESI

NEELAM NOEL ANDRADE

The editorial team realizes that this list is not all inclusive of the many talented women OMSs who are leaders. We seek apologies in advance and any such omission is not intentional. This is simply a slice! April 2021

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Build your career and our profession

Join IAOMS Today •

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Learn with IJOMS, one of the world’s leading OMF journals with the highest impact factor of all OMF publications; read Face to Face, written for and by members

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ranging from trainee to experienced surgeons: ICOMS, the IAOMS’ biennial signature educational and networking conference and “The Next Level Forum;” International Symposia, and regional conferences*

Enhance patient care through webinars and

other e-learning opportunities* •

Prepare for the International Board for the

Certification of Specialization of Oral and Maxillofacial Surgery (IBCSOMS) with the IAOMS Review Course

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Support the next generation through the

IAOMS Foundation Fellowship and Scholarship opportunities

Experience events for all OMF surgeons,

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Expand your knowledge; access innovative

best-in-class training •

Connect with peers throughout the world

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Grow among the next generation of oral and maxillofacial surgeons through our NextGen programmatic initiatives; network with your colleagues through our online community

Visit iaoms.org to become a member or renew your membership. Questions? Contact Membership Manager Katie Cairns at kcairns@iaoms.org

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*IAOMS members may benefit from reduced fees.

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www.iaoms.org

FOUNDATION CHAIRMAN REPORT

Dear Friends and Colleagues, This year, the IAOMS Foundation is thrilled to celebrate our 25th Anniversary. In honor of this milestone, the IAOMS Foundation will present a podcast series titled IAOMS Foundation: 25 Years and Beyond. This series will highlight the Foundation’s programs and accomplishments over the past 25 years and examine how the IAOMS Foundation can play a vital role in shaping future surgeon leaders within the oral and maxillofacial surgical specialty. Our conversations will include a variety of IAOMS Foundation program participants from our cornerstone fellowship and scholarship programs, the Gift of Knowledge Program, and a report from the Committee on Global Surgery (COGS). We are excited to reflect on the journey leading up to the 25th anniversary, and the future ahead. In other news, the IAOMS Virtual Conference in collaboration with Osteo Science Foundation will return for a second year in June 2021. More information about the program and speakers will be announced soon. I would like to extend our gratitude to Osteo Science Foundation for the continued growth of our partnership and their support of the IAOMS and IAOMS Foundation. At this time, I would like to take the opportunity to acknowledge our Emerald Level Sponsor, KLS Martin, for their continued support of the IAOMS and IAOMS Foundation programs this year. KLS Martin has supported several IAOMS e-learning programs, most recently the IAOMS Scientific Webinar presented by Dr. Deepak Krishnan and the IAOMS/ ALACIBU NextGen Online Conference. We are looking forward to a special IAOMS Scientific Webinar featuring Dr. Gwen Swennen and supported by KLS Martin on May 29th, 2021. Throughout the years, the Foundation has seen the demand for education expand and continues to explore new ways to support the educational needs of the OMF specialty. To meet this demand, we need your assistance. To ensure we are prepared for the future, please consider making a gift to the Foundation at www.iaomsfoundation.org. This spring, we will publish the 2020 IAOMS Annual Report highlighting the efforts and successes of our program participants, donors, and partners. I look forward to sharing this with you soon. On behalf of the IAOMS Foundation Board of Trustees, thank you for your ongoing support of the IAOMS Foundation.

Larry W. Nissen IAOMS Foundation Chairman

April 2021

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WOMenS

BE SEEN AND HAVE A VOICE The mission of the newly launched WOMENS LEADERSHIP INITIATIVE is for women to be seen and have a voice by increasing the number of female speakers participating at Oral and Maxillofacial Surgery meetings, conferences, and events. The WOMENS LEADERSHIP INITIATIVE is, by design, not an organization or group but rather an endeavor supported by Oral and Maxillofacial Surgeons around the world. While the database is housed on a secure section of Osteo Science Foundation’s website, the WOMENS LEADERSHIP INITIATIVE is organized by professionals in the field who have a passion for increasing the visibility of women in Oral and Maxillofacial Surgery. This is an independent initiative, not tied to any one organization but supported by many. “We have an incredible, untapped resource in the number of women in Oral and Maxillofacial Surgery who are available to speak on a wide range of topics, thus strengthening our community with their expertise,” said Suzanne McCormick, MS, DDS, one of the members of the WOMENS LEADERSHIP INITIATIVE Steering Committee. “For too long, we haven’t been listening, but the WOMENS LEADERSHIP INITIATIVE is an opportunity to hear and learn from new voices and perspectives.”

“Take the chance and sign up for this platform as a potential future speaker by including your academic background, scientific and clinical expertise” Gabriele Millesi, MD, DMD

The WOMENS LEADERSHIP INITIATIVE celebrates diversity and is committed to creating an inclusive environment for all speakers. While these efforts are intended to increase the number of female OMS speakers, the database and related programs are not limited by gender. To add your name to the database or to look up Oral and Maxillofacial Surgeons for speakers at upcoming events, visit omswli.com. ■

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INTRODUCING

WOMENS

LEADERSHIP INITIATIVE Be Seen and Have a Voice Focused on inspiring and empowering a new generation of female OMS leaders, the WOMENS LEADERSHIP INITIATIVE is a newly established venture to help women in Oral Maxillofacial Surgery be seen and heard throughout our specialty. Female surgeons are often underrepresented as speakers at OMS events. We proudly aim to raise the bar by creating a unique online platform to bring interested academic speakers and OMS event developers together. Add Yourself to Our Ensemble of Select Speakers* By adding your information to our searchable, protected database, you can immediately elevate your professional standing, gain exposure to OMS event planners, and unlock a host of speaking and mentoring opportunities. The Benefits Are Real n n n n n n

Gain access to OMS speaking opportunities Increase exposure to OMS course developers Boost your professional profile Build lasting mentorships and guide the next generation Expand your network across our specialty Hone your skills through our Speaker Training Program

SIGN-UP NOW

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We’re committed to making a measurable and positive impact by expanding and promoting the speaking pool of talented OMS Surgeons - Suzanne McCormick, MS, DDS

To register, and for more details, visit omswli.com We celebrate diversity and are committed to creating an inclusive environment for all speakers. While this initiative is intended to increase the number of female OMS speakers, the database and related programs are not limited by gender. *Membership in a regional, country, or international OMS Society or Association is required and will be verified before the listing submission is approved. Inclusion on the database is complimentary; there is no registration fee, nor any additional association membership costs.

Affirmed by:

Research • Education • Improved Care Shaping the Future of Regeneration

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How I do it RADIAL FOREARM FLAP

CHI T. VIET, DDS, PHD, MD Assistant Professor. Loma Linda University. EE UU

JUSTINE S. MOE. DDS, MD Assistant Professor. Michigan Medicine Oral Surgery Clinic. EE UU

THE RADIAL FOREARM FLAP is a fasciocutaneous flap that was first described by Guofan Yang et al. in 1981, and is also known as the “Chinese flap” due to an additional case series published from China after its first description. It was popularized as a versatile flap for intraoral reconstruction in the early 1980s. The flap is based on the radial artery and cephalic vein or the vena comitantes; it can be harvested as a composite flap that includes bone, muscle (brachioradialis), tendon or nerves (vascularized sensory). The skin of the distal third of the forearm is most commonly harvested. The flap size, skin pliability, rich vascularity, and long pedicle length have made the radial forearm flap a frequently used flap in head and neck reconstruction. Oral maxillofacial surgeons most commonly use the radial forearm flap to reconstruct complex intraoral defects, including tongue, floor of mouth, buccal mucosa, or palate. It can be used to reconstruct defects of the lip, forehead, scalp, nose, orbit, or in pharyngoesophageal reconstruction. A beavertail modification includes the harvest of fat and fascia in the upper forearm, which serves as a random adipofascial flap that adds bulk to the reconstruction. Preoperative exam includes an assessment of the superficial veins, skin thickness, and hair growth, to determine the flap design. The dimensions of the flap are determined after considering the ablative defect. The Allen test is the most important component of the exam because it determines the reliability of the ulnar artery in supplying blood flow to the hand. There is a 3% rate of positive Allen test in the general population. Several donor site problems may occur, with the most devastating being that of an ischemic hand. An Allen test performed both preoperatively and intraoperatively could mitigate this problem. Skin graft failure of the donor site is another issue, which is exacerbated by the failure to preserve the paratenon over the flexor tendons during flap harvest. Lastly, donor site aesthetic deformity despite skin graft is a main disadvantage of the flap. In this article, we will describe the harvest of the fasciocutaneous radial forearm free flap. We would like to acknowledge Dr. Allen Cheng (Head and Neck Surgical Associates), Dr. Courtney Kilkuts and Dr. Sung Han (Loma Linda University OMFS residents) for their assistance with the photos. 44 iaoms.org

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Surgical steps PATIENT POSITIONING AND FLAP DESIGN With the patient supine, the donor arm is placed on an operating arm board with the shoulder abducted. A tourniquet is placed along the upper arm. Anatomic landmarks are identified, including the paths of the radial artery and cephalic vein along the distal and middle third of the forearm. A skin paddle is designed along the radial aspect of the distal forearm, centered over the radial artery and including the cephalic vein. A curvilinear releasing skin incision is designed from the proximal skin paddle to the anticubital fossa. The arm is exsanguinated and the tourniquet is inflated to 250mmHg with a timer set for 60 minutes (Figure 1).

(A) Surface anatomy of the forearm, with the radial artery, cephalic vein, and planned flap size marked.

Planned flap harvest

Radial artery

Cephalic vein (B) The radial artery is identified and ligated with silk sutures.

(C) The radial artery, vena comitantes and cephalic vein are harvested with the flap, while preserving the paratenon of the flexor tendons.

(D) The confluence of the vena comitantes and cephalic vein is identified. April 2021

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DISTAL FLAP ELEVATION The distal, ulnar and radial margins of the flap are incised (Figure 1). The flap is elevated from the ulnar to radial side in the subfascial plane with care to preserve the paratenon overlying tendons. The flexor carpi radialis (FCR) is identified. The flap is then elevated from the radial to ulnar side over the brachioradialis (BR) muscle and tendon. The superficial branch of the radial nerve is identified and preserved. The overlying cephalic vein is often included with the flap. The radial artery and venae comitantes are identified distally in the intermuscular septum between the FCR and BR and are divided. During the elevation of the ulnar aspect of the flap, the palmaris longus tendon may be harvested to be used for suspension procedures if indicated.

PROXIMAL FLAP ELEVATION The skin along the proximal margin of the flap and the curvilinear incision along the middle and proximal forearm is incised. Along the proximal aspect of the flap, subcutaneous tissue can be harvested depending on the reconstructive requirements of the case. This includes the option to harvest a proximal paddle of subcutaneous tissue. The medial and lateral antebrachial cutaneous nerves are preserved. The lateral antebrachial cutaneous nerve can be harvested if indicated for a sensate flap. The cephalic vein is traced to the anticubital fossa and dissected from the overlying skin and underlying BR muscle.

PEDICLE ELEVATION The investing fascia overlying the FCR and BR is incised. The BR is retracted to the radial aspect to expose the underlying radial artery and venae comitantes in the middle and proximal forearm. The dorsal branch of the radial nerve may also be identified and is preserved. The pedicle is now elevated from distal to proximal. Distally, the intermuscular septum is incised with care so as not to dissect the pedicle away from the skin paddle. Multiple interosseous and intermuscular perforators are divided (Figure 2). The pedicle is traced into the anticubital fossa, and the vascular anatomy is delineated, including the takeoff of the radial and ulnar arteries from the brachial artery. The confluence of the vena comitantes and cephalic vein may be identified (Figure 3). The tourniquet is released. Flap harvest is completed with the division of the cephalic vein, the radial artery and venae comitantes (Figure 4). If the flap is used to reconstruct an intraoral defect, the pedicle is passed from the oral cavity to the neck using a penrose drain filled with water to minimize shearing of the pedicle.

(A) Deep branches supplying muscles of the forearm or the radius are clipped and ligated during the flap harvest. 46 iaoms.org

(B) The radial recurrent artery is encountered and may be ligated if necessary.

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(A) The radial artery and vena comitantes are traced deep to the brachioradialis muscle.

(B-C) The confluence of the vena comitantes and cephalic vein is identified and preserved to allow for venous anastomosis through a single vein.

The fasciocutaneous flap with the dimensions matching the ablative defect is harvested with radial artery, vena comitantes and cephalic vein.

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DONOR SITE CLOSURE The wound is irrigated and primary hemostasis is obtained using cautery. The proximal releasing incision is closed primarily over a suction drain. Small flap defects of the distal forearm flap defect may be closed primarily. However, a skin graft is often required. A full thickness skin graft may be harvested from the ipsilateral medial upper arm or abdomen (Figure 5). Alternatively, a split thickness skin graft from the thigh, or from the flap skin itself prior to flap elevation may be used. The flap defect is reduced by advancing the radial skin edge to cover the superficial branch of the radial nerve. The skin graft is inset using resorbable suture, and a bolster is placed. Alternatively, a wound vac system may be used over the skin graft (Figure 6). The arm is then wrapped and placed in a volar splint with 45-degree wrist extension.

5C (A) A full thickness skin graft (FTSG) is harvested in the upper arm with the same dimensions as the donor site defect. (B) The upper arm is closed primarily. (C) The skin graft is sutured in place with resorbable suture.

6A (A) The skin graft is sutured in place. A suction drain is placed in the forearm. (B) A wound vac is placed over the skin graft for five days, after which it is removed and the skin graft is dressed with xeroform and gauze.

7 Video describing the radial forearm flap harvest and inset.

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Sternocleidomastoid muscle Internal jugular vein Common facial vein

Facial artery

8 Arterial and venous anastomoses. (A) A patient with a tongue and floor of mouth squamous cell carcinoma prior to resection. (B) Radial forearm flap reconstruction of a tongue and floor of mouth defect.

10A 10B

10C 10D April 2021

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Immediate postoperative and long term follow up photos of a ventral tongue (A and B) and hemiglossectomy (C and D) reconstruction.

NextGen

NEXTGEN VIRTUAL CONFERENCE By Alfred Lau

Hong Kong I AM SURE everybody agrees with me it has been a tough period to us as maxillofacial surgeons, and of course to IAOMS and perhaps to the entire world. I still remember when COVID-19 first came to my awareness in January 2020 as it affected my travel plans to various OMS conferences and courses. It was such a pain for us to cancel our orthognathic conference in Vienna and the ICOMS in Glasgow. We hope everything will be going back to normal like our good old days, but yet we cannot just sit and wait until the “normal “comes back to us. Perhaps it is a pandemic of no return. As a NextGen of the IAOMS, we are born to be strong, smart and to adapt quickly. IAOMS as a leader of the field, had collaborated with ALACIBU to host this first ever conjoint online event between the two associations. Effectively after 2-3 online meetings, the whole programme had already been set and lined up. We have broken down the events into five days, with a different theme for each day. The five topics are Surgical Innovations, New Techniques in Dental Implants, Dynamic Cases in Orthognathic Surgeries, Insights and Best Practices in Pathology and From Diagnosis to Outcomes in Cleft Lip & Palate and Reconstructive Surgery. We had invited world class lecturers as well as young speakers to present their work. It is always so important to let our NextGen learn from seniors for the conventional wisdom, from their experiences and sharing of practical tips related to various surgical techniques. It is equally important to let young people expose to new technologies, researches and new trends of treatment and different treatment concepts. So it is of utmost importance to have speakers from across the globe. One key component we have always been working a lot on is to give opportunities, especially this kind of international event, to our young speakers

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to speak on stage. It is always essential to train our next batch of world class speakers,and nothing could be better than to give them trust and real chance to do it, just like how we all learn to do our surgeries. On each day of our event, we had lined up both master speakers and young speakers chaired by experienced moderators so as to arouse discussion and questions from the audience. Numerous questions were received during and after the event. The discussion was very fruitful. All in all, the event was very successful and well received. We had recorded 1,000 registration from 69 countries all over the world. We have around 500 attendees online each day. All the effort from the organizing team had paid off. We have to say special thanks to KLS Martin for supporting this event. We also have to say special thanks to ALACIBU and their president Dr Raul Parra in collaboration of this NextGen virtual conference. We have already started putting our heads together thinking of the next step, where hopefully we could organize a similar event for Asian countries by the end of 2021 that we could cater more audience in another time zone. Please kindly stay tuned for our further announcement. Last but not least, I have to say special thanks to IAOMS for giving me the opportunity to serve as the Chairman of the NextGen. More importantly, on behalf of all the NextGen, I have to say heartful thanks to IAOMS as NextGen has been put at a very important position in IAOMS. Let’s gather and walk hand in hand, no matter how difficult the world is going to be, we are still the NextGen warriors for OMS. Let’s NextGen together to define our own future. ■

April 2021

Recorded Program Available March 2021

The IAOMS/ALACIBU NextGen Online Conference will provide a dynamic and robust five-day program with live presentations followed by question and answer opportunities. Each day will include a variety of sessions presented by master surgeons from across the specialty as well as the next generation of young OMF surgeons. Participants will have the opportunity to participate in 2.5 hours of educational content per day throughout the duration of the conference. Thank you to our Emerald Level sponsor for supporting this conference.

SESSION TITLES BY DAY Monday Surgical Innovation Tuesday New Techniques in Dental Implants Wednesday Dynamic Cases in Orthognathic Surgery Thursday Insights and Best Practices in Pathology Friday From Diagnosis to Outcomes in Cleft Lip & Palate and Reconstructive Surgery

Visit www.iaoms.org/nextgenonlineconference to register today.

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New Publishing

A Gift from AOMSI download a textbook

THE ASSOCIATION OF ORAL & MAXILLOFACIAL SURGEONS OF INDIA (AOMSI) has a strong commitment towards global dissemination of knowledge. In ensuring this, the AOMSI has chosen to commemorate the fiftieth year of its inception (golden jubilee) through a unique gesture - the dedication to the international fraternity of OMS, a book titled “Oral and maxillofacial surgery for the clinician” published by Springer. The book was released on the International OMS day, February 13, 2021. This monumental venture incorporates 88 chapters in 2008 pages, with contributions from 142 authors around the world. This is an open access book , free to download for anyone over a multitude of devices and platforms. Printed copies are also available which can be ordered online. The editorial team led by Prof Krishnamurthy Bonanthaya, former President of the Association of Oral & Maxillofacial Surgeons of India (AOMSI) and Vice President, International Board for the Certification of Specialists in Oral and Maxillofacial Surgery (IBCSOMS), comprises of Dr Elavenil Panneerselvam, Dr Suvy Manuel, Dr Vinay Kumar and Dr Anshul Rai along with the video editors Dr Jimson Samson and Dr Nehal Patel.

Krishnamurthy Bonanthaya

Elavenil Panneerselvam

This book presents an exhaustive compilation of the principles and practice of oral and maxillofacial surgery with in-depth coverage of topics encompassing the spectrum of both Oral Surgery and CranioMaxillofacial Surgery. The text of each chapter is amply supported with a blend of life-like illustrations, photographs and representative radiographs. These are complemented by a library of 68 demonstration videos which offer a rich multi-media experience to the readers. It is designed to include evidencebased practices, guidelines, protocols and potential complications. Each chapter culminates with relevant clinical scenarios for enhanced practical experience. This multidisciplinary book is not only a guide for residents, young and experienced clinicians, but also a resource book for those preparing for university and board certification exams. ■

Textbook link -OPEN ACCESS 52 iaoms.org https://link.springer.com/book/10.1007/978-981-15-1346-6

Anshul Rai

Jimson Samson

link for ordering PRINT VERSION AprilThe 2021

Suvy Manuel

Vinay V. Kumar

Nehal Patel

https://www.springer.com/gp/book/9789811513459

TAIL PIECE

The truth about... WEB-LECTURES The pandemic has forced several of us to learn and teach from homes. The zoom faux pas has become viral on social media. Our own Alfred Lau shared his trick to looking professional for his lectures!

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200 E. Randolph St., Suite 5100 Chicago, IL 60601 USA www.iaoms.org

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