Face to Face by IAOMS

Issue 54 / July 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

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

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

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

There is a constant, steady and progressive expansion of oral and maxillofacial surgery to all corners of the globe. More and more health professionals decide to dedicate their efforts and their professional career to our strong, wonderful and essential specialty. That enormous extension of our planet that is Middle East is a clear example of our global growth. Be curious and read about the experiences, desires and needs of our colleagues in a region that goes beyond traditional continental borders.

CONTENTS July 2018 10 SPECIAL REPORT

Maxillofacial Surgery in the Middle East.

SO, YOU WANT TO WORK... 16 In Italy.

20 WOMEN IN IAOMS Meriem Boulanane.

FROM PROUST TO PIVOT 24 Kenichi Kurita.

26 COPY ME

Malignant peripheral nerve sheath tumor.

FELLOWSHIP 29

25 years in Neiva.

32 NEXT GEN

My first experience presenting my research as a resident.

WHERE ARE YOU NOW? 34 Mario Scarrone.

38 A DAY IN THE LIFE OF

A Maxillofacial Resident in Ankara.

WORKING IN PARADISE 41

43 BEYOND THE O.R.

Know your competitors.

Venezuela.

THE GLOBAL LEADER IN OMF EDUCATION

n fewer than 12 months, IAOMS Fellows, affiliated associations, corporate sponsors and others will gather in Rio de Janeiro for ICOMS, our organization’s signature educational and networking conference. I invite you to visit www.iaoms.org where you can register, submit an abstract and read about some of the expert speakers and topics you will hear. The Local Organizing Committee, under Dr. Luiz Marinho’s leadership, is working to ensure that ICOMS offers something for everyone – IAOMS members and non-members alike – at any stage in their career. We hope you will join us for an educational and memorable event in Rio. Because we know the importance of educational opportunities for IAOMS members, we continue to enhance and expand the many ways in which we’re bringing the best in global OMF education directly to members. For example, I know many of you participate in our live and on-demand webinar series – both Scientific and Next Level Forum/Digital. The IAOMS Foundation launched an exciting, new program – Visiting Scholars – and you can read more about it in Dr. Larry Nissen’s column. We are continuing to forge and grow partnerships with affiliated associations. Last month, I had the pleasure of traveling to Antalya, Turkey for the first IAOMSAÇBİD Congress, which more than 400 OMF surgeons attended. My thanks to AÇBİD President Dr. Timuçin Baykul and General Secretary Dr. Hakan H. Tuz. We hope this is the first of many successful joint meetings. It’s through these local partnerships that we bring the expertise of the IAOMS to regions throughout the world – just one way that this global association works regionally to further enhance educational opportunities for OMF surgeons on a local level. I hope to see you at the 100th meeting of the American Association of Oral and Maxillofacial

Surgeons (AAOMS) in Chicago this fall. The AAOMS played a special role in the creation of the IAOMS and many AAOMS members are also IAOMS members because they see and experience the value of a “dual membership.” Similarly, many members of regional and/or national OMF associations are IAOMS members because they want (and need) the global perspective and expertise that only the IAOMS offers. These are just some of the ways that the IAOMS is becoming even more member-focused. In that spirit, I encourage you to engage with us – via a live webinar (where you can ask questions of the expert presenters), participate on a committee, partner with us on a local educational event or provide feedback (communications@iaoms.org). I am encouraged by the progress we’ve made together – and I look forward to working with you in the months ahead. It is the strength of our volunteer leaders – as well as IAOMS Fellows -- who through various IAOMS programs, are helping to improve the quality of patient care throughout the world. IAOMS begins with you. Thank you for your membership, which helps us build your practice and the OMF profession throughout the globe.

With thanks,

Mitchell Dvorak EXECUTIVE DIRECTOR, IAOMS

Letter from the President COLLABORATION FOR TRAINING AND GROWTH Dear Colleagues and Friends :

had the privilege of traveling to Turkey last month to attend the joint IAOMS-AÇBİD Congress held in beautiful Belek, Antalya, celebrating AÇBİD’s affiliation with the IAOMS. Under the leadership of AÇBİD President Dr. Timuçin Baykul, its Board of Directors, and Dr. Doğan Dolanmaz, Conference Chair, this visionary educational partnership provided a great scientific and networking forum. I had the opportunity to see the enthusiasm of new IAOMS Fellows from Turkey coming together to this high-level meeting with speakers from all continents of the world. This meeting is just the latest example of how the IAOMS is collaborating with national and regional OMS associations and deepening partnerships to promote the advancement of patient care, education and research in oral and maxillofacial surgery. An example of regional association collaboration is the upcoming 13th Asian Congress of Oral & Maxillofacial Surgery in November, being celebrated in Taipei. These are some of the ways that the IAOMS, as the specialty’s global voice, is reaching surgeons around the world. Because of the increasing number of requests, we receive from organizations, the Headquarters staff, in consultation with our Education Committee Chair, Dr. Ghali Ghali, have developed an education partnership/sponsorship package that outlines a range of opportunities for regional and national OMF associations to partner with the IAOMS. Watch for this partnership package in the coming weeks; I think you’ll find that the range of opportunities provides something for every association considering such a partnership. The IAOMS looks forward to collaborating with more associations so that together, we can create greater awareness for the specialty – and more importantly, advance research, improve patient care and develop the next generation of OMF surgeons.

I also had the honor to preside over my first Board of Directors and Executive Committee meetings in Miami, where we welcomed IAOMS leaders from around the globe. Some of the highlights during the meetings were:

“The IAOMS looks forward to collaborating with more associations so that together, we can create greater awareness for the specialty – and more importantly, advance research, improve patient care and develop the next generation of OMF surgeons.” • IAOMS’s NextGen initiative, led by Drs. Alfred Lau (Hong Kong) and Gabrielle Millesi - Vice President including the NextGen focus at the ICOMS Next Level Forum. Read about the “Pearls of Wisdom” and “Ignite” sessions. •w ww.iaoms.org – our new website, will be launched in the next few weeks. We expect this will become a global “hub” for our specialty. I extend my gratitude to Dr. Fred Rozema, Website Task Force Chair, for his leadership in this important project, along with the efforts by his committee in creating a website that is intuitive, versatile and offers members of all ages the tools and communications needed for their busy schedules.

more about the Foundation’s programs and how you can support this vital work •R evising our association’s bylaws so that they are aligned with best practices •A n update on ICOMS 2019 in Rio De Janeiro – planning and coordination is moving along at a rapid pace. We are incorporating the ICOMS website into our new IAOMS website to make the process of registration more streamlined. This meeting, the flagship of the IAOMS, promises to be a most exciting and educational ICOMS, back in Latin America. Thank you to everyone who participated in these meetings. I know you had great distances to travel and I particularly appreciate the time you have taken from your practice and teaching commitments to be with us in Miami. These meetings are essential in growing the association but also to connect – face-to-face -- and have some less formal time to catch up with colleagues and further deepen relationships. I look forward to seeing many of you in the upcoming meetings in the fall, including the EACMFS September in Munich, Germany, and the 100th Anniversary celebration of the American Association of Oral & Maxillofacial Surgeons, in Chicago this October. And for those of you heading into the summer season, I hope you have an opportunity to relax and enjoy some time with family and friends. Thank you for your commitment and membership in the IAOMS -- the global voice of the specialty.

• An update from our Executive Director, Mitch Dvorak, on several initiatives he is spearheading related to governance, administration, programming and membership • New programs from the IAOMS Foundation – and a reminder from our hard-working Foundation Chair – Dr. Larry Nissen – about the importance of giving back to the specialty. Visit www.iaoms.org to learn

Alexis B. Olsson IAOMS PRESIDENT 2018-2019

special report Maxillofacial Surgery in the

MIDDLE EAST

01 A spotlight on OMS in IRAQ

By Adel Aubed, BDS, ABHS (OMFS) Board certified, Oral and Maxillofacial Surgeon. Alkadhmiya Teaching Hospital

n Iraq, Oral and Maxillofacial Surgery is surgical specialty with a prerequisite dental degree (BDS). There are two pathways for specialization in OMS - a national training program regulated by Iraqi Board of Medical Specialization (IBMS) that has existed since 1993 and an Arab training program regulated by Arab Board of Health Specialization (ABHS) that has been around since 1998 in Arab countries and made an entry in 2007 to Iraq. Admission to oral and maxillofacial surgery training programs is rigorous and competitive in Iraq. In order to be considered for training, the candidates should have completed one-year dental internships at specialized dental Centers followed by at least one year (and often 2 years) of a pre-board training internship in oral and Maxillofacial Surgery. With that background, candidates appear for a highly

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competitive written examination followed by an interview for admission to OMS training. In the last few years, both programs received about 16 residents and most of them were distributed between two training centers; Ghazi Alhariri Hospital for specialized surgery and Alkadhmiya Teaching Hospital. OMS training curriculum comprises five years of hospital-based residency, this includes rotations on general surgery, emergency medicine, internal medicine, otolaryngology; plastic surgery, orthopedics, anesthesiology, ICU, radiology, neurosurgery, and ophthalmology. Further, residents receive training in all aspects of oral and maxillofacial surgery -trauma, benign and malignant pathology of head and neck region, cleft lip & palate, orthognathic surgery, Dentoalveolar and Dental implant surgery, salivary gland surgery and TMJ disorders.

July 2018

OMS. The first and second world wars helped change the face of dental surgery in Europe, leading to the naissance of our specialty as oral and maxillofacial surgery. During the past 14 years in Iraq, several thousand oral and maxillofacial trauma patients have been treated by Iraqi hospitals leading to the surgical interventions that dramatically improved the surgical skills, training, experience, knowledge and scientific research among oral and Maxillofacial surgeons and residents and thus, patient outcomes. The gravity of this theater is enormous when considering the fact that surgical education and patient care is often eclipsed by personal tragedy, lapse of security, threatened medical staff, working in meagre facilities, equipment and materials. Only time will tell what the future of our specialty will be in Iraq, bearing in mind the variability of the available resources, the diversity of educational and

Al-Kadhimiya Teaching Hospital. Baghdad.

Residents are required to succeed in the primary examinations in basic medical sciences during the first two years of their residency. At the end of the fifth year, they are permitted to appear for the final examinations that comprises of a written exam and clinical & oral exams. In addition, as a requirement for obtaining the certificate of completion of specialist training certificate, candidates must submit a short thesis (dissertation) and a logbook of the surgical procedures they performed.

Ghazi Alhariri Hospital. Baghdad.

We are dedicated and determined to maturing this important surgical specialty in Iraq by improving training programs, to be able to provide dual degree qualifications, and advanced fellowship programs following completion of basic training.

training philosophies, and perhaps the uncertainty of the perils of war. The management of war casualties has become a significant part of our practice and the nature of injuries is unparalleled.

War continues to be a grand theater and despite its graveness, a great school for surgeons. Historically, military conflicts had provided significant opportunities for the advancement o f surgical specialties particularly

However, we believe that OMS will remain a dental surgical specialty for the predictable future in Iraq, with an increase in the number of dually qualified oral and maxillofacial surgeons. â&#x2013;

July 2018

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Oral and Maxillofacial Surgery in ISRAEL

By Nardy Casap MD DMD1 and Michael Alterman DMD2 1 Chairman, 2Attending. Department of Oral and Maxillofacial Surgery, Faculty of Dental Medicine, Hebrew University and Hadassah Medical Center, Jerusalem, Israel

Israel is a country in the Middle East, on the southeastern shore of the Mediterranean Sea and the northern shore of the Red Sea. It has land borders with Lebanon to the north, Syria to the northeast, Jordan on the east, the Palestinian territories of the West Bank and Gaza Strip to the east and west, respectively, and Egypt to the southwest. Israel was established in 1948, and recent surveys estimate its population at approximately 8,800,000 citizens. The history of Oral and Maxillofacial Surgery (OMS) in Israel begins in the early 1950’s with the formation of the first two departments of OMS, one at the Faculty of Dental Medicine of the Hebrew University and the Hadassah Medical Center of Jerusalem, and the other at the Rambam Medical Center and the Technion in Haifa. The first chairmen of these departments where Prof. Jacob Levin-Epstein and Prof. David Guthman, respectively. Today there are 15 departments of OMS in Israel, 9 of which hold residency programs. The OMS residency program lasts 5 years and the residents are required to matriculate the 2 stages of the National Board Exams in order to obtain a specialty degree.

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Three medical schools at the Hebrew University of Jerusalem, the Tel Aviv University and the Technion in Haifa offer a special MD track for OMS specialists that includes 2 years of academic studies and an additional 9 months of clinical internship. Up to date, there are more than 200 OMS specialists in Israel, of whom most are active members of the Israeli Association of Oral and Maxillofacial Surgery, which is a part of IAOMS. Israel is often coined “The Startup Nation” due to its well-known reputation as a world center for cuttingedge research and innovation, startup companies and R&D centers in different industries. The OMS community, too, is highly involved in the development of various innovative technologies and techniques in all fields of surgery. This includes the development of modules for smart operating room environments, various surgical tools and appliances, minimal invasive techniques and technologies, etc. Multiple Israeli surgeons have received worldwide recognition for inventions and developments that are considered pioneer and groundbreaking, among whom are Professor Dorit Nitzan in the field of TMJ arthrocenthesis, Professor Oded Nahlieli in the field of Sialendoscopy, Professor Adi Rahmiel in the field of Maxillofacial Distraction Osteogenesis and Professor Nardy Caspi-Casap in the field of Navigation Surgery. In this context, it is important to mention that most residency programs have research laboratories and all department members, both attending physicians and residents, have fruitful R&D relationships with the Israeli high-tech community.

July 2018

Prof. David A. Koppel Dr. Nardy Casap and Dr. Gabriele Millesi.

Dr. Adir Cohen, Dr. Yoav Leiser and Dr. Michael Alterman.

Over the years, experience and knowledge have been collected on the subject of treatment of maxillofacial trauma with an emphasis on the treatment of war and terror-related injuries. In the recent years, Israel has opened its borders in order to treat individuals wounded in the civil war taking place in Syria. Despite the fact that Israel does not have diplomatic relations with Syria, thousands of those injured men, women and children, with differing levels of injury, have been transported to Israel with the help of humanitarian organizations. At the border, field hospitals receive patients for triage and primary survey and these patients are later transferred to the government hospitals for continued treatment. Because many of those wounded sustain maxillofacial injuries, OMS surgeons play an important role in the ongoing treatment. Dr. Alejandro Roisenthul, a past president of the Israeli Association of Oral and Maxillofacial Surgery and the chairman of the OMS unit at the Ziv Medical Center in Tzfat, received the 2017 AAOMS Board of

July 2018

Trustee Special Citation Award for his outstanding role in this unique and important humanitarian effort. The Israeli OMS community holds close ties with the international OMS community in all fields of action. Israeli teams participate in international R&D teams, young Israeli specialists participate in international fellowship programs and the ratio of peer-reviewed publications to number of OMS professionals is considered one of the highest in the world. OMS in Israel is constantly continuing to grow and develop out of the understanding that alongside the ongoing technological developments in the field, there is no equal to high-level academic learning, hands-on clinical experience and constant self-improvement of manual surgical skills. Our community is committed to the high standards of IAOMS and we are looking forward to continued collaboration and cooperation with the international community and to playing key roles in IAOMS activities in the future. â&#x2013;

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Greetings from the SULTANATE OF OMAN! By Noor Al Saadi Oral and Maxillofacial Surgeon. Oman Medical Speciality Board . Sultanate of Oman

The Sultanate of Oman is a coastal country in the Western part of Asia located at the Southeastern coast of the Arabian Peninsula in the Middle East, with an estimated population of almost 4.4 million according to 2016 statistics. In the last 50 years and following the discovery of oil, the Omani nation with its rich history and unique culture and traditions swiftly entered an era of modernization and development in all sectors, including health and education. The first attempts of setting up a public health system were initiated in 1958. These services were basic with a single small rudimentary hospital covering the whole country. It was not until the year 1970 when Sultan Qaboos became the leader of Oman, that the Ministry of Health was established and subsequently a plan of developing a modern national health care system commenced by building hospitals, outpatients clinics, specialist centers, primary healthcare centers, reaching to all towns and rural areas. The birth of the first Oral Surgery Department in Oman goes back to the year 1974 when Dr. Saud Al Kharusi, the first Omani general dental practitioner joined the public health system and started managing facial fractures, mainly mandibular fractures by using intermaxillary fixation. But it was not until the year 1986, when the Ministry of Health appointed Dr. Bryan Snelling as a consultant in Oral and Maxillofacial (OMF) surgery, that modern OMF surgical service was established. He was later joined by Dr. Mohamed Al Ismaili upon his return from

training in the UK in 1988. Eventually, a solid team of four surgeons was established after the appointments of Dr. Manjunath Margasahayam and Dr. Nader Hanna in 1990 and 1994 respectively. Initially, oral and maxillofacial surgery was basically devoted to the management of oral pathology, dentoalveolar surgery and facial trauma. Diseases of the mouth and maxillary bones were rampant due to nonavailability of primary oral health care service. A high incidence of road traffic accidents causing facial trauma was also common. In the late eighties, facial trauma was treated with intermaxillary fixation, interosseous wiring, external pins and rods, Gunning

orthognathic surgery, temporomandibular joint surgery including arthroscopy, cleft lip and palate repair, head and neck surgery and many more. In parallel with the witnessed remarkable development in healthcare, there was a similar development in education, at all levels from basic to higher education. In 1986, the newly established Sultan Qaboos University also created a new Medical School. The first batch of qualified doctors graduated in 1993. Later, the Oman Medical College was established in 2001 followed by Oman Dental College in 2006. The first batch of locally trained dentists graduated in 2012.

“Following graduation, young OMF surgeons are encouraged to pursue further fellowship training in recognized hospitals abroad.” splints and external frames. However, by the early nineties, Oman joined the rest of the modern developed world in the use of internal fixation systems based in the Champy principles of bone fixation using plates and screws. The service continued to progressively expand and prosper to its current level. Today, a wide variety of treatment modalities are provided to patients including

Dr. Noor Al Saadi and medical team.

Local training program in OMF surgery was initiated, developed and reinforced with a period of overseas training. In 2010, the OMF training program was formally approved and was the first surgical program to be accredited by the Oman Medical Specialty Board, which is the governing body for medical and dental specialty training. The training program, which started with a single resident per year, is currently accepting 2-3 residents per annum, into six main training centers. The training program is 4.5 years long, and includes different medical and surgical rotations in addition to research and elective blocks locally or abroad. Following graduation, young OMF surgeons are encouraged to pursue further fellowship training in recognized hospitals abroad. Currently, an estimated number of 30 oral and maxillofacial surgeons and trainees are working in the various healthcare sectors of Oman, including public services, military medical facilities, university hospital and private healthcare establishments. The collaborative work of OMF surgeons from the different sectors was crowned by the recent formation of the official professional representative organization called the Oman Oral and Maxillofacial Surgery Club under the umbrella of The Oman Dental Society. The future is at the hands of those who prepare for it today. We are proud of what we have achieved so far and we are still determined to continue the journey of advancing all aspects of OMS practice. Although educating and training is a laborious process, it is a quest towards advancement and innovation. Quoting our leader His Majesty Sultan Qaboos (1991 at the graduation ceremony of the second batch of Sultan Qaboos University). “We shall, for our part, spare no effort to provide opportunities for the training of Omanis at all levels of education”. ■

So, you want to work...

...IN By Manlio Galiè EACMFS Education & Training Officer. SICMF Executive Committee Officer.

taly is Europe’s fifth most populous country (with a population of about 60.6 million) and a popular destination for immigrants and expats alike throughout history. With its culture-rich cities, 7,600 km of beautiful coastline, lakes, mountains and islands, each one of Italy’s regions has its own unique qualities. Located in the Southern part of Europe, Italy is a country with a particularly rich cultural heritage, dating all the way back to the Roman Empire and its countless monuments, museums, churches, and galleries attract both tourists and expats to all corners of the country. Due to its geographical position, Italy has different climates, with the Northern Alpine regions experiencing vastly different temperatures from Sicily (in the South), for example. Contrary to popular belief, Italy is not always hot and sunny. If you are considering moving to Italy, remember that the official language of Italy is Italian. English is not as widely spoken all over Italy as in some other European countries, so learning some Italian prior to moving 16 iaoms.org

is necessary. However, similarly to much of Europe, English is more widely spoken in the large cities like Rome and Milan, and is very often the language of business transactions. Italy is the world’s eighth largest economy and an EU Member State. It is, amongst other things, a member of the European Union of Medical Specialties (UEMS). Nationals of non-EU countries shall apply for a work permit before starting to work in Italy. NATIONAL HEALTH SERVICE AND AUTHORITIES The Italian National Health Service was established on December 23, 1978 by a law approved by 85% of the Parliament (L .833/78). The NHS is founded on the principles of universal coverage, social financing through general taxation and non-discriminatory access to healthcare services. The fundamental values the Italian National Health Service embodies based and its considerable July 2018

strength have been recognized over the years by various international bodies such as the World Health Organization and the OECD.

member of neither the EU nor the EEA have the same rights and duties as EU citizens for the purpose of this document.

The World Health Organization has ranked the Italian health system second best in the world (after the French NHS). Although the Ministry of Health is ultimately responsible for the administration of the Health Service, much of the control is now in the hands of the Regions.

Citizens of all other countries do not have the same rights and duties.

Doctors who do not have Italian citizenship or who graduated from a non-Italian medical school/ university must meet the requirements to register with the Italian Medical Council in order to practice the medical profession in Italy.

The regulations take into account citizenship and legislation on immigration and the validity of any qualification attained outside Italy.

Registration with the Italian Medical Council is a mandatory requirement to practice medicine in Italy. Before registering with the Italian Medical Council it is necessary that the applicant’s European Degree be validated by the Italian Ministry of Health. The application form for this procedure is available, together with all required information, at http://www. salute.gov.it/ProfessioniSanitariePubblico/ An application for registration on the National Register of Practitioners, filed to the Italian Medical Council, requires a close examination. The length of time required for this depends on the specific features of the application. The Italian Medical Council must accept the application or reject the application within the legal time limit of three months from the date of submission.

The European Union (EU) comprises the following countries: Austria, Belgium, Bulgaria, Cyprus, Croatia, Czech Republic, Denmark, Estonia, Finland, France, Germany, Greece, Hungary, Ireland, Italy, Latvia, Lithuania, Luxemburg, Malta, Netherlands, Poland, Portugal, Romania, Slovakia, Slovenia, Spain, Sweden, and United Kingdom. Citizens of these Nations are “EU citizens” and a degree taken in any of these countries is called a “European Union Medical Degree” (hereinafter “European Degree” for short). The European Economic Area (EEA) includes all the EU countries, as above, plus Iceland, Liechtenstein and Norway. For the purpose of this document, all citizens of EEA countries have the same rights and duties of EU citizens. Lastly, citizens of Switzerland, although their country is a July 2018

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THE ITALIAN ASSOCIATION OF MAXILLOFACIAL SURGERY • The Italian Association of Maxillofacial Surgery (SICMF) was established in 1987 by the merging of two Associations: the AICMF (Italian Association of Maxillofacial Surgeons) and ASCMFOI (Association of Italian Hospital Maxillofacial Surgeons and Stomatologists). •T he SICMF holds a National Congress every 2 years on major scientific and clinical topics as well as organizational issues regarding specialty training in Italy and the European Union in cooperation with UEMS (European Union of Medical Specialists). • Currently SICMF has 307 active members. SPECIALTY TRAINING •M axillofacial Surgery Training and Specialization curricula are based on a primary Medical qualification (basic Medical Training). •P resently there are maxillofacial surgery Units in many general and university hospitals in Italy, while there are 9 postdoctoral training programs for a total of 35 new residents each year. •T he University Training Centers are located in Turin, Milan (Statale and Bicocca), Novara, Verona, Rome, Naples, Parma and Siena. •T he duration of the specialty training is 5 years and access to it requires a Master’s Degree in Medicine and Surgery (6 course years). •O ral Surgery can be practiced not only by the Specialists in Maxillofacial Surgery but also by Dentists, whereas maxillofacial Surgery (which is a medical qualification) can be practiced only by Specialists in maxillofacial Surgery. •T here is not a common path between the medical and the dental degree, and graduates of dentistry are not eligible for admission to maxillofacial Surgery training or specialization curriculum.

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• This means that an OMS who wishes to move to Italy for work here must have a medical degree plus training in maxillofacial surgery or a double degree (medicine & surgery and dentistry) plus training in maxillofacial surgery. •C urrently there are about 500 maxillofacial surgeons in Italy. An average monthly salary for a consultant in Italy would be around 2500-3000 Euros depending on the experience, region and hospital. NATIONAL AUTHORITIES IN ITALY •M inistry of Health (MOH) www.salute.gov.it/portale/home.html • Ministry of Education, Universities and Research (MIUR) www.miur.it/guida/guide.htm • Information Centre on Academic Mobility and Equivalence (CIMEA) www.cimea.it/en/index.aspx. ■

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FOUNDATION CHAIRMAN REPORT

A bi g

yo u

Dear Friends,

reetings from the IAOMS Foundation! As we are quickly approaching the midpoint of the year, there is so much exciting activity in the IAOMS community. Volunteer leaders are working on new education and training programs and events around the world that will provide greater access to education than ever before. Our staff is working hard to prepare brand new online platforms for a launch this summer, which will improve the way we access information and interact with each other across the OMS community. And, our team in Brazil is hard at work planning for a fantastic ICOMS in Rio de Janeiro next May. At the Foundation, we are pushing forward as well. Following our successful initiative last year, we are once again aiming toward a goal of raising $500,000 in total commitments in 2018. Five months into the year, we have secured over $250,000 in commitments, and we are pursuing exciting partnership opportunities with individuals, regional organizations, and corporations. We expect a busy summer! As we receive support from you and the broader OMS community, our goal is to elevate our impact around the world through new and expanded programming such as: •V isiting Scholars – As you have seen in recent announcements, this program is accepting applications. This is a 2-4 week destination training opportunity that will bring a muchrequested complement to our longer Fellowship Program. Learn more HERE. • I COMS Scholarship Program – The American and Canadian OMS associations are the first associations to sponsor a scholarship for trainees and residents from their respective countries to attend ICOMS. •R esearch Fellowship Program – The first IAOMS Foundation program in basic and clinical research is a 12-month fellowship that offers a training opportunity at the University of Michigan. More information on the program’s launch will be shared soon. Through these programs and all of the Foundation’s activities, we seek to educate and empower the next generation of OMS professionals around the world to provide the best patient care, and to pass along the gift of knowledge to others. Friends, I ask that you join us in our efforts. Challenge yourselves to consider what our specialty, as well as the IAOMS community, has meant to you and your career. Our goal is that every IAOMS member will get involved and consider making an Annual Appeal commitment at a meaningful level this year. You can visit our Foundation page and make a commitment at www.iaoms.org. On behalf of the IAOMS Foundation Board of Trustees, thank you for your support. We look forward to sharing more exciting progress with you soon! ■ Larry W. Nissen IAOMS Foundation Chairman July 2018

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Women in IAOMS

AS A SU

RGEON

IN ALG

ERIA

By Meriem BOULANANE Chirurgie Maxillo-faciale/Maxillofacial Surgery. E.P.H. Medjdoub Said, Taher. Jijel - Algerie

â&#x20AC;&#x153;A life is a story, and a story is not necessarily a fairy tale,â&#x20AC;?

Yasmina Khadra - Algerian author.

nd, it is undoubtedly, the struggles of men and women, some of whom, out of the ordinary, that patients have seen their story soften, sometimes becoming a fairy tale.

Subsequently, improvement in socio-economic conditions and the introduction of new technologies have inevitably contributed to a revival of the specialty; including the interest in orthognathic and reconstructive surgery.

The late P. Salim Hafiz introduced OMS in Algeria in the early 1980s. He had studied dental surgery, and then medicine and surgery in Algeria, with further training in France, before fighting to create, impose and advance maxillofacial surgery in Algeria as a specialty. Since then, some ten surgeons have been trained each year in centers in Algiers, Constantine, Blida, and Oran. Unfortunately, the black decade that my country has experienced influenced the advancement of the specialty, and trauma has taken precedence over other aspects of OMS. 20 iaoms.org

Algiers. July 2018

I TRAINED IN THIS CONTEXT, THIS ERA. I was born in Algiers, Algeria, and I had the chance to travel a lot during my childhood. I also had opportunities to visit hospitals and came across several surgeons as a patient. Several of them were positive role models and influential in my decision to pursue that career and eventually become one of them. I graduated from general medicine following seven years of study. I had to now choose between entering the practice of primary care medicine or choosing further training in a specialty. My interest in surgery, my curiosity for embryology, and my fascination for reconstructive surgery, led my choice to maxillofacial surgery. Following completion of my two years of common trunk surgery training, I joined the team of Dr. S. Hafiz, Mustapha Bacha University Hospital in Algiers, in the oldest hospital and the first oral and maxillofacial surgery service in Algeria. My training lasted just over three years, first under the direction of Prof. Bensaadellah Rabah and then Pr. Ferdjaoui Abdelkader who is the current head of that department. We owe much to an outstanding team of surgeons -Drs. Ouaguenoune Y, Azouani Y., Pr. Benbelkacem H., Pr. Bouhouche L., and Boutemeur S., for our training. We also learned a lot from Prof. Kebir A., professor of oral pathology. In October 2013, I participated in ICOMS held in Barcelona, and it is undoubtedly the prime event of my residency. I interacted with residents of other countries, compared our backgrounds, our choices, our patients, our projects, and sought advice from accomplished surgeons. That experience cemented my faith in my choice of my career.

“In October 2013, I participated in ICOMS held in Barcelona, and it is undoubtedly the prime event of my residency. I interacted with residents of other countries, compared our backgrounds, our choices, our patients, our projects, and sought advice from accomplished surgeons.”

Currently, I am the only maxillofacial surgeon in a Public Hospital Establishment in Jijel, a small port city, located 300 km east of Algiers. Although my practice of OMS is embedded within a surgery department, I have made an impact to this community by taking care of patients who live in this remote area and thus carved a niche for our specialty here. My position at this hospital was created as a mandatory provisional rotation for two years, to help serve the needs of the local population. It has been a rewarding experience when you make a positive impact on a rural and fragile population. I believe that being a woman makes it easier for patients to have trust and confidence in me. My patients are mostly members of a modest, conservative society. There are many “tales of experience” that I can tell. One of my best stories is that of a 19 year old who came to me for management

Being a surgeon, and being a woman in Algeria is a challenge. Having said that, it is my experience that in our fine specialty, women are well integrated. I had the honor and privilege of working with the first woman OMS, Pr. Hayet Benbelkacem and was influenced positively by her. Algiers-department.

of her palatal cleft. She barely spoke because nobody ever understood her. A few months following her cleft repair and speech therapy, I saw her again; there she was - happy to appreciate the taste and textures of her food, and not wanting to be silent anymore! The ability to repair a malformation, name a disease, or take care of cancer in time is priceless. I can finally smile!

Me and some colleagues at the Frenchh congress of the SFSCMFCO.

My career continues, and soon, I will be moving on to becoming a teacher-researcher. I would be required to move to another city where I will be able to practice surgery, teach medical students, and start a research work. To me, this is a new beginning after several sacrifices - a new challenge awaits me: I will utilize this opportunity to contribute my part to the specialty, multiply our

exchange projects, and continue my training, especially in the surgery of the clefts â&#x20AC;&#x201C; that will honor my ambition. My advice for young OMFS?

Choose your dreams well; they may come true! â&#x2013;

The

NEW NEW THING IN OMFS Dr. Florencio Monje (Badajoz, Spain) The Halstedian model (observe, practice, and teach) works very well for open surgery. But when dealing with the so-called minimally invasive surgery, where the learning curve is steep and sometimes the practice is frustrating, it can be definitely insufficient. The world of simulators has invaded our daily life. In this short video we will present an extremely realistic simulator to teach, learn and practice Temporomandibular Joint minimally invasive surgery. This new model allows the surgeon to palpate the joint structures, with a realistic perception of the tactile sensation and the resistance of the tissues.

Enjoy Dr Monje video 22 iaoms.org

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From Proust to Pivot

AN APPARENTLY INNOCENT QUESTIONNAIRE FOR ORAL AND MAXILLOFACIAL SURGEONS

Dr. Kenichi

Kurita

First Department of Oral and Maxillofacial Surgery, Aichi-Gakuin University School of Dentistry. Nisshin Campus, Japan.

What is your favorite word? Will. What is your least favorite word? Command. What is your favorite drug? Anti-histamine agent. What sound or noise do you love? Laughter. What sound or noise do you hate? Cry. What is your favorite curse word? Neglect. Who would you like to see on a new banknote? Mt. Fuji.

What profession other than your own would you not like to attempt? Musician. If you were reincarnated as some other plant or animal, what would it be? Cherry tree. If Heaven exists, what would you like to hear God say when you arrive at the Pearly Gates? You are here early. What is your idea of perfect happiness? Health. What is your greatest fear? Malignant tumor.

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July 2018

What is the trait you most deplore in yourself? Acoustic sensitivity. What is the trait you most deplore in others? Non-cooperation. Which living person do you most admire? Not exist. What is your greatest extravagance? Voyage. What is your current state of mind? Stable. What do you consider the most overrated virtue? Equality.

On what occasion do you lie? When I am asked about my weight.

Which talent would you most like to have? Multilingual capability.

Where would you most like to live? Hawaii.

What do you most dislike about your appearance? Lentigo on the upper lip.

If you could change one thing about yourself, what would it be? Musical sense.

What is your most treasured possession? Antique clock. What do you regard as the lowest depth of misery? Hunger. What is your favorite occupation? OMS. What is your most marked characteristic? Novelty. What do you most value in your friends? Honesty. Who are your favorite writers? Ernest Hemingway. Who is your hero of fiction? Humphrey Bogart in Casablanca. Which historical figure do you most identify with? Samurai.

Which living person do you most despise? Someone in North Korea.

Who are your heroes in real life? My father.

What is the quality you most like in a man? Honesty.

What are your favorite names? Nothing.

What is the quality you most like in a woman? Honesty. Which words or phrases do you most overuse? Please.

This chinese sign drawn by Dr. Kurita meaning WILL.

What or who is the greatest love of your life? My family including a stupid dog.

What do you consider your greatest achievement? When I score 300 on bowling game.

When and where were you happiest? When I score 300 on bowling game.

If you were to die and come back as a person or a thing, what would it be? The same as me.

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What is it that you most dislike? Snake. What is your greatest regret? I have not had chances to work outside of Japan. How would you like to die? During sleep. What is your motto? Life is short. â&#x2013;

Copy Me MALIGNANT PERIPHERAL NERVE SHEATH TUMOR Head and neck malignant peripheral nerve sheath tumors are rare (5-10%), aggressive, high-grade soft tissue sarcomas associated with poor prognosis. They arise from peripheral nerves or cells of the peripheral nerve sheath. Most often, they develop sporadically but can emanate from malignant transformation of Schwannoma or as stigmata of neurofibromatosis (NF-1&2). The neck is the most common site of presentation. Presenting symptoms can vary from an enlarging palpable mass with or without pain, airway obstruction, severe headaches, diplopia, etc. based on anatomic location. Rapid enlargement is usually associated with NF-1.

os alavrez holas K

Nic

Diagnostically, they are challenging due to morphological and immune-phenotypic features that overlap with melanoma and other high-grade soft tissue sarcomas. Negative indicators for prognosis are advanced tumor stage, early recurrence and NF-1 associated lesions. High rates of local recurrences (22-52%) and distant metastasis (18-33%) favor a multimodality treatment approach. However, this has little effect on long-term survival. The role of neo-adjuvant chemotherapy is uncertain and is reserved for sites where radiotherapy might be difficult to deliver. Mainstay of treatment is principle surgery followed by adjuvant radiotherapy.

Deepti Sinha

MR NICHOLAS KALAVREZOS FRCS FFD MD University College London Hospitals NHS Foundation. DEEPTI SINHA University College London Hospitals Nhs Foundation Trust.

Preoperative clinical photographs showing a right level 4 & 5 neck swelling.

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2 CT neck with contrast showing right carotid sheath tumor arising from the vagus nerve.

3 MRI neck with contrast showing right carotid sheath tumor arising from the vagus nerve.

MRI segmentation rendered 3D virtual surgical planning for surgeons and a useful patient education tool. Note PICC line in situ as patient received neoadjuvant chemotherapy.

Internal jugular vein

MPNST from CN X

MRI segmentation rendered 3D image, MPNST visualized from medial aspect of the neck.

Sternocleidomastoid muscle

External carotid artery

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Total Pixels: 81,051

MRI segmentation rendered tumor volume 30.8900 cm3 & surface texture analysis showing homogenous smooth tumor surface.

External carotid artery MPNST CN X Internal jugular vein

Sternocleidomastoid muscle

Right supraclavicular skin incision.

Resected anatomical specimen.

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Exposed carotid sheath revealing MPNST arising from CN X.

Fellowship

25 YEARS IN NEIVA By David Hoffman Director of Division Oral and Maxillofacial Surgery Staten Island University Hospital. Staten Island, New York.

hen we embarked on our first “Healing the Children (HTC)” trip to Neiva, Colombia, 25 years ago, I suspect that none of my oral and maxillofacial surgery colleagues or me, for that matter, would have imagined that we would be returning to this same city for 25 more years in a row. This June our surgical team will be returning to Neiva for our 25th anniversary. Originally, we started out as a small group of oral and maxillofacial surgeons, plastic surgeons, anesthesiologists, and nurses in 1993, traveling to a regional hospital in Neiva, Colombia, a city of about 450,000 people in the State of Huila. The program was first developed at the request of Dr. Carlos Fajardo. Dr. Fajardo met one of the Connecticut directors of Healing the Children, Angie Glick, who was escorting a small child back to the United States for Military and police helping on screen day to amuse the kids. surgery. He was struck by the fact, that there were children who were not receiving healthcare from all over Central and South surgeons in 1993. Drs. Don Booth, Larry Herman, America whose only chance to be cured was to Laura Sudarsky and myself were the first doctors come to the United States for surgery. As he was to use two operating theaters with two operating retiring back to his hometown of Neiva, tables in each room. We provided cleft lip Colombia, after his successful career and cleft palate reconstructive surgery to as a civil engineer, he decided he “In the last 30 to 40 children over a five-day period. wanted to help enable doctors to 10 years, the The program continued and doctors come to his hometown and work program initiated returned each year until about its fifth in the Hernando Montcaleano comprehensive care for year, when it was determined it was too University Hospital, where he the children that needed dangerous for the American doctors to became a member of the Board travel to Neiva due to terrorist activity cleft lip and cleft of Directors. Although it was the by the FARC as well as drug-related major community hospital for Neiva palate surgery.” activities. At that time, Carlos Fajardo and with over 600 beds, it certainly was the local plastic surgeon, Dr. Trespalacios, small in comparison to what we consider arranged for some of the surgeons from Bogota a university hospital in the United States. to come to help with the program that had to be Carlos hosted the first group of doctors, a combined aborted about a week before this planned surgical team of plastic surgeons and oral and maxillofacial July 2018

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More children waiting for surgery screen day close to 1000.

Carlos Fajardo and his wife they started this program 25 years ago.

trip. A group of surgeons from Bogota led by Drs. Andres Ferio and Anna Maria Lehmana were committed to making the program viable and filled in for the missing American doctors. The following year though, it became a joint effort with both Colombian doctors as well as visiting doctors. By the 12th year, we were running eight operating tables and treating upwards of 200 kids per year for surgery. The program then expanded to treat microtia, facial and hand deformities. It was supported extensively by the local civic organizations in Neiva including the Rotary Club, the Chamber of Commerce, the government and the First Lady of the country and also Smile Train grants. The military was always available for support and added a sense of security! Over the next few years the program continued to grow and included a pediatric orthopedic team from Boston Children’s Hospital providing care for children with clubfeet and hip dysplasias. The team, led by Drs. Brian Snyder, Collin May and Robert Fajardo (Carlos’ son) performed about one third of the surgeries during that week. This team of orthopedic surgeons not only provide surgical treatment but also have developed and planned educational preventive techniques to minimize the extent of this problem. 30 iaoms.org

In the last 10 years, the program initiated comprehensive care for the children that needed cleft lip and cleft palate surgery. Local orthodontists were recruited to enable several children to get ready for orthognathic surgery. A speech team led by Dr. Kate Crowley who teaches bilingual cleft lip and palate speech therapy at Colombia Teachers College began to run programs for both Colombian speech therapists as well as a speech camp for healthcare professionals. The maxillofacial surgeons have become an elite group of surgeons headed by Dr. Sid Eisig, Dr. Pedro Franco (a Colombian OMS who practices in Dallas) Dr. Daniel Perez, an oral and maxillofacial surgeon who trained in Bogota but now resides in San Antonio, Texas and Dr. Maria Fey. Each year, our group has brought residents to experience a variety of surgical care for children with cleft lip and cleft palate deformities. This has been one of the highlights of their residency-training program. The HTC program has received funding from a variety of different places including Smile Train, which for years helped fund the mission and now provides direct care to the local doctors who July 2018

provide ongoing care. The mission itself has taken on a new role by providing comprehensive cleft care and will be setting up a cleft lip and palate center in Neiva, Colombia and hopefully into two adjacent areas, Villavicencio run by Dr. Libardo Vacca, an oral and maxillofacial surgeon who lives and works in Villavicencio and a children’s hospital in Pasto, Colombia. We are looking forward to some paradigm shifts in the upcoming years with our comprehensive cleft clinics as well as our integrated electronic medical records using fingerprint ID to keep a log so that we may begin to look at our results and outcomes. Dr. Steve Roser and I have also been working with the IAOMS to provide opportunities for doctors to participate in other volunteer endeavors. Currently, opportunities exist with Operation Smile and the Mercy Ship as well as funding for local doctors from Smile Train. At the biannual meetings, there are symposiums that have allowed many doctors to talk about their volunteer experiences and I look forward to creating those opportunities for others at the upcoming meeting in Brazil. ■

In data

What started out as a routine trip for traveling doctors with “Healing the Children” has matured to a meaningful and monumental accomplishment. I never anticipated this program to run for 25 years and that was not my intended goal way back then. On the completion of this year’s trip, we will have provided upwards of 5,000 surgical procedures for children of Neiva and surrounding area and screened over 15,000 children for healthcare. This feat is the accomplishment of multiple people over long periods of time. I have been nothing more than a ribbon around a bouquet of wonderful surgeons, pediatricians, anesthesiologist and nurses, and other specialties providing care for the children of Neiva. Each year I am still amazed by the number of children and families that patiently await our arrival. The hospital literally converts the parking lot into a carnival-like waiting room with tents for each type of surgical problem while the police and military provide food, music and entertainment. We have become a major event for the city of Neiva!

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NextGen

My first experience presenting my research as a resident By Rodolfo Asensio MD, DDS, Oral and Maxillofacial Surgery. Hospital Escuela Centro infantil de Estomatología, Cleft Lip and palate, Reconstructive, Facial plastic surgery. Guatemala

or some, public communication skills come easy. However, when my time came, that was not the case; and it represented a big challenge for me. These skills are an important part of the teaching in a residency-training program and presenting one’s experience in research. Let me tell you about my evolution in the arena of public speech. From the day, a topic was assigned to me, anxiety and stress crept in. I did not know where to start, what to write, how to write or the time that it was going to take to do it and meet the deadlines to submit my work. I was so overwhelmed with planning that I failed to acknowledge the most challenging part - I was going to be speaking in public. Realizing the fact that dozens of people will be waiting for me to speak right, was just too much for me – downright raw stress! Finally, the moment came and today I can say that it has been a significant moment in my professional life. So significant that I now divide my whole career marked as “before” and “after” my first research presentation. DUBROVNIK 2012 - my first regional European meeting; presentation in English (my second language) and, I was probably one of the youngest in that session. I felt completely overwhelmed. In the audience were major gurus in the field, even some authors of the books from where I had taken notes for my presentation. I was ready. I felt ready! I had read all about my articles and had practiced my talk several times. When I got to the podium I introduced myself, I was nervous but thought of all the good advice, I had received - to just focus on one person, talk slowly and clearly, avoid playing with the pointer, avoid repeating the same word in a sentence. I went through with it and ended 4 minutes before my allotted time limit. I could have been slower and calm, but I finished well. 32 iaoms.org

Now I could focus on everyone and noticed nods of satisfaction in the crowd - “what a relief”, is an understatement. That of course is when I noticed three people standing to ask questions: the chief of service from Cairo, Egypt, a Dutch colleague and another from India. I will never forget these people. Finally, the session ended, while there was a deep sense of accomplishment and relief, I was not very sure if indeed I was feeling joyful. A swarm of people quickly surrounded me from my table, other colleagues and friends asking more questions and congratulating me for my good presentation. I knew I had worked very hard but never imagined what it felt like when all the hard work put onto something helps you achieve goals. I became overcome with a pure personal satisfaction and an immediate stimulus to continue sharing my passion and knowledge with everyone. That of course is what I have continued to do ever since. One small step forward can be a leap…. July 2018

By Gabriele Millesi Vice President IAOMS

f one has the chance to attend an abstract session at a conference as a senior, it is quite obvious to judge who is beginner or who is a coached presenter. When I was a youngster, my former chief demanded that every trainee had to do a rehersal in front of the whole team. This audition was absolutely valuable because you had a critical audience. Your slides were checked that there were

“All these recommendations and advice are of major importance for our Next Gen and will increase self confidence.” no unreadable tables or colours. No more than 2 slides per minute were allowed and you had to wrap up with a take home message. All these recommendations and advice are of major importance for our Next Gen and will increase self confidence. It is our duty as seniors to support and encourage, unfortunately not always selfevident. To close my comment with a short bizarre story I experienced in my residency: A trainee colleague was supposed to present a study at a meeting. On the way to the conference the senior professor, who was involved in the presentation, bought a type writer to change the contents. And after the trainee´s presentation, the professor stood up to discuss and question his results! A life time experience for the poor resident ! So let us try to do better and get ready for the stage! ■

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WHERE ARE YOU NOW?

TodDr.ay Mario Scarrone By Deepak Krishnan Associate Professor of Surgery, University of Cincinnati, Cincinnati. Ohio

What do you read in OMS literature these days? The achievements in the field of communication have prompted the dissemination of scientific advances. Therefore, I still keep in touch with the institutions that receive me as a member. In these associations (IAOMS, ALACIBU, SECOM, SACTBMF SUCTBMF) I find the publications about the development of the specialty. I have always had a fascination with the real advance experienced by the OMS surgery, resulting from the technological advances at the service of different chapters of the specialty. If I had to choose one special area, I would say that facial reconstruction and orthognathic surgery planning have experienced a vertiginous advance in a short period.

Prof. Mario Scarrone and Prof. R. Walker.

ear Dr. Scarrone

How do you spend your time these days? I am 78 years old, and now after so many years devoted to my professional practice, I have time to enjoy certain activities more intensely and to perform others, which have been postponed due to lack of time. My colleagues, friends and specially my family are of great importance in my life, now I have more time to see them and enjoy their company. I also devote some time taking care of my health, attending to medical checkups and doing physical exercise regularly. After exercising my specialty during 50 years, I still keep permanently in touch with the associations in which I have always participated actively and where I proudly feel that my ideas are still valued. I also devote some time to my hobbies, such as sport fishing, arts and crafts and gardening. I am taking courses in landscaping, organic garden and furniture restoration.

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What do you consider the single most meaningful contribution you made to the specialty of Oral Maxillofacial surgery? One of my greatest achievements has been to design, draw up and direct the Course in OMS Specialty, endorsed by the School of Dentistry, by the University of the Republic and by the Ministry of Public Health of Uruguay. I definitely believe that it has been my most meaningful contribution to the specialty. We had to undergo a long process in order to implement the project. The beginning dates back to 1987, when I was invited to participate in the ICOIMSA Meeting held in Tenerife, where we conducted an in-depth study on education and training for future OMS surgeons. It is also worth mentioning the First Latin American Workshop in training dentists as OMS surgeons in the IX ALACIBU meeting, held in Punta del Este in 1988. Then there followed the work carried out by ALACIBU together with AAOMS and CAOMS embracing IAOMS directives, in order to establish a standardization criteria in professional training with one work per continent. Based on the conclusions of the above-mentioned works I was able to draw up and submit the referred Project of the Specialization Program.

July 2018

What is your perception of how the specialty has changed from when you started to now? The specialty was still weakly developed in my country when I started it. At that time, one would have to go abroad and work with large centers in order to receive professional training. In my case, Prof. Javier Pietropinto was my great Teacher and played a vital role in my career. At that time, the specialty had still not been recognized. The most significant change occurred when the training of residents and the regulation of the practice of the specialty were implemented. When the specialty was officially recognized and received the support of the academic institutions and of the government, the conditions were favorable to advance, and contributed to the development of the specialty. Many countries of our continent were in the same situation. We could say that the concern to regulate these aspects existed worldwide. In fact, the goals of the Tenerife and Bermudas meetings aimed at their improvement. The current situation is quite different as now there are rules and principles that regulate the training aspects and professional practices. What do you miss the most about work? The patient - without a shred of doubt. The fact that throughout my professional career I have made every effort to understand the human beings, who place their confidence and concerns on us, has strengthened this feeling of absence. Patients are not a ‘clinical case’; patients should be the center of our professional actions and concerns, in order to achieve their final rehabilitation. What do you not miss about work? As time passes the weird feeling that, pupils nor patients no longer constantly require you gets weaker. This feeling turns into relief and eventually other rewarding activities and challenges come up, demanding dedication and practice. As within my family circle, I am the son of a dentist, the father of an OMS surgeon, the father in law, uncle and brother in law of OMS surgeons, in family gatherings there always come up issues related to our professional practice, so surgery still plays a vital role in my life.

of SUCTBMF during the last period. I always attend to the academic meetings of this institution where I meet its members. With reference to the Specialty Program, I am always ready to make a presentation, to give an opinion or to receive a foreign scholar whenever requested. I meet with residents and through these activities, I keep in touch with the members of the School of Graduates and the School of Dentistry who have always supported me. At an international level, I keep in touch with our dear ALACIBU, where I hold a managerial position in a Commission. The pleasant communication with the present directors of ALACIBU is made directly through a WhatsApp group, where I give my opinion whenever required. It is worth pointing out that I try to be cautious, and I am aware that our distinguished and younger colleagues with innovative ideas are the ones who should carry forward the destiny of the Association. Finally, I also keep in touch with three international associations of which I am member: the Sociedad Argentina de Cirugía y Traumatología Bucomaxilofacial, the Sociedad Española de Cirugía Oral y Maxilofacial and the International Association of Oral and Maxillofacial Surgeons. What would you change about your career path if you could go back and do so? Under the same circumstances of the time in which I started my specialty 50 years ago, I would follow the same path, trying to shorten administrative procedures. If reality were like today’s, with stronger administrative and academic foundations, I would undertake targeted

Do you keep in touch with former colleagues? I keep in touch with many colleagues, mainly through my son who was President

Fishing with m

y grandchildre

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actions in two fields: one to improve teaching to the benefit of the resident and another to have access to a permanent updating of my professional skills to the benefit of both patients and students. Which technological advance in the specialty would have made a difference in your surgical activity? Throughout my professional career, I was able to value and enjoy the technological advances that permanently modified my surgical practice. At certain times, some advances emerged, that were then rejected for being unproductive and were replaced by other techniques that had been previously abandoned. I will refer to some of the advances that brought about some changes in my surgical practice. The rigid fixation in traumatology and orthognathic surgery, the osseointegration in dental or joint implants, the predictive studies in orthognathic surgery, the vascularized grafts of soft and bone tissues, the stereo-lithographic models, etc. These are just a few of the technological changes that have modified our procedures and that resulted in the advance of our profession. I believe that the technological advances will constantly continue to impact on our activity. What advice do you have for the OMS trainee starting training in 2018? •T ry to organize his/her agenda in order that family and professional activities would not affect a responsible and dedicated fulfillment of the professional tasks required. •L earn the importance of respecting the patient in the wider sense of the word.

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• Understand from the very beginning that professors have agreed with UNESCO to achieve changes in the three aspects referred to educational attainment, in which they will be evaluated 1) intellectual training (expertise), 2) operational performance of the health provider (know-how) 3) human and professional guidance (being). Remind them that ‘being’ is related to the professional and human development of the resident, including three scenarios: relationship with the patient – relationship with health team members relationship with oneself. It is of vital importance to inform the resident about the desired abilities: skills, decision making capacity, technical expertise, teamwork and problem solving skills. A deeper analysis of this issue could be made, but the above diagram summarizes the performance of a good resident. How do you reflect on your involvement in the IAOMS? How important was the association in your career? First, I want to say that the only problem concerning my relationship with IAOMS has been communication, as unfortunately I do not speak English. Anyhow, I believe that in both directions much has been achieved, although my participation has not been as frequent and deep as desired due to the above-mentioned reason. I believe that IAOMS has been of major importance in the development of our specialty. It is worth pointing out its valuable contribution with reference to the guidelines provided to each continent and the active participation of its members in drawing up documents and rules to ensure progress in Latin American countries. These advances were frequently achieved through the working groups in which I had the honor to participate, with the invaluable support of IAOMS. All my achievements for the proper development of our institutions would not have been made possible without the two associations ALACIBU and IAOMS. Maybe I am being repetitive by mentioning both, as when speaking about ALACIBU we are also referring to IAOMS. Personally, I have had the honor of being member of IAOMS for a long period, until I reached the category of LIFE FELLOW.

July 2018

What are the qualities you most value in a career academic surgeon? I believe that a good academic surgeon must have some of the qualities that will be ruling his professional practice. There follows a list of some of them: • Training. • Constant updating . • Emotional stability. • Calmness. • Empathy. Devotion to patients. •C oncern about studying the patient in an integral manner. • Availability at any time.

Evidently, the list could be longer. What are you currently reading? I have already mentioned some of my reading material that keep me informed, related to my professional practice, especially about OMS surgery, as I mentioned earlier my son is a OMS surgeon too and with him I keep up to date with the texts of recent edition. Also, I have started some recreational activities which have always interested me, and also enjoy reading and getting informed about them. I am also interested in publications related to health issues and physical activities. I also enjoy reading history and books of general interest. ■

In Memoriam

Dr. Conrad Masureik 2018 Pretoria, South Africa By Dr. Johan Reyneke Past president: SASMFOS (1994-1998)

One of the most comprehensive, influential and illustrious careers in the South African field of Maxillofacial and Oral surgery came to conclusion with the death of Conrad Masureik. Conrad’s health had been deteriorating for most of the last year and he finally lost the battle against cancer on the 29th of April 2018. Conrad’s main interest was Orthognathic surgery and facial reconstruction and he certainly developed into one of the top Orthognathic surgeons in our country. He continued his academic links and remained an influential force in the training of post graduate students at the University of Pretoria and later at The Medical University of South Africa. Soon after completing his studies, he was elected to serve on the Executive Committee of the South African Society of Maxillofacial and Oral Surgeons (SASMFOS), where he later served as President from 1984 - 1989. During his term as Immediate Past-President of SASMFOS he also served as Council member for SASMFOS at the International Society of Oral and Maxillofacial Surgeons (IAOMS). He was thereafter elected as a member-at-large on the Executive Committee of the IAOMS, representing South Africa for the period 2001 – 2003.

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This giant in our profession was a friendly, respected, wise and humble gentleman who exerted a special influence amongst his patients, his peers, his students and his friends and he will be missed dearly. In the words of the well-known South African poet Jan F.E. Cilliers, in his poem entitled Christiaan de Wet:

“Quit brothers, there goes a man, there was but one like him”(direct translation). ■ iaoms.org 37

Hours A DAY IN THE LIFE OF A MAXILLOFACIAL RESIDENT IN ANKARA By Dilara Oztturk Department of Oral and Maxillofacial Surgery, Gazi University. Ankara, Turkey

ver since I was a child, being the daughter of two MD’s, I have always wanted to be a doctor but especially a surgeon of some kind. Years went by and that little girl finished dental school at Ankara University and without a second thought applied for residency in the department of Oral and Maxillofacial Surgery at Gazi University, Ankara, Turkey.

dental (orthodontics) departments working as their resident.

In our unit, we work in five different groups rotating among themselves for variable periods. One is the clinic where minor procedures such as basic tooth extractions, removal of sutures, biopsies and general outpatient examinations and consultations occur. The second unit is stationed in the minor surgery clinic where procedures such as impacted teeth extractions, corticotomies, autologous graft harvesting, preprosthetic surgeries, arthrocentesis, laser interventions, physical therapy, sinus lift procedures and implant surgeries are performed under local anesthesia. The third group is on duty at the sedation unit for interventions that are performed under deep sedation. The fourth group is involved in rotating with different medical (such as anesthesia and reanimation, general surgery, ENT, plastic, reconstructive and esthetic surgery, emergency) and

6.20 am

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The fifth group, which is generally, determined weekly for 3-4 days of the week by our fellows with a daily operation team who perform major surgeries under general anesthesia and let me, share a busy day of my life with this group with you.

My alarm is banging in my ear with “No stress” by Laurent Wolf and I know I have to get up quickly and get ready to go to work. I shower and get dressed. At this point, I have to check my schedule for the day. I am in the fifth group and today we have a bi-maxillary osteotomy case and a secondary cleft reconstruction case with Prof. Mustafa S. Ataç. Therefore, I have to get to the hospital before 7.30 a.m. and check the patient’s file one more time. I eat a quick breakfast, take my coffee and leave the house. Luckily, I live at a 15-minute walking distance from the hospital.

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4.30 pm 7.20 am

It is time for our inpatient ward rounds with the attending surgeons and the team. We check on the patients, review their charts and orders. In our department, only 2 residents stay for the night shift. We have the attending surgeon and the anesthesiologist on call for emergencies; but this is my 4th year and true emergencies have been rare, to this day. During our night shifts, we are only responsible for the hospitalized patients

I arrive at the hospital and go to check all the routine medical records and registration procedures of the patients. Then I visit the patients in our inpatient ward and give instructions for them to get ready before the surgery. As I sit back in the doctorsâ&#x20AC;&#x2122; room to drink my coffee and check the patientsâ&#x20AC;&#x2122; files one last time, I hear the attending surgeons of the day before and today come into the ward to check on the patients and give orders for managing the service. When they leave to get prepared for todayâ&#x20AC;&#x2122;s operations, I notify the nurses and the anesthesiology team to get the operation room ready, I write orders for the other patients and quickly change into my major surgery scrubs. I take the first patient inside and the hustle and bustle of the operating room starts.

3.00 pm The operations are over, the patients are at their rooms, and the orders are given. I eat lunch with the operation team quickly and go downstairs to the minor surgery clinic to see my follow-up patients. While going downstairs I check my phone and see countless messages and calls from patients, family members etc. but there is no time to get back to all of them so I keep on walking. Awaiting me, are five patients, which I was not expecting on my schedule. I take them in one-by-one for treatment. I see that there are more patients waiting for some minor operations. I call a patient inside and extract his impacted wisdom tooth.

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in our ward. We manage every aspect of their care including monitoring, and medical management. One of our greatest problems as female residents is that when we stay for the night shift, our patients assume that we are nurses and they treat us as one, unless they are informed otherwise.

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Hours 8.00 pm It is time to order food whether it is pizza or kebab does not matter as long as it quenches our hunger. There is a dictum passed on to Turkish surgeon trainees: “A surgeon has to sleep whenever there’s time, and has to eat whenever there’s anything edible.” Sometimes other resident friends of ours come to visit us or bring snacks to hang out. Other times I utilize the time for academic endeavor. I prepare for seminars, work on scientific articles or just check out what is new in the literature. However, it is not all nice and quiet in the night shifts; it is not unusual to have to attend to emergencies that are not true emergencies. One night, I remember sprinting from the doctors’ room literally jumping

over my fellow resident as if we were playing leapfrog after hearing the emergency alarm from one of the rooms and the patient telling us they are out of soap. Interesting things like this happen in our daily life. Other calls may be related to true patient care emergencies. The past 4 years have taught me lessons of patience and given me strength to be able to cope with the intense pace of our jobs.

12.30 am I usually go to sleep after midnight when all is quiet in the ward. I sleep for 2-3 hours, set an alarm for 3.00 am and wake up to check on the patients. I go to bed again only to open my eyes again at 7.00 am.

7.00 am I wake up, hear our cleaning personnel outside, and know immediately that he has our morning tea ready. I get dressed; brush my teeth and see the patients before the attending surgeons make rounds. With my other resident friend, we check on the patients then go to the doctors’ room to have breakfast. Another day starts while I gulp down my tea and I feel happy as much as I am tired because I love my job and the opportunity to make people’s lives better, daily. ■

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WORKING IN PARADISE By Raúl Parra Caracas, Venezuela

enezuela today is on the front page of the world news. Despite the irony that we are in the news not for reasons Venezuelans are particularly proud of, we remain a country of friendly people, willing to work with quality and passion for our profession. We remain the country of the Salto Angel, the highest waterfall in the world, the archipelago of Los Roques, a natural paradise cataloged as a natural heritage of humanity, and the island of Margarita, a place that has become a culinary and cultural center also a preferred travel destination to people all over the world. We remain a country known for our beautiful and intelligent women, and for our rums, drinks that have won awards as the best drink in the world.

And these simple reasons are still making people want to visit our beautiful country every year. Our specialty OMS, also remains proud and high in Venezuela and although many of our specialists have migrated, we still have an association of oral and maxillofacial surgeons and with well-trained members, who today have chosen not only to conduct their consultations with quality, but also are traveling around the world to share our knowledge and experiences with colleagues in other countries.

“Despite the irony that we are in the news not for reasons Venezuelans are particularly proud of, we remain a country of friendly people, willing to work with quality and passion for our profession.”

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We have been the venue for international congress such as CIALACIBU 2013 (Latin American Congress of OMS) where we have more than 2000 attendees, with speakers from more than 12 different countries, with diverse topics and a very high scientific quality. More recently, the National Congress of the Venezuelan Association of Oral and Maxillofacial Surgery organized by its president Dr. María Herminia Bellorin and her team was an event replete with international speakers from all over Latin America and Europe.

Over the years, we have become a popular destination for patients from many countries to undergo surgical and restorative procedures in our capital, the city of Caracas. Adapting to this unique demand, Venezuelan practitioners have perfected protocols that permit treatment planning, visit times, procedures and recovery. In addition, our economy permits an affordability of procedures when compared to other medical tourism destinations, without ever compromising the highest quality of care. In our consultations, both public and private, we provide advanced equipment, high quality materials and most importantly, well prepared staff trained and willing to attend each patient’s needs, even adapting to their language requirements. To us, despite our current geo-political undulation, working in Venezuela still means working in paradise, and we hope that in a short time, our situation will improve, and that we will be able to welcome you as always with open arms. ■

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Beyond O.R.

Know your competitors By Javier González Lagunas (follow me on

@golagunas)

We all live in a hypercompetitive professional environment. Too many doctors, too many dentists, too many oral and maxillofacial surgeons. You turn over a rock and a dozen of professionals appear, available and able to do the same things as you. One of the key points to succeed in this turmoil is knowing where the strengths and weaknesses of your competitors lies. You need a strategy. There is no better handbook of strategies than, “The Art of War”. This book is attributed to a in 5th Century BC Chinese military strategist called Sun Tzu. It was translated into French in 1772 and since then+ has had a deep impact not only in military, but also in politics, sports or business strategy and tactics. Sun Tzu was a clever forerunner of modern day strategic planning concepts and his book has it all. Many of Sun Tzu´s aphorisms indulge mostly in urging his readers to analyze the enemy. For him, this knowledge represents the main ingredient for the victory. “If you know the enemy and know yourself, you need not fear the result of a hundred battles. If you know yourself but not the enemy, for every victory gained you will also suffer a defeat. If you know neither the enemy nor yourself, you will succumb in every battle”. In fact, knowing your enemy is an essential part of Modern Strategic Planning. Read carefully the Reality

Analysis and the External Assessment, or the SWOT: analyze the market place, your competitor’s strengths or weakness, how they apply new medical technologies or how they are using the social networks. To know yourself and your competitors in OMS is key to success. From your practice perspective, knowing yourself means having clearly identified your limits and capabilities, the choice of scope of OMS that you wish to practice, the techniques and processes that you offer that give your patients an advantage, when compared to your competitors, and a clear VISION of your future. Be aware that “Know your Competitor” does not mean “Copy your Competitor”. As in many other fields of professional services, you should follow the principle of First Come, First Serve. Sun Tzu said “Whoever is first in the field and awaits the coming of the enemy, will be fresh for the fight; whoever is second in the field and has to hasten to battle will arrive exhausted”. It is not easy to replicate and adopt a winning strategy. You have to learn from it and apply it in another sector or market niche. Being the first means being on “Top of mind” of your consumers/users/clients/ patients. And for that, it might be easier to look for a new product/technique and improve oneself, than to overthrow the king. ■ https://suntzusaid.com/download.php

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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

July 2018