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THE IAOMS

NEXT LEVEL

FORUM

TAKE YOUR CAREER TO THE NEXT LEVEL JOIN US FOR NEXT LEVEL FORUM MONDAY, MAY 20, 2019 A complimentary day of programming on leadership and management for OMF surgeons at any stage in their career. 8:30–12:00

Next Level Forum: Pearls in the Career of NextGen: from Marketing to Mentoring Ideas from experienced surgeons plus the debut of “Get Inspired” — personal stories from NextGen surgeons featuring up-and-coming OMF surgeons. 14:45–18:00

NextGen Scientific Symposium: What if Bad Things Happen? Focus on complications in oral and maxillofacial surgery with global leaders in the field. REGISTER TODAY AT icoms.iaoms.org/registration


Issue 57 / March 2019

Editor-in-Chief Javier González Lagunas

Assistant Editor Deepak Krishnan

Graphic Designer María Montesinos

Executive Committee 2018-2019 Board of Directors

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

Members-at-Large

Rui Fernandes Javier González Lagunas Sanjiv Nair

Regional Representatives

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

Committee Chairs G.E. Ghali, Education Alejandro Martinez, Governance and Ethics Alfred Lau, Membership and Communications Sean Edwards, Research Luiz Marinho, 24th ICOMS-2019, Brazil David Koppel, 25th ICOMS-2021, Glasgow Ed Dore, 26h ICOMS-2023, Vancouver ©Copyright 2018. International Association of Oral and Maxillofacial Surgeons. Chicago, Illinois, USA. All rights reserved under international and Pan American copyright conventions.

CONTACT US IAOMS

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


Letter from the Editor AS I SEE IT

W

e start 2019 with a topographic issue dedicated to West Africa. We worked hard to find some of our colleagues working on the ground, sometimes in difficult circumstances. The United Nations includes 16 countries in the area with a population esteemed to exceed 360 millions. Immediate health challenges include the need for new facilities, the maintenance of existing medical centres, and attracting and retaining health professional willing to stay in the area. However, at even a more fundamental level there is a lack of infrastructures: lack of electricity, difficulties in transportation and evacuation of patients or problems in communication. We think that we need to pay attention to those areas of the world where we do not find a structured speciality of Oral and Maxillofacial Surgery. We have a double objective. First to recognise, encourage and congratulate those surgeons with the drive to pursue a career sometimes in extremely tough conditions. They deserve our compliments for their work and engagement. Second, to call the attention of health authorities, scientific associations and non-profits regarding the needs of the population living there. A reliable partner for them could be the WAHO (West African Health Organization), a branch of ECOWAS (Economic Community of West African States), located in Burkina Faso. However, there is more than that. Our contributors to this issue are coming from the five continents, not only from Africa. A beautifully presented technique for clefts coming from New Zealand, a three generations family history coming from Central America, the voice of our residents coming from Europe, while our colleagues in Singapore talk about the Asian meeting. Learn also about our speciality in the beautiful Mediterranean country of Greece. How can I end this column without mentioning Dr. Peter Banks, former president of IAOMS and a key figure in the development of our speciality. We deeply regret his death and send our sincere condolences to his family. Rest in peace.

Javier Gonzรกlez Lagunas EDITOR IN CHIEF


CONTENTS March 2019 10 SPECIAL REPORT

Maxillofacial Surgery in the West Africa.

IAOMS FOUNDATION 16

17 FELLOWSHIP

Medical University of Vienna (Austria).

SO, YOU WANT TO WORK... 18 in Greece.

21 FATHER TO SON

Rodolfo Asensio Guerrero.

FROM PROUST TO PIVOT 23 Michael Miloro.

26 COPY ME

Alveolar bone grafting of the cleft maxilla.

NEXT GEN 31

Maxillofacial Surgery in rural Africa.

34 THE AUSTRIAN SYSTEM OF TRAINING in Oral and Maxillofacial Surgery.

A DAY IN THE LIFE OF 36

A Maxillofacial Resident in Spain.

40 ACOMS MEETING 46 BEYOND THE O.R.

Do we need chutzpah?

NEW PROJECTS 42

Building on success in education for IAOMS.


MODERNIZING AND EXPANDING IAOMS

J

ust a few months into 2019, and IAOMS is striving to advance our mission while modernizing the opportunities we provide to our members. Last year, we heard from our members regarding the challenges facing the international OMF community. IAOMS is hearing those voices loud and clear and implementing strategic action plans to help expand our educational programming and networking opportunities. Online learning is at the forefront of our efforts to ensure IAOMS remains a prominent voice for the OMF specialty. This past February, our first ever Virtual Conference took place allowing participants to access this live event from the comfort of their home or office. Implementing programming such as this allows participants to engage, ask questions, and learn from presenters and attendees alike in a dynamic learning environment. The Virtual Conference provided a keynote session by Dr. G. E. Ghali, and three additional breakout sessions that catered to different topics in the specialty. IAOMS is dedicated to strengthening online learning that it is more accessible to those in regions where access to handson opportunities is limited. The IAOMS Review Course has been made available to members and non-members with updated content. The review course contains ten modules that are available for purchase individually or as a full course. Additionally, our new NextGen page has just launched and provides a unique platform for the NextGen community to engage and stay up to date. Features include chatting with the community, challenging yourself with a Scientific Quiz, having quick access to IJOMS and ICOMS registration, and much more!

Our biennial ICOMS is just a few months away in May! We have just announced the addition of simultaneous interpretation in Portuguese that will be offered in select sessions throughout the conference. For those it may apply to, MedTech Europe has determined the ICOMS compliant, and more information can be found on IAOMS.org. Be sure to attend the pre-conference day at ICOMS on May 20 and participate in the Next Level Forum “Get Inspired” session which will bring together six young surgeons who each have a personal connected that inspired them to pursue a career in the OMF profession. And don’t forget to attend our social events at ICOMS. Witness the beauty of Brazil at Brazilian Cultural Night or join us at our Gala Dinner at the Casa das Canoas. During the month of March, we will be asking for your participation in an IAOMS needs assessment survey. The purpose of this survey is to continue to understand the needs of IAOMS members, and how we might develop products, services and meaningful experiences for you as a member of the IAOMS community. The survey will take less than 10 minutes of your time. We encourage your participation! We are excited to continue to provide leading opportunities across our learning management system, online webinars, online resources, and biennial ICOMS to further your knowledge in Oral and Maxillofacial Surgery. Warm Regards,

Mitchell Dvorak EXECUTIVE DIRECTOR, IAOMS


Letter from the President LOOKING AHEAD Dear Colleagues and Friends,

I

t is with great sadness that I convey to our membership the passing of our colleague and friend, Peter Banks. A lifelong Fellow and President of the IAOMS from 1997-1999, Dr. Banks helped grow and propel the Association into the 21st, Century, and was instrumental in the success the IAOMS enjoys today. Our heartfelt condolences go out to his wife Diana and family. On February 13, the IAOMS honored the OMS community and gave special recognition to its members for International OMS Day. Once again, we would like to say thank you to all you surgeons that have a such a strong impact on individual lives daily! As we gear up for an exciting year ahead and our upcoming ICOMS in Rio de Janeiro, we encourage you to join IAOMS if you have not yet done so. Our membership grace period is expiring on March 31. For uninterrupted benefits, renew your membership today and receive reduced rates to join us at ICOMS in May! Although ICOMS is open to members and non-members, members received the best possible price. Please keep in mind, we are also excited to offer the opportunity to pay for ICOMS in two installments. View membership types on our website to find the best fit for you and join today! Thank you too all those who renewed for 2019, and welcome to our many new members. As our ICOMS is quickly approaching, it is very heartening to recognize some of the national organizations who are helping to sponsor trainees attending the upcoming Brazil ICOMS this May. Associations, like the Austrian Society of Oral & Maxillofacial Surgeons, who are supporting two of their trainees. In addition, through the generous foundation donations of the American and Canadian Assoications of Oral & Maxillofacial Surgeons, AAOMS is sponsoring 2 American trainees and CAOMS is sponsoring one Canadian trainee to attend the Rio

meeting. Furthermore, In the inaugural year of the IAOMS Foundation Visiting Scholars Program, the 2018 Scholarship recipients have been announced; Dr. Özge Doğanay from Turkey and Dr. Olanrewaju Adediran from Nigeria- to visit and learn with their chosen academic/training center in the world. Congratulations to all of you! Our live webinars and e-learning programs have been off to a great start in 2019. In January, the IAOMS offered a live webinar on “Cleft Lip and Palate Management with the ‘Asensio Method’: Fifty-Two Years of Experience in Guatemala” presented Dr. Rodolfo Asensio Mármol and Dr. Rodolfo Asensio Guerrero. In February, we conducted our first ever Virtual Conference with speakers Drs. Ghali Ghali, Shelly Abramowicz, Moni Abraham Kuriakose, and Mike Leung on a wide range of topics of Sleep Apnea, Robotic Surgery, Juvenile Idiopathic Arthritis, Advanced Oral Cancer and Orthognathic Surgery. In March, we will be offering another Scientific Webinar Presented by Deepak Kademani on “Hypoglossal Nerve Stimulator for OSA”. More details to come on future educational programming! I am also excited to announce that in 2019 the IAOMS is partnering with the Patient Safety Movement Foundation to eliminate preventable patient deaths in hospitals worldwide. This is in keeping with our core principles, advocating patient safety. We will keep you posted as this develops. Thank you to all our Fellows and trainees, and welcome to our new members! On behalf of the Board, Executive Committee and Staff, we hope to see you all at ICOMS in Rio de Janeiro May 21-24! Warm regards,

Alexis B. Olsson IAOMS PRESIDENT 2018-2019


special report

An Introduction to

AFRICAN MAXILLOFACIAL SURGERY By Eric Kahugu President, African Association of Oral and Maxillofacial Surgeons

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frica has long been recognised by industry, as a continent rich in potential and human resource. In the medical arena, it is commendable that organisations like the International Association of Oral Maxillofacial Surgeons (IAOMS) have appreciated this and sought to partner with surgeons in Africa. The African Association of Oral Maxillofacial Surgeons (AFAOMS) is the regional chapter of the IAOMS. Africa is a large continent and in the recent past AFAOMS has extended its network throughout Africa, involving more and more surgeons in its activities. By harnessing the connectivity created through social media platforms, we have become truly networked, creating a large community of surgeons who can participate in the global arena. As a result there has been an increased number of multinational and international activities taking place in Africa. These include and are not limited to;

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•P  an African Conference on Oral and Maxillofacial Surgery. • Pan African Cleft Lip and Palate Conference. • IAOMS Hands on Microvascular Surgery courses. • International OMFS Conferences. •A  OCMF Advanced hands on courses and symposia and trauma courses. There has been increased collaboration in research and training between Universities in Africa with Universities in other continents. There has been increased recognition of the need to establish examination centers within Africa by organisations like the International Board for Certification in Oral Maxillofacial Surgery (IBOMS). Africa is truly a continent of great potential, a hub of increased activity and a region that will influence surgical teaching and practise globally. IAOMS through its Face 2 Face Magazine has published several articles and features on activities in Africa. This feature focuses on West Africa. ■

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Maxillofacial surgery in GHANA By Solomon Obiri-Yeboah Kwame Nkrumah University Of Science and Technology. KNUST

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he Ghana Association of Oral and Maxillofacial Surgeons was formed somewhere in 2010. It currently has a membership of twenty-nine (29) with Professor Grace Parkins as president and Dr. Emmanuel Amponsah as the Vice president. The practice of Oral and Maxillofacial Surgery (OMFS) in Ghana is mainly developed in our four Teaching Hospitals. The scope of practice ranges from management of odontogenic tumours and cysts, salivary gland lesions, orofacial infections, cranio-maxillofacial injuries, minor oral surgery to the management of cleft and craniofacial anomalies. The OMFS training in Ghana like other postgraduate medical and dental training is in two stages; Membership training and Fellowship training. The Membership training is three years after two years of internship/housemanship during which the junior resident spends one year in rotations in General Surgery and other allied Surgeries, Anaesthesia, Internal Medicine. There are also internal rotations in other dental disciplines. The remaining two years are spent in the OMFS department. After the three years, the resident can sit for the Membership examination of either the Ghana College of Physicians and Surgeons (GCPS) or the West Africa College of Surgeons (WACS) or both. Successful candidates are considered as Specialists. After one-year post-membership rotation in a district hospital, the doctor may apply to start the Fellowship training as a senior resident for a period

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of two years. During this period, the senior resident gets further training in advanced maxillofacial surgical procedures. The resident is also required to carry out research work and present a dissertation as a prerequisite towards the award of a Fellowship of GCPS and/or WACS. There are four training centres in Ghana for OMFS; Korle Bu Teaching Hospital, Accra, Komfo Anokye Teaching Hospital, Kumasi, 37 Military Teaching Hospital, Accra and Sunyani Regional Hospital, Sunyani. Currently, there are three senior residents in the fellowship training and twelve junior residents in the membership training. Our needs regarding training are in the area of craniomaxillofacial surgery including orthognathic surgery and orofacial reconstructive surgery. â–

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02

The Practice of Oral and Maxillofacial Surgery in CAMEROON By Benjamin Fomete Maxillofacial Unit, Ahmadu Bello University Teaching Hospital, Zaria Nigeria

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eographically, Cameroon is situated in West Africa but politically it’s in the central Africa region. As of 2010, the population was 22 million. French and English are the offi-cial languagesof the country. This duality of the official languages has also affected the educational system. There are two Dental Schools in Cameroon; one owned by the government and the other, a private venture. The country has three Medical Schools; two owned by the government. Postgraduate training in Cameroon is a national pro-gramme pursued at the University of Yaoundé. However, there’s a Pan African Associa-tion of Christian Surgeons that train specialists at the Baptist Mission Hospital in the Northwest region. There is no postgraduate training in Oral and Maxillofacial surgery. Oral and Maxillofacial surgery is a sub specialty of Dentistry and in the francophone system, Maxillofacial surgery is practiced by MD holders while Oral surgery is for BDS/DDS. In Cameroon, Oral and Maxillofacial surgery started in 1979 with the first in-digenous doctor, a French trained stomatologist, Dr. Temoka Dieudoné. He worked with the government until 1994 where he decided to settle in private. As of today, there are only five Oral and Maxillofacial surgeons in Cameroon excluding myself, although I go there from time to time to do cleft surgeries and trauma cases.

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Challenges on ground are those of manpower, infrastructure, and training. THE BURDEN OF ORAL AND MAXILLOFACIAL SURGERY IN CAMEROON It’s made up of benign and malignant tumours. Ameloblastoma leads the benign while oral SCCAs leads the malignant. Globocan1 in 2012 stated that head and neck cancer is the 5th most common cancer in Cameroon and the 3rd most common in men. Odontogenic tumours are dominant2 among the benign tumours seen. Trauma is also very common with many patients dying before arrival at the hospital. In a single institution report, 152 patients were recorded with Maxillofacial trauma within 6 months3. Clefts lip and palate were also very common but have been taken care off by "Mercy Ship" surgeons, "Smile Train" and "Operation Smile" volunteers.

March 2019


“As of today, there are only five Oral and Maxillofacial surgeons in Cameroon... Challenges on ground are those of manpower, infrastructure, and training.”

*I wish to acknowledge Dr. Acha for the photos.

CHALLENGE OF MANPOWER AND INFRASTRUCTURES There are only five Oral and Maxillofacial surgeons in Cameroon. All of them practice in Douala (1) or Yaoundé (4). Two of them are in private practice, one is a government retiree. All the others are in government service. The infrastructure necessary for delivery of standard oral and maxillofacial surgical care is either non functional or altogether lacking. Majority of trauma cases are treated with dental wires, as it is the only skill mastered by the surgeons. The few suspensions carried out were either by me when I visited or by the really qualified Oral and Maxillofacial surgeons. The use of plates is not common as it’s unaffordable and requires additional skills. Due to lack of manpower, general dental practitioners dabble into trauma cases but they can fix only simple mandibular fractures. The ENT surgeons, numbering about 80, handle most of the facial trauma and tumours and the results are very poor. The Gen-eral surgeons also take over the responsibilities of managing tumours and soft tissue traumas. According to Dr. Temoka, most of the badly managed trauma now find themselves with a Maxillofacial surgeon but are unable to afford the fee. Those that sustained Maxillofacial fractures especially pan facial fractures are poorly assessed and most of the time are brought in late and patients often don’t make it to the hospitals. With the unrest in some parts of the country, the number of trauma due to gunshots (fig1 &2) has increased in the far north (the second most populous region) and in the anglophone regions. In other parts of the country,

March 2019

motorcycle accidents are the com-mon causes of trauma. Douala was the first big city to have a Maxillofacial Centre in 1984 after Dr. Temoka was moved from Nkongsamba and for a very long time it remained so. Safari surgery are carried out by visiting Oral and Maxillofacial surgeons from mission hospitals and "Mercy Ship". TRAINING Cameroon is bilingual (Anglophone and Francophone). This has influenced the train-ing of Oral and Maxillofacial surgeons. The francophone will require an MD or MBBS for Maxillofacial surgery and DDS or BDS for oral surgery. While the Anglophone will require a BDS or both MD and BDS. There’s no training for Oral and Maxillofacial surgery in Cameroon even though it has 2 Dental Schools. The first Oral and Maxillofacial Surgeon, Dr. Temoka Dieudonné is a stomatologist from Nante after his MD in Toure, both in France and others are trained in Africa and only one is trained in the anglophone system excluding myself. The Oral and Maxillofacial surgeons teaching in the dental schools are from outside the country as none of the 5 within the country lectures. CONCLUSION Oral and Maxillofacial surgery in Cameroun, though started as far back as 1979, has not grown and the burden has not reduced. With the Dental Schools, there is now pressing need for training to start. ■

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03

My IAOMS fellowship experience

SPECIALTY DEVELOPING INITIATIVES FOR WEST AFRICAN AND OTHERS ALIKE By Tuoyo Okoturo Clinical Senior Lecturer / Maxillofacial Head & Neck Oncology Lagos State University College of Medicine (LASUCOM), Nigeria

I

t has been a while since I completed my oneyear IAOMS fellowship in head & neck surgical oncology and reconstruction at the HNS of Mazumdar Shaw Cancer Center, Bangalore in 2011 and I am delighted I decided to work with my mentor Moni Kuriakose. My responsibilities during the training included running one of the three daily outpatient clinics, daily minor, and major operatory while I worked on my dissertation. It’s stating the obvious that what I learned during that period helped shape my future career. Since then, I had gone on to set up a practice in head and neck oncology before which I knew very little. My hospital in Lagos now has a regional head & neck cancer unit with routine reconstruction service amongst others – in an environment where sub-speciality training is not very common. In my opinion, this fellowship enabled me to offer quality treatment to patients, promote collaboration amongst colleagues and impart knowledge of head

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and neck surgery and microvascular reconstructive procedures on residents and colleagues through training and cooperation. We now accommodate residents from other centres for short head and neck surgery postings. Beyond the absence of dual qualifications and mid-level economy challenges, Oral and Maxillofacial Surgery in my region is considered an emerging speciality by consensus with regular sub-speciality training still a short time away. I have mentioned in several forums that the IAOMS initiative, while very commendable, should be considered a superb starting point with a lot more required in the region including other subspecialities like orthognathic/craniofacial surgery. Suffice to say, the little done at the moment does very little at achieving meaningful impact in terms of quality care delivery and training. There is a need to have more surgeons undergoing similar training. Ways in which this can be achieved include, more centres availing

March 2019


Mazumdar Shaw Cancer Center. Bangalore.

Moni Abraham Kuriakose.

Moni Abraham Kuriakose, Eyituoyo Okoturo and other members of staff.

themselves to accepting international surgeons for the same level of training host fellows experience, as I did in Bangalore. Having only one receiving hospital in India and two in China is definitely inadequate considering the availability of centres in Europe, North and South America, or Australia. Some centres have started online international head and neck fellowship with local visits and examninations. While this is a laudable first step, it does very little for hands-on training which is vital to developing necessary skills for quality training. I should acknowledge Luiz Kowalski who in the height of my quest, informed me of a part-funded international fellowship opportunity at his centre in Brazil. Funding, licensing, insurance and compliance have always been some reasons adduced for lack of support of such expanded initiative. However, I think creative solutions to these challenges can be developed. I have always advocated centre-only licenses and temporary (supervised) registration (like its done in the UK) for a fixed period with no path to regularisation. Funding and insurance require the will and support of the association and the host centre. Offering fellowship awards (full, part or none) are options that should be openly

March 2019

discussed amongst stakeholders to find some common grounds. If these issues can be addressed head-on and implemented, I have no doubt whatsoever on the upward trajectory our speciality will attain in regions like West Africa and others alike. My experience and that of my centre is evidence that the IAOMS fellowship initiative works. All these issues can be addressed, and caveats put in place to ensure compliance. Lastly, translational research is another area for local improvement of the speciality. Through networking achieved from my fellowship, I am presently involved in the study of the transformation of pre-malignant neoplasms of head and neck cancer using a high throughput sequencing-based approach. I am also putting together an application for funding on an African Cancer Genome Project. Thus, I was looking forward to the first IAOMS clinical research fellowship at the University of Michigan as a crucible to discussing this proposal. While this may be somewhat ahead for my region, cataloguing of African-African ancestry somatic mutations is essential to identifying any variant peculiarities and possible therapeutic checkpoints. â–

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“The at work around the world” 019-2020 FELLOWSHIP RECIPIENTS

Cleft Lip and Palate and Craniofacial FRANCISCO ROSADO (Dominican Republic) GSR Institute of Craniomaxillofacial and Facial Plastic Surgery in Hyderabad, India & Bhagwan Mahaveer Jain Hospital in Bangalor, India

Oral & Maxillofacial Oncologic and Microvascular Reconstructive Surgery

KLS Martin Oral & Maxillofacial Oncologic and Microvascular Reconstructive Surgery

WAYNE MANANA (Zimbabwe) Peking University School & Hospital of Stomatology in Beijing, China

BILAL MSALLEM (Switzerland) The Ninth People's Hospital in Shanghai, China

2019-2020 VISITING SCHOLARS RECIPIENTS DR. OZGE DOGANAY (Turkey)

DR. OLANREWAJU ADEDIRAN (Nigeria)

Visiting: University of Illinois, College of Dentistry, Oral & Maxillofacial Surgery Chicago, IL Prof. Michael Miloro and Northwestern Memorial Hospital, Chicago, IL Prof. Alexis B. Olsson

Visiting: Department of Oral and Maxillofacial Surgery, Vienna General Hospital Vienna, Austria Prof. Emeka Nkenke

ICOMS SCHOLARSHIP RECIPIENTS

MATTHEW GREEN Nassau University East Meadow, NY Supported by AAOMS

SIMON JEAN Laval University Quebec, Canada Supported by CAOMS RIAN CHO University of Tennessee Knoxville, TN Supported by AAOMS

ICOMS Scholarships for this year are facilitated in partnership with the American Association of Oral and Maxillofacial Surgeons (AAOMS) and its partner, the OMS Foundation, and the Canadian Association of Oral and Maxillofacial Surgeons (CAOMS) to provide registration, travel, and accommodations scholarships to the ICOMS!

“These are just some of the faces of those taking part in IAOMS Foundation programs in the coming year. We continue to press forward in our mission to elevate the standard of OMFS care around the world, and we’re grateful for all of our individual, corporate, and organization members who support this mission. We are looking forward to a big announcement about the Foundation’s future at ICOMS in May. See you in Rio! ■

Larry W. Nissen IAOMS Foundation Chairman


FELLOWSHIPS

My Experience at the Medical University of Vienna (Austria) By Dr Moses O lanrewaju Ade diran IAOMS Founda tion Visiting Sc holar

M

y joy knows no bound as one of the recipients of the Foundation scholarship of International Association of Oral and Maxillofacial Surgeons (IAOMS).

I started my one month stage on February 18th 2019, and throughout my stay, I had a tight schedule of daily medical activities. I was able to observe in several surgical procedures like orthognathic surgery, distraction osteogenesis, cleft surgery, orbital decompression, microvascular reconstruction, open reduction and internal fixation of maxillofacial fractures with osteosynthesis, tumour surgery and a full array of other surgical procedures that covered the whole spectrum of our speciality. My experience in Viena was completed by morning and afternoon presentations, observing in the outpatient clinic and by attending the clinical rounds to visit patients admitted in the Department. My appreciation goes to Prof. Gabrielle Millesi who painstakingly made bilateral sagittal split osteotomy and Le Fort 1 osteotomy with or without segmentation ridiculously easy for me. You are an excellent erudite scholar and you will forever occupy a worthy place in my hall of praise.

and other administrative staff of the Department of Cranio Maxillofacial and Oral Surgery on the Medical University of Vienna.

My gratitude also goes to the Head of Department Prof Dr Dr. Emeka Nkenke for his mentoring in the management of cleft lip and palate. Prof. Baumar gave beautiful intraoperative teachings on orbital decompression and management of fractures of the floor of the orbit. I also appreciate the friendly environment provided by consultants, residents

Finally, I want to thank the Chair and Trustees of the IAOMS Foundation for the unique opportunity of being one of the recipients of the Visiting Scholarship programme. The knowledge and medical skills acquired will serve to improve and advance in the practice of Oral and Maxillofacial Surgery in areas where it is most needed. â–

March 2019

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So, you want to work

...IN GREECE By Evangelos Kilipiris Thessaloniki, Greece

G

reece, officially the Hellenic Republic, is a picturesque country located on the southeastern tip of Europe at the crossroads with Asia and Africa. Most of you, have immersed in the glittering Aegean Sea with the quaint whitewashed buildings and walked in the footsteps of Hippocrates, Aristotle and Socrates, or you are planning to do so. Together we’ll walk on the path of Oral and Maxillofacial Surgery (Στοματική και Γναθοπροσωπική Χειρουργική, the official name of the specialty in Greece) training and working requirements in this culturally diverse, vibrant and friendly location. THE JOURNEY IF YOU WANT TO BE AN OMFS RESIDENT IN GREECE… Our first itinerary will follow the steps of those candidates who are not Oral and Maxillofacial surgeons, but would like to obtain the training and receive the specialty title in Greece. The nominate person should know that like in most European Union countries, Oral and Maxillofacial Surgery is posted as a medical specialty according to the Directive 2005/36/EC described on the Annex V and published by the European Commission in order to comply with the European Union regulations. However, the OMFS specialty is set as a medical and dental specialty, according to the national law. The training path begins after completion of both the medical and dental degree studies (9-10 years in Greece), regardless of which degree was acquired

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first. Medical and/or dental degrees that are awarded by foreign Higher Education Institutions should be recognized by the Hellenic National Academic Recognition Information Center (ΔΟΑΤΑΠ in Greek language). The recognition process of titles obtained in other European Union countries outside Greece is easy and fast and requires the submission of a list with basic documents. This process is different for diplomas received from universities outside the European Union. In addition to the submitted documents, the title holder has to appear for an exam covering basic knowledge obtained in the undergraduate level. After finishing the basic medical and dental training, you should pass through a national entrance exam. Residency in Oral and Maxillofacial Surgery lasts for 5 years. The training program is subdivided in two main parts: •T  he first part with duration of 12 months consists of rotation in other specialties like general surgery, ENT, plastic

March 2019


surgery, anesthesiology and intensive care medicine. • The second part lasts 48 months and includes the main training in Oral and Maxillofacial Surgery. There are 23 Oral and Maxillofacial Surgery departments distributed across the main urban areas of the country in 9 different cities with half of them located in the capital city of Athens. The training program in OMFS is carried out at 9 training hospitals. Most of the training centers offer one position per year, but this greatly varies from year to year. The integrated clinical and didactic program is designed to meet the full scope of the specialty, with the resident fully exposed and gaining expertise in the diagnosis and treatment of diseases affecting the oral cavity, jaws, face, head and neck. Each educational department has a training faculty who guides and evaluates the performance of the residents. At the end of the specialty program, the resident has to pass a final exam to receive the title in OMFS.

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THE ROUTE IF YOU ARE AN ORAL AND MAXILLOFACIAL SURGEON AND YOU WOULD LIKE TO RELOCATE TO GREECE… In our second itinerary, we would travel along the pathway, that a trained Oral and Maxillofacial Surgeon from another country, has to cover in order to reach his gateway to Greece. The Oral and Maxillofacial Surgeon with a medical and dental background can apply for recognition of the specialty. The procedure varies, depending on whether the titles have been awarded in a European Union country or not. The length of clinical training, and the professional experience received, have to be verified for their validity, and compared with the requirements in Greece, respectively. Evaluation of the documents is done by the Hellenic National Academic Recognition Information Center and the Ministry of Health. If the Oral and Maxillofacial Surgeon holds only the dental degree from his country, it is not possible to proceed with the recognition of the specialty. However, the candidate can work as an Oral Surgeon on an outpatient basis. WHEN THE JOURNEY REACHES ITS FINAL DESTINATION, AND YOU DISEMBARK IN GREECE, THE FOLLOWING OMFS EXPERIENCE AWAITS YOU… Currently, the total number of OMFSs in Greece is about 240. According to a recent statistical analysis, this number is capable and sufficient to cover all the needs in the Greek territory.

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The Hellenic Association of Oral and Maxillofacial Surgery (HAOMS) is the official scientific association for OMFS in Greece (www.haoms.org). About 85Â % of Greek specialists are members of HAOMS. With a continuous history of 60 years, with a rich past and comprised of distinguished members, HAOMS plays an integral role in the improvement of quality of life, healthcare safety, and promotion of education and research, not only in Greece, but also in the international OMFS scientific community. The HAOMS is responsible for the organization of exclusive OMFS scientific sessions, but also educational meetings and seminars with a broad spectrum of content. The Junior Hellenic Oral and Maxillofacial Surgery Group is an effort created by medical, dental students and young trainees interested in OMFS. Its aim is to provide guidance and to create a strong network among the new generation in Greece and abroad in

Salaries in the public sector may start at 1500 euro per month for trainees including the on-call service, and may increase up to 3000, based on the personal qualification and experience. Working in private practice is of paramount importance and very popular in Greece. Large

collaboration with the Hellenic Association of Oral and Maxillofacial Surgery. This project has already received promising comments. The last years, the deep financial crisis in the country slowed down the development of the departments in the vulnerable public health sector, and created difficult conditions in an environment with highly demanding population needs.

private hospitals and clinics in the major cities accept patients covered by all public medical insurance organizations, and have special contracts with private medical insurance companies. They provide the highest standard in the medical and nursing care, much higher salaries, and are a good alternative and/or additional option for OMFS specialists. â–

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March 2019


Father to Son

THREE GENERATIONS, 52 YEARS OF EXPERIENCE By Rodolfo Asensio Guerrero Antigua Guatemala

T

he ancient principle “primum non nocere� rules every medical practice, and remains a critical component of all high-quality treatment rendered to this day. It is in the core of our training and constitutes an ineluctable task - it increases patient safety, follows ethical surgical principles and transcends the dictum to future surgeons through our education. A 52 years trajectory can only be defined in consistency, discipline and a relentless search for perfection.

1. Dr. Rodolfo and Oscar Asensio. 2. Dr. Rodolfo Asensio Marmol and Rodolfo Asensio Guerrero. 3. Dr. Oscar Asensio. 4. CIE Inauguration. 5. CIE 1965.

In 1956, my grandfather PROF. DR. OSCAR ASENSIO DEL VALLE, a Guatemalan Dental Surgeon from Universidad de San Carlos de Guatemala was driven by a spirit of service and set on a path pursuing his passion of giving a better life to children with cleft lip and palate in Guatemala. He co-founded the Guatemalan Association of Oral and Maxillofacial Surgery. During his career, he focused his studies on the growth and development of the middle third of the face and dominated the knowledge in nasolabial anatomical structures and geometrical concepts. He developed the Asensio cleft lip and palate techniques. The fundaments of his methods are based in advancement and rotation with the reconstruction of the nose and lip, independently, having as a hallmark the recovery of the functionality of the orbicularis muscle taking it to its ideal position through a quadrangular flap.

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In 1972, the Asensio techniques were presented internationally for the first time in the Congress of the American Association of Plastic and Reconstructive Surgery and were published in their journal the same year. Soon after, due to its versatility, functionality recovery and esthetic results, the Asensio techniques gained interest in both American and Latin American Oral and Maxillofacial programs, and Guatemala started being a referal center for the treatment of cleft lip and palate patients and educating future maxillofacial surgeons. Ever since, we have had students from all over the PanAmerican region.

Prof. Dr Asensio Marmol is the author of multiple papers and books published internationally. He is a member of the Asociación Latinoamericana de Cirugía Bucal y traumatología Maxilofacial (ALACIBU) and an honorary member of the Asociación Guatemalteca de Cirugía Oral y Maxilofacial. As the venue of the Commemorative Congress 50 años del Método Asensio, Guatemala was the headquarters for many well-recognized professionals from Latin America, United States and Europe. During the event, the Dental School of Universidad de San Carlos de Guatemala granted the Centro Infantil de Estomatología the category of an academic training center in cleft lip and palate. Around this time, the center brought on its new member, a third in the Asensio generation.

But nothing would have happened without the firm belief in teamwork by Prof. Dr. Asensio del Valle, who associated with both national and international institutions to create a foundation and make his dream a long-term reality. It was then, that the Centro Infantil de Estomatología in Antigua Guatemala was born. His second son, PROF. DR. RODOLFO ASENSIO MARMOL, a medical doctor graduated from Universidad de San Carlos de Guatemala, began his training journey with his father to be specialized as a cleft lip and palate surgeon. Rodolfo’s passion and skills mirrored his father’s. His close observations of his father’s surgeries, detail and deep attention in changes through growth and development of children made him aware that there was something beyond excellent surgical correction. Into their adolescence, each patient will need a minimum of 4 surgeries and several multidisciplinary interventions to rehabilitate their quality of life with appropriate function and esthetics. Prof. Dr Asensio Marmol sees the need and benefit of following guidelines to take the management of each patient right from the prenatal period. He created the “Asensio Method” which has its foundation in cleft lip and palate surgery, orthopaedics and orthodontics, odontopediatric follow-up, alveolar bone graft surgery, speech and psychotherapy and cleft rhinoplasty. This method is the core of the management of every patient that comes to Centro Infantil de Estomatología.

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This was my turn: DR. RODOLFO ASENSIO GUERRERO. I obtained my medical degree from Universidad de San Carlos de Guatemala as well. Five years later, I graduated as an Oral and Maxillofacial Surgeon and then as a doctor in Dental Surgery in the Universidad Europea de Madrid. I returned to my home country as the first one in the saga having trained in both medicine and dentistry. I intend to take advantage of the expertise of my predecessors and follow the same path as my father did. I joined the cause of Centro Infantil de Estomatología, starting in the specialty of cleft lip and palate reconstruction, supporting and applying the Asensio Method. As a qualified surgeon and dentist, I adhere to the concepts of orthognathic surgery and bone distraction in cases that had lost an adequate follow up during their development. Fifty-two years later, we still believe in the need of staying updated for self-improvement and of applying and adapting our protocols to best benefit our patients. ■

March 2019


From Proust to Pivot

AN APPARENTLY INNOCENT QUESTIONNAIRE FOR ORAL AND MAXILLOFACIAL SURGEONS

Michael

Miloro

DMD, MD, FACS Professor and Head, Oral and Maxillofacial Surgery University of Illinois, College of Dentistry University of Illinois, Chicago (US)

What is your favorite word? Outstanding.

Who would you like to see on a new banknote? Steve Jobs.

What is your least favorite word? Cannot.

What profession other than your own would you not like to attempt? Proctologist.

What is your favorite drug? Exercise (Peloton© cycling).

If you were reincarnated as some other plant or animal, what would it be? Great Leonopteryx (flying king lion from Avatar).

What sound or noise do you love? The surf. What sound or noise do you hate? Fingernails on a chalkboard (back when those existed).

If Heaven exists, what would you like to hear God say when you arrive at the Pearly Gates? We’ve been expecting you.

What is your favorite curse word? Fail.

What is your idea of perfect happiness? Knowing that I’ve done my best.

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Cubs-world-series-2016.

What is your greatest fear? Not trying. What is the trait you most deplore in yourself? Perfectionist. What is the trait you most deplore in others? Inconsistency. Which living person do you most admire? Elon Musk. What is your greatest extravagance? Audi R8. What is your current state of mind? Reserved optimism. What do you consider the most overrated virtue? Magnificence.

My family.

On what occasion do you lie? When the truth is not absolutely, positively mandatory or required. What do you most dislike about your appearance? My hair (I’ve always wanted Jeff Bridges’ hair). Which living person do you most despise? David Berkowitz (Son of Sam, NYC, 1976). What is the quality you most like in a man? Integrity. What is the quality you most like in a woman? Honesty. Which words or phrases do you most overuse? I told you so.

If you could change one thing about yourself, what would it be? Nothing. I accept me for who I am. What do you consider your greatest achievement? My family. If you were to die and come back as a person or a thing, what would it be? Tony Stark. Where would you most like to live? Palermo.

What or who is the greatest love of your life? My wife.

What is your most treasured possession? Penol fountain pen collection (Copenhagen, Denmark).

When and where were you happiest? In utero.

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

Which talent would you most like to have? Guitar-playing rock star.

What is your favorite occupation? Deep sea diver.

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Michael-Beth-Miloro.

Who are your favorite writers? Asimov, Vonnegut, Salinger, Chauncey, Irving, Milton, Hemingway. Who is your hero of fiction? Peter Parker. Which historical figure do you most identify with? Joe DiMaggio. Who are your heroes in real life? Those who protect us, teach us, and care for us: armed forces, police, firemen, teachers, doctors. What are your favorite names? Seven, and soda. What is it that you most dislike? Negativity. ICOMS 2017 Hong-Kong.

What is your greatest regret? Not performing regular self-care earlier in my life.

What is your most marked characteristic? Conscientiousness.

How would you like to die? I wouldn’t.

What do you most value in your friends? Loyalty.

What is your motto? In life, be a driver, not a passenger. ■

NEWS RECOGNITION In honor of the American Association of Oral and Maxillofacial Surgeons (AAOMS) 100th Anniversary, the IAOMS presented AAOMS with a gift of a work of art. The art piece, “Endurance,” was installed at the AAOMS headquarters office in Chicago, IL in January, 2019.

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Copy Me ALVEOLAR BONE GRAFTING OF THE CLEFT MAXILLA Again in thin section, our invited contributor addresses surgical techniques for management of clefts. Dr. Erasmus from New Zealand shares his experience in the reconstruction of the different types of alveolar clefts, a key factor for the correct development of the middle face.

JASON ERASMUS Consultant and Head of Department Oral & Maxillofacial Surgery, Christchurch Hospital, New Zealand.

TIMING • Secondary bone grafting in the mixed dentition phase. •T  iming is based on the stage of root development of the permanent tooth adjacent to the cleft (canine or lateral incisor): ideally when two thirds of root development has been completed.

TECHNIQUE 1: Buccal advancement and palatal rotation flaps Indication: small to medium size palatal defects

1

Incisions along the bony margins of the alveolar and palatal cleft. Mucobuccal fold.

Alveolar cleft margin.

Palatal cleft margin. Sulcular incision carried back to distal of last molar. Technical note: • Ensure adequate soft tissue for closure of the nasal floor when making the incisions around the cleft margins. •N  o bone exists at the superior aspect of the mucobuccal fold. Take care not to perforate into the nasal cavity. 26 iaoms.org

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2

Raising the flaps. Dissection to expose the piriform aperture and nasal floor. Buccal attached gingiva and mucosal flaps raised to expose the buccal aspect of the cleft. Cleft still open, leading to nasal cavity.

3

Repair of the nasal floor. Technical note: • In principle: always start closure of the nasal floor at the labial side and work towards the palate. • The mucosa lining the sides of the cleft is raised as a full thickness flap and elevated superiorly to reconstruct the nasal floor. The periosteal surface is now facing to the mouth and the epithelial surface to the nasal cavity. •T  he edges are rolled in and sutured with a continuous resorbable suture along the entire length of the new nasal floor mucosa (suture #1). •W  hen the 2 sides of the cleft mucosa are now elevated, the contact area is lined by periosteum • contact area is sutured using resorbable interrupted horizontal mattress sutures (suture #2).

2

1

1

4

Bone grafting of the alveolar cleft. Particulated autogenous cortico-cancellous bone graft packed into the cleft.

Technical note: • The oral side of the newly repaired nasal floor can be lined by a resorbable collagen membrane. • The bone graft is densely packed into the cleft, ensuring adequate filling of the superior area around the piriform aperture. March 2019

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5

Closure of the buccal advancement flap. Periosteal release and advancement of full thickness buccal flap. Defect distal to last molar to healing by secondary. Technical note: • The bone graft can be covered by a resorbable collagen membrane. • Advantage: - Broad-based flap with good blood supply. - Ensure adequate keratinized gingiva at the cleft site. • Disadvantage: - It is not possible to extend the buccal flap over to the palatal side. - B e cognizant of the potential deleterious effect of raising a full thickness flap on future maxillary growth.

6

Palatal closure. Full thickness incision 5mm away and parallel to the palatal gingival margin. Cutback incision opposite first molar (if required). Technical note: • The amount of palatal advancement achievable limits the size of the palatal defect that can be closed using this method. The palatal rotation flap is reserved for small to medium size defects. • The palatal flap is raised as a full thickness flap. •A  dvancement can be enhanced by using a cut back releasing incision opposite the first molar. Beware of the risk of sacrificing the greater palatine vessels with this technique.

7

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Final closure using buccal advancement and palatal rotation flaps.

March 2019


TECHNIQUE 2: Buccal mucosa finger flap Indication: large palatal defects

8

9

10

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Incisions along the bony margins of the alveolar and palatal cleft.

Raising the flaps.

Repair of the nasal floor.

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11

Raising of the buccal mucosa finger flap.

Based at superior aspect of the alveolar cleft, extending posteriorly in the buccal mucosa. Technical note: • The finger flap is raised in the submucosal plane (i.e. partial thickness flap) Be cognizant of the 1:3 length to width ratio limitation.

12

Rotation of the finger flap for closure of both buccal and palatal aspects of the cleft alveolus.

Technical note: • Advantage: - Tension-free closure is relatively easy to achieve - Avoids large surface stripping of buccal periosteum in the growing maxilla. • Disadvantage: - Shifting of unattached mucosa into the cleft site - Length limited by width of the flap.

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NextGen

MAXILLOFACIAL SURGERY IN RURAL AFRICA

By James Kirimi African representative NextGen Council. Meru Kenya

I

work in Meru, Kenya. Kenya is a country of 45 million on the East Coast of Africa, and Meru is a small rural town 250km north of the capital city of Nairobi. Further north, Kenya neighbours Somalia, Ethiopia, and South Sudan. Meru town is located right at the equator, about 8 km north of the equator and at 1500m above sea level, one is guaranteed beautiful weather throughout most of the year with average temperatures of 22 Celsius. Meru town and its precincts (Municipality) have a population of about 250,000 in a mainly agricultural area. It is the commercial and administrative headquarters of Meru County, one of 47 counties in Kenya. The hospital where I work is called Meru Teaching and Referral Hospital. It is a referral facility for Meru County as well as at least 4 neighbouring counties in the northern part of Kenya, with an estimated population of 3 million. I grew up in Meru town, and I chose to come and work here after my residency in Maxillofacial Surgery at the University of Nairobi. I like Meru because having grown up not far from the hospital where I work it is close to my heart in many ways. My parents, as well as many of my childhood friends, are still living in Meru. There is a vibrant economy around agriculture that keeps Meru town a buzz. Meru sits right on the equator and is also March 2019

home to two major tourist attractions in Kenya, the Meru National Park and Mt Kenya. The Kenza Wildlife Service (a Government of Kenya agency) describes Meru National Park as; “Brilliant on a magnificent scale, the Meru National Park features luxuriant jungle, coursing rivers, green swamp, khaki grasslands and gaunt termite cathedrals all under the sky’s great blue bowl. Little visited and utterly unspoilt, few places are comparable to the remote and rugged atmosphere found here. Visitors can see Rhinos, Lions, Grevy’s zebras, Elephants, leopards, cheetahs, Bohor reedbucks, hartebeests, pythons, puff adders, cobras, buffalos and more than 427 recorded species of birds”. This lush, unspoilt jungle is only 45 minutes drive from the hospital where I work. Any visit to Meru is incomplete without a visit to Meru National Park where sightings of either lions, elephants and rhinos or all the big five animals are almost guaranteed. Meru is also home to two of the three major routes used to climb Mt Kenya, which at 5,199m (17,048 ft) is Africa’s second highest mountain. The Chogoria route is a one hour drive from my hospital and is indeed the most scenic of theroutesm. “The magic of Mt Kenya comes to life on this spectacular route. With the steep faces of the ‘Gorges iaoms.org 31


Valley’ and the beauty of the high-altitude tarns, this route is never to be forgotten. This route to Point Lenana at 4985m (16,355ft) incorporates some of the most beautiful and scenic sites on the mountain.� Meru is without a doubt a beautiful place for nature lovers who wish to explore the unspoilt wilderness of Africa. It is also home to numerous rivers with their magnificent waterfalls and steep gorges. You will also find the people of Meru to be some of the most hospitable African tribes in Kenya. I run the maxillofacial unit within the dental department at the Meru Teaching and Referral hospital. Currently, I am the only maxillofacial surgeon, but I work with a dedicated team of two young doctors, nurses, dental officers and dental trainees. We run a daily clinic for minor dental and

malignancies and benign jaw swellings. Very often, patients will come to us when pathologies are huge and advanced. The most common benign jaw lesions are ameloblastoma and cysts while squamous cell carcinoma of the tongue and the mandible tops the list of oro-facial malignancies I attend to. Every Thursday my team and I run the maxillofacial operating room while emergency cases are operated as they come. I work closely with the hospital`s ENT and the ophthalmology surgeons for the multidisciplinary cases. Some of the tumours are usually advanced requiring an interdisciplinary approach especially for reconstructive surgery. Because the operating room is not dedicated to maxillofacial cases only, we are just able to operate on elective cases once a week. The same OR is

maxillofacial procedures which are done under local anaesthesia in the clinic. The team is able to run this clinic with minimal consultations coming to me. The more complex cases are referred to the maxillofacial clinic which I conduct every Wednesday. In this clinic, I attend to between 25 to 30 old and new patients mainly for consultations, surgical planning and postoperative follow up. There are a diverse number of maxillofacial cases I will attend to routinely in the weekly clinic. However, maxillofacial trauma and pathologies top the list. The majority of injuries are related to vehicular/motorbike accidents and interpersonal violence including gunshot wounds. There is also the occasional trauma after an attack by wild animals like lions and buffalos. The most common pathologies are head and neck

shared by other surgical disciplines throughout the week. Besides being the resident maxillofacial surgeon in the hospital, I am also the chief executive of the hospital where I am heavily involved in the day to day running of this 360-bed facility. The hospital offers a wide range of generalised medical/surgical services as well as a vibrant specialised service in oncology, renal, laparoscopy, obstetrics, paediatric and trauma surgery. The hospital has over 400 full-time employees and has on average 700 outpatient visits every day.

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My cup is always full. . . my skills still tested and more importantly my heart is happy. There is time to play too. . . I live on the equator!!!!! After all... â– March 2019


“PRESIDENT’S INVITE”

As Chairman of the Local Organizing Committee of the 2019 ICOMS, I would like to reinforce the invitation to the 24th ICOMS in Rio.

It is carnival time in Brazil, and we can already feel the heat from Rio. As your host, the Local Organizing Committee is working hard to make sure that you have an unforgettable time in Brazil. An inspiring and strong scientific program was put together with the contribution from fellow colleges from all over the world. It will be a great time to celebrate our speciality in a relaxed and invigorating city such as Rio de Janeiro. With carefully chosen locations, the social agenda will certainly leave long and lasting memories for all of us especially the Brazilian Night! Rio de Janeiro offers great tourism and leisure opportunities, with the striking contrast of a city blessed with tropical forest and a magnificent bay and its beaches. It is a real feast for the eyes that can be savoured in many ways. Cultural diversity and friendliness is a hallmark of Rio de Janeiro. For those who want to know more of Brazil, Rio is a gateway to our continental size country where one can travel from the Iguaçu Falls in the south, through the breathtaking beaches of our coast and up to the Rain Forest in Amazon. One can say that we are spoilt for choice. Brazil and the city of Rio de Janeiro open its arms and heart to welcome you to an in an atmosphere of science, union and relaxation. Come and taste yourself the flavours of Brazil and leave your mark in yet another great ICOMS. Save the date and start the warming up. We are looking forward to welcoming you to Rio de Janeiro.

By Luiz Marinho Chairman of the Local Organizing Committee 24th ICOMS

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The Austrian system of training in Oral and Maxillofacial Surgery

By Jessica Wittmann University Hospital for Cranio Maxillofacial and Oral Surgery. Medical University of Vienna (Austria)

W

hen I was asked to write an essay on the Austrian system of OMFS training I began to think about it thoroughly and realized that it’s one of the most extensive trainings one can opt for within the field of medicine. In Austria it is required to study both

dentistry and medicine to become an OMF surgeon. After finishing medical school at most university clinics there is the possibility to start your specialist training right away and simultaneously study dentistry, which takes additional four years. This system enables students to finance their dental studies

CTORS NOW IN LATIONS FOR ALL DO GU RE G IN AIN TR FS *THERE ARE NEW OM FIRST OF JUNE 2015 TRAINING AFTER THE EIR TH D TE AR ST VE AUSTRIA WHO HA

MEDICAL STUDIES (6 YEARS) M.D. Dentistry studies (4 years) D.M.D.

OMFS – Training (4 years): • Common trunc (9 months) • Basic training (15 months) •S  pecial subject specialisation (24 months): - Oral surgery, Implantology, Preprosthetics - Traumatology - Septic surgery, salivary gland, sinus surgery - Orthognathic surgery - Tumor and reconstructive surgery MEDICAL SPECIALIST EXAM 34 iaoms.org

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initially through full-time employment at an OMFSdepartment and later through night shifts during the more time-consuming study phases. A calendar filled with studying, exams, and night shifts can be very demanding. I remember having passed a practical exam on carving teeth after a 48 hour shift, when I first carved the wrong tooth!! , luckily I passed the exam. Although these were tough times, it was a nice feeling to grow and progress both in my job and in my studies and to see the mutual influence in both aspects. For example, it often happened that a patient with a dental trauma had to be surgically taken care of during my duty at the hospital and in the next few days continued to receive dental care at the dental clinic where the theoretical and practical part of the dental studies took place. It was such a great opportunity to see the result of my own primary treatment. There are new OMFS training regulations for all doctors now in Austria who have started their training after the first of June 2015.* A "common trunc" with the duration of nine months must be completed. This applies both to training as a general practitioner and as well as a specialist like an OMF-surgeon. During this time one has to work at surgical and conservative departments. The common trunc is followed by a "basic training" for fifteen months which includes both an OMFSspecific theoretical part and a basic practical part. Knowledge about the principles of OMF Surgery is acquired and minor preocedures are performed.

In practice, the different modules overlap of course and are not carried out strictly in order. During the entire training period, you gain experience in all fields of Oral and Maxillofacial Surgery Surgery. It is common to start with ward work to understand the hospital’s customs and typical procedures. During this time, the main areas of responsibility are patient admissions, monitoring and discharge, dressing changes and minor interventions. In the outpatient clinic diagnostics are learned, therapy decisions are made and besides taking biopsies and incising abscesses, emergency care is provided. At the same time, in order to improve the surgical abilities to the next level, oral surgery is performed as an outpatient procedure under local anaesthesia. You start with the help and guidance of a more experienced surgeon until you are finally on your own. From time to time you can also assist more extensive operations under general anaesthesia until the scalpel is finally handed to you. After two years of professional experience in the field of Oral and Maxillofacial Surgery, you can take the medical specialist examination. The preparation time for this exam is long and hard. However, the extensive study of anatomy, physiology, pathophysiology and therapy concepts gives an even deeper understanding of the field. Since I only

THIS PHASE IS FOLLOWED BY A "SPECIAL SUBJECT SPECIALISATION" FOR TWENTY-FOUR MONTHS TO COMPLETE THE TRAINING. THIS SPECIALISATION PHASE COMPRISES THE FOLLOWING FIVE DIFFERENT MODULES: • Oral Surgery, Implantology and Preprosthetics (25 pre-prosthetic, 200 oral surgical procedures including implants). • Septic OMF surgery, salivary gland and sinus surgery (100 procedures). • Traumatology (100 procedures). • Orthognathic surgery (10 orthognathic procedures, 10 corrections of malformations). • Tumor and reconstructive surgery (50 resective interventions, 90 simple and complex reconstructive operations). March 2019

finished the exam a few weeks ago, I can say that I haven’t learned with so much interest and joy for any other exam before. This enthusiasm made me realize that a few years ago I had made the right decision to choose this great subject. ■ iaoms.org 35


Hours A DAY IN THE LIFE OF A MAXILLOFACIAL RESIDENT IN SPAIN By Elena Baranda 5th year Resident at Ramón y Cajal University Hospital. Madrid. Spain.

I

n 2013 I finished my studies in Medicine and got my degree at the University of Valladolid. I prepared for the national exam to become a specialist, and then I applied for a position of Oral and Maxillofacial Surgery Trainee at Ramón y Cajal University Hospital. In May 2014 I started my residency, that I will finish in May 2019. The residency period is 5 years long, including several rotations in other surgical departments (General and Digestive Surgery, Otorhinolaryngology, Vascular Surgery and Emergency Department).

reconstructive cases) and Craniofacial Surgery (trauma cases, facial deformities and TMJ pathology). Now I´m going to show you how it is a typical day for me in the Department!

06:30 h

I wake up, take a shower and have breakfast at home. Today is going to be a long day, so I must get my strength! I leave at 07:15 and drive to the Hospital. I arrive there at 07:45, change my clothes, and there I am: ready to start!

The Oral and Maxillofacial Surgery Department at Ramón y Cajal University Hospital has 16 faculties and 8 residents, under the direction of Prof. Dr. Acero as the Head of the Department. The Department´s activity is divided into 3 sections: Oral and dentoalveolar Surgery, Cervicofacial Surgery (treating oncological patients and

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08:00 h I meet the other residents at the 10th floor´s ward for the first round. We see our patients every single morning and check if they are doing well or if we have to change something in the treatment plan, complementary tests, etc. We also collaborate with Internal Medicine specialists and comment on the cases with them on a daily basis, so that they can help us with the medical aspects or potential complications. After that, we have a daily conference with our specialist’s staff and present them every case, especially the new admissions.

08:30 h Now we go to the Clinical meeting of Orthognathic Surgery, that takes place every week. In this meeting, we meet the Orthodontists and discuss the patients with dentofacial deformities, and decide which is the best treatment for them. Some of the patients may need only an orthodontic treatment, but others will require a combination of orthodontic and surgical treatment to solve both functional and aesthetic problems. Other days at the same time we attend different multidisciplinary meetings such as the Head and Neck Tumours Committee on Wednesdays and Fridays.

09:00 h

The clinical session is finished, and then I go to the operating room. Today is Tuesday, and we have an oncological patient in which we have to perform an extensive resection of the tumour and a reconstruction with a microvascular flap. Every week we schedule at least one complex surgery, such as oncological patients or complex reconstructive surgeries, including skull base resections (that frequently takes the whole day).

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Hours 14:00 h

21:00 h

Some of the surgical team take a break during the operation, and now it´s time to see the patients again, this time with the consultants. Now we decide the patient´s discharges.

Time for dinner. I go to the coffee-shop, grub some food and meet other colleagues. The phone starts ringing so…I must leave and go to the Emergency Department!

18:00 h Surgery´s finished! The microvascular anastomosis is working, and we have reconstructed the defect after the oncological resection. Today I´m on call, so now I have to go to the Intensive Care Unit and meet the Anesthesiologist team that will take care of the patient during 24-48 hours until he´s ready to go to his room. For the trainees in our department, it is mandatory to be on duty in-house at least five days every month.

23:00 h

After finishing with the emergencies, I have to check if the patients that are undergoing surgery tomorrow have all the preoperative tests ready. I talk to the patients and answer their questions to calm them (some of them are so nervous!)

00:30 h

It´s been a long day. Now I go to bed but…only for a while. I have to check every 2 hours if the microvascular flap is doing well, so I set all the alarms and try to sleep for a while.

07:00 h Good morning! The night was not bad; I visited several times the patient at the ICU, and he is doing well…excellent news! Now I have to meet my trainee colleagues and consultantsorder to have them informed of the last hours. After 24 hours I´m tired, but happy for the patient and his family. This is definitely the best part of my job! ■

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UNIQUE SOCIAL EVENTS IAOMS FOUNDATION LUNCHEON AT WINDSOR ROOM (atop the Windsor Barra Hotel) Wednesday, May 22, 2019

12:30–14:30

Learn about the latest Foundation programs and connect with colleagues. Details on the speaker and topic will be announced soon.

GRAND CARNIVAL BALL AT CITY OF SAMBA Wednesday, May 22, 2019

19:00–22:00

Enjoy Carnival with music and a Samba performance, along with drinks, canapés, snacks and dessert. Special hand-made Carnival masks will add to the festivities.

BLACK TIE GALA DINNER AT CASA DAS CANOAS Thursday, May 23, 2019

20:00–23:00

The ICOMS Rio Gala will transport you to Old Rio in the heart of the Tijuca Forest, among the world’s largest urban green spaces. Enjoy a wonderful evening with music and a three course dinner.

Register today at icoms.iaoms.org/registration


Report of Regional Meetings

SINGAPORE: a small country well represented in ACOMS By Raymond Wong Councillor for Singapore IAOMS

L

ocated at the tip of mainland South East Asia, the tiny island nation of Singapore has a small community of oral and maxillofacial surgeons serving its healthcare needs. The speciality has existed as Oral Surgery previously, and in 1991, the Association of Oral and Maxillofacial Surgeons of Singapore (AOMSS) was formally established. It was one of the founding members of the Asian Association of Oral and Maxillofacial Surgeons. Being a former colony of the United Kingdom, traditionally we have had close links to the British healthcare system. In recent years, more of our local surgeons have had opportunities for training and attachments to institutions in the United States, Canada, the Netherlands, Switzerland, Sweden, Hong Kong and China. 40 iaoms.org

Our current active membership, comprising a mix of public and private practitioners, is around 65 surgeons serving a population of about 5.8 million. Despite our small numbers, the speciality tries to punch above its weight locally and in the region, with active participation in professional education courses and regional conferences. During the past year, we co-hosted a local Symposium on Orthognathic Surgery with the Association of Orthodontists Singapore in January 2018, ran workshops on botulinum toxin injections for facial esthetics and were host to the Biannual Tri-Nations Symposium on Oral and Maxillofacial Surgery, comprising Hong Kong, Singapore and Indonesia with speakers from various regional countries in July 2018. A workshop on the De Puy Synthes Tru-Match Orthognathic system was held before the symposium. March 2019


speaker selected for the “Get Inspired” session at the ICOMS. In 2020, Singapore will take up the mantle of host for the 14th ACOMS. Scheduled to be held from 23rd – 25th October 2020, this is the first time we will host the ACOMS. The local organising committee has been hard at work, and the conference venue will be at the world famous Marina Bay

On the regional front, we sent a delegation of participants, speakers and residents to support our parent body, the Asian Association of Oral and Maxillofacial Surgeons and our Taiwanese friends at the Asian Congress on Oral and Maxillofacial Surgeons (ACOMS) in Taipei, in November 2018. This year, there will be a small delegation from Singapore at the ICOMS in Rio de, and we have a March 2019

Convention Centre, part of the Marina Bay Sands Hotel Complex. We have lined up an exciting scientific program, memorable and spectacular venues for the dinners, good food, excellent infrastructure and connectivity and most of all, we promise everyone a good time in 2020. All are welcome! ■ iaoms.org 41


New Projects

BUILDING ON SUCCESS IN EDUCATION FOR IAOMS By G. E. Ghali Chair, IAOMS Education Committee

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hank you to the IAOMS Board and Executive Committee, the newly expanded IAOMS Education Committee, the IAOMS Foundation and the IAOMS staff for their collaborative efforts to continue to strengthen educational offerings provided by the IAOMS. As Chair of the IAOMS Education Committee, it has been my pleasure to spearhead the continued expansion in educational offerings and programs while continuing to increase our role and

visibility in global oral healthcare. As an overarching initiative, we continue to review and refine our educational content strategy. At the forefront of this effort is the expansion of the Education Committee, with representatives from four regions across the globe providing expertise and insight on a more local level. Building on the success of the past, we have been hard at work to develop new programs which provide interactive and rigorous educational content via in-person and digital opportunities. This past October, I had the privilege to execute a unique, hands-on event that was the first of its kind at the AAOMS 100th Annual Meeting in Chicago titled “World Café.” This initiative was designed to spark discussion of various approaches to patient cases, best practices, and surgical challenges across the specialty. World Café provided a networking opportunity for OMF surgeons from more than 11 countries to interact, connect, and learn from senior surgeons from around the globe. Through gracious partnership with AAOMS, we have extended this


opportunity across the next five years under a new name: Global Health Café. In addition, we continue to facilitate world-class education and training through the Gift of Knowledge program, funding speakers and knowledge sharing around the world. IAOMS leaders volunteer their time to design, promote, and implement comprehensive educational sessions in areas of the world where access to this type of training is limited. Most recently in October, the first session for the IAOMS - AMCBMC (La Asociación Mexicana de Cirugía Bucal y Maxilofacial, Colegio) took place at the Autonomous National University of México in conjunction with the National Government Health Care System for Federal workers with representation of all these institutions. In January, I visited Mandalay, Myanmar for a three-day IAOMS conference in partnership with the Myanmar Society of Oral and Maxillofacial Surgery. This opportunity consisted of two days’ worth of lectures involving Orthognathic Surgery, Cosmetic Surgery and Trauma Management, while the third day implemented a hands-on lab component. Our Learning Management System allows us to expand our reach and deliver digital content in a variety of ways. In addition to our on-going scientific webinar series, we have recently launched an updated Review Course covering ten topics that is available as a full course or individual modules. Our first ever Virtual Conference concluded in February, providing attendees an opportunity to learn in a March 2019

new way. This unique format for digital learning allowed attendees to view a keynote presentation followed by a choice of three additional lectures. All attendees were able to interact with the session speakers and other surgeons attending the conference. As Chair of the IAOMS Foundation Fellowship Committee, I am pleased to participate in the selection process of the 2019-2020 Fellowship recipients. The IAOMS Foundation offers three selected young trainee surgeons a one-year immersion in one of two areas; Oral & Maxillofacial Oncologic and Microvascular Reconstructive Surgery taking place in Beijing and Shanghai, China, and Cleft Lip and Palate/Craniofacial Surgery taking place in Bangalore, India for six months and Hyderabad, India for an additional six months. There have been 24 participants thus far since the Fellowship inception in 2010.

Our education content strategy will continue to build momentum as we strive to provide unique opportunities to the Oral and Maxillofacial Surgery community. I look forward to continuing the collaborative efforts with the staff to build on the success of our educational programming, while ensuring that IAOMS continues to be the leading voice for the specialty. ■ iaoms.org 43


In Memoriam

Peter Banks 23 July 1936 – 3 March 2019 By John F. Helfrick University of Texas Health Science Center. Houston

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he specialty lost a great man and good friend in the early morning hours of Sunday, March 3rd following an illness of several months. Peter was President of the IAOMS from 1997 – 1999 and a diehard OMS! He loved the specialty and, for his many OMS colleagues, their feeling about Peter was mutual. Peter was a Consultant Maxillofacial Surgeon and devoted much of his professional life to The Queen Victoria Hospital. His first association with Queen Vic was as House Surgeon to Sir Terence Ward in 1960, subsequently spending three years as a Senior Registrar from 1966, prior to his appointment as Consultant Maxillofacial Surgeon to Addenbrookes hospital in Cambridge in 1969. Peter returned to The Queen Victoria Hospital as Consultant in 1971 where he worked

“He loved a good glass of wine, a chat, and to tell a hilarious story or two . . . and boy, could he tell stories!” tirelessly to keep Queen Victoria Hospital at the forefront of maxillofacial surgery, retiring in 1999. Peter served as Vice Dean of the Faculty of Dental Surgery and as a Member of Council of The Royal College of Surgeons. He held the highest offices in oral and maxillofacial surgery, being President of the British Association of Oral & Maxillofacial Surgeons in 1995 and President of the IAOMS. During his career he published 48 scientific papers in refereed journals, 2 books and 3 book chapters. His awards and honours are too numerous to mention. That was Peter the professional; however, to most who knew him, his greatest qualities were as Peter, the friend! He loved a good glass of wine, a chat, and to tell a hilarious story or two . . . and boy, could he tell stories! In writing this and reflecting on Peter, I couldn’t help but smile as his story telling, with his wonderful British affect, was second to none. He loved to read and would often relate a passage in a novel to an every day event. And finally, Peter loved to be with his friends and former colleagues. During the past four years we were blessed to meet during September with Peter and Diana, along with four other past IAOMS presidents and their wives, for a mini reunion where Peter was the life of the party! His friendship and camaraderie will be greatly missed by all who knew him. Peter is survived by his wife of 56 years, Diana, their three children, and 8 grandchildren. Our thoughts and best wishes are with them at this time. ■

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March 2019


Beyond O.R.

Do we need Chutzpah? By Javier González Lagunas (follow me on

@golagunas)

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hutzpah is defined as extreme selfconfidence or audacity. According to Webster Dictionary, it can be described as shameless audacity, imprudence or brass.

Now, think about our speciality, its history and its development. And then, think about our neighbour specialities, its power and its numbers. How could we survive to the figures, strength, political influence in the university and health services of professions like ENTS, plastic surgeons, general dentists or periodontologists? Well, I definitely think it is all about Chutzpah. This is a word not commonly used in Spanish, and it was not long ago, when I first heard about it. But after discovering its meaning, now I think that we are The Chutzpah speciality. How else, if not with Chutzpah could we have evolved from minor oral surgery to the surgical management of cancer, with complex resections and reconstructions? If we had listened to the distrust and disregard of some ENTS, plastic surgeons and general surgeons we would continue solely dedicated to the extraction of wisdom teeth. Why have we gone from an orthognathic surgery exclusively based on occlusion to what has become definitively the aesthetic surgery of the facial skeleton? Thanks to the support and the impulse of the cosmetic surgeons? No way!

examples in this particular issue of Face to Face on West Africa. Very often, I recommend some readings outside the box. In this particular column, I have a double recommendation somehow related to Chutzpah. First, Angela Duckworth’s Grit: the power of passion and perseverance and a single quote “Passion begins with intrinsically enjoying what you do.”. Second Daniel H. Pink´s Drive. “Living a satisfying life requires more than simply meeting the demands of those in control. Yet in our offices and our classrooms, we have way too much compliance and way too little engagement. The former might get you through the day, but the latter will get you through the night.” So, which should be the right attitude for our Nextgen? The Chutzpah attitude, of course: Nothing is going to stop you from doing what you really want to do. ■

Nothing is going to stop you from doing what you really want to do

What about dental implants? How have we been able to withstand the pressure of thousands of general dentists, periodontists who, with much less surgical training, want to expel us (at least in some countries) of implant dentistry?. The answer lies in the tireless work of leaders of the speciality, of visionary surgeons who have opened the doors of our specialty and have expanded our field of experience, of researchers who have established a solid scientific foundation of our daily clinical practice. But it is not only the big names in the books and scientific papers. Chutzpah is also in the anonymous work of those maxillofacial surgeons who are fighting with the economic and politic reality of underdeveloped countries to open the doors of maxillofacial surgery to patients poorly diagnosed and treated. You have a few

March 2019

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FACE TO FACE ASPIRES TO BE A COLLABORATIVE MAGAZINE. That means that we are seeking your suggestions, proposals, projects, and ideas, regardless of where you are from, your scope of practice or your current position. We invite enthusiastic Oral and Maxillofacial surgeons with the drive to take our association and our specialty one step forward. Feel free to contact us, and join us on our path of improvement. Dr. Javier Gonzรกlez Lagunas Dr. Deepak G Krishnan

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

March 2019

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