23rd International Conference on Oral & Maxillofacial Surgery 2017
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Issue 45 / April 2016
Editor-in-Chief Javier González Lagunas
Managing Editor Lisa Markovic
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 Kishore Nayak, Interim Executive Director
Members-at-Large Javier González Lagunas Sanjiv Nair David Wiesenfeld
Regional Representatives Abdellfattah Sadakah, Africa Kenichi Kurita, Asia Nick Kalavrezos, Europe Alejandro Martinez, Latin America Arthur Jee, North America Jocelyn Shand, Oceania Nabil Samman, Editor-in-Chief, IJOMS
Committee Chairmen Rui Fernandes, Education Committee Joseph Helman, Research Committee Deepak Krishnan, IAOMS NextGen Committee Steve Roser, COGS Committee Fred Rozema, IT Advisory Committee Mark Wong, IBCSOMS Representative Nabil Samman, 23rd ICOMS-2017, Hong Kong Luiz Marinho, 24th ICOMS-2019, Brazil David Koppel, 25th ICOMS-2021, Glasgow
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Letter from the Editor HOW I SEE IT
ello and goodbye. My column in this issue has a bittersweet taste. On one side we are opening a new mandate with our new president, Julio Acero, who officially took office in January. Julio has been responsible for many of the educational projects of the IAOMS. He is well known and respected worldwide and his imprint on the specialty will be long-lasting. In the next two years he will be undertaking new projects and giving consistency to all the initiatives that Piet Haers and others before him started, with the common goal of having a strong, sustainable and reliable association. But, we are also saying goodbye to Pierre Desy, our Executive Director. Two years ago Pierre took the challenge of bringing the structure of the association up to date. Those of us who have been working with him know of his enthusiasm and know-how, and we will miss his resolution, commitment and dedication to IAOMS. I personally wish him all the success in his new project. Life of a scientific association depends on continuity. With the extraordinary job that our previous presidents had done, we can only go forward. I am sure that in two year’s time when Dr. Acero will leave the presidency, IAOMS will be in a stronger position as the global association for all oral and maxillofacial surgery professionals. Our new Executive Director Mitchell Dvorak will also play a key role in the development and implementation of the projects that will make IAOMS bigger and better. In this issue of Face to Face, we are introducing to all our members ICOMS Hong Kong, to be held in March 2017. The papers that Nabil Sammam’s team have prepared for us are just an amuse-bouche of the great meeting we will enjoy next year. You can also find the first Spotify list especially devoted to oral and maxillofacial surgeons: is there anything more maxillofacial then the lips? ■ Javier González Lagunas EDITOR IN CHIEF
“Life of a scientific association depends on continuity”.
CONTENTS April 2016 10 SPECIAL REPORT Hong Kong
NEXT GEN Dear Dr. Acero...
FELLOWSHIP Cleft Lip and Palate and Craniomaxillofacial Surgery
FEMALE TO FEMALE 20 The Secret World of Women Surgeons
22 FROM PROUST TO PIVOT Julio Acero 24 COPY ME
Autotransplantation of premolars with simultaneous bilateral intraalveolar sinuslift
SO YOU WANT TO WORK IN... PerĂş
32 BEYOND THE OR Me & them
CHANGES IN THE EXECUTIVE DIRECTION
ear members of the IAOMS:
It is with mixed emotions that we announce the resignation of our Executive Director, Pierre Désy effective March 11, 2016. Since 2014, Mr. Désy has skillfully helped stabilize the organizations’ operations, finances, and infrastructure; strengthened governance in collaboration with the Board of Directors; and led the development and implementation of strategic initiatives that positioned the association and the foundation for significant growth. “After two years as Executive Director of the IAOMS, I have asked the IAOMS Board of Directors to consider my resignation so that I may pursue another exciting career opportunity,” said Pierre Désy. “I am extremely proud of IAOMS and the IAOMS Foundation and the work we have accomplished together. I feel confident that I will be leaving a more solid, growing organization that has come to be recognized as the global association in the field of oral and maxillofacial surgery. The board is strong and the staff at IAOMS are outstanding. They are a cohesive team committed and dedicated to the work they do,” said Désy. “It has been a great honor for me to serve as Executive Director of IAOMS, and to have the opportunity to work for a dynamic and nimble organization led by highly committed professionals. I extend my deepest appreciation to all of our Board, Executive Committee, corporate partners, staff, and members. It is the people who have made these experiences exceptional. I will forever cherish having had the opportunity to meet and develop friendships with so many of you. Thank you for two fantastic years!” “On behalf of the IAOMS Board of Directors, we want to thank Mr. Désy for his service to the organization and our mission,” said Julio Acero, IAOMS President. “Although we are sad to see him go, we are excited for him as he initiates this important next stage in his life and his career. We are grateful for the incredible work Mr. Désy has done with the association and the foundation, helping to heighten the specialty’s visibility, along with the ability to manage difficult situations,” said Acero. “We appreciate Mr. Désy’s advice and assistance in supporting a smooth transition during this time. The Board of Directors, Executive Committee and IAOMS Staff wish him all the best in his professional life. Mr. Désy will always have a home in our association. So this is not good-bye, but merely see you next time, albeit in a different capacity.” Over the course of the next few weeks, the IAOMS Board of Directors will conduct interviews to identify Mr. Désy’s successor. We look forward to continuing IAOMS’ work of strengthening our specialty through collaboration, supporting ongoing strategic planning and advancing the field of Oral and Maxillofacial Surgery worldwide. We are eager to see what the future brings as we move forward, energized in our mission. ■ Pierre Désy IAOMS EXECUTIVE DIRECTOR
Julio Acero PRESIDENT IAOMS
ANNOUNCEMENT NEW EXECUTIVE DIRECTOR
ollowing Mr Pierre Desy´s resignement, which was effective on last Friday March 12th, an extensive search for the selection and appointment of a new Executive Director was performed by the IAOMS Board of Directors along with the collaboration of our Interim Executive Director, Kishore Nayak, and our past Executive Director, Pierre Desy. According to this, the Board of Directors and the IAOMS Executive Committee are delighted to announce the selection of Mitchell Dvorak as the new Executive Director of IAOMS, which will be effective April 18, 2016. Mr. Dvorak has extensive experience working with nonprofit organizations in the healthcare and patient safety fields. Most recently he was elected to the Board of Directors of the Association Forum in 2015. He has also served as Chair of the 2014 – 2015 ASAE Small Staff Association Committee. In 2012 Mitch was named a Young and Aspiring Association Professional by Association TRENDS. Mitch earned his graduate degree in Public Service Management from DePaul University and his bachelor’s degree in Political Science/Public Administration from the University of North Dakota.
“Mr Dvorak will build on the strong foundation laid by the IAOMS Board of Directors and the previous Executive Director, and will lead the IAOMS into a new phase of development...”
I am sure that Mr Dvorak will build on the strong foundation laid by the IAOMS Board of Directors and the previous Executive Director, and will lead the IAOMS into a new phase of development, focusing on implementation of strategic initiatives, strengthening our specialty through collaboration and continuing to advance the field of Oral and Maxillofacial Surgery worldwide. Please join me in welcoming Mr. Dvorak to the IAOMS family and in wishing him the best for this important assignment.
With my best regards. ■ Julio Acero PRESIDENT IAOMS
Letter from President IAOMS ONLY 11 WEEKS after taking on the role of IAOMS President, it feels like an entire lifetime has passed by with work dedicated to the Association! Many exciting developments happened in such a short period of time. As I said in my first message, one of the key aspects of my Presidency will be taking a step forward to bring the Association to our members and have them express their opinions on the development of new projects. The IAOMS Board of Directors, Executive Committee, and the dedicated staff of the IAOMS were very excited about analyzing the results of different surveys that were conducted. For our next IAOMS Board of Directors and Executive Committee meeting being held in April, the surveys will be one of the topics covered during our strategic planning meeting. MAY I TAKE THIS OPPORTUNITY TO THANK all members of the new Board of Directors, Dr. Olsson, Dr. Millesi, Dr. Jee and Dr. Haers, as well as to the entire Executive Committee for their support and commitment to the Association. It is my pleasure to announce the appointment of Dr. Larry Nissen as the IAOMS Foundation chair for a new term Important changes have occurred in the last couple of weeks at the IAOMS Headquarters. It is with mixed emotions that we announce the resignation of our Executive Director, Pierre Désy. Mr. Désy was offered a career opportunity he could not refuse. On behalf of the IAOMS Board of Directors, I want to thank Mr. Désy for his incredible service to the organization and we wish him all the best in his new endeavor.
Lisa Markovic who stood in as the Executive Secretary. I had the opportunity to visit the IAOMS Headquarters which recently moved from Rolling Meadows to a more functional space in Chicago. The move will also have an impact in reducing the leasing expenses with a significant benefit to the Association’s finances. WE’RE EXCITED TO ANNOUNCE that we’re introducing a new IAOMS website that will better serve our members. We know our current system needed improving, and that membership renewal was often difficult. This new system should alleviate those problems and we’re pleased to introduce a simpler more streamlined system. The new website will also include our eLearning program, the IAOMS Review Course, along with some exciting interactive benefits such as Group Forums, Find A Member. WE WILL CONTINUE to strengthen Continuing Education worldwide as a unique tool aiming in the harmonization and progress of the Specialty. Besides ongoing programs like those run by the Education Committee in Panamá and Sri Lanka, we are planning to launch some exciting educational projects, such as short IAOMS International Symposia to be held in different regions. Latin America would most likely host the inaugural Symposium in collaboration with the Columbian Association. Another Symposium in the Middle East is underway with our colleagues in Qatar. We will keep you informed of all educational projects supported by the IAOMS worldwide.
AN EXTENSIVE SEARCH FOR A NEW EXECUTIVE DIRECTOR was performed by the IAOMS Board of Directors immediately after Mr. Désy communicated his resignation. This process led to the appointment of Mr. Mitchell Dvorak as the new IAOMS Executive Director, effective April 18th, 2016. Mr. Dvorak has extensive experience working with nonprofit organizations. I am sure Mr. Dvorak will continue to lead the IAOMS toward a new phase of growth, focusing on the implementation of exciting strategic initiatives.
LAST BUT NOT LEAST, PLEASE MARK YOUR AGENDA with the dates March 31st - April 3rd, 2017 when we will all meet at the 23rd ICOMS to be held in Hong Kong. The Organizing Committee chaired by Nabil Samman is working very hard and it is sure to be a superb scientific and social event. My gratitude goes out to all colleagues engaged in so many projects in the different Committees and groups under the IAOMS umbrella. I invite you to join us by participating in Association activities so we can continue our aim of promoting the progress of the Specialty of OMS at a global level. ■
MAY I ALSO TAKE THIS OPPORTUNITY to thank Kishore Nayak, who helped us during the transition period serving as the Interim Executive Director, and
Julio Acero PRESIDENT IAOMS
Asiaâ&#x20AC;&#x2122;s world city
Five reasons to come to Hong Kong
By Mike YY Leung
Clinical Assistant Professor. Oral and Maxillofacial Surgery within the Faculty of Dentistry. The University of Hong Kong
ong Kong is well known for the huge varieties of food. The collections of cuisines from all over the world offer a great choice for foodlovers. There are also many Michelin-recommended
restaurants that are ranged from a budget café to a luxurious meal. For local cuisines, you may like to try the Dim Sums in a local Chinese restaurant, or the fresh seafood on Lamma Island. Vegetarian menu and Halal food are easily available in the city as well.
ong Kong has been named as the “Pearl of the Orient” for many years. A tram ride to the peak at night will show you a stunning night scene of the Victoria Harbour. Rides on the Ferris wheel in Central or the cable car in Ngon Ping demonstrate different impressions of the energetic city. The daytime and nighttime scenery can be very different too.
To SHOP- to many
ong Kong is the shopping heaven. You can easily kill a day in modern malls in Tsim Sha Tsui or Causeway Bay. Local markets in Stanley and Mongkok are great places to find interesting things with a bargain. Shops selling the most advanced models of electronics and computers are everywhere. You may regret you have not brought enough cash or another credit card for your spendings!
ong Kong is great for adventurous people. There are many scenic hiking routes on the Island or around Sai Kung. A ride on the slow old tram on the Island offers a different experience in between the hustling city. The ferry ride is a budget way to enjoy the wind and the scene of the Harbour
To ENJOY family time
Tourist tram at the Peak, Hong Kong.
ong Kong is very kids-friendly. Ocean Park and the Disneyland are the two world-class theme parks that are both worth to go with the family. Parents travelling with toddlers or children will also enjoy the excellent transportation system throughout the city. Nursing rooms and baby rooms are conveniently located in most malls. ■ iaoms.org 11
02 History of Oral and
Maxillofacial Surgery in Hong Kong By Alfred Lau
Specialist in Oral and Maxillofacial Surgery. Dental Implant and Maxillofacial Center. Room 1901, The Center. 99 Queen’s Road Central. Hong Kong
he history of oral and maxillofacial surgery (OMS) in Hong Kong could be traced back to around 65 years ago when it was still a colonial city under the British government. At that time the traditional “western” education especially medicine and dentistry were very British-influenced. After the World War II, There were dental clinics established under the Hong Kong government medical system to serve the civil servants and their family members for general dental treatments. Due to the ever-increasing demand of dental service, mostly related to the increased in population, the HK government expanded its dental service to include the general public, but only emergency dental needs were served, specifically, dental extractions. Subsequently more surgical-related situations were being referred, including surgical removal of impacted teeth, jaw fractures, removal of pathological lesions such as jaw cysts and tumors. This made up a referral center and had outlined the picture of OMS nowadays. THERE WERE LIMITED DENTAL SURGEONS who were competent to provide these kinds of surgical treatments to the patient at that time. In the mid 1960s, dentists who were interested in surgical training were being sent to countries such as UK and Australia for further training in oral surgical procedures. After which the government dental service unit appointed the first consultant in Oral surgery. This was a milestone in the field and thus provided the establishment of oral and maxillofacial surgery in Hong Kong. The pioneers enabled widening of the scope in oral surgery with the knowledge gained overseas; it ranged from dentoalveolar surgery, pre-prosthetic surgery, 12 iaoms.org
TMJ diseases, maxillofacial traumas, oral and jaw pathologies, salivary gland diseases, tumor resection and reconstructive surgeries. This made up almost a full scope of OMS nowadays. Since the rapid development and the needs in oral surgery, the local system became more aware of this important specialty. The first title of specialist in Oral Surgery was granted to Dr Eric H. Fung in 1980. THE SECOND IMPORTANT MILESTONE was the establishment of the department of oral surgery and oral medicine at the newly formed faculty of Dentistry of the University of Hong Kong in 1980. Professor Geoffrey L. Howe from London was appointed as the Dean of the faculty as well as the Chair Professor of the department at that time. Teaching was mainly conducted in the Prince Philip Dental hospital where dental extraction and minor oral surgery was taught to undergraduate students. The Master of Dental Surgery programme was subsequently established for more advanced OMS procedures. In-patient surgical
and experiences among colleagues around the world. Professor Nabil Samman was elected as the President of Asian Association of Oral and Maxillofacial Surgeon (AAOMS) in 2004 to 2006 and was then elected as the President of the International Association of Oral and Maxillofacial Surgeons (IAOMS) from 2007 to 2009. He is currently the editor-in-chief of the International Journal of Oral and Maxillofacial Surgery (IJOMS). With the establishment of the Hong Kong College of Dental Surgeon as a constituent college of the Hong Kong Academy of Medicine in 1993, an official specialty training pathway was established in the Faculty of Dentistry and among the government hospitals. OMS was recognized as a specialty by the Academy of Medicine of Hong Kong among all other Medical Specialties. As one of the active regional OMS centers, Hong Kong had held the Asian Conference on Oral and Maxillofacial Surgery (ACOMS) in 2006. The association also collaborated with the Chinese Association of Oral and Maxillofacial Surgeons co-organized the International Conference on Oral and Maxillofacial Surgery (ICOMS) in 2009 held in Shanghai, China.
Hong Kong at night.
procedures were performed at a separate hospital at that time. It was later relocated to Queen Mary Hospital which was also the official teaching hospital for the faculty of medicine. Professor Henk Tideman came to Hong Kong as the Department Head in 1988. Professor Tideman made a lot of effort to promote the field and to establish the importance of OMS among other medical specialties. The Department was subsequently renamed as Department of Oral and Maxillofacial Surgery. Under his leadership and his significant contribution to the specialty, together with the subsequent department heads, Professor Lim Cheung and Professor Nabil Samman, the department has further developed into an important training center both regionally and internationally. DR ERIC H. FUNG FOUNDED the Hong Kong Association of Oral and Maxillofacial Surgeons (HKAOMS) in 1990. This was indeed an important step that connected the local field to the rest of the world, enhancing interaction and exchange of knowledge April 2016
DESPITE THE GROWTH OF OMS within the profession, the specialty of OMS is still relatively unknown to the public. This is relatively the same everywhere in the world. It was reported in a recent survey (Lau 2014) that there were 75% of interviewee claimed they had never heard of the specialty of OMFS, while the other 25% reported that they had heard of it. Within these 25% who heard of OMS, 54% said that they did not actually know what OMS was about, while the rest claimed that they had knowledge about OMFS to a certain extent but a significant part of these people had a wrong concept of what OMS is about. There is a very low awareness of OMS to the general public in terms of its scope of service, the provision of service and training by the government and institutes. One of the aims of HKAOMS is to promote and arouse the interest of OMS in Hong Kong. Efforts have been made to increase public awareness through public lectures and seminars, participation with other specialties and compliance with the public media. Recently the younger generation has been very active and keen to learn about OMS and to promote the specialty to medical and non-medical related people. The establishment of Young Oral and Maxillofacial Surgeon Group of Hong Kong in 2014 has gathered around 350 dental students and OMS trainees who have the same interest and mission. Beside regular educations programme and social gatherings, they also organize charity work within and outside of Hong Kong. UP TO 2016, we have around 50 registered OMS specialists and 20 trainees in Hong Kong. Around half of the registered specialists worked in Private Sector and half in University or government settings. We hope that Hong Kong will flourish more specialists with its local training. We are pound to announce that ICOMS 2017 will be held in this world Asia city and we are all looking forward to see you all in Hong Kong. â&#x2013;
Training of OMFS in Hong Kong, by a resident By Mei Chong Dental Implant & Maxillofacial Centre. 5 Canton Road, Tsim Sha Tsui, Kowloon
he specialty training program in Oral and Maxillofacial Surgery in Hong Kong provides an advanced surgical training based on the dental degree. The specialty training follows the Hong Kong Academy of Medicine 6-year program like all other specialties, composing of 3 years basic and 3 years advanced training in the specialty. Oral and maxillofacial surgery is a surgical discipline of dentistry. It is a unique discipline in the fact that it lies at the interface of the dental and medical professions. The Faculty of Dentistry of the University of Hong Kong provides both oral and maxillofacial teaching and service functions at the Prince Philip Dental Hospital and Queen Mary Hospital. The scope of services provided includes dento-alveolar surgery, maxillofacial trauma, surgical management of TMJ disorders and oral pathologies, reconstructive surgery for developmental and congenital deformities of facial skeleton. After finishing the undergraduate dental degree, the options to further with specialty training usually starts by working as a first year houseman in the discipline of interest. As a houseman in Oral and Maxillofacial Surgery, there is vast exposure to the field through working with senior trainees in the surgical field, hospital ward, and working independently for minor oral surgical procedures. After this exposure, the commitment to training in the specialty follows. Training in the specialty requires full-time devotion to develop competence in the full scope of the field. Training through the University will require enrollment 14 iaoms.org
“Close interaction with other specialties in orthodontics, and prosthetics serves to strengthen the resident’s background in comprehensive case management in orthognathic, pre-prosthetic and implant surgery.” in a master’s degree program for oral and maxillofacial surgery. The program, although academically and financially challenging, of long duration, and not the only option in OMS training. However, the April 2016
Hong Kong harbour with tourism junk.
opportunity to be broadly educated and trained in a recognized program is desirable. Close interaction with other specialties in orthodontics, and prosthetics serves to strengthen the residentâ&#x20AC;&#x2122;s background in comprehensive case management in orthognathic, pre-prosthetic and implant surgery. Supervised surgery permits continuous learning from different peers and supervisors which permit trainees to best impart surgical knowledge and cadre of skills. With the privilege for surgery comes responsibility in patient management. Residents will alternate on an on-call roster to provide proper in-hospital patient support and post-surgical management. The program involves structured learning and formal periodic evaluation and April 2016
examination after the first three years of basic training before allowed to proceed to the advanced training. As part of the masterâ&#x20AC;&#x2122;s degree program, participation in research is required. It is encouraged to make scientific presentation and to publish in the scientific literature. The final subsequent years of advanced training allow for more independent surgeries entrusted responsibly. In summary, the training program incorporates a pathway to include a number of factors that contribute to the development of expertise in the surgical field. The training promotes sound judgment, technical skills, integrity to encourage responsibility as ambassadors of the specialty. â&#x2013;
Dear Dr. Acero... By Deepak Krishnan
Congratulations on your Presidency. We eagerly look forward to your era of leadership.
Engage us in the greater good: As the Association looks to grow a disaster response strategy worldwide, we hope that you will include the trainees and young OMSs in that plan. The NextGen could prove to be an effective catalyst in this endeavor with our communication network, recently acquired skills in management of complex trauma and triage with a relatively flexible schedule. The Generation Y OMS hope to use their special skills for a greater good and want to make a difference in the world around them. We hope that you will grant the NextGen with more power and hence more responsibility. à
Accept us for who we are: It is a changing world and as much a changing specialty. That change means different things to Oral Maxillofacial Surgeons (OMSs) the world over. One of the biggest changes is the emergence of the next generation of OMSs – our own NextGen. We are sure that you have noted through your own interactions with the NextGen OMS, one common theme resonates – we are a different breed. Much like most of those before us, we are motivated, focused and driven, but at a different pace, a different style and a different direction. We hope that you appreciate this difference and embrace it. à
Provide mentorship for involvement and ascension in IAOMS: We want to be a part of the process and are motivated to help IAOMS evolve. We need your guidance to make this transition to leaders. Please encourage your contemporaries to take a NextGen surgeon under their guidance and help usher them to greatness. Sometimes some of us don’t know where to start despite our best intentions. Most of us are ambitious and genuinely care to shoulder the future of this organization and our specialty. Your leadership can mentor us towards meaningful roles in IAOMS. à
Give us an identity: Worldwide, OMS struggles with an identity crisis. Some of us have a crisis of existence. In some countries, the specialty remains in its infancy; whereas in others, we have experienced a metamorphosis of convenience. In the US, the practice of OMS is threatened by the economic realities of decreasing re-imbursement forcing the average practitioner to abandon major surgery and hospital based care for only office-based dentoalveolar procedures. This cuts at the very root of what a previous generation had struggled to build. à
Meanwhile in Europe, we have become a medical specialty treating malignancies and deformities in large hospital centers. In China, large cities host regional referral centers with multiple hospital floors dedicated to the practice of OMS, whereas in Malawi, general surgeons continue to treat maladies of the face, mouth and jaws out of primary care hospitals. We hope that your presidency will look at the root causes of this disparity within our specialty and charge the NextGen with building bridges for the future. Perhaps the next generation of OMSs will no longer live in an amphibian world struggling with identity crises in practices, medical centers and cocktail conversations. April 2016
Don’t be a stranger: Despite the generational differences we have more in common than what meets the surface. Don’t exclude us because we are different or younger. We like feedback – tell us what we are doing is good and what you would like us to do differently or better. We do well when given direction but not micro-managed. You, our President are our best ally and biggest patron. à
A new era is aft for IAOMS. Your mentoring and leadership of the next generation of OMSs is the best investment for the organization and the specialty. We look to you as our guiding beacon. ■ iaoms.org 17
p i h s w o l l e F Cleft Lip and Palate and Craniomaxillofacial Surgery Professor Kurt-W. B端tow
Professor Kurt-W. B端tow has had his training at various Universities and received the following degrees: BSc[Chemistry and BotanyBiochemistry](RAU), BChD, MChD[in Maxillo-Facial and Oral Surgery](Stell), DrMedDent(Erlangen), PhD, DSc[Odont](Pret), a Colleges of Medicine of South Africa fellowship(pr), FCMFOS(SA), and fellowships by invitation was conferred in England and USA as LFIBA and FABI. He is the only South African MaxilloFacial and Oral Surgeon who is registered with a professional doctor title and holds three academic doctor titles.
t gives me great pleasure to write about the International Fellowship and our experience involving the international fellows in the combined university and private hospital unit.
retoria (South Africa), the largest CLP-unit in Africa, together with Orlando (USA) and Bandung (Indonesia), was selected by the IAOMS to train the first group of young international selected Oral-Maxillofacial Surgeons for the Fellowship in Cleft Lip and Palate and Craniomaxillofacial Surgery.
t was decided that international fellows, as applicable and fitting for national fellows, should be exposed to a comprehensive treatment, from infant to adolescent, and to the philosophy of the multi-disciplinary approach. The fellows were handson exposed to the primary, secondary and tertiary surgical treatments. 18 iaoms.org
he protocol starts with the presurgical treatment as jaw-orthognathial suction and drinking plate. The fellows had to place presurgical plates and were recently exposed to the NAM treatment. Primary unilateral cleft lip surgical exposure entailed 3 different surgical techniques and the bilateral cleft lip 2 different ones. It included the primary anterior nasal floor reconstruction, and 2 different techniques for the primary hard palate reconstruction. Furthermore, fellows were exposed to 3 different surgical techniques for the reconstruction of the primary soft palate, columella lengthening in bilateral clefts and mandibular osteotomy and distraction for neonates with the Pierre Robin sequence. The involvement for intermediate reconstruction included 3 different velopharyngeal techniques. Secondary surgical involvements were for osteoplasty/fusion, including harvesting bone from the crista iliaca, various orthognathic surgical techniques for the maxilla with April 2016
or without intra-oral or craniomaxillary distraction and specific orthognathic-aesthetical surgery for the mandible in adolescent patients with clefts. Part of the secondary/tertiary surgery included cleft rhinoplasty and revision surgery. As an assistant surgeon, exposure to rare types of cleft deformities was obligatory. These deformities include oblique facial clefts, lateral facial clefts, holoprosencephaly treatment and other craniofacial surgery. Each fellow meticulously had to keep a surgical logbook of procedures done as a surgeon and as an assistant surgeon, which was certified at the end of their fellowship period. As such a fellow could reach the following surgical numbers in a period of 6 months: 305 procedures of which 163 were in primary reconstruction; 71 procedures performed as surgeon and 234 as assistant surgeon.
art of this intensive training was to be involved and contribute to the multidisciplinary cleft clinic, the preoperative and postoperative ward rounds, and discussions of ±30 PowerPoint lectures received on every aspect of primary, secondary, tertiary and exceptional deformity treatment. With the patient or parent’s permission, photographic material was collected by the fellows for personal use, which was then duplicated and submitted to the Director.
“Due to this continuous interaction, together with the photographic material collected, the fellows were able to present papers, co-author abstracts and journal publications and could present cases for their additional professional examinations in other countries.”.
his intensive one-on-one teaching and time spent with the fellows was very rewarding for me as a Director. Questions such as “why?”, “why not?”, “what about this?” and request “show me again” stimulated a number of research discussions and topics. Due to this continuous interaction, together with the photographic material collected, the fellows were able to present papers, co-author abstracts and journal publications and could present cases for their additional professional examinations in other countries. This material, in conjunction with the presented PowerPoint lectures and their research contribution, induced the publication of the book “Cleft – Ultimate Treatment” (Reach Publishers), which included fellows’ photographic material and their research references.
A The multi-disciplinary facial cleft deformity clinic in Pretoria. April 2016
ll the fellows travelled to certain parts of South Africa and all paid a visit to the famous Kruger National Park with its abundance of African wildlife, including the Big Five. This comprehensive training in Pretoria and their visit to South Africa will undoubtedly leave them Famous Kruger Park. with a lifelong memory due to the exceptional comprehensive subspecialist knowledge gained and surgical experience obtained. ■ iaoms.org 19
Female to female
THE SECRET WORLD OF WOMEN SURGEONS By Gabriele Millesi, IAOMS Vice President Elect
ear Colleagues and dear Friends of the IAOMS,
When I was appointed Vice President Elect at the ICOMS in Melbourne, it was a wonderful experience. So many nice words and hearty congratulations flew my way, from colleagues from regions all over the world. I was addressed primarily by our female members, and I realized in that moment that we have many female OMS viewpoints. Approving a female onto the Board of Directors was a strong signal from the IAOMS to encourage our young females to stay in the OMS field and feel represented in the specialty. The IAOMS is one of the first Associations to recognize a female in its governing body. As the first woman to sit on the IAOMS Board of Directors, I hope to be a positive example in this leadership role. I 20 iaoms.org
will have an open ear for any concerns from our young colleagues, both female and male. Taking it One Step Further One essential step in your career is networking and exchanging experiences, both positive and negative. This essential step may help you organize your own professional and private life. We therefore decided, with our F2F Editor Javier Lagunas Gonzales, to create The Secret World of Women Surgeons as a featured article in every issue of Face to Face. We will ask colleagues in different levels of their careers, rotating from region to region, to give us a short personal insight into their professional and private life, sharing positive and negative experiences. Finally, we will provide you with contact information so you are able to interact with these colleagues in the future and gain a valuable networking experience. April 2016
AS AN EXAMPLE, FOLLOWING IS MY STORY! By the time I finished Medical School, I decided to go into dentistry, but soon after, I realized that Oral and Maxillofacial Surgery was my thing. I started residency at the University of Vienna and have stayed there ever since, ending up as an assistant professor. Retrospectively, two realities influenced my life. For private reasons, I did not do a long lasting fellowship abroad, something that I often see with young male and female colleagues today. Would I have been in a different place had I participated in a fellowship abroad? Of course! Fellowships are very important because they inspire your professional development! My second hurdle was that during my work for my PhD, I became pregnant. I was entangled in an intrauterine rabbit project with up to a thousand histological specimen and two babies. Naturally, family won the battle (a typical female fate). So what is my advice? If you want to have children, go for it, but believe in your academic and surgical career! Maybe you only have to slow down and re-orient yourself, but be attentive and work on your practical skills, as surgery is a practical trade. In female colleagues, I sometimes observed an alarming sign: lack of courage, self-consciousness and missing the routine of their job. To make all of this work, it requires the support and belief of your Chief, which I experienced; and ideally, flexible working hours. In my observation, the work environment as an OMS is improving for the better, hopefully not for the sacrifice of training, however.
The bottom line: Work on your practical skills and stick to your ambition. â&#x2013;
From Proust to Pivot
AN APPARENTLY INNOCENT QUESTIONNAIRE FOR ORAL AND MAXILLOFACIAL SURGEONS You’ve heard of the Proust Questionnaire Adapted and made famous in the back pages of Vanity Fair Magazine, it was named not for questions, but for the answers given by Marcel Proust to a set of questions asked by his friend Antoinette Faure. Then, for many years Bernard Pivot conducted a cultural program in french TV called “Apostrophes”. All his guess received the same 10 questions at the end of the interview So, in Face to Face we thought that being oral and maxillofacial surgeons human beings as the rest, those questionnaites were a great method to let us know some personality traits of our interviewed. Enjoy, and compare their answers with those of celebrities!!!
Julio Acero What is your favorite word? Family What is your least favorite word? Envy What is your favorite drug? Oral and Maxillofacial Surgery What sound or noise do you love? The Birdsong What sound or noise do you hate? Air compressors What is your favorite curse word? None Who would you like to see on a new banknote? The IAOMS Foundation logo What profession other than your own would you not like to attempt? Mathematician 22 iaoms.org
a respectable position in my specialty, OMFS If you were to die and come back as a person or a thing, what would it be? As myself again, am sorry for that Where would you most like to live? Where I am living, in Spain What is your most treasured possession? My family and My friends throughout the World ie the maxillofacial global family
If you were reincarnated as some other plant or animal, what would it be? A lion If Heaven exists, what would you like to hear God say when you arrive at the Pearly Gates? I forgive you...
What do you regard as the lowest depth of misery? Making profit of the human disasters
What is your idea of perfect happiness? 2 ideas: Being with my family in peace and harmony. And appreciating a good result after treating a patient What is your greatest fear? War What is the trait you most deplore in yourself? I have not time to look into my traits
What is your favorite occupation? Oral and Maxillofacial Surgery. Walking, Cinema, Theater What is the quality you most like in a man? Seriousness and honesty
What is your most marked characteristic? Constancy What do you most value in your friends? Loyalty and solidarity
What is the trait you most deplore in others? Sloth
What is the quality you most like in a woman? Seriousness and honesty
Which living person do you most admire? All those who give their life for the others
Which words or phrases do you most overuse? I dont know
Who is your hero of fiction? Don Quixote
What or who is the greatest love of your life? WHO: My wife and my children. WHAT: My specialty OMFS
Which historical figure do you most identify with? Julius Caesar
What is your greatest extravagance? My hats in summer What is your current state of mind? Accelerated but in peace and order What do you consider the most overrated virtue? Altruism (Difference between Theory and practice) On what occasion do you lie? Never (almost) What do you most dislike about your appearance? Nothing Which living person do you most despise? All those who mistreat others
When and where were you happiest? Many times: my infancy, my family life, my professional life, my appointment as the IAOMS President Which talent would you most like to have? Prudence If you could change one thing about yourself, what would it be? Being able to find more time for my family life.. What do you consider your greatest achievement? Achieving April 2016
Who are your favorite writers? Cervantes, Ken Follet
Who are your heroes in real life? The Missionaries What are your favorite names? Maria Angeles, Belen, Julio, JesĂşs What is it that you most dislike? Disloyalty and lies What is your greatest regret? Not having more time to participate to humanitary missions How would you like to die? In peace What is your motto Give as much as you can and you will receive much more. â&#x2013;
Copy Me AUTOTRANSPLANTATION OF PREMOLARS with simultaneous bilateral intraalveolar sinuslift Autotransplantation of premolars in young patients may be a treatment of choice in patients with aplasia of other premolars or loss of incisors caused by trauma. In the “Oslo-protocol” we prefer to use premolars for autotransplantation where the root has reached 1/2 to 3/4 of the expected root development. Some times the autotransplantation can be performed only with sedation, but in other cases it is necessary to use general anaesthesia with nasal intubation in these cases. We present a case with a 13 year old female with aplasia of the first maxillary premolars with the sinus floor in close relation to the roots of the deciduous first molars.
BENTE BROKSTAD HERLOFSON1 , assoc. prof., DDS, PhD.
TORE BJØRNLAND , prof., DDS, PhD.
is the current Norwegian councillor of IAOMS 1
(A) Preoperative Ortopantomogram shows non-erupted 2nd mandibular premolars and aplasia of 2nd maxillary premolars with sinus floor in close proximity to the roots. (B, C) Intraoral radiograph of right (B) and left (C) recipient sites showing the deciduous teeth with large maxillary sinus.
Preoperative situation before autotransplantation.
3 After extraction of the right 2nd deciduous mandibular molar, removal of bone and exposure of the non-erupted premolar keeping the dental follicle intact.
(A) After extraction of the left 2nd deciduous maxillary molar, preparation of a new alveolus with conical burs 60 or 70 mm wide, (B) and lifting of the sinus membrane. April 2016
Â&#x2020;Â&#x2020; iaoms.org 25
Careful removal of the 2nd premolar from the alveolus before transplantation to the recipient alveolus.
After transplantation of the mandibular left premolar to the left maxillary 2nd premolar area. The dental follicle is intact. The premolar is secured with only sutures, a so called H-suture. It is important the there is no occlusal contact with the opposite jaw. The patient should not participate in sport activity for 2 weeks, and a soft diet is administered.
One week postoperative control on right side (A) and left side (B). The sutures are kept for 2 weeks.
8 Two weeks postoperative with the two transplanted premolars in the place of the maxillary 2nd premolar. The patients recovered well without any complications and only slight pain.
Postoperative intraoral radiographs showing the transplanted premolars in infraposition on the right side (A) and left side (B), with the roots extending above the sinus wall. It is expected that the transplanted teeth will erupt with normal vitality. 26 iaoms.org
FOUNDATION CHAIRMAN REPORT
A bi g
THE FOUNDATION TRIADE
After two eventful years for the IAOMS Foundation, I thought it would be helpful to review the three principles that are the cornerstones of a foundation. These principles can be referred to as the Foundation Triade and even though they may be separate, they all are interdependent. These principles are Talent, Time and Treasure. Without understanding the importance of these three, it is difficult to maintain continual growth of the organization.
is truly a major portion of the IAOMS Treasure. The second part of our Treasure is-of course- the financial resources that our Fellows and corporate partners provide. The past two years have been the best in the history of our Foundation with the KLS Martin Group Challenge Grant and our Fellows and friends giving over $100,000 per year in donations. The generous pledges to the Laskin Legacy Society will also help to better solidify future donations.
The first principle, TALENT, is easy to explain â&#x20AC;&#x201C; it refers to the people who are available to present the many programs that our Foundation provides. Fortunately, the IAOMS is blessed with many exceptionally gifted Fellows who understand that sharing knowledge is critical in achieving the mission of the Foundation and Association. The willingness to provide expertise in the various areas of the specialty is universal to our specialty and allows a variety of speakers that are able to present in all areas of the world.
As we have discussed in the past, building the corpus of our Foundation allows the Board to predictably budget for future programs. Even though we have had great successes in the past two years, it is somewhat troubling that these donations came from less than 10% of our membership. If we were to triple or quadruple the number of donors, we could see an even greater impact on the corpus of our Foundation, and provide further educational experiences around the world.
TIME is the second principle, and relates directly to the first. Not only do we have talented individuals to present, they are willing to take the Time to prepare lectures, travel to various venues, often in remote locations, and provide educational experiences that will be invaluable to the attendees. Many of us who do not lecture may not readily understand the commitment that our speakers have or the number of hours required to provide these outstanding programs.
Looking forward in 2016, I ask that each member commit to the Foundation Triade. We need your Talent, your Time and your Treasure, in order to meet the educational challenges of the world and better achieve the mission of the IAOMS Foundation. â&#x2013;
The third principle, TREASURE, can be interpreted to have two parts. The first part, encompasses the first two principles. To have a cadre of knowledgeable Fellows that are willing to share their expertise and time to provide exceptional educational experiences April 2016
Larry W. Nissen IAOMS Foundation Chairman iaoms.org 27
So you want to work...
...IN PERÚ By Leopoldo Meneses
Oral and maxillofacial surgeon Prof. of the Universidad Peruana Cayetano Heredia President ALACIBU
he Republic of Peru, is a representative democratic republic of South America whose west coast is bordered by the Pacific Ocean and has a population of almost 32 millions inhabitants. It consists of 24 departments and one constitutional province. Lima, the capital, concentrates the 32% of the Peruvian population and the official language is the Spanish. Oral and maxillofacial surgery in Peru is a dental specialty. The degree is obtained after completing a 4 years residency.
required . Finally it should be noted that to work in the public secto, r the Rural and Marginal urban health certificate is also required (SERUMS. www. minsa.gob.peserviciosserums2010). If you are a foreigner wishing to work in Peru, the first thing you should ask for is the recognition of your degrees and titles by the SUNEDU. This is an administrative procedure that recognizes the Diploma obtained abroad as long as it isissued by an University, and authorised by the legally competent authority of that particular country. This is only possible when there is an agreement of Cultural Reciprocity or Trade Agreement governing the recognition, between the Peru and the country in which the academic
For an oral and maxillofacial surgeon to work in the Peru, he must first have his title of surgeon-dentist and his title of specialist in Oral and Maxillofacial Surgery issued by a Peruvian University. He must also be registered in the College of Dentists and in its national registry of specialist issued by the Dental Association of Peru (colegio Odontológico de Peru). Currently the recognition of degrees and qualifications of the National Superintendency of University Higher Education (SUNEDU. www.sunedu.gob.pe) is also 28 iaoms.org
degree or professional degree was obtained. If you you can not access the automatic recognition, then you can go through a revalidation process, which is an academic procedure performed through an authorized Peruvian University (www.sunedu.gob. pegrados-y-titulosrequisitos-grados-y-titulos).
The second step is to be enrolled in the national registry of degrees and titles in the SUNEDU (www.sunedu.gob.pegradosy-titulosrequisitos-grados-y-titulos). After registration, enrollment is required in the College of Dentists (www.cop.org.pecolegiatura) and in the National Registry of Specialists (www.cop. org.peinscripcion-en-el-registro-nacional-deespecialistas-magisterdoctor), both granted by the Dental Association of Peru. Salaries in Peru for the oral and maxillofacial surgeon depend on where you work. In the public sector monthly salaries range from 750 to 1700 dollars with a working load of 6-8 hours per day. In private practice wages are slightly higher with an average of 2000 dollars. The current practice in our country is to work in the public system in the morning and in private hospitals in the afternoon. There is a limited number of positions in the public system. The most profitable activity for the surgeon in the Peru is private practice. â&#x2013; April 2016
The Data In Peru, we have a total number of 123 oral and maxillofacial surgeons enrolled in the National Register of Specialist. They work in different public or private institutions and in teaching, in only 7 of the 24 geographical departments. Most work in the capital Lima, followed by Arequipa, La Libertad, Puno, Cusco, Piura and Tacna. The scientific association that represents OMFS in Peru is the Peruvian Association of oral and maxillofacial surgery: ASPECIBUM www.aspecibum.org.pe
THE ULTIMATE GUIDE
AsianOMS Manila Philippines November 9-12 2016 EACMFS London UK September 13-16 2016
EACMFS London UK September 13-16 2016 AAOMS Las Vegas US September 18-23 2016
AAOMS Las Vegas US September 18-23 2016 ALACIBU Buenos Aires Argentina August 6-9 2017 ANZAOMS GoldCoast, Australia October 20â&#x20AC;&#x201C;22 2016
ALACIBU Buenos Aires Argentina August 6-9 2017
PanAfCOMS Sharm el Sheikh, Egypt April 29, May 1 2016 (TBC) HKAOMS Hong Kong March 23, 3 April 2017
TO SCIENTIFIC MEETINGS
ICOMS Hong Kong March 23, 3 April 2017
AsianOMS Manila Philippines November 9-12 2016 PanAfCOMS Sharm el Sheikh, Egypt April 29, May 1 2016 (TBC)
ANZAOMS GoldCoast, Australia October 20â&#x20AC;&#x201C;22 2016
ME & THEM By Javier GonzĂĄlez Lagunas
pening a practice is normally the result of individual drive, its concept, its development, its implementation requires time and effort from its founder. This solo practice will eventually grow, and the surgeon will suddenly face a lack of time, a lack of capacity or the lack of resources. So the moment has arrived to associate, to find partners and to delegate! This might be a forbidden word for many surgeons. It is a common thought that we are essential in our practice, and that if we do not operate a particular case, the patient will complain because it is YOU who he is looking for. First we have learned that we are not indispensable. Next, we have to learn how to educate our patients to explain to them that now we are a team, and that our medical staff or partners are as good as we are. 32 iaoms.org
Finally, you need to hire and to retain the right partners in your practice: you want them to be engaged, caring for the practice and recognized for their work. They must be aligned with the vision of your practice. But they can also be an extraordinary force helping you to explore new pathways that can open new doors to your career. But you still have to go one step further. Now you need to be the practice leader: administrator, director, controller, while you continue to be the visible surgeon of the practice. Partnership is not easy: Which is the value of the practice? Which part of the share is distributed? Who makes the decisions? Those are important strategic aspects that have to be dealt with in-depth. But definitely the most difficult decision is to get the ball rolling to change the model of your practice. Are you reluctant to change? â&#x2013; April 2016
iaoms.org April 2016