Face to Face -- March 2018

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Issue 53 / March 2018

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


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


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

Letter from the Editor HOW I SEE IT Javier González Lagunas EDITOR IN CHIEF

Have a close look at our new section “The new new thing in OMFS”, Do you want to share your ideas with us?


Lawyers in Maxillofacial Surgery


20 SO, YOU WANT TO WORK... In Pakistan

WOMEN IN IAOMS 22 Patrishia Bordbar

24 ME TOO IN MEDICINE Gabriele Millesi




Waferless maxillary positioning...



Get ready for the stage


A Maxillofacial Resident in SWEDEN



John Helfrick


45 BEYOND THE O.R. Surgical porn

Dominican Republic



n early February, I had the honor of attending the IAOMS Symposium in conjunction with the AEEDC Dubai World Oral and Maxillofacial Surgery Conference in Dubai. The special twoday Conference reflects the growing collaboration between the AEEDC and the IAOMS and is just the latest example of how the IAOMS is partnering with regional and national OMF associations to bring IAOMS experts from throughout the globe “closer to home.” My congratulations to the Conference organizers and to the AEEDC Board members: Tariq Khoory, Dr. Abdul Salam Al Madani, Dr. Nasser Al Malik and their team on creating the largest dental event in the Middle East, North Africa and South Asia region – and the second largest dental conference in the world. And I offer my congratulations and thanks to: Dr. Mohammed Abedin (Scientific Chairman of AEEDC Dubai World OMFS Conference), Dr. Maha Negm (Scientific Coordinator AEEDC Dubai World OMFS Conference) and their respective teams, for their hard work and partnership. In my last column, I summarized many of our 2017 accomplishments. One of those accomplishments was the development and approval of the IAOMS strategic plan, which will help ensure continued growth of the IAOMS and help us anticipate (and meet) member needs. Because this plan is such a critical and foundational element of the IAOMS growth strategy, I wanted to share with you the goals outlined in the plan. As you’ll see, the initiatives we are pursuing and the enhanced member benefits we are creating are direct outcomes of the strategic plan. The plan has five primary business goals:

In addition, the IAOMS Foundation has set some bold goals, including continuing to build our individual and corporate donor base and introducing new programs (such as the Visiting Scholar Program). With your generous support, we look forward to having 2018 be another record-setting year for raising funds to ensure educational opportunities for OMF trainees throughout the world. And of course, this “LOOK AHEAD” column wouldn’t be complete without talking about ICOMS, our signature educational and networking event that brings together the best thinking and research in OMF and participants at every stage in their career, to learn, network and even have some fun! Please mark your calendars for May 21 – 24, 2019 for ICOMS 2019 in Rio (link to: http://www.icoms2019.com.br/). My thanks to Dr. Luiz Marinho and his team for their work to ensure that this event continues to “set the bar” for global OMF conferences. The IAOMS is offering many opportunities for you to learn, connect and grow – whether that’s in-person at a regional educational event – or online (live and on-demand) through our Scientific Webinars and Next Level Forum Webinars. I hope you have the opportunity to learn and grow with us. We are proud to help you build your practice and the OMF profession. Thank you for your membership – and for being an important part of our IAOMS family.


1. Ensuring member retention and growth 2. Strengthening our financial position 3. Optimizing brand awareness and impact

Kind regards,

4. Improving infrastructure and technology 5. Becoming the OMFS Knowledge Leader


Letter from the President THANKS TO ALL OF YOU FOR GIVING ME THE OPPORTUNITY... Dear Colleagues and Friends :


irst, my thanks to all of you for giving me the opportunity to serve as your IAOMS President. I am looking forward to building on the legacy of my predecessor, Dr. Julio Acero – along with our Board of Directors, Executive Committee, Executive Director and staff -- to ensure that our organization can grow from a position of strength. Dr. Acero, thank you for all your work on behalf of the Association. I know you will continue to be an excellent IAOMS Ambassador in your role as Immediate Past President. This is an exciting time for the IAOMS and for our members. We are growing our membership throughout world. We now have members in 120 countries – and we are helping to ensure the leadership of the IAOMS well into the future with our NextGen Council. Equally important, we are continuing to strengthen our programming through live and ondemand webinars to respond to topics and needs you’ve identified. And finally, we are working on a regional level with some of our affiliated associations to create joint conferences and meetings to help bring some of the organization’s expertise to regional conferences. This regional collaboration benefits both the national organization and the IAOMS as we seek to provide more benefits to members and reach them when and where it’s most convenient for them. All of these benefits are geared to help you build your practice and our profession. I was glad to see and meet new colleagues at the AEEDC Dubai World Oral & Maxillofacial Conference in early February. This is a model for other educational collaborations. It also highlights the core values of the IAOMS and the

implementation of its strategic plan goals. To illustrate, our four core values guide our work on behalf of our members and colleagues: 1. P ROMOTE AN INCLUSIVE AND WELCOMING GLOBAL COMMUNITY. You will experience this both at regional meetings as well as at ICOMS, our signature educational and networking event (May 21 – 24, 2019 in Rio de Janeiro; link to: http://www.icoms2019.com.br/).

On a personal level, I have been involved in IAOMS for more than 25 years and throughout that time, I have developed relationships with OMFs that have helped me in my surgical career; many of those OMFs have become life-long friends. An inclusive and welcoming community fosters deep relationships, healthy dialogues and information exchanges which ultimately benefit our patients.

the Foundation’s first Annual Appeal, raised more funds than the previous two years – combined! Regardless of where you are in your career, I strongly encourage you to support the Foundation and help ensure the vibrancy of its programming.


The IAOMS team consists of its leadership, members and a terrific Executive Director and professional staff who work with various volunteer leaders on a number of issues including program development, events and creating positive member experience. Collaboration and teamwork are essential components of this organization’s “DNA” and I know I – along with our staff team – appreciate the time and commitment of all of our volunteer leaders.

You will learn about our commitment to the highest standards of care through our live and on-demand webinars – as well as through other educational opportunities. This particular value is the very essence of the IAOMS; as surgeons, we are committed to providing excellent patient care and the many benefits of IAOMS – whether it’s the IJOMS, webinars, ICOMS or other events – are geared to helping IAOMS members deliver the highest quality patient care. 3. SUPPORT CONTINUOUS LEARNING AND RIGOROUS RESEARCH. Whether you are participating in one or more of our webinars or have been selected to participate in one of the IAOMS Foundation Fellowship programs, continuous learning and rigorous research is so important, regardless of where you are in your career. The Fellowship Programs provide the opportunity for a select group of trainees to apply for a year of surgical fellowship to train alongside expert Oral & Maxillofacial Surgeons. I want to acknowledge the hard work and complete dedication of our IAOMS Foundation Chair Dr. Larry Nissen. He is a tireless champion of the Foundation and last year, through


I look forward to working with you throughout my Presidency to ensure that the IAOMS continues to be the leading, global voice for the specialty as we seek to improve the quality and safety of healthcare worldwide through the advancement of patient care, education and research in oral and maxillofacial surgery.


Alexis B. Olsson IAOMS PRESIDENT 2018-2019

special report


in Maxillofacial Surgery

01 Informed Consent

By Mark Adams General Counsel. AAOMS Associate Executive Directors. Rosemont, Illinois


n the United States, there are requirements that an oral and maxillofacial surgeon must first obtain a patient’s informed consent prior to the performance of surgery, with certain limited exceptions such as in emergency situations. The state where the doctor is licensed and practices will have laws, regulations and

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case law requirements of which the surgeon must be aware. In addition, the professional liability insurance company that provides coverage to the surgeon, surgical team and facility likely will have recommended patient consent forms that are to be used or considered by the surgeon with their patients. The surgeon may also

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have a practice attorney who provides advice as to the manner and method for the surgeon to obtain informed patient consent. Finally, the surgeon may be a member of a professional membership association, including the

American Association of Oral and Maxillofacial Surgeons (AAOMS), which has a Code of Professional Conduct that the doctor has agreed to abide by as a condition of membership in the organization.

THE AAOMS CODE OF PROFESSIONAL CONDUCT is publicly available at https://www.aaoms.org/images/uploads/ pdfs/code_of_professional_conduct.pdf.

b. It is unethical if the patient is unfamiliar with the surgeon who performs their surgery. Therefore, if an oral and maxillofacial surgeon performs itinerant surgery, the patient must be provided, in writing, the full name of the surgeon, their state license number, their primary address or main office address, their office telephone number, and their after-hours number prior to their surgical appointment. c. It is unethical for the surgeon to delegate their primary patient responsibility. Therefore, if an oral and maxillofacial surgeon performs itinerant surgery, they shall comply with the current published AAOMS Parameters of Care for patient assessment and the Office Anesthesia Evaluation Manual for outpatient anesthesia. 1) The surgeon shall perform a patient assessment including a medical history and a physical examination prior to performing surgery. 2) The surgeon shall document the patient’s physical status in their record using the American Society of Anesthesiology physical status classification prior to surgery, and 3) The surgeon shall document a diagnosis justifying surgical care. d. It is unethical for the surgeon to perform surgery in an unsafe or unsuitably equipped facility. The AAOMS Office Anesthesia Evaluation program establishes the required vital sign monitors for the safe delivery of office based anesthesia. Therefore, if an oral and maxillofacial surgeon performs itinerant surgery, they shall comply with the current published AAOMS Office Evaluation Manual for facility and anesthesia team requirements for each office utilized for itinerant surgery. To further comply with required vital sign monitoring; each office where the surgeon operates

SOME OF THE PERTINENT PROVISIONS OF THE CODE INCLUDE: B. Patient autonomy, self-determ ination and confidentiality. B.1 The oral and maxillofacial surgeon has a duty to respect the patient’s rights to self-determination and confidentiality. B.2 The oral and maxillofacial surgeon should inform the patient of any proposed treatment and any reasonable alternatives, so that the patient is involved in his/her treatment decisions. Advisory opinion B.2.00 Oral and Maxillofacial Surgeon Responsibility and Patient Consent: The responsibility of the oral and maxillofacial surgeon includes preoperative diagnosis and care, the selection and performance of the operation, and postoperative surgical care. It is unethical to mislead a patient as to the identity of the doctor who performs the operation. Because modern oral and maxillofacial surgery is often a team effort, oral and maxillofacial surgeons may delegate part of the care of their patients to associated oral and maxillofacial surgeons, residents, or assistants under their direction. However, oral and maxillofacial surgeons must not delegate or evade their responsibility for supervising assistants, and ensuring their patients are cared for according to accepted practice standards. It is not improper for the responsible oral and maxillofacial surgeon to permit an assistant to perform all or part of a given operation, provided the oral and maxillofacial surgeon is present and an active participant throughout the essential part of the operation. If a resident is to operate upon and take care of the patient, under the general supervision of the attending oral and maxillofacial surgeon who will not participate actively, the patient should be so informed and provide consent. Additionally, the Code attempts to provide for additional patient protections through its statement on Itinerant Surgery: C.5 Itinerant Surgery: Defined as elective oral and maxillofacial surgery performed in non-accredited surgical facilities other than the facility or facilities owned and/ or leased by the oral and maxillofacial surgical practice employing the oral and maxillofacial surgeon. a. Fellows and members are strongly discouraged from participating in itinerant surgery.

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should have its own vital sign monitoring equipment which undergoes regularly scheduled maintenance to ensure the equipment is properly calibrated and in working order. Required monitoring includes ECG, Blood Pressure, Pulse Oximetry, and End Tidal CO2. In addition, the Oral & Maxillofacial Surgeon is required to comply with State laws pertaining to permitting and licensing of any office facility utilizing and providing intravenous sedation and/or general anesthesia. All facilities utilized for such patient care must therefore, comply with State and Federal permitting and licensing requirements. As a minimum requirement, each surgeon shall provide their state component an affidavit confirming their compliance with the above standards of care including a list of each facility in which they perform itinerant surgery. Furthermore, an oral and maxillofacial surgeon must comply with the Drug Enforcement Agency (DEA) requirement to have and maintain a current and separate DEA registration for each office where the surgeon performs itinerant surgery. Appropriate storage of medications in a secured location must comply with requirements outlined in the DEA Practitioner’s Manual. The manual is available at www.deadiversion.usdoj.gov/pubs/manuals. e. It is unethical for the surgeon to perform surgery in an unsafe or unsuitably staffed facility. Therefore, if an oral and maxillofacial surgeon performs itinerant surgery, they shall comply with the state laws, rules and regulations for dental office based anesthesia/ sedation procedures regarding staffing requirements. As a minimum requirement, each surgeon shall personally utilize a minimum of two operating room assistants properly trained to assist during itinerant procedures, anesthesia and patient recovery and be trained in emergency management. f. It is unethical for a surgeon to delegate post-operative care to a person who is not similarly qualified to recognize, treat, and manage all surgical complications. This includes the ability and privilege to admit patients to an extended care hospital for surgical care and/or other management. Therefore, if an oral and maxillofacial surgeon performs itinerant surgery, they shall be responsible for the outcome of the post-surgical care and shall maintain communication to ensure the patient receives proper continuity of care. g. T he provisions of this Code do not apply to the occasional performance by a fellow or member from performing surgery at a facility for the purposes of teaching or charity patient benefit.

AAOMS and its thousands of oral and maxillofacial surgeon members strongly support the provision of comprehensive and understandable informed patient consent through meaningful forms, documents and discussions by surgeons with patients prior to the performance of surgery. In this way, it is hoped that an optimal achievement of patient health and satisfaction with the surgical treatment will be obtained. ■

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Some Lawyers and Some Doctors By José Vinaixa Lawyer. Legal advisor of SECOM (Sociedad Española de Cirugía Oral y Maxilofacial)

“There are two kind of lawyers: Those that know the Law and those that just know English”


his is a sort of joke among Spanish lawyers (only from the first group, of course) and describes quite well t he situation of the legal profession in Spain.

While some lawyers, particularly tho se working in the Spanish branches of reputable English or US Law firms only dedicate their time to read and talk about contracts submitted to foreign laws (mainly English or US), other lawyers draft agreements submitted to Spanish law (the law they are qualified to practice) and defend them in Court when necessary and some of these also advise and defend foreign clients in English language. The point I am trying to make is the importance of using the right tools in any profession (legal or medical, for example). If a qualified Spanish lawyer spends his time in adapting, interpreting, summarizing foreign law topics –and even does it in English - but without using the knowledge he is supposed to apply (i.e. how to apply Spanish Law either in drafting a contract or in defending a case in Court) he might be considered at first as an experienced and international open minded lawyer fluent in English but when you ask him a question dealing with the application of Spanish Law to a particular topic, he will reply (in his best English, of course) with generalisations, common places and a bit of “common sense”.

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AND SOME GET AWAY WITH IT I am not implying that common sense is not important or practical. Just the opposite: One has to use it all the time , but not in lieu of using the technical tools. Common sense is always a plus, not an aliud. The medical profession is differen t in the sense that while Law is mainly domestic (Spanish, French, English) medicine is universal since humans have the same problems regardless the country they come from and the solutions given to these problems are universally valid. But having said that, there are some similarities between the second kind of lawyers described above and certain doctors: I believe that some doctors may be very good in giving long speeches on a large number of topics, attending numerous congresses etc… but when they have to identify and solve a particular problem to a particular person in a particular operation theatre, for example, they panic and just give excuses to avoid faci ng the real situation. In a way, they are like some Spanish lawyers that just know how to summarize in English a foreign law topic but they ignore the Spanish applicable law to a particular case (and instead run away in panic if they have to do it).

problem appears these innocent people die of go to jail or loose all their money in a wrong transaction or develop a tumour that could have been stopped using the right technique. HOW CAN WE DEAL WITH THIS PROBLEM? Finding out if a specific i ndividual has applied the lex artis ad hoc to a particular problem. I am talking about an individual and not about a team because many misunderstandings and disappointments arise when someone announces the excellences of a clinic or law firm with very smart legal or medical teams but one does not really know the real aptitudes of the individuals of the gr oup.

One important similarity between both types of – lets call them- nonsense lawyers or doctors- is how they react when they do not know the solution to a problem: the do nothing, not because the have decided that the best solution in that case is to wait and see but because they do not really know what to do. Instead they talk a lot o nonsense, disguised as ”common sense”.

Putting yourself in the hands of a self announced “dream” team does not necessarily guarantee that you will end being treated by the individual of your dreams and when things go wrong, responsibility will be scattered among the group, something that could have been avoided if the choice of the right person would have been made from the very beginning (doing a thorough search)

These people are particularly dangerous because the y play with the good faith of honest people that have relied in a false reputation and when a real

Finally, I would like to express my admiration to those doctors and lawyers –the majority of them- that carry out their duties with vey high professional skills. ■

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The challenges in creating a globally acceptable Informed Consent Document

By George Paul MDS, DNB, LLB (law degree), Post graduate diploma in medical law. Salem, India

INTRODUCTION Informed consent, as we understand it today, is of recent provenance. It is an implied or explicit permission given by a patient to a healthcare provider to perform procedures based on credible information made available to the former. Informed consent is based on the ethical principle of autonomy which gives the patient a right to decide what can and cannot be done to her body. While it may not always be an absolute right, it takes away the old paternalistic attitude of traditional physicians and surgeons. Undoubtedly, some form of implied consent must have been obtained from patients even in the past, but it is unlikely to have been based on relevant information or in a written format. Today, informed consent is an important document used extensively before diagnosis, treatment, research or any transaction between doctors and patients or researchers and subjects. Informed consent, as a contract, is indubitably influenced by regional laws. Consent requirement is also influenced by political systems and health policy doctrines of different governments and medical systems. Totalitarian states may have different standards from democratic establishments in the practise of obtaining an informed consent. The challenge in creating a common global informed consent is therefore subject to all these factors.

consents, William Beaumont in 1833 laid down the first principles of consent, as a requirement for clinical trials. There were several others. Consent as a basic right of a patient’s right to ‘self- determination’ was decided in the Schloendorf case (1914). It would be almost a half century before mere consent evolved into one that is given based on information (Salgo Case 1957). Informed Consent in research has a more colourful history resulting in numerous codes. GLOBAL VARIATIONS IN INFORMED CONSENT REQUIREMENTS The quality of informed consent depends largely on the political system of nations. Liberal democracies seem to value autonomy of its citizens much more than totalitarian states. Informed Consent in North Korea is not even talked about. Societies that remain closed, particularly communist regimes like Cuba, do have some kind of code of ethics but they retain the paternalistic streak where the state is expected to provide quality health care based on the principle of ‘beneficence with trust’.

HISTORY OF INFORMED CONSENT While Edward Jenner and Louis Pasteur successfully researched vaccines without the constraint of ethical boundaries or informed

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Countries in transition to a market economy, like China, have progressively adopted informed consent documents that respect the rights of patients. This is a significant shift from the paternalistic attitude of Confucian philosophy which governed medical ethics in the immediate post revolution era. Wealthy, vibrant democracies, like USA, Canada, Australia and several European countries on the other hand have stringent informed consents that are often reviewed from time to time to ensure maximum autonomy to patients. Poverty, illiteracy and noncomprehension also impact the quality of Informed Consent in regions like Africa and South Asia. India, for instance has robust laws and statutes requiring credible informed consent. However, illiteracy and poor access to universal health care compromises the effective implementation of these procedures. CHALLENGES IN DEVELOPING A GLOBAL INFORMED CONSENT DOCUMENT Standard Informed Consent formats have been defined in Good Clinical Practices (GCP) documents separately developed by the WHO and the International Committee for Harmonization (ICH). Both are used for clinical trials, in particular, pharmaceutical trials for drug development. However, a standardised global Informed Consent Document for clinical practice is still in the offing. The best possible way of achieving this would be through International non-government agencies or associations which have a global reach. They can be persuasive to the member countries through the respective national associations. The International

“Informed consent is based on the ethical principle of autonomy which gives the patient a right to decide what can and cannot be done to her body.� March 2018

Association of Oral and Maxillofacial Surgeons (IAOMS) for instance, has members from 120 countries and accepts affiliations from national and regional associations. It is certainly plausible to develop procedure specific informed consent documents that can include risks and foreseen events which can be incorporated into templates that can be used globally- at least by member countries. Today, with Informed Consents moving on from being an ethical obligation to a legal compulsion in most countries, it has become a need for National and International associations to adopt universal standards that can be deployed in the interest of autonomy as well as legal recourse. CONCLUSION A universal informed consent document can be made a reality only by non- governmental International specialty associations like the IAOMS, who can develop templates that can be adopted by national associations. These documents may eventually be assimilated as official templates to meet ethical standards in the respective countries. â–

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EACMS Munich September 18th-21st 2018 AAOMS Chicago October 8th-13th 2018 ACOMS Taipei November 8th-11th 2018 ANZAOMS Crown Perth October 18th-20th 2018

EACMFS Munich September 18th-21st 2018 AAOMS Chicago October 8th-13th 2018

ALACIBU Cancun December 1st-4th 2019

ICOMS Rio de Janeiro May 21st-24th 2019

ICOMS Rio de Janeiro May 21st-24th 2019

ALACIBU Cancun December 1st-4th 2019 PanAfCOMS

2019 To be determined

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9 1 0 2 8 1 0 2

ACOMS Taipei November 8th-11th 2018

ANZAOMS Crown Perth October 18th-20th 2018

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In Memoriam

Prof. Dr. Rudolf Fries 1928 – 2017 Linz, Austria By Prof. Dr. Bernd Gattinger Former President of the Austrian Association of Oral and Maxillofacial Surgery


e have the sad duty to inform you, that Professor Rudolf Fries passed away on September 11th after a long and severe illness at the age of 89 years Linz. Professor Fries was the head of the Department of CMFS of the Common Hospital Linz from 1971 to 1989. As a founder or cofounder of numerous national and international societies, he contributed significantly to the development of Cranio-Maxillo-Facial Surgery. The list of scientific awards (including the Martin Wassmund Prize) and honorary memberships is accordingly long. In 1967 he was founding member of the “Austrian Society of Oral and Maxillofacial Surgery”, in 1970 co-founder of the European Association of Cranio Maxillofacial Surgery (EACMF).

of Oral and Maxillofacial Surgery also in Eastern European countries. He invested tireless energy in harmonization of the training of Oral and Maxillofacial Surgery globally which was awarded with honorary membership of the Royal College of Surgeons in London and the AAOMS. Besides, he was a wonderful teacher and friend to many of us and we will always remember him. ■

In 1969, he and Professor Spiessl founded the “German-Austrian-Swiss Working Group for Tumors in the Jaw and Facial Area (DÖSAK)”. For many years, he was the head of the oral cavity cancer research group, chairman of DÖSAK and later honorary chairman. From 1990 to 1992 , he was the President of EACMFS and from 1995 to 1997 the President of IAOMS. After the break down of communism and the opening of Eastern European, his major impact was to promote and develope the speciality

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A bi g



yo u

Dear Friends, Greetings from the IAOMS Foundation! It’s hard to believe we are already a couple of months into 2018. Time passes quickly, and there are so many exciting things happening at IAOMS. New educational programs are being formed, conferences and events are taking place around the world, and our leadership can’t wait to share some new platforms and products with you soon. We continue to break new ground at the IAOMS Foundation as well. In 2017, we launched an annual appeal with a goal of securing $500,000 in commitments to the Foundation. I am excited to share with you that we met this goal. I’d like to take this opportunity to say thank you – personally, and on behalf of the IAOMS Foundation Board of Trustees. The support we have received from individuals, corporations, and affiliate organizations has been outstanding, and we’re humbled by your generosity. In addition to our ongoing Fellowship program, global training and speaking, and educational programs, we’re excited this year to be planning the launch of two new programs. The Visiting Scholars program will be a short-term training opportunity for young surgeons to attend institutions around the world for a period of 2-4 weeks. This program has grown out of demand for a short-term opportunity to complement the Foundation’s Fellowship program. Second, the Research Fellowship program will provide an opportunity for a 12-month basic and applied research training period, first held at the University of Michigan, led by IAOMS senior members. I want to leave you with a brief story. At the 2017 ICOMS in Hong Kong, we had the pleasure of speaking with a young trainee from Saudi Arabia at the IAOMS Foundation booth. She simply wanted to tell us that the work of the Foundation is important. She encouraged us to continue to bring education and training to Saudi Arabia, and to other countries that can benefit. Even as a trainee, she made a significant contribution to the Foundation. This is why the IAOMS Foundation exists, and this is why we will continue to push for growth and partnership – so that we can fulfill this mission, and elevate our impact around the world. So we say thank you to all those who have been a part of our growth. In 2018, we are once again making a push to secure $500,000 in commitments. Please join us as we pursue our mission. To make your commitment today, visit the Foundation’s giving page. (link to: https://iaoms.site-ym.com/donations/donate.asp?id=13705) On behalf of the IAOMS Foundation, I wish you all the best in 2018! ■ Larry W. Nissen IAOMS Foundation Chairman

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So, you want to work...

...IN PAKISTAN By Dr. Mahmood Haider President of PAOMS (Pakistan Association of Oral & Maxillofacial Surgeons)


akistan is a large country with a population of 210 Milllions and spread over 881,9 km2 taking up the north western fringes of South Asia straddling along the Himalayas, Karakoram and Hindukush. It is a land rich in history, culture and heritage: the land of Indus Valley and the Gandhara civilizations. Today, Pakistan is an emerging modern state with ample human resources as one of its most valuable assets.


The medical profession has grown exponentially in the last few decades; the Pakistan Medical & Dental Council (PMDC) is the regulator of Medical & Dental profession and education along with the Higher Education Commission. There are 230.235 registered Medical & Dental practitioners in the country, out of which 42.168 are registered as specialists.

The MCPS is a 2-years training sub-specialist qualification. The FCPS is a specialist examination, and acceptance for the training is based on interviews. Candidates are required to clear the Part 1 FCPS examination which is a Basic Sciences examination. Every year hundreds of candidates take this on-line examination. Selected candidates are enrolled with the CPSP for a 4-years structured training, which includes writing of a dissertation, a mid-training intermediate


Oral & Maxillofacial Surgery training and specialisation is based on a primary dental qualification. The training requirement depends upon the chosen track. The College of Physicians and Surgeons of Pakistan (CPSP) offers Membership (MCPS in Oral Surgery) & Fellowship (FCPS in Oral & Maxillofacial Surgery) Diploma examinations at the approved training centres.

There are 107 Medical and 49 Dental Colleges in the country, when combining the private and the public sector . Primary criteria for admission into a Medical or Dental degree are the Higher Secondary Certificate Examination (HSCE) and the Medical College Entrance Test scores. The language of instruction is English. International students can apply on general or reserved seats and should contact the individual institutions. They will require IBCC equivalence. In order to obtain a licence to practice in Pakistan, overseas graduates need to take the NEB examination. 20 iaoms.org

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i PAKISTAN MEDICAL & DENTAL COUNCIL www.pmdc.org.pk/Home/tabid/36/Default.aspx

module examination followed by rotation amongst allied specialities and on completion of training, an exit FCPS Part examination. Those who clear this examination are registered as specialists with the PMDC and they can apply for appointments as consultants. Further information on the CPSP training programmes can be seen by following the links below. The other track is to join a university administered Master of Surgery (MS) or Master of Dental Surgery (MDS) examination. These again are 4-years programme with a strong academic and research component. The clinical training is aligned with the CPSP training programme. Interested applicants are advised to contact the admissions offices of the universities offering these programmes. University of Karachi amongst other few has an ongoing hospitalbased programme. WORK OPPORTUNITIES, Jobs are still easy to get due to shortage of specialists in the country. On completion of training those interested in living and working in Pakistan will have to meet the immigration requirements. On an average a faculty OMFS can reasonably expect to draw USD 32,000 from their faculty appointment and can substantiate that with intramural or private practice.

HIGHER EDUCATION COMMISSION www.hec.gov.pk/english/Pages/Home.aspx NATIONAL EXAMINATION BOARD www.pmdc.org.pk/ ForeignQualificationsNationalExamination/tabid/129/ Default.aspx INTER BOARD COMMITTEE OF CHAIRMAN www.ibcc.edu.pk/ UNIVERSITY OF KARACHI uok.edu.pk/admissions/pg-index.php KARACHI MEDICAL & DENTAL COLLEGE kmdc.edu.pk/ PAKISTAN ASSOCIATION OF ORAL & MAXILLOFACIAL SURGEONS paoms.org.pk

INTERNATIONAL STUDENTS, traditionally Pakistan has been a preferred destination for medical education and specialist training for a lot of aspiring students from the neighbour countries due to affordable education and cost of living and the medium of instruction. SCOPE OF PRACTICE, The speciality training includes the full range of Oral & Maxillofacial Surgery with expertise in facial trauma, pathology, head and neck cancer, and developmental disturbances. PAKISTAN ASSOCIATION OF ORAL & MAXILLOFACIAL SURGEONS is a vibrant group of practicing surgeons and trainees, and its present strength stands at its 310 Full Members and 156 Trainee Members. It organises an annual conference and other scientific events. â–

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Women in IAOMS

By Dr Patrishia Bordbarr Oral & Maxillofacial Surgeon The Royal Children’s Hospital Melbourne, The Royal Melbourne Hospital, Australia

THE PAST I never imagined I would have anything in common with Lenny Kravitz, until I heard him say in an interview that by the time he was six years old, he already knew what he would be when he grew up. He spent the rest of his childhood just waiting to grow up! Similarly, I have been very fortunate. I have always known from a very young age that I would be a surgeon, but as a child I had never even heard of Oral & Maxillofacial Surgery (OMS).

It was only through what at 17 years of age, I thought was a terrible mistake by the universe, after receiving an offer into The University of Melbourne’s Dental School (instead of a place in the Medical School) that I discovered the field of OMS. A month after commencing Dentistry I was busy plotting a transfer to the Medical School when by chance I happened to attend a presentation by Professor Bruce Levant about the new OMS programme that was unveiled in Melbourne that year (1992). For the first time OMS candidates would be required to complete both Medical and Dental Degrees before completing their OMS training. Professor Levant presented the scope of the expanding OMS specialty, and I have never looked back. Professor Levant died the year before I commenced my OMS training in Melbourne in 1999, and although I never had the opportunity to train with him, he changed the course of my career completely. Perhaps it was my unconventional childhood and family (I attended multiple schools across three different continents, studying in three different languages), or just naïve youth, but I never thought that surgery was an unusual career choice for a woman. Nor did my family suggest otherwise when I told them of my chosen career path as a child, and later at University.

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is a scientific discipline and as such performance is outcome based, and our colleagues by nature have to be objective. This certainly makes it harder to dismiss someone based on stereotypes. The Australian and New Zealand Association of Oral & Maxillofacial Surgeons (ANZAOMS) has had two female presidents and whilst the ratio of female to male surgeons remains low, several of the women have held and continue to hold key leadership roles across the specialty. My own experience with the profession has been that both at the national and international level the profession has embraced me. My colleagues have entrusted me with key professional leadership roles, and the care of their family. I credit this to both the men and women in our profession who came before us. The latter for paving the way, and the former for keeping an open mind.

“My advice to them will be not to place any limitations on their goals because it is possible to “have it all” if you are prepared to work very hard.”

My earliest recollection that gender could even play a role in the selection process into surgical training was through idle gossip. In my year of Dentistry, another female student, who was a strong candidate was also interested in OMS training and I heard several students saying that “they” would never accept two female OMS candidates in the same year in Melbourne. I am pleased to report that “they” did accept both female candidates into OMS training that year. THE PRESENT Fast forward ten years as a specialist and I feel very fortunate to be part of the OMS community. I have been mentored (and continue to be supported) along the way by some of the most amazing surgeons in our specialty. I have worked in Australia, India and England and have been made to feel welcome in operating rooms all around the world. Our OMS family is small and tight knit and no matter where we go around the world I find there is always an instant connection we make with one another when discussing our surgical patients, or the struggles of our specialty and this transcends age, gender, ethnicity and religion. Gender equality is very topical around the globe right now, and it would be disingenuous of me to pretend that our specialty, in parallel with the broader global community, doesn’t face its own challenges. Surgery March 2018

THE FUTURE I think the future is very bright for our specialty. With each generation, our specialty grows stronger. My advice to all the trainees is to remain eternally optimistic and never take No for an answer when it comes to pursuing your goals. On a personal note, I enjoy constant change. I try to actively push myself outside my comfort zone. I now have two young children (who happen to be girls). My advice to them will be not to place any limitations on their goals because it is possible to “have it all” if you are prepared to work very hard. ■ iaoms.org 23

me too


By Gabriele Millesi Vice President IAOMS


hen our Next Gen Chair, Alfred Lau, and I were pondering over our up-coming topic for the Next Gen group: “Get ready for the stage”, where everyone should share their memories of their first presentation of a paper, a poster, my thoughts also travelled to the start of my career. In my first year of residency, my first official show up was a poster presentation on the outcome of carotid artery ligation in advanced cases of head and neck malignancies, a study of a senior professor, I was allowed to present at an Head and Neck meeting. Needless to say that I was very excited and later, after my presentation, an ENT chief congratulated me on my interesting poster, and added, “by the way, I was amazed by your black stockings“! In the beginning I was quite confused by this comment… now, I can only laugh retrospectively because time has moved on and by now I know that people are listening to what I present. But let us trasmit the same scenery to the present time and the “Me Too” movement! Is there a place for “Me Too” in the medical professional field as well? I can only dare to write this delicate article as first female Vice President of IAOMS. Yes of course, there is. We are all human beings, regardless of the profession and the level of hierachy and interpersonal behaviour, and attractions between females and males have not changed. Following the “ Me too” campaign in the media, I want to comment from a very personal point of view. Unfortunately we are torn away from one extreme to

another, a typical sign of our digital, multimedia times. But there are situations where males should learn and others where females should grow. Of course there is no place for sexual harassment. If a student friend of Med School tells me, that she was applying for a job in a hospital and the head of department asked her to show her breasts at the interview, he is taking advantage of a powerful position and it is sexual harassment. Another “medical” story, different department, a female colleague makes an obvious medical mistake and the chief calls her in and impends with persecution or to get an optional blow job. Hard to believe but true. How did the woman react? She turned around and said either to forget any of this conversation right away or to make it public, and there is nowadays enough back up and awareness from official authorities, if needed. This should be learned from all these Harry Weinstein debates. And what should women learn? To have enough self-esteem and self-confidence, to respond adequately and ask for help in case of harassment but to take it easy and not to overreact in case of a slippery compliment. ■

“After my presentation, an ENT chief congratulated me on my interesting poster, and added, “ by the way, I was amazed by your black stockings“! 24 iaoms.org

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“PRESIDENT’S INVITE” Dear colleagues:

patient care, treatment planning, pain management and emergency management. The program also will provide information on the AAOMS Office Anesthesia Simulation Program, which is designed to assist OMSs and their staff in preparing for office emergencies.

One hundred years ago, 29 doctors gathered at the Auditorium Hotel in Chicago, Ill., for the first meeting of the American Society of Exodontists. This society would eventually become AAOMS. A century later, we will reunite in the same city to fondly remember our past and look forward to the future. We will celebrate AAOMS’s centennial during the Association’s 100th Annual Meeting from Oct. 8 to 13 in Chicago, Ill. During the meeting, we will reconnect with friends, and we hope to see our colleagues from the largest global professional organization representing the specialty. IAOMS and AAOMS have enjoyed a long history together. More than 4,000 doctors, staff and others are expected to convene for the comprehensive educational program and exhibition. With the theme of “Safety and Innovation for the Next Century,” the meeting will reflect on the past and explore the possibilities of the future. Attendees will have numerous opportunities to earn continuing education credits. I hope you can attend this historic occasion, which will feature a new format of clinical education tracks, a history museum relating to the specialty, and the session I am most excited about – the keynote address delivered by Former Secretary of State and Chairman of the Joint Chiefs of Staff, General Colin L. Powell, USA (Ret.). Powell, who held senior military and diplomatic positions during four presidential administrations, will speak on “Leadership: Taking Charge” on Oct. 10. New this year, the Annual Meeting will deliver nine clinical education tracks. Each track will involve a large plenary session during which distinguished speakers will discuss the most recent evidence-based research. The plenary session will split into five breakout sessions for greater discussion. Track topics are based on the OMS scope of practice and cover cosmetic and orthognathic surgery, anesthesia, pediatrics and cleft, dental implants, dentoalveolar, head and neck oncology, reconstruction, temporomandibular jaw, and trauma. Attendees will be able to select tracks based on their clinical interests.

We will once again offer a cadaver workshop, an Exhibit Hall featuring more than 200 vendors displaying their cutting-edge products and services, and a robust program of more than 100 educational sessions. Among other exciting opportunities, attendees will be able to pose questions to three renowned OMSs during one-hour Meet the Expert sessions in the Exhibit Hall. At the World Café, G.E. Ghali, DDS, MD, FACS, FRCS(Ed), will lead group discussion. Case studies, best practices and solutions to important international issues will be discussed. As we celebrate our centennial, we will of course honor our history. The “100 years of AAOMS” course on Oct. 10 will recap the specialty’s history and discuss the evolution from exodontists to oral and maxillofacial surgeons. The Annual Meeting also offers opportunities to recognize our colleagues’ accomplishments, celebrate our successes and have fun. Members, fellows and residents will receive awards for their research, humanitarianism and other endeavors during the Dedication, Opening Ceremony and Awards Presentation on Oct. 10. And last but certainly not least, the President’s Event at the iconic Art Institute of Chicago on Oct. 12 will celebrate my family and my time as AAOMS President. Visit with friends and enjoy food while taking in the sights of one of the largest and oldest art museums in the country. I hope to see you in Chicago this October. We have planned a comprehensive, rewarding experience that commemorates AAOMS’s 100 years. For more details about the Annual Meeting, please visit AAOMS.org/Chicago. Sincerely,

The popular Preconference on Office-based Anesthesia program will review significant advancements involving

March 2018


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Report of Regional Meetings

AAOMS Annual Meeting will honor history

By Sarah Trotto AAOMS Editorial manager


or its 100th anniversary, the AAOMS Annual Meeting will return to where the Association originated – the Windy City. The Oct. 8-13 event in Chicago, Ill., is designed for practitioners, faculty, residents and professional allied staff. With the theme of “SAFETY AND INNOVATION FOR THE NEXT CENTURY,” the comprehensive educational program and exhibition will reflect on the past and look ahead to the future, revealing industry trends and advancements in clinical research, procedures and practice. The Exhibit Hall, featuring more than 200 vendors, and most educational sessions will take place at 26 iaoms.org

McCormick Place, while the business sessions, Opening Ceremony, Welcome Reception, some sessions and social functions will occur at the headquarters hotel, Hilton Chicago. The full-day, hands-on cadaver workshop, “Upper Facial Rejuvenation,” will be held offsite at Rush University Medical Center. EXPLORING THE HIGHLIGHTS Former Secretary of State and Chairman of the Joint Chiefs of Staff, General Colin L. Powell, USA (Ret.), will present the keynote address, “Leadership: Taking Charge,” on Oct. 10. Powell held senior military March 2018

OPPORTUNITIES FOR LEARNING The new clinical education format will feature nine tracks, each of which will include a large plenary session where renowned speakers will discuss the most recent evidence-based research. The sessions will split into breakouts for increased discussion. In addition, abstract sessions are dedicated to each clinical track. The topics are based on the scope of practice and divided into cosmetic and orthognathic surgery, anesthesia, pediatrics and cleft, dental implants, dentoalveolar, head and neck oncology, reconstruction, temporomandibular jaw, and trauma. This platform allows attendees to select from the tracks and breakout sessions according to their clinical interests. This year’s educational program extends through Saturday afternoon. The Anesthesia Safety Program – Closed Claims and Near Misses will share closedcase examples from OMSNIC to illustrate patient safety and risk management principles for officebased anesthesia administration. During three onehour Meet the Expert sessions in the Exhibit Hall, attendees will be able to pose questions to expert OMSs. At the new World Café, Dr. G.E. Ghali will lead group discussion on international issues. The educational curriculum also features practice management courses. With the Day Pass, attendees pay a flat fee for a full day of courses to explore opportunities and challenges facing practices. and diplomatic positions during four presidential administrations.


During the centennial celebration, AAOMS’s past will be a common theme for the Annual Meeting.

The Exhibit Hall, open from Oct. 11 to 13, will display equipment, products and services relating to the specialty.

The “100 years of AAOMS” course on Oct. 10 will address the specialty’s history, discuss the evolution from exodontists to oral and maxillofacial surgeons and examine how the scope of practice has developed over the last century. A history museum in the Exhibit Hall will showcase artifacts and displays related to the specialty. In addition, attendees will receive a keepsake lapel pin, and photographs snapped during the Annual Meeting will be featured in the centennial history book currently under development. The Dedication, Opening Ceremony and Awards Presentation on Oct. 10 will honor members’ accomplishments, and the President’s Event on Oct. 12 will celebrate AAOMS President Dr. Brett Ferguson and his family. March 2018

The Member Pavilion will offer resources for residents and new OMSs, educational and clinical products for practices, and access to the AAOMS Career Line for job opportunities. At the AAOMS Social Media Bar, attendees can receive one-on-one consulting on how to enhance social media presence through sites such as Facebook, Twitter and Instagram. As for exhibitor-hosted programs, the Corporate Forums will allow attendees to learn and discuss how the most recent technologies and services can benefit their practices. The Product Theaters allow OMSs and their staff to learn about specific exhibitor products. For more information and to register, visit AAOMS. org/Chicago. ■ iaoms.org 27

From Proust to Pivot


Prof. Kurt


Hospital Department Maxillo-Facial and Oral Surgery, University of Pretoria Pretoria, South Africa

What is your favourite word? Creativity. What is your least favourite word? No-time. What is your favourite drug? Water-with-fruit-juice. What sounds or noises do you love? Chirping of birds with sounds of African wild life in the back ground. What sound or noise do you hate? Grinding noise heard when closing a door over a small stone. What is your favourite curse word? Pay-attention. Who would you like to see on a new banknote? Mother Teresa. What profession would you not like to do? Hang-gliding-instructor. If you were reincarnated as some other plant or animal, what would you like to be? Be-loved domestic cat.

If Heaven exists, what would you like to hear the Lord say when you arrive at the Pearly Gates? You have done your best and have done your utmost to fulfil your obligations. What is your idea of perfect happiness? Piloting my rotor or fix-wing aircraft over a beautiful landscape. What is your greatest fear? Cannot really answer. What is the trait you most deplore in yourself? Perfectionism. What is the trait you most deplore in others? Procrastination. Which living person do you most admire? Dr Gary Parker, Maxillo-Facial

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Surgeon, the exceptional modernday Albert Schweitzer. What is your greatest extravagance? Funds spent to keep my aircrafts aviation sound. What is your current state of mind? Contemplative. What do you consider the most overrated virtue? None can be overrated. On what occasion do you lie? The last lie I remember telling was when I was about 10 years old and I denied to my parents that my nausea was caused by smoking the piece of cane (from a chair) that I had lit. What do you most dislike about your appearance?

When the circumstances necessitates my wearing sloppy trousers. Which living person do you most despise? Anyone who belongs to the category of being a crook. What are the qualities you most like in a man? Humility, honesty and compassion. What are the qualities you most like in a woman? Humility, honesty and compassion. Which words or phrases do you most overuse? Just now. What or who is the greatest love of your life? My family. When and where were you happiest? Putting the last touches to a painting* in my study. Which talent would you most like to have? To have advanced my proficiency post-student days in playing musical instruments. If you could change one thing about yourself, what would it be? Be more pragmatic.

What do you consider your greatest achievement? To have tested and/or used my given talents. If you were to die and come back as a person or a thing, what would it be? I have never thought of this scenario or option! Where would you most like to live? In a country where there is permanent peace and infinitive tolerance. What is your most treasured possession? Intellectual properties of my creative works. What do you regard as the lowest depth of misery? The poor who have no access to medical treatment. What is your favourite occupation? I have numerous favourite ones.

What is your most marked characteristic? “Never let the sun set on something which could have be completed that day.” What do you most value in your friends? Those who are truthful to themselves. Who are your favourite writers? Anyone who has created a brilliant piece of writing. Who is your hero of fiction? I have no heroes of fiction. Which historical figure do you most identify with? Prof Martin Wassmund, one of the most brilliant pioneers in MaxilloFacial Surgery. Who are your heroes in real life? All those, who committed their lives to achieving wonders for the destitute. What are your favourite names? There are too many beautiful names for males and females to pick only a few. What is it that you most dislike? A lie or half-a-truth. What is your greatest regret? Not using every day’s 24 hours efficiently. How would you like to die? Peacefully, without being a burden to the family. What is your motto? “Success through Creativity.” (*KuWiBu, an abbreviation in some paintings of Kurt Bütow)

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Copy Me WAFERLESS MAXILLARY POSITIONING USING CUSTOMIZED SURGICAL GUIDES AND PATIENT SPECIFIC OSTEOSYNTHESIS IN BIMAXILLARY ORTHOGNATHIC SURGERY In complex two-jaw surgery cases, manual model surgery requires many laboratory based steps that are time-consuming and may contain potential errors. In the field of orthognathic surgery, treatment planning has been largely dependent on personal clinical experience, two dimensional radiographs and manual plaster model surgery. Computerized and customized wavers have lacked to improve accuracy of maxillary positioning, resulting in a draw back of computer-assisted orthognathic surgery. The aim of this report is to demonstrate a new technique of waferless maxillary positioning using customized surgical guides and patient specific osteosynthesis implants in bimaxillary orthognathic surgery. With this new method maxillary and mandibular positioning can be performed intraoperatively independent from the mobile mandible or maxilla.


t Kueb Norber

Majeed Rana

MAJEED RANA1 and NORBERT KUEBLER 1 PRIV.-DOZ. DR. MED. DR. MED. DENT. MAJEED RANA Vice director Department of Oral and Maxillofacial Surgery Heinrich Heine University Duesseldorf

1 A 23 y.o. patient with a frontal open bite and maxillary excess (gummy smile).

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2 Planning of the patient: specific guide with drill channels and drill holes for a maxillary impaction of 5 mms, and the predrilling position for the mandible with ramus fixation.

3 Planning of the osteosynthesis and design of patient specific implant with a maxillary advancement of 1mm.

4 Preoperative screw positioning considering the bone quality.

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Patient specific guide with drill channels and drill holes for the osteosynthesis of the patient specific implant. It is used to drill on both sides of the LeFort I osteotomy, the maxillary bone and the midface.

PSI, passively placed onto the lower, tooth-bearing maxillary part and fixed with 1.5 mm screws using the pre-drilled holes.

7 Mandible positioning after a standard BSSO, employing patient specific guide with drill channels and drill holes and a wafer in final occlusion. Fixation of the mandible with patient specific implants.

8 Post-op: a 23 y.o patient after waferless bimaxillary orthognathic surgery using maxillary positioning using customized surgical guides and patient specific osteosynthesis.

9 Lateral view of the patient before and after surgery.

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Report of Meetings

A look at PAfCOMS in SUDAN By Eric Kahugu The Maxillofacial Clinic, Upper Hill Medical Centre next to Nairobi Hospital


he 6th PAfCOMS was held in Khartoum, in conjunction with the Sudanese Association of Oral Maxillofacial Surgeons (SAOMS) from the 21st to the 23rd of February. The conference was held at the Corinthian Hotel which is a 5 star architectural gem, with excellent conference facilities, rooms and restaurants. Aside from the main conference, three pre-conference workshops and onepost conference workshop were organised at The National Ribat University. Also, a parallel AOCMF course was held at the conference hotel. Those courses covered the following topics:

• F acial Cosmetics and Rhinoplasty workshop.

•O rthognathic and Trauma Cadaveric workshop.

• B asic Sialadenoscopy workshop.

• H ands On Cadaveric

workshop on Flaps and Tracheostomy workshop.

• A OCMF Management of Facial Trauma course.

The conference was very well organised and I congratulate the SAOMS for putting together such a detailed program. We specially thank Professor Elimairi and the SAOMS team for being such wonderful hosts. ■ March 2018

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Get Ready for the Stage By Alfred Lau President, Hong Kong Association of OMS Chairman, NextGen, IAOMS


here are many qualities that one needs to develop to become a successful Oral and Maxillofacial Surgeon (OMS). You cannot be one without acquiring good knowledge, developing competent surgical skills, cultivating a creative and innovative mind, being actively engaged in research and publications and maintaining constant interaction with other colleagues. Add to that, the ability to speak in public on a stage – an important attribute that elevates you to a higher level. The ability to deliver, when given the opportunity to a lecture/ speak means that you have already acquired those essential qualities and characteristics. I am able to carry out the public speaking as if I am doing my music or magic performances.

Like many, I was very stressed when I went on stage for the very first time as a trainee. The fear of being in the spotlight, the fear of forgetting important points, the fear of being questioned, and the fear of being non-fluent under stress overwhelmed me. I largely overcome these fears by drawing on my experiences with stage performances. I have to give this credit to my music teacher when I was little, who is also my magic teacher now. Through these stage opportunities, 34 iaoms.org

There are a few essential advices that will be helpful. First of all, you need to make a presentation script. This is essential especially to you who are not presenting in your native language. Practice your script several times in front of a big mirror, so that you can almost memorize the things you need to say as well as being aware of your own body gesture and movements. Video yourself if possible so you can watch yourself. It is often odd to look and listen at yourself, but that is how you can reflect and improve. You have to be quite familiar with your presentation materials, and you it goes to say that you must understand the content better than the audiences must, as if you are performing a magic but only you are aware of the trick. Try to present your own work/ publications as this will give you confidence as well as better credibility to the audience. I also find it very useful to attend a speakertraining course, as the professionals will give you practical tips on improving your art of speech. Last but not least, practice makes perfect. Try to gain speaking opportunities whenever possible. I wish you all the best of luck in this journey. â– March 2018

“Throughout the years I have been repetitively exposed to being on stage, in school, college, internship and nowadays as a resident. I can’t recall the last time I was afraid of that and I highly link it to the amount of times I’ve been exposed to the situation, in other words “desensitized”!

By Noor Jabbar Ai Saadi OMS Resident, Oman Medical Specialty Board, Sultanate Oman Regional Representative, NextGen, IAOMS


ave you ever felt like “I saw the crowd and I just melted”... that’s how Adele, the famous British music icon, once stated in an interview describing her feeling when she hits the stage. Despite performing before millions of people, touring the world and earning countless global awards, Adele has stage fright! In 1915, Prof. Walter Cannon first described the fight or flight response, where at stressful times, we are programmed to secrete stress hormones to prepare our bodies to perceive the emergency we are facing, and that’s exactly what happens in the stage fright. We are basically charging our minds with energy to impute worry that being on stage is a “risk” March 2018

or an “emergency”, albeit rather this feeling can be diminished by a concept called “desensitization”, which was first initiated by psychologist Cover Jones in 1924 when she published a “laboratory study of fear”; she postulated that the most effective method to remove fear response is repetitive exposure to a fearful stimuli, thus the more we expose ourselves to presenting on stage, the less fearful we get, and that’s how “Adele” is keeping it all together; performing with confidence and appearing completely composed on stage ... Going back to her interview, she continues “ After second or third song, I was chill, I was alright”. Throughout the years I have been repetitively exposed to being on stage, in school, college, internship and nowadays as a resident. I can’t recall the last time I was afraid of that and I highly link it to the amount of times I’ve been exposed to the situation, in other words “desensitized”! ... As most of our fears are built in us even without a previous harmful incident, we assume things will go wrong, our brain conceive scenarios, similarly on stage, we dread making mistakes or getting ourselves embarrassed in front of the crowd. Nevertheless, keeping in mind that consciously redirecting this thinking, slowing down and taking deep breaths, in addition to knowing the topic proficiently and being well prepared will all contribute to good outcome on stage. ■ iaoms.org 35

Hours A DAY IN THE LIFE OF A MAXILLOFACIAL RESIDENT IN SWEDEN By Anna Filip Larsson Department of Maxillofacial Surgery University of Gothenburg. Sweden


n 2005 I got my DDS at the University of Gothenburg. My last semester at university was influenced by participating as a part of the Swedish Disaster Victim Identification team in Thailand after the tsunami and with greatest humility for life I left my home town to work in south of Sweden.

I spent two years doing general dentistry in the region of the IKEA origin. It is mandatory to do this time of work experience in Sweden before one can apply for registrar posts. The organisation I worked with had a great �rookie� program and we got to work closely to specialists in all dental fields. One of the surgeons I met gave me the advice to go abroad to gain experience and numbers and so I did become an Senior House officer at Queen Victoria Hospital NHS in the UK for half a year.

With new experiences and a new perspective on surgery I decided to go back to med school aim for a double qualification. This year it is 5 years ago since that graduation and the last years have been dominated by internship, research and the start of a specialist training as a registrar.

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0.4 km

fter the fist ferry there is a small ride and then A on to… Yes !the next ferry. Biking off the ferry to hit the challenge head wind, who ever said life should not give you lemons, but the beauty of it is the fact that it not is below zero, its not in November at least!

30 km

Not a new time record but I am happy to jump into the showers. Now scrubs on. As I am doing one of many side educations I go to the morning meeting of the plastic surgeons. I am assisting one of the cleft surgeons today.

The Oral and Maxillofacial department in Gothenburg has 12 specialists and 4 registrars with individual time plan due to research and other engagements. In average the specialist training is finished in 4 years. There is no formal request of double qualification. Our week starts with Monday morning meeting where the week duties are defined; eventual presentations, visitors or multidisciplinary meetings etc. We have an outpatient clinic every day with appointments and surgery and an “on call” clinic. In the main building of Sahlgrenska hospital across the street we have our inpatients at the Plastics or ENT ward and it is also where theaters for general anasthesis cases are. NOW PLEASE FOLLOW MY ROUTE OF A DAY at the time being in my plastic surgery side education.

0 km

ake up all to quickly get in to my cycle gear and on my W sweet bike! Joy to the world I have the opportunity to bike to work.

0.2 km

I take the ferry from the island where I live together with my family. I truly enjoy lining in this place.

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30.4 km

ff to the ward and see todays two cleft cases and O round patients. Then I take off to theatre. Me and the consultant have a coffee and talk through the operation.

30.6 km

After finishing the first case there will be a break for lunch and the theatre staff will not get the next case until 12:45. In my life this is an opportunity to get some training done. So I get changed and run to the Botanical Gardens that lies behind the hospital main building.

34.8 km

hat a boost of energy. Great interval work in 30 min, W 10 min shower and 5 min grab bite to eat on the way back to theatre. Scrubbing intoanother interesting and challenging case of bilateral cleft surgery. The plastic surgeons in Sweden have a great tradition of this work and we have multidisciplinary meetings together on a regular basis for these cases.

35 km

After finishing the second case I attend a case in the theatre next door to assist in a breast reconstruction with a DIEP flap. It is a good opportunity to be a part of this as the amount of dissection and suturing gives more “tissue” experience.

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35.2 km

ll cases done for the day and I get on my A bike back to the island again. My on call started at 16.00 hr, so ear plugs in if I get called. Beeing on call as a maxfacs I have a maximum of 2 hr to get into the hospital. Hence I can stay at home if the sea allows me going in our own boat. Speeding up the pace a bit to make sure I get home to see my family.

65.2 km

Home and no calls yet! On to Lego play with my son, hey this is pure joy being a surgeon loving construction. Supper and then bedtime stories and with the knowledge it can call at any time, but we finish the chapter and he falls asleep. Is there anything more peaceful?

65.4 km

Getting into the boat, lifejacket on and “on call” mobile in the pocket, sea is calm tonight but it is cold. Taking all safety precautions not to have any “issues” on the way. Sahlgrenska Emergency department (A&E) called me in to see a “bleeder”. The report in this case was; an elderly man on antiplatlets who started to bleed perfusely from the mouth 4 days after having implants installed in the lower jaw, Hb 104 but vital signs without remarks.

95.6 km

Nope, I do not bike in the night when on call, I got a car. Getting changed, meeting up with my assisting nurse in the ED and off to our on call room. To see the patient. The report is on spot but from the

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Sahlgrenska U niversity Hospi


history of labs his habitus of Hb is around 100! However I decide to in local explore and stop the bleeding that seems to come from the flap. This is done successfully and patient observed for 1hr. He gets to go home with accompanying prescriptions and a referral to have his dosage of antiplatelet medication checked.

125.8 km

Back on the island again and checking out next to the “on call” mobile, that stays quiet for the rest of the ours to next morning.

126 km

Back on the ferry and early morning calm sea and nippy air. I look forward to another day at the best work ever, on day I might get somewhere meanwhile I am living my dream! ■

March 2018

In first person

THE ROPE FROM BAGHDAD TO NOTTINGHAM The dream of a woman to the world of Head and Neck Oncology Surgery By Hiba Aga Consultant Head & Neck Oncology, Maxillofacial and Reconstructive Surgeon Queen’s Medical University Hospital (Nottingham, UK)


eing a Maxillofacial Surgeon had always been my dream since I was a dental student in Baghdad. Part of that desire came from witnessing 2 wars and the resulting devastating facial injuries. I came over to the United Kingdom after graduating from Baghdad Dental School. Glasgow was my first “port of call”. I was introduced to the world of Maxillofacial Surgery in general but specifically into the Head and Neck Oncology side of the specialty.

I had to go through many postgraduate dental exams and then to fight for a place in a Medical School to fulfill the dual qualifications requirements of the British training pathway. Overall, we moved across the United Kingdom (UK) five times. Every move was a big hurdle and an emotionally draining process. Particularly, when you consider that both I and my closest classmate (and by the way, husband) have been working with (not against) each other to obtain two positions in the training programme. We needed to keep our career dreams and our family together.

“This is a great job to help people fighting cancer. I want to be a Head and Neck Surgeon.”

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“It has been 15 years of passionate swimming against difficulties, and holding onto my Head and Neck life’s rope. The rope has stretched a long way to my new home as a Consultant Surgeon at Nottingham University Hospital. ”

As we continued our path in UK, our parents were living at the war zone in Iraq. During my training, I had always enjoyed Head and Neck Oncology. I felt the special privilege that comes from helping cancer patients and their families through the long journey fighting the disease both physically and emotionally. The world of Head and Neck is fascinating. The surgeon’s knowledge and the skills (both resective & reconstructive) have to be simultaneously processed in order to be effective in managing these difficult cases. In the UK, Head and Neck Maxillofacial surgeons get comprehensive training in both resection and reconstruction. I completed my senior registrar training in Birmingham, where I learnt how crucial it is to build up a multidisciplinary team in order to efficiently tackle complex cases. Another hurdle was to access a nationally approved Head and Neck fellowship. Those positions are very sought after and the process is highly competitive among the specialties of Maxillofacial, ENT and Plastics surgery. Yet, the hard work throughout my journey and training paid off. I got my first choice, Glasgow. It is the busiest unit in the UK and probably in Europe. It was a rather emotionally and financially demanding year. I had to spend the working week in Glasgow and travel back 300 miles to my family in Birmingham over the weekend. On a working day, my day started at 7AM and would regularly finish any time that day, or even the early hours on the 40 iaoms.org

next day. I had to find a remedy to cope with all the associated stress. After a month, I rediscovered an old friend of mine that I had not visited for years, “painting”. It was such a lucky moment in my life. I went to buy a TV but ended up with a canvas and oil paintings instead. Since then, painting has been extremely helpful to reload my concentration and sooth my frustrations. It is a fact that there will be many frustrating moments in a routine day of a Head and Neck Oncology Surgeon but painting allows me to focus on something totally different to my professional career. Outside the hospital, I spend my time with my daughter who has been my best and the most inspiring friend. I have to admit, that at the start of this long pathway I felt that I would not be able to find the right balance between my family and this career. I soon realized that working hard on both aspects has enabled me to paint a beautiful harmony in my life. It has to be inspiring when my daughter tells me “This is a great job to help people fighting cancer. I want to be a Head and Neck Surgeon.” It has been 15 years of passionate swimming against difficulties, and holding onto my Head and Neck life’s rope. The rope has stretched a long way to my new home as a Consultant Surgeon at Nottingham University Hospital. Lastly, Head & Neck Oncology Surgery is a lifelong commitment. We have to devote ourselves into the privilege and the challenge of treating our patients. ■ March 2018


TodDr.ayJohn Helfrick the specialty. Everything from advances in imaging, to the genetic basis of diseases, to technological advances in the surgical management of patients. I fully expect these advances to escalate over the next 10 years – it is an exciting time!

By Deepak Krishnan Assistant Professor of Surgery, UC Health. Cincinnati


ear Dr. Helfrick

How do you spend your time these days? Since 2003, I have been “Senior Consultant for Healthcare quality and Patient Safety” at Partners Healthcare International. Although I still reside in Sugar Land, Texas, my office is in Boston. We work with hospitals internationally who want to improve healthcare quality and patient safety, commonly resulting in accreditation by Joint Commission International. My 17 years of involvement with The Joint Commission prepared me for this role. The overall experience has been hugely rewarding and has provided me with the opportunity to become familiar with large parts of the world I otherwise would not have visited – I am currently heading towards 12 million miles on American Airlines! What do you read in OMS literature these days that fascinate you? I am most interested in how technology is changing

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What do you consider the single most meaningful contribution you made to the specialty of Oral Maxillofacial surgery? I believe my greatest contribution to OMS was my active involvement/role in the advancement of the specialty. This began with my decision in 1972, to become an educator and things took off from there. I was fortunate in that many of our colleagues who trained in the late 60’s and early 70’s made the same decision and we were all insistent on advancing the specialty and, fortunately, we have been successful beyond our imaginations. What is your perception of how the specialty has changed from when you started to now? The greatest change has been that we are now the undisputed surgical specialists for the oral and maxillofacial region. This was achieved through a lot of hard work and by never taking our eye off the ball – we simply had to be better. Over the years, other surgical specialties began to recognize our contributions to surgical care and this was recently validated by the acceptance of our colleagues into Fellowship in the American College of Surgeons. In 1970, this was considered an unattainable goal! What do you miss the most about work? I am still working but not in OMS. As I mentioned previously, the aspect of my surgical career that I miss most is the active involvement in education and the overall advancement of the specialty. The good news is that there is a new and very active generation of young surgeons who have picked up

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the chalice and are continuing the “advance the ball”. What do you not miss about work? Dealing with insurance and human resource issues. The HR problems in clinical practice were something that I was not prepared for! Do you keep in touch with former colleagues? Absolutely! For 8 years after my term as IAOMS past president concluded, I served as Executive Director of the IAOMS, and for the past 6 years, I have had the same role with the American Academy of Craniomaxillofacial Surgeons. This has kept me involved without being active in education and clinical practice. In addition, for the past three years, several past presidents of the IAOMS and myself have had an annual reunion at an international venue of our choosing. I have included a photo from one recent reunions in the U.K. What would you change about your career path if you could go back and do so? Quite honestly, not a darn thing! I cannot imagine a more fulfilling career path. Good thing, as I am not going to get a second chance! Which technological advance in the specialty would have made a difference in your surgical activity? I am going to spin this a bit and mention what I think had the greatest influence on the advancement of the specialty in my career – the development

of acceptable bone plates and rigid fixation. I was trained on the “75 different ways” you could use 26-gauge wire and, in retrospect, it was awful! Rigid fixation not only improved care, it allowed us to do things that we were previously unable to do. What advice do you have for the OMS trainee starting training in 2018? Stay actively involved in the specialty! In addition, that means all aspects: maintain an active hospital practice as well as an outpatient practice; continue with major as well as minor surgery; teach; be active “politically” in your local, state and national organizations. How do you reflect on your involvement in the IAOMS? How important was the association in your career? One of my mentors as a resident was Fred Henny who, along with Sir Terrence Ward, founded the IAOMS so there was never a question in my mind that I would be involved someday in international OMS. It has probably been the most fulfilling professional activity I have been involved with. It provided me with a very different perspective of healthcare issues worldwide – both in OMS and healthcare in general. I now count many international colleagues as some of my closest friends. What are you currently reading? My 401 K! ■

From left to right, those in the photo are Jill and John Williams, Diana Banks, myself and Nancy, Paul and Ria Stoelinga and Peter Banks

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WORKING IN PARADISE By José M. Contreras Oral and Maxillofacial Surgeon. Hospital Dr Dario Contreras. Santo DOMINGO, RD


he Dominican Republic is an island located in the sun’s pathway, in an incredible archipelago of sugar and alcohol, nestled between four cardinal mountain ranges, and bathed by virgin beaches and large bays. Its city, the great Santo Domingo, is full of history and tourist attractions. For this and many other reasons, working in this country is like working in paradise itself. I started my professional and teaching life in the city where I was born at the end of 1989, soon after finishing my training at the Dr. Dario Contreras Teaching Hospital. Although we have many hospitals in our country, the Dr. Dario Contreras Hospital is the busiest; the statistics suggest that trauma associated with automobile accidents is most frequently treated. This hospital’s Department of Oral and Maxillofacial Surgery has a team of more than 15 assisting physicians in charge of training the future generations professionally and ethically.

Republic for head and neck cancer and facial reconstructions are performed under general anesthesia. Outpatient procedures, such as oral surgeries and surgeries of soft facial tissue, are performed in our daily consultation. We currently have more than one hundred and forty-five maxillofacial surgeons in the country and many of us have further specialized in other areas, such as orthognathic surgery, oncological and reconstructive surgery and dental implants.

Our department uses the operating room three times a week and procedures of relative complexity, such as traumatology surgery, surgery

“This hospital’s Department of Oral and Maxillofacial Surgery has a team of more than 15 assisting physicians in charge of training the future generations professionally and ethically. ” March 2018

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Every year, charity labor is carried out for the facial reconstruction of patients with cleft palate and lip. The Government of the Republic offers prevention and primary care nationwide through its Secretariat of Health and social programs and, although some things could certainly be improved, access to dental care could be considered satisfactory at the national level; personally, I feel satisfied with the care that we provide to our patients. This paradise on earth is well-known for the white beaches of Punta Cana and Las Terrenas or my very beloved Puerto Plata, the “Bride of the Atlantic”. We welcome tourists year-round due to our favorable weather conditions and tropical climate. We have the most automobile accidents during the spring and summer; tourists are rarely involved in these incidents but, if so, access to health services is guaranteed. We have regional hospitals and personnel trained in the management of these events in each one of the provinces.

We are also well-known for our “health tourism”. The Dominican Association for Health Tourism works hand-in-hand with health care and wellness centers, hotels, health risk managers, patients and healthcare professionals with the purpose of exceeding health tourists’ expectations and offering high quality and cost effective medical, dental and wellness services. The Dominican Republic has it all! ■


NEW NEW THING IN OMFS In 1999 Michael Lewis wrote his book on Silicon Valley, The New New Thing. Now almost twenty years later, In FACE TO FACE we are looking for new trends in technologies, surgical techniques, or speciality organization that can shape the future or Oral and Maxillofacial Surgery.

Enjoy Doug Fain´s video 44 iaoms.org

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Beyond O.R.

Surgical porn By Javier González Lagunas (follow me on



f you think this paper is about people having fun in the operating theatre (in other activities then operating, of course...), you are wrong.

In this case we want to approach surgical porn like we do with food porn. A good definition of the latter could be “Close up images of juicy delicious food in advertisements”. or “..taking mouthwatering pictures of delicious foods and proliferating them throughout various social media websites as status updates”. The Oxford dictionary defines it as “Images that portray food in a very appetizing or aesthetically appealing way”. So please forget about the web`s thousands of images of surgeons and nurses, surgeons and patients, nurses and patients, surgeons and anesthesiologists, in any particular number or gender combination. Instead, think about surgical pictures shared in Instagram, Snapchat or any other social media, and how easily they compare to foodporn as defined in the previous paragraph. So, what do surgeons crave for, when surfing the social networks? In an initial analysis, surgical porn can be classified in 3 different categories:


haring pictures of your patients before and S after surgery, beatifully presented perfectly finished, and often touched up. Those presentations show how good you are and create a desire of being operated by you. You look for a “like” from potential patients.


haring pictures of the process of the S operation. Perfect pictures of a bloodless surgical field, showing anatomy of the area as it has never been showed before. Those pictures show not only that you have good results, but that you are a dedicated and skilful surgeon that perfectly knows anatomy March 2018


of the area. You look for a “like” from savvy colleagues. haring pictures of (other’s) bad results. S Websites as www.awfulplasticsurgery.com show us those rich celebrities who made the wrong decision when choosing a surgeon.

It is safe to assume that the popularity of smartphones have played a major role in the spread of surgical porn. More then 375.000 smartphones were sold worldwide just in the first quarter of 2017. So, surgical porn will steadily increase in the next few years in the social networks, sharing photos of cases with colleages, patients and followers. Smartphone use for medical photography might be an issue in the next few years. Regulations are thin but new platforms as Sharesmart in Canada have appeared that allow doctors to share in secure social networks pictures of patients. ■ https://www.urbandictionary.com/define.php?term=food%20porn https://www.restoconnection.com/food-porn/

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8618 W. Catalpa Ave., Suite 1116, Chicago, IL 60656 U.S.A. www.iaoms.org 46 iaoms.org

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