Issue 55 / October 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
Eric Kahugu, Africa Kenichi Kurita, Asia Nick Kalavrezos, Europe Alejandro Martinez, Latin America Arthur Jee, North America Jocelyn Shand, Oceania Nabil Samman, Editor-in-Chief, IJOMS
Committee Chairs G.E. Ghali, Education Alejandro Martinez, Governance and Ethics Alfred Lau, Membership and Communications Sean Edwards, Research Luiz Marinho, 24th ICOMS-2019, Brazil David Koppel, 25th ICOMS-2021, Glasgow Ed Dore, 26h ICOMS-2023, Vancouver ©Copyright 2018. International Association of Oral and Maxillofacial Surgeons. Chicago, Illinois, USA. All rights reserved under international and Pan American copyright conventions.
CONTACT US IAOMS
8618 W. Catalpa Ave., Suite 1116, Chicago, IL U.S.A. 60656 1.773.867.6087 / email@example.com
Letter from the Editor HOW I SEE IT Dear friends and colleagues.
would like you to pay special attention to the main topic of this issue. We have been able to gather a few maxillofacial surgeons that have accepted to share with us their experiences as patients. Patients that have undergone serious diseases and complex procedures: malignancies, severe facial fractures or orthognathic surgery. We want to thank them for their generosity to talk about the process of their disease. Treating our peers is never easy, and handling those challenging conditions adds an extra stress to our practice. Read as well about the experiences of the College of Physicians of Barcelona, and its platform to treat patients with addictions or severe stress. The numbers they present about the prevalence of those problems in the medical population are at least, alarming. We have a few more contributions that will make you enjoy FACE TO FACE. Learn about the construction of the specialty in Cambodia. Read about the efforts of Australian doctors in their humanitarian missions in Southeast Asia. From the Netherlands, we receive insight for our Women in Surgery section. The team of NextGen, active as a usual, continues to push hard to improve our association. We are opening as well a new section titled “From Father to Son”, families with a strong tradition in maxillofacial surgery, and we are starting it in Argentina. We devote our Proust questionnaire to an esteemed colleague deeply involved with the specialty, not only in his country, but also in the regional association, and of course IAOMS. As your editors, Deepak Krishnan and myself are trying to have an open minded, global, collaborative magazine, that shows the world the variety of activities that individual surgeons, groups of interest or associations are undertaking all over the world. We love our profession and our specialty, and we want FACE TO FACE to serve as a showcase to promote all activities related to oral and maxillofacial surgery.
Enjoy the magazine. Javier González Lagunas EDITOR IN CHIEF
Treating our peers is never easy, and handling those challenging conditions adds an extra stress to our practice.
CONTENTS October 2018 10 SPECIAL REPORT The sick doctor.
SO, YOU WANT TO WORK... 18 In Spain.
22 WOMEN IN IAOMS
Stefanie van den Bosch.
FROM PROUST TO PIVOT 24 Leopoldo Meneses.
Why OMS needs researchers?.
NEXT GEN 28
Craniofacial Surgery Fellowship in Paris: My personal experience. Martin Rachwalski.
30 FATHER TO SON
Carlos and Adrian Bencini.
TRAINING PROJECT 33 Cambodia.
Committed to volunteer.
BEYOND THE O.R. 39 Overtreatment.
ICOMS 24: BRINGING THE WORLD OF OMF SURGEONS TOGETHER TO LEARN AND CONNECT
ext May, the IAOMS will bring together OMF surgeons from throughout the world for our 24th annual International Conference on Oral and Maxillofacial Surgery (ICOMS) in beautiful Rio de Janeiro, Brazil. For those of you who have attended, you know it’s the pre-eminent global Conference you won’t want to miss. And for those of you who have yet to attend, I hope to see – and meet -- many of you there. While ICOMS is open to IAOMS members and non-members, if you are not an IAOMS member, I encourage you to consider joining as we start our membership renewal “season” next month. In addition to all of the other educational events (including live and on-demand webinars and regional conferences), there are many ways to connect with and learn from members on a more informal basis. If you are attending ICOMS and you are not a member, you will receive the best possible registration rate if you become a member. View membership types to find one that’s right for you. To make membership even easier, we recently implemented a two-year membership option. I hope many of you will join the IAOMS family at ICOMS. We also have some exciting social events planned. Be sure to join us for the Brazilian cultural night – a fun and lively evening of food, music, Samba demonstrations and dancing amid some of the most exquisite Carnival floats. The black-tie Gala dinner will take place at a historic, colonial home where we will celebrate the achievements of colleagues and enjoy the evening with friends in a lush and elegant venue.
Although the focus is on NextGen: “Pearls in the Career of NextGen,” the topics and strategies we’ll cover will help participants at any stage in their career. Finally, partnering with – and through the generosity of -- the American Association of Oral and Maxillofacial Surgeons and the Canadian Association of Oral and Maxillofacial Surgeons, (along with their Foundations), ICOMS Rio will be the inaugural year for a limited number of scholarships available to American or Canadian IAOMS trainees and residents to attend ICOMS. We look forward to expanding this national program partnership in the coming years to help other trainees and residents experience ICOMS. Watch for details on upcoming live webinars where you will learn from expert OMF surgeons and have the opportunity to ask questions following their presentations. While this is an IAOMS member benefit, we will offer one webinar this autumn to nonIAOMS members. In closing, I would like to thank IAOMS members for their membership and welcome new members to the IAOMS family. PS – Early registration for ICOMS closes on November 30, so please register today to benefit from the lowest registration fees.
Watch for ICOMS updates on the ICOMS website and via your in-box. And if you are interested in submitting an abstract, the deadline is October 31. Two more notes on ICOMS: I invite you to join us on Monday, May 20 for our second Next Level Forum.
Mitchell Dvorak EXECUTIVE DIRECTOR, IAOMS
Letter from the President IAOMS, GLOBAL VOICE OF THE SPECIALTY Dear Colleagues and Friends :
long with its usual line-up of terrific features, the focus of this quarter’s Face to Face is doctors
as patients. I think it’s safe to say that all of us – at one time or another – have experienced being a patient or being with a loved one who was a patient. It is a topic that hits close to the vest. Surgeons are supposed tobe strong, clever, resourceful professionals, yet are heir to human frailty and illness, like anyone else. I myself have heard and said this all before. You know… doctors are lousy patients. Maybe we know too much or expect perfection that we ourselves can’t deliver. In addition to a surgeon’s technical expertise and training, the importance of good “people skills” or “bedside manner” cannot be under-estimated. Through IAOMS educational offerings – whether it’s webinars, events such as ICOMS or Fellowships for trainees, learning how to communicate successfully is a critical component in providing the best patient care. If you are a young trainee, a resident, an established OMF or even if you retired, there’s no better organization than the IAOMS to connect you with the global OMF community and provide you with learning opportunities in locations throughout the world – or even at your desk top. The IAOMS provides you with educational and networking opportunities to help you wherever you are in your career. While it’s always a good time to join the IAOMS (or renew your membership), I encourage all of you to take a moment to do that now. One particularly timely benefit: even with the membership fee, IAOMS members still receive the best rates for ICOMS, our signature educational and networking event. After you’ve renewed or become a member, register for ICOMS and submit an abstract. Read more about our upcoming 24th ICOMS in beautiful Rio De Janeiro, Brazil. Two upcoming and important deadlines: the abstract submission period ends October 31 and the best registration rates (early registration) close on
November 30. While registering, also remember to join us for Next Level Forum, a complimentary session on May 20, 2019 and open to all ICOMS attendees. Learn more. (And watch for our line-up of this fall’s live webinars – coming soon!) While registering, do take some time and explore our new and improved website, your virtual hub and gateway to your association and global community. I recently had the distinct pleasure to bring IAOMS greetings and participate in the 24th Congress of the European Association for Cranio Maxillo Facial Surgery (EACMFS) held in Munich, Germany. The meeting was a scientific and networking success, bringing cutting edge research and education to surgeons from Europe and around the world. This meeting reflects the strength of cooperation and support that exists between the IAOMS and EACMFS in advancing our specialty. I extend my congratulations to President Prof. Klaus-Dietrich Wolff and the EACMFS on this most magnificent event. In my 26 years (and counting!) as an IAOMS fellow, I continue to learn more about the specialty, meet new friends and colleagues and cherish the friends I have made over the years. The prospect of being engaged with our terrific specialty internationally, the opportunities to learn from experts (and learn about different cultures) through the IAOMS, makes joining the IAOMS an obvious choice. I hope it is such a choice for you and your colleagues. I am proud of our organization’s commitment to education and its reputation as the global voice of the specialty. I look forward to welcoming you (or welcoming you back) as an IAOMS member – and to seeing you at our ICOMS next May in Rio de Janeiro! With thanks for your continued support of the specialty!
Alexis B. Olsson IAOMS PRESIDENT 2018-2019
SICK DOCTOR 01 The
Scars are not beautiful, but rather people behind the scars are
By Elena Gรณmez Department of Oral and Maxillofacial Surgery. Hospital La Paz, Madrid (Spain)
. t n e d i c Ac
Dr. Gรณmez suffered an accident in 2001, resulting in severe facial trauma. She received treatment at the Emergency OR in her hospital.
scar across my face, every time I look in the mirror I see it, but now, seventeen years after the trauma, it is a part of my anatomy, and I take care of it without any special attention.
When you suffer a complex facial trauma, scars are caused by injury or maybe because of the treatment. Although the presence of the scar makes people around aware of trauma endured, these marks are not so prominent unless they result from soft tissue loss or violation of key structures such as lips or eyelids. Although bone support is extremely important to restore facial appearance, in my experience, this has evolved to become a priority in modern reconstructive surgery. Perhaps some years ago, it may have been a lot more challenging to restore bone architecture, and properly reduce bone fragments. Orbital surgery has improved exponentially since navigation has
2 4 CT scan showing the extent of Dr. Gomez’s Lefort 3 fracture.
become commonplace in restoring orbital symmetry, size, volume and form. Titanium meshes have become routine in orbital reconstruction, replacing bone grafts that were the gold standard, especially in 2001, when I suffered my accident. In cases of complex, comminuted orbital and naso-ethmoidal factures, the most difficult point in treatment was the restoration of ocular dynamics, avoiding enophthalmos and rehabilitating oculomotor function. Over time, many changes in techniques and technology have emerged in this field helping patients and surgeons to achieve improved results. Despite the lack of such opportunities at the time of my surgery, I know my colleagues did their best, leaned on their experience to restore my orbital appearance and function. Since a multidisciplinary approach was essential to treatment, an ophthalmologist also collaborated from the beginning. Perhaps the fact that most of my doctors were treating a colleague of theirs adds a layer of complexity to my situation. On one side, the doctor, as patient, must understand the limitations of surgical techniques and the extremely varied criteria or techniques. This may engender scepticism about the specialist who is performing surgery or hinder the acceptance of possible complications or poor results. On the other side, the colleagues who are treating the patientdoctor are under greater pressure than when treating other patients, which is prejudicial for both the doctors and the patient.
Nevertheless, doctors who become patients typically develop a practical understanding of the actual patient experience and their attitudes and expectations regarding recovery may be unique. They have now lived the patient’s perspective! After a very complex midfacial fracture, sequelae both expected and unexpected were certain. The understanding of the limits of treatment allowed me to await secondary treatment in a “calm wait mode”. Psychologic strength and social support, especially family and friends are essential to deal with this kind of situation, affecting your outcomes and your ability to move on. Secondary treatment helped me recuperate to my previous lifestyle, but some limitations have been necessary to assume, because there are some permanent changes. Cranial nerve lesions, such as oculomotor nerves are impossible to recover ad integrum although ophthalmologic surgery could improve in a great way. Nobody can offer you the full recovery of your previous gaze, but you can get at least, a new one close to the standard. When doctor–patients return to their working lives, having experienced a trauma may imply a handicap, since their damaged appearance may affect the way in which their patients and colleagues see them. A facial surgeon with a distorted face may project an inherent bias of distrust in their patients. On the other hand, the doctor who has undergone a trauma may be able to relate to patients who are have similar injuries, since they now share a similar experience. In fact, in this relationship, the doctor receives support from the
special report patient that can be as important as that of the doctor’s family and friends. Also, I have to show my gratitude to all the colleagues who gave me support, allowing me to demonstrate that I was prepared to go back to work. Alike I never had problems with patients. I only went back to my department when I was sure that I could safely perform my duties.
you use to deal with your problem. I have shared many advices about scar care, lymphatic drainage, oculomotor training etc. with my patients, offering them new opportunities to return to normalcy and routine as soon as possible. The proper vision of the surgery also allows the doctor to share a realistic expectation in the outcome.
In the doctor–patient relationship, the flow of positive energy is not one-way; our patients also care for us in a tangible way, helping us to keep going. The focus of the doctor–patient relationship changes, becoming more intense, since the doctor now knows, from his or her own experience, exactly where the patient needs his or her help. This experience can subconsciously transmit to your patients, allowing you, as a doctor, to share the approaches
Facial Trauma is a broken line across the face, a reminder of the complexity of our own appearance. However, technical support and improved surgical skills makes it possible to achieve good results. Dealing with soft tissue damages and dynamic functional impairment, such us oculomotor paralysis or facial nerve paralysis makes it much difficult to restore facial appearance, although secondary techniques can help optimize eventual outcomes. ■
At The Receiving End
“is a word, not a sentence.” By Kishore Nayak Oral and Maxillofacial Surgeon, Bangalore (India) Former President IAOMS
have thought long and hard about writing this. It has been through my mind many times over and I must admit that I have put ‘pen to paper’ often (or should it be fingers to the keyboard) to express what it was like to be at the ‘receiving end’. Why do I call it that? It was different being on the other side of the consulting table not just once but many times over. It was a different experience being conveyed the diagnosis that we take for granted when we deal with patients sometimes with empathy and perhaps with a certain casual demeanour.
The sweep of emotions tinged with the fear of the unknown is very hard to describe. However, in the fitness of things, I must rewind and make that journey again to describe the eventful decade of my life just gone by. I had my first encounter with the “Big C”, the emperor of maladies, in the summer of 2007 with a diagnosis of a malignant polyp in the descending colon. This was followed by another lesion in the small bowel in 2010 and a larger one in the remnant of the colon in 2012 all
of which were treated surgically. This was interspersed with the advent of multiple myeloma in 2011, which required chemotherapy and an autologous Bone marrow transplant. It will be easy to place a chronology of events as they happened and relate the various procedures and travails that I went through. Rather than doing that, I would like to dwell more on the emotions, thoughts and consequences of my battle with malignancy.
“The most exquisite pleasure in the practice of medicine comes from nudging a layman in the direction of terror, then bringing him back to safety again.” Every time I was confronted with the diagnosis and the implications the inevitable question was, “Why me?” The obvious answer was, “Why not?” I was as human and susceptible to this happening as anyone else was. I suspect that the conveying of the diagnosis must have been a difficult task for my colleagues who now happened to be my treating physicians and surgeons. I do not know if they felt the same difficulty in telling me the worst as much as we sometimes experience when dealing with other patients. What did I feel like on those multiple occasions being at the receiving end of the diagnoses? The reports before me were easy to decipher. I knew what afflicted me, but the treatment modalities on every occasion were like an alien concept. The only criteria for me moving forward, with the treatment offered, was that I would go ahead and accept what was the best option that evidence indicated would produce the best outcome. This had been the policy that I faithfully applied to my patients in my practice and I had no doubt, was the only way forward. Looking back, trusting the decision-making of your doctors and allowing them to make and take decisions on your behalf, albeit being fully informed of the rationale and consequences has been the enduring reason of my journey so far.
transplant has not been easy. The moments in the ICU, the fading of the operating lights as the Propofol runs cold through your veins, the thrombosed intravenous catheters, the discussion and casual talk by nurses and doctors at your bedside as though you didn’t exist, the difficulty in mobilising yourself post surgery - it’s a long list that isn’t easy to even compile. Yet, it is something that we put all our patents through. It was a revealing and learning experience. All I can say is that it makes it pertinent that we empathise even more with all our patients. They certainly need every bit of our professional and emotional support to endure what we put them through. I now believe that each patients carries his own doctor inside him or her. To continue believing in yourself, believing in the doctors, believing in the treatment, believing in whatever I chose to believe in, that was the most important thing. We need to ensure we give our patients the best we can and the best available. Nothing else is acceptable.
“You can be a victim of cancer, or a survivor of cancer. It’s a mindset.”
Being through multiple surgery, PET scans, chemotherapy and a bone marrow
special report Without doubt the most enduring and important part of the battle with adversity was the presence of family and friends. When we understand the connection between how we live and how long we live, it’s easier to make different choices. Instead of viewing the time we spend with friends and family as luxuries, I now know that these relationships are among the most powerful determinants of our well-being and survival. I have absolutely no doubt that the quality of relationships is what affects the quality life but also survival. The wonders of modern medicine no doubt make a huge difference to the way we deal with disease. With the right support we are so much braver and stronger than we imagine, and belief is one of the most valiant and strongest human characteristics. I made some choices along the way on the road to recovery. A few years into it all I made the decision to give up my surgical practice. I started doing the things that made me happy. Travel, golf, reading, walking the dogs and spending time with family and friends and laughing out loud at every opportunity, it has been a wonderful last few years. If I could rewind the clock, would I change the way things have panned out? Nothing can challenge adversity nor change the way it hits you. But you learn from it. You become stronger and move on. Have I won the battle? It will be futile looking to answer that and I have stopped asking myself this. Believe me ,I am a lot happier having done that!
“Life’s not about how hard of a hit you can give... it’s about how many you can take, and still keep moving forward. That’s how winning is done.”
We are much stronger than we imagine and believe that we can overcome is one of the most valiant and long-lived human characteristics. As humans, we know that nothing can cure the briefness of this life, that there is no remedy for our basic mortality, which in itself is a form of bravery.
“Snoopy, one day we will die, but on all the other days we will not.” Charlie Brown It was self-belief that I would overcome adversity that has helped me every single day. Let the belief go and it will beat you. I did not fully see, until my encounters with cancer, how we fight every day against the creeping negatives of the world, how we struggle daily against cynicism. Dispiritedness and disappointment, these were the real perils of life, not some sudden malady. I know now why people fear cancer: because they perceive it as a slow and inevitable death, the very definition of cynicism and loss of spirit. It is not. For me it paved the way for a new and joyous life!
“Science may provide the most useful way to organise empirical, reproducible data, but its power to do so is predicated on its inability to grasp the most central aspects of human life: hope, fear, love, hate, beauty, envy, honour, weakness, striving, suffering, virtue.” Paul Kalanithi Cancer is an awful word we all fear. But in that brief dark moment we hear it, the world we live in and the people we share it with, begin to illuminate things we did not even pay attention to. It didn’t shut the world down for me. It opened it up like never before. ■
Orthognathic Surgery By Christopher Ban Oral and Maxillofacial Surgeon, Pittsburgh (USA)
for granted. I spent several hours total in consultation with my surgeons, however, these few hours dwarfed the even longer hours spent at the orthodontist in prep and post-op orthodontia. We should not overlook the opportunity to cultivate trust from our patients during consultation simply by helping to understand their procedure as completely as possible. While the purpose is certainly not to simply show off all that we know, we should not hesitate to demonstrate our deep understanding of the nature of orthognathic surgery or any procedure to patients. I do not feel that oversimplifying the description of the procedure, its risks, or its benefits is in the patients’ or our own best interests.
have had the unique vantage point of being involved in orthognathic surgery from both a patient’s perspective and as a practitioner. In February of 2007, I had a LeFort I/BSSO to correct a Class III dentofacial skeletal deformity. Since that time, I have talked to several other OMS who have also had this procedure performed on them in the past. I have been fortunate to be able to draw on my experiences in preparing patients for their surgery. My experience as a patient. The following strike me as the most salient and applicable memories from my experience:
GOING HOME FROM THE HOSPITAL. I feel that it is impossible to fully convey to our patients just how different and potentially difficult the transition from the hospital to home may be for the first few days. My experience was not outside the norm, but I did have pain control issues and nausea over the first few days. The feeling of helplessness was something for which I was not prepared. My surgeon made it clear that I could get in touch with him any time of day for the first few weeks, which was reassuring and very often helpful. I found that it was essential that I have somebody at home with me for those first few days. I cannot imagine not having had help. I generally insist that my patients have adequate support at home after orthognathic surgery, in particular for double jaw surgeries. URGEON’S KNOWLEDGE. We sometimes S forget just how impressive is our breadth of knowledge as oral and facial surgeons. I do not mean this in any shallow, egotistic sense, but rather am stating that the fund of knowledge required to plan and execute a successful orthognathic procedure is considerable. After years of training and practice, we can take this
RUST. In this litigious era, I am struck by how T completely and absolutely I remember trusting my surgeons to take excellent care of me. This trust did not waver. After my consultation, preoperatively, and throughout the several months of post-op follow up, I realize that I was prepared for and did not fear any of the potential complications as described to me, due to trust in my surgery team. I also ended up with a persistent and residual paresthesia (and at 11 years, I have little doubt that this sensation will return), which does not bother me at all, since I was adequately prepared for this possibility. My bottom line here is this: go forth and practice with open eyes and without fear. None of our orthognathic patients begins treatment with any interest in an adversarial relationship with their surgeon. ■
Helping Our Peers By Carolina Roig, MD PAIMM coordinator, Girona Chapter (Spain)
he Council of Medical Colleges of Catalonia created the Galatea Foundation in 2001 in response to the experiences of the Program of Attention to the Sick Doctor (PAIMM). The primary intent of creation of this foundation was to watch over the health and wellbeing of all health professionals (medicine, nursing, veterinary medicine, pharmacy, psychology, dentistry, physiotherapy and social work) and, therefore to ensure a better quality of care for the public. Due to the nature of their activity, health professionals face psychosocial risk factors such as healthcare pressures; decision making that affects lives of patients, a need to be constantly updated, occupational stress in complex organizations, and negotiating multidisciplinary teams on a constant basis. Those factors, if not properly managed, can cause syndromes of physical and mental exhaustion, burnout situations, emotional stress and depression, as well as other psychiatric and psychological problems. For these reasons, the Galatea Foundation carries out many initiatives to address the risk factors that affect the practice of professions related to health sciences. GOALS
o promote the health and a balanced lifestyle T among doctors. o rehabilitate those health professionals T with mental health conditions/ addictions and return them to work with the ultimate goal of ensuring the quality of care for the public.
PREVENTION AND HEALTH-PROMOTION PROGRAMS The foundation studies health, lifestyles and working conditions of health professionals, and provides a variety of prevention and health promotion programs. Many of these programs are designed interventions that help the busy healthcare professional prevent stress and improve their well-being and quality of life. Through a broad and diverse range of training, practice and easy implementation tools (workshops, courses, lectures and conferences, among others), the Galatea Foundation provides key concepts on the care of oneâ€™s health and also the skills and attitudes necessary for the success of health care professionals. ASSISTANCE PROGRAMS Our different assistance programs support health professionals with mental illness and addictive behaviors. What is PAIMM? The College of Physicians of Barcelona was a pioneer in Europe in the development of care for doctors with mental problems and addictive behaviors that could interfere with their professional practice. For this reason, in 1999 the Program for Comprehensive Care for the Sick Physician (PAIMM) was created. The PAIMM assistance program - managed by the Galatea Foundation - is a program specifically designed to help collegiate doctors affected by mental
disorders and addictive behaviors including alcohol or other drugs. The aim of the program is the treatment, recovery and the return and reinstatement of the healthcare provider to clinical activity under optimal conditions and, thereby ensuring safe clinical practice. Since the inception of the program in November 1998 until December 31, 2017, more than 2000 doctors have participated. What is the SEPS? Since 2017, doctors have access to the Emotional Support Service for Health Professionals (SEPS) that responds to a specific problem of health professionals. This program addresses not only serious mental disorders, but also the emotional discomfort associated with medical practice. The SEPS program attends to health professionals with emotional problems related to occupational stress. However, cases that may not be occupation-related are also treated.
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Clinica Galatea is the physical center for the treatment of addictions and mental disorders especially for health professionals. Located in the outskirts of Barcelona, the clinic customizes therapeutic programs tailoring them to individual patient´s needs. Strict measures are implemented to ensure maximum confidentiality of personal data of sick professionals in treatment. The high levels of personalized care and successful rehabilitation of their special clientele, and a strong commitment to research in this special environment has helped catapult the Galatea Clinic to the stature of a national and international pioneer in this niche arena. ■
What is Galatea Clinic?
KEY POINTS 1. THE AVERAGE LAG TIME FROM THE FIRST ADDICTIVE BEHAVIOR TO SEEKING HELP AMONG DOCTORS IS TWO YEARS. 2. DROPOUT RATE IS NEGLIGIBLE. DOCTORS SIGN A THERAPEUTIC CONTRACT. 3. STRESS IN HEALTH PROFESSIONALS IS A REALITY: MORE RISK OF MENTAL DISORDERS THAN IN GENERAL POPULATION, ESPECIALLY IN WOMEN. 4. HIGHER CONSUMPTION OF ANTIDEPRESSANTS, HYPNOTIC DRUGS AND ALCOHOL THAN IN GENERAL POPULATION.
So, you want to work...
By Javier González Lagunas Barcelona (Spain)
any of you might consider the option of changing your residence and start living in Spain, a country with a longstanding history, fantastic climate and quality of life on the Mediterranean.
So what are the requirements to work as an oral and maxillofacial surgeon in Spain? IF YOU ARE NOT AN ORAL AND MAXILLOFACIAL SURGEON, BUT YOU WOULD LIKE TO TRAIN IN SPAIN... You have to know that like in many countries in Southern Europe, Oral and Maxillofacial Surgery (Cirugia Oral y Maxilofacial, the official name of the specialty in Spain) is a medical specialty, so working as a specialist in OMFS is not an option if you do not have a medical degree. A Medical degree takes 6 years to obtain in Spain. When you finish your basic medical training, you have to go through a national exam (MIR exam), that is common to all students and universities and that covers all the topics you have studied during the previous 6 years. Then, when you have your grades, you can choose your specialty in order of punctuation. That means that number 1 of MIR exam can choose the specialty he wants in whatever hospital and city he decides. However, if you are number 3000, then you have fewer choices and probably you will have to work in a less attractive specialty and not so well known hospitals. Residency in Oral and Maxillofacial Surgery will require 5 years of your life, normally in a single hospital. You will be required to rotate with other specialties like general surgery, critical care medicine, plastic surgery and ENT. External rotations abroad are generally supported. Non-formal dental training is offered in all centers, and a significant number of trainees acquire an official dental degree (Licenciado en Odontología) eventually. Dental training and licensure is not compulsory in Spain, it is just a recommendation. 18 iaoms.org
Each hospital has a training tutor that directs the path the residents are following. They are evaluated yearly, and that evaluation is reviewed by the Training Director/Department of the hospital and by the Ministry of Health. The general training program in Oral and Maxillofacial surgery is affiliated with the Comisión Nacional. Currently, some of this affiliation is in the process of an update to include new procedures and techniques. There is no possibility of official training in Oral and Maxillofacial Surgery, apart from the MIR system. The system has over 30-year history of proven fairness and reliability. This has allowed generations of Spanish specialists to have a solid and uniform training. Every year around 30 positions to train in oral and maxillofacial surgery are available in the MIR exam. Most of the training units offer one position per year, while some busy hospitals can offer up to two. October 2018
degree will not be recognized by the state (as a matter of fact, dental specialties are not recognized by the Ministry of Health, they are only academic titles). You can work performing oral surgery or implantology (any dental chair procedure), but it will not be legal that you announce yourself as an Oral and Maxillofacial Surgeon. Of course, you can enter the Medical School, and then follow the path of the rest of M.D.s.
AN OMS WITH A MEDICAL BACKGROUND (OR DOUBLE DEGREE), can apply for recognition of your speciality. There are different procedures depending on whether you hold a degree from a country in the European Union or not. Some of the requirements include: The Comision Nacional monitors that the training units fulfil the legal requirements to accept residents (number of procedures, number of outpatients, scientific sessions, publications, research etc.) IF YOU ARE ALREADY AN ORAL AND MAXILLOFACIAL SURGEON IN YOUR COUNTRY... The situation depends whether you come from a country where OMFS is a dental speciality, a medical speciality, or if you need both degrees. An OMS with a dental background, does not have options to obtain acceptance of your degree in Spain. You can ask for recognition of your dental degree in the Colegio de Odontรณlogos y Estomatรณlogos (College of Dentists), but your OMFS October 2018
1 2 3
he specialist degree must be official and must T enable the candidate to work as a specialist in the country of origin. raining must have taken place at a university, T university hospital, or health care center.
he candidate will have to verify length of T training, time of dedication, and professional expertise achieved in order to compare the acquired competences of the candidate with the requirements in Spain.
Effective knowledge of Spanish language.
The Ministry of Health will refer all the information to an Experts Committee of Evaluation that will be directly assessed by the Comision Nacional de Cirugía Oral y Maxilofacial. The evaluation might determine the need for (1) further clinical evaluation on site, (2) the need of a complementary period of training in a university hospital, or (3) theoretical/practical exam followed by additional training.
WHAT TO EXPECT FROM ORAL AND MAXILLOFACIAL SURGERY IN SPAIN
a recent national survey showed that all our residents had a job 6 months after training completion.
The scientific association for OMFS in Spain is SECOM. More than 90% of Spanish specialists are members of SECOM. SECOM has long-standing history of quality post-graduate training in OMFS, and offers official training in Implantology, TMJ, aesthetics, and orthognathic surgery.
Salaries in the public system are variable depending on the region (Comunidad Autónoma), and they are common to all specialties. A surgeon with 20 years of expertise will have a salary in the range of 45.000 to 60.000 Euros per year.
Oral and Maxillofacial Surgery in Spain is reaching a point of saturation. Consultant positions are becoming scarce in the major hospitals. The demography of the current working OMSs in Spain demonstrate that the number of surgeons close to retirement is low suggesting a lag of a few years before a sound renewal of departments. Unfortunately, the economic crisis suffered by Spain in the last few years meant that new units and departments cannot be created. However,
On the other hand, trainees have a salary that starts with 18.000 euros in the first year, and steadily increases to around 30.000 by the 5th year (including their on-call activity). Working in private practice is a solid option in Spain. With new private hospitals opening in the main cities, and with a percentage of population close to 25% that have private insurances, the liberal practice of medicine is an open door to new specialists. ■ http://www.boe.es/boe/dias/2010/05/03/pdfs/BOE-A-2010-6960.pdf
NEW NEW THING IN OMFS
Intern Bootcamp 2018
FOUNDATION CHAIRMAN REPORT
A bi g
ver the past two years, you have heard a lot about the IAOMS Foundation. During this time, we have accomplished a great amount:
• We conducted a comprehensive Study to determine the best way for us to work with the members and partners of IAOMS to elevate the standard of care around the world. • We launched, and completed, the first formal Annual Appeal in 2017, raising $500,000 in total commitments. • We have organized leadership around the world to help us advocate this message to oral and maxillofacial professionals globally. Along the way, we have asked you to participate in this process through giving. Many of you already have, and for that, I say thank you for your ongoing support. What I want to share with you, briefly in this space, is why the Foundation’s work matters, and why you should consider participating through giving. Since the IAOMS Foundation was founded over 20 years ago, its mission has been to “improve the quality and safety of healthcare worldwide” by elevating patient care and educational standards. We’re very proud of what we have accomplished in a short time, mostly in the past several years: We have raised nearly $2 million and provided nearly $1.5 million in direct educational funding. Why must we do more? We reach just a small portion of OMF surgeons around the world, and in order to elevate the standard of training and education, we must reach more people with personalized courses, scholarship programs, and other opportunities. We envision a specialty – our specialty – in which all surgeons have access to the training they need to improve their careers, and more importantly, help others to better serve their patients. Friends, your participation is not simply giving to a good cause. Your giving is an investment in the future of our specialty, and in each and every one of your peers worldwide. With this in mind, the IAOMS Foundation Board would like to challenge each of you to consider joining us, today, with a commitment of $1 per day – a contribution of $365. With this commitment, you can make your investment in your own specialty, and help us raise the standard of care, globally. To do so right now, go to IAOMSfoundation.org, and click on the “GIVE” page. 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
Women in IAOMS
A VIEW FROM THE NETHERLANDS By Stefanie van den Bosch Oral and Maxillofacial Surgeon, Amsterdam UMC (Netherlands)
ust a few days ago, at the end of a consultation, a patient said to me that he had only seen male oral and maxillofacial surgeons before and was very surprised to see me. Some female colleagues might also recognize the situation in which a patient presumed the male resident joining clinic, to be the consultant surgeon. Apart from this, personally, I am fortunate not to really encounter any gender related â€œissuesâ€? working and living in the Netherlands. Female surgeons are still a minority nowadays, This is however drastically changing with the feminization of medicine. Dutch predictions show that in 2022 there will be as many female as male medical specialists. This is of course a great development and an absolutely awesome achievement of our
predecessors. The feminization, however, goes on and will lead to 57% female versus 43% male medical specialists in 2030. What are the consequences for our profession, do we face new challenges with this, and what causes the feminization in medicine are just some questions that arise to me. One of the causes for the feminization might be the selection procedure of medical and dental schools which differs from country to country, also in Europe. In the Netherlands until last year, a majority of the students was selected based on their high school grades. As girls are usually more diligent at high school age than boys, this might lead to better exam results and more female students being selected,
With two of our most senior and most junior residents: Renee and Sophie (left and middle).
With Leander Dubois, consultant OMF surgeon (left) and Ruud Schreurs (technical physician).
hence feminization occurs. Selection based on grades instead of combining these with other competences such as social skills, communication and ability to collaborate, seems very much outdated and in stark contrast with all that follows. All their subsequent professional development after all is dedicated to competence based training, personal leadership and maximum development and use of talents. Personalized training, which is tailored at talents and interest and which is broader than collecting knowledge alone should start at primary and secondary schools. By realizing a more personalized educational system, both boys and girls will get the chance to develop optimally at their own pace. Consequently, the selection of medical students can be more balanced to the needs in the different fields of medicine. And instead of setting quota for the
number of women or men that have to be appointed in a training program or consultant position, we can finally select the right person for the job. As for the new challenges we face, the trend to work part-time might is one of them. Although in general women still work parttime more often, men are also increasingly opting for a part-time job. This requires different management and organization of our clinics and training programs. The way in which we fulfill our job as clinicians, researchers, managers and teachers may change. We might have to implement more flexible working hours and thereby opening hours of our clinics. The latter also being supported by the increasing need for maximum and optimal use of our resources, and to keep up the same quality of training. These challenges demand creativity, flexibility and adaptation. I believe in our oral and maxillofacial surgery community we have shown to have the ability to adapt and use the challenges we face to grow and evolve. So it is with great enthusiasm and curiosity that I look towards the future of our beautiful specialty! â–
From Proust to Pivot
AN APPARENTLY INNOCENT QUESTIONNAIRE FOR ORAL AND MAXILLOFACIAL SURGEONS By Javier González Lagunas Editor-in-Chief, Barcelona (Spain)
Oral and Maxillofacial Surgeon, Lima (Peru) Past President ALACIBU.
What is your favorite word? Humility. What is your least favorite word? Arrogance. What is your favorite drug? My job. What sound or noise do you love? Fusion peruvian music.
If you were reincarnated as some other plant or animal, what would it be? A condor.
You may come in.
If Heaven exists, what would you like to hear God say when you arrive at the Pearly Gates?
What is your greatest fear? The death of my loved ones.
What is your idea of perfect happiness? Does not exist.
What sound or noise do you hate? Heavy metal music. What is your favorite curse word? “Carajo”! (...in spanish). Who would you like to see on a new banknote? Mother Teresa of Calcuta.
Working for the CBMF of my beloved Latin America.
What profession other than your own would you not like to attempt? Lawyer.
Producing Peruvian pisco “Don Polo”.
The countryside a wonderful place to be with family and great friends.
What is the trait you most deplore in yourself? Naivete.
What is the greatest love of your life? My parents.
What is your most marked characteristic? Simplicity.
What is the trait you most deplore in others? Hypocrisy.
When and where were you happiest? Whenever I’m with my family or my true friends. Anywhere.
What do you most value in your friends? The truth.
What is your greatest extravagance? My watches. What is your current state of mind? Balanced. What do you consider the most overrated virtue? My patience. On what occasion do you lie? When I want to solve other people’s problems. What do you most dislike about your appearance? My current overweight. Which living person do you most despise? Nicolas Maduro. What is the quality you most like in a man? Humility. What is the quality you most like in a woman? Humility. Which words or phrases do you most overuse? I think that or I do not think that.
Which talent would you most like to have? Be a good singer. If you could change one thing about yourself, what would it be? More than change, I would like to be less naive. What do you consider your greatest achievement? To do what I most like. If you were to die and come back as a person, what would it be? The same person I am, but avoiding as many errors as possible. Where would you most like to live? In my country house. What is your most treasured possession? The patients I treated and cured. What do you mean as the lowest depth of misery? Losing human values and virtues. What is your favorite occupation? To work as an oral and maxillofacial surgeon.
Who are your favorite writers? Mario Vargas Llosa, Alfredo Bryce Echenique. Who is your hero of fiction? “Zorro”. Which historical figure do you most identify with? The work of Mother Teresa of Calcutta. Who are your heroes in real life? Those who fight for equal rights of people. What are your favorite names? Mery, Leopoldo. What is it that you most dislike? Arrogance and hypocrisy. What is your greatest regret? Not having dedicated so much to my family for my professional development. How would you like to die? With euthanasia. What is your motto? Above all, to be better people. ■
By Sean Edwards Chairman of the Research Committee IAOMS Ann Arbor, Michigan (USA)
erhaps instead, I should ask: IS RESEARCH IMPORTANT IN SURGERY? I think we would all reflexively confirm its paramount importance to our clinical work but I think it is useful to consider why this is the case and indeed why it is so critical to Oral and Maxillofacial Surgery. Research can be hard. It requires investment. Young faculty need protected time to develop their investigative and grant writing skills. Let me first examine the value of research to OMS. I have in recent years had the opportunity to attend several national meetings of other dental and medical specialties and have been struck by how different some of these meetings can be. In many ways, some of these meetings seem more like trade shows than a scientific events. The appeal of such a meeting is obvious. Itâ€™s a light-hearted overview of the current state of a specialty. Entertainment can take the place of scientific rigor and debate. Such a meeting requires little enterprise to establish a funded research program and all that entails â€“ study design training, ethics reviews, grant writing, standardized patient care, rigorous outcome assessments, abstract presentations, and the like. Its easy, social and fun. Devoid of research, these meetings do little to advance patient care. SO WHY SHOULD WE, AS ORAL AND MAXILLOFACIAL SURGEONS, RESIST GOING DOWN THE SAME ROAD? WHY SHOULD WE INVEST IN RESEARCH? 26 iaoms.org
Of course, research improves the care we provide. We must always seek to do better for our patients. This is part of the trust that society places in medicine and dentistry. Better care means better outcomes and fewer complications. Invalid and ineffective treatments are at best, a waste of precious health care resources and at worst, dangerous leading to harm in October 2018
our patients. This is first and foremost why we need research in OMS. From a more practical standpoint, research is also key for ensuring remuneration for our efforts. Insurance companies are loathe to pay for unproven treatment. Good clinical research will ensure that we are remunerated for our work.
to be the best OMS performing a given procedure, nor is it enough to be the best surgeon, specialty notwithstanding. Clinical excellence requires innovation and validation. This comes from research. More importantly, when the innovation and validation comes from within OMS, it validates our role in a given arena. With research, we contribute on the highest level.
WHY THEN SHOULD THE RESEARCHERS BE ORAL AND MAXILLOFACIAL SURGEONS AND WHY SHOULD RESEARCH BE PART OF OMS TRAINING?
WHY SHOULD WE INVEST IN ORAL AND MAXILLOFACIAL SURGEONS AS RESEARCHERS? DO WE NEED SURGEON-SCIENTISTS? SHOULD THIS WORK COME FROM WITHIN?
Oral and Maxillofacial Surgery has enjoyed an expansion of our scope of practice over the past few decades. Research has been critical to this expansion and, critically validates our efforts to do so. As a specialty, we must be adding to the general knowledge of medicine and dentistry. It’s not enough
The simple answer is yes. We are unique in our training, bridging medicine and dentistry, and as a result we are unique in our ability to identify problems and diseases and innovate their solutions. This must come from within our specialty to validate the role of OMS and the care we provide. I must admit feeling a sense of pride when I read a study with important findings conducted by an OMS. As I have mentioned, this is not easy. We are experiencing a decline in the number of surgeon scientists and this is a trend we need to reverse. Our length of training and the declining availability of research funding are two key challenges. Heavy clinical and administrative demands are omnipresent. This challenge will require investment in our trainees and faculty. This investment is not just financial. It is not just mentoring. It must include the time required for a surgeon to establish him or herself as an investigator. This has always been a challenge but it is one too important ignore. SO HOW DO WE ENSURE THAT WE WILL HAVE RESEARCHERS WITHIN OMS? First, we need to make certain that trainees are taught the importance of evidence based practice. Reliance on the literature for decision making needs to be a constant element of all daily teaching. Second, we need to laud our researchers for their efforts. Their work, research, must continue to be the focus of our scientific meetings. Pushing abstracts off to the end rooms and the dark corners of a meeting sends an indelible message that research is secondary in importance. Lastly, we need to create research educational opportunities for our trainees and junior faculty and we need to help create funding opportunities. Working with our associations, such as the IAOMS and our home universities we can make this happen. ■
“Research improves the care we provide. We must always seek to do better for our patients. This is part of the trust that society places in medicine and dentistry.”
CRANIOFACIAL SURGERY FELLOWSHIP IN PARIS:
e c n ie r e p x e l a n o s r e p My
By Martin Rachwalski, MD, DDS Department of Maxillofacial and Plastic Surgery. Hôpital Universitaire Necker-Enfants Malades. Paris (France)
t was 10 years ago. I was a dental student and was assisting with a fronto-orbital advancement in a patient with Pfeiffer syndrome when that “aahamoment” occurred!
The facial transformation of the child and the overwhelming happiness of the parents gave me a sudden uplifting feeling, as I have never experienced before. From that day on, I knew that I wanted to dedicate my future career to pediatric craniofacial reconstruction. Over the years, my fascination to this field has grown and I have tried to acquire knowledge whenever I could. During my Maxillofacial Surgery training at the University Hospital in Cologne, Germany, I had further exposure to Cleft and Craniofacial Surgery, however I felt that I would like to gain more experience at a high-volume center abroad.
state-of-the-art. The staff were welcoming and friendly. I was assisting numerous surgeries carried out by the Plastic Surgeon Dr. Eric Arnaud who today leads the unit and the pediatric neurosurgeon Dr. Giovanna Paternoster. I was exposed to the Paris technique for the treatment of Trigonocephaly and Scaphocephaly and several Monobloc and Le Fort III distractions on
My first choice was the French National Craniofacial Unit at Necker Enfants Malades Hospital. This is a pediatric teaching hospital affiliated to the University of Paris Descartes. It was the first pediatric hospital in the world, founded in 1778 by Madame Necker, wife of Jacques Necker, Minister of Louis XVI. Many eminent physicians have worked at Necker, amongst them Eugène Apert, after whom Apert Syndrome was named. The Craniofacial Unit at Necker was founded in 1976 and serves as the national referral center and performs around 200 intracranial cases per year, making it one of the largest centers for craniosynostosis in the world. The operating theatre at Necker was brand new and 28 iaoms.org
syndromic cases. In the OR, one could notice that all procedures were standardized and that infection control and minimizing complications were absolute top priorities. During surgery, Dr. Arnaud would give explanations and share his tremendous experience with his international visitors, while maintaining a relaxed atmosphere. On the wards, I would join the senior surgeons seeing their patients postoperatively. Hence, I was able to engage in continuity of care by following several patients from the initial
Each would be photographed, receive a CT /MRI, as well as have blood samples taken for genetic testing. I was very impressed by the excellent documentation, long follow-up and extensive genetic assessment that permits interesting studies in the future. Patients would not only come from France and other European countries, but also from the Northen and Northwestern African countries, which have a higher incidence of oxycephalies. During the monthly craniofacial staff meeting, the focus would be on complex syndromic cases where indications for surgery are discussed extensively in a multidisciplinary setting. However, during my stay in Paris there were obstacles to overcome as well. Although my French language skills have significantly improved over time in Paris, it is imperative to have a sound foundation of the language (at least level B2) when considering working here to be fully accepted and integrated. Especially at the beginning, I had issues understanding my fastspeaking colleagues over the telephone or some of the parents that had a strong dialect (e.g., south of France, Africa etc.). The pediatric services at Hospital Necker strive for excellence and are therefore strongly senior surgeon driven. This means that being allowed to make clinical decisions independently or to operate unsupervised, as a junior surgeon is not possible. This is understandable, considering that parents travel often from all over France or aboard to Paris for their child to be operated on by a specific surgeon.
contact in the outpatient clinic until their discharge and beyond.
During my time in Paris, I also had the chance to profit from this amazingly beautiful city, its vast cultural offers and the brilliant French cuisine. I found the French people to be very open and pleasant, in addition to having a good sense of humor, both at work and in private. They seem to find the right balance between having a professional and a joyful life.
My weekly schedule would comprise of at least 3 full days of craniofacial surgery at Necker and also incorporated two craniofacial outpatient clinics and research at the Imagine Institute for Genetic Diseases where I worked on a craniofacial/skeletal dysplasia mouse model. Outpatient clinics often ran very late into the evening as the number of patients seen was overwhelming. There was a very standardized approach when accessing the patients.
In summary, after cautious deliberation, I would recommend that everybody try to spend some time abroad. Working in a different country certainly gave me new perspectives on clinical patient management, improved my inter-cultural competences and provided me with plenty of amazing colleagues and friends. â–
FATHER TO SON
From father to son. FAMILY TRADITIONS IN MAXILLOFACIAL SURGERY By Carlos (“Tano” ) and Adrian Bencini La Plata (Argentina)
many of the surgeons whose names I had been hearing for years in my father’s classes. Who do you remember? Mainly Professor Hugo Obwegeser. I had heard a lot about him. He attended my father’s conference, congratulated him and invited us to his clinic, which we visited at the end of the congress. But I also hold dear several Spanish colleagues and friends such as doctors Navarro Vila, Aguado Santos, López-Arranz y Arranz, among many others. Carlos (“Tano” ) and Adrian Bencini.
octor Bencini, how did you discover your vocation for oral and maxillofacial surgery? For the most part, by observing since a young age the passion this specialty awoke in my father Prof. Dr. Carlos Alberto Bencini. He was a prominent oral and maxillofacial surgeon who began practicing this specialty in the 60’s. His time and dedication were distributed between assisting patients at the hospital and giving lectures at the university, with the same enthusiasm on all occasions. I recall, at only 7 years of age, to stay at night watching how he prepared his lectures, which he constantly updated by adding new clinical cases and surgical techniques. When I was a teenager, I had already defined that this was my real vocation. For that reason, I read several books, especially about anatomy, with that passion I saw in my father. In 1986, when I was 15 years old, I accompanied him to the VIII Congress of the European Association of Maxillo-Facial Surgery (E.A.M.F.S) which was held in Madrid, presided over by his friend Dr. Alonso del Hoyo. In that congress, my father presented his experience in Orthognathic surgery, one of the areas where he developed most of his practice. I remember that event with nostalgia, because I met
And did you continue sharing experiences with your father? Yes. From that congress on, I began to travel with him to essentially all the national and international congresses of the specialty. I had the pleasure of being able to share with him not only the passion for surgery, but also his friendships, which I preserve to this day. In fact, when I presided over the national congress of my country in 2006, where we had scarce economic resources, we were able to receive great surgeons such as William Bell and Carlos Navarro Vila, among others, product of their generosity and in honor of our friendship. And how did your professional career begin? I began my academic education and training as a dentist at the National University of La Plata. Then I did my postgraduate studies at the Argentine Society of Oral and Maxillofacial Surgery and Traumatology, while I continued working with my father in the Hospital, in the University and in our clinic. Once I obtained this postgraduate degree, I had the fortune of being able to travel to different training centers in the world, to perfect myself in different areas and surgical procedures. And what is your occupation at the moment? At the present time I have multiple occupations. I am the Head of the Oral and Maxillofacial Surgery
Dr. Carlos Bencini, Dr Rui Fernandes and Dr Adrian Bencini - Icoms Chile 2011. Prof. Dr. Adrian Bencini.
Dr. Carlos Bencini And Dr Adrian Bencini. Dr. Carlos Bencini, Dr. Robert Walker and Dr. Adrian Bencini Icoms India 2007. Dr. Adrian Bencini President of Alacibu. Dr. Adrian Bencini, Dr. Daniel Laskin and Dr Carlos Bencini Icoms 2011.
Dr. William Bel and Dr. Adrian Bencini Argentina 2006.
Service at San Juan de Dios Hospital in La Plata, where I lead the Oral and Maxillofacial Surgery Residency. I hold a position as Professor of Oral and Maxillofacial Surgery at the National University of La Plata as well as at the Catholic University of La Plata. I also have the responsibility to be currently the President of the Latin American Association of Oral and Maxillofacial Surgery and Traumatology. I have been married to Andrea for 21 years. A great woman, excellent wife, mother and life partner. We have three children, Florencia (14), Matías (18) and Federico (20). Both of them are studying Medicine. Do you want at least one of your children to dedicate to oral and maxillofacial surgery? I have been married to Andrea for 21 years. A great woman, excellent wife, mother and life partner. We have three children, Florencia (14), Matías (18) and Federico (20). Two of them are studying Medicine. I want them to do anything they want, anything that gives them happiness. When you love your profession, when you dedicate yourself to what awakens passion in you, never in your life will you have to work, you will just enjoy what you do. I believe they have well-defined vocations in other areas, which I value and admire. It gives me pride as a father to see how at this young age they have already chosen their own paths. How is the training to become an oral and maxillofacial surgeon like in Latin America nowadays? It is not the same in all Latin American countries. We are working on the unification of programs, establishing minimum standards. The residency I lead is a full-time 4-year training program. Admission to the program is by an entrance examination. The residents have a monthly salary, which allows them to live and devote themselves completely to the study and practice the specialty, with intense focus in surgical training in a public hospital where the care is subsidized for the patients. There are however, countries in Latin America where the trainees are required to pay monthly for their training and that complicates the full-time dedication. What is the relationship between ALACIBU and the Latin American countries with IAOMS? It’s excellent. For years we have been working together on several projects. In recent years, primarily, we have organized symposia and conferences for the training of young surgeons in Central America and the Caribbean. ALACIBU, and all the member countries, work hard to improve the quality of training, as well as to ensure that all our oral and maxillofacial surgeons are affiliated with
IAOMS and contribute to the IAOMS Foundation, which does so much for surgeons all around the world How was your father involved with regional association (ALACIBU) and IAOMS? My father participated in the National Association (Argentine Society of Oral and Maxillofacial Surgery and Traumatology) and in the Regional one (ALACIBU) very actively since the ‘70s. He held several positions in the National Association, and in the year 2000, he became president. In the regional Association he was secretary between the years 2003 and 2006. He always maintained a close relationship with the IAOMS, of which he was a member throughout his professional life, and participated in numerous ICOMS. When my father was president of the National Association, he worked hard to make sure all Argentines were members of the IAOMS. During his life, and after his death, he received multiple awards from the different national and international associations of which he was part of, for his management. How was living and working with someone who was at the same time your father and your mentor? The relationship I had with my father was very special. He was my father, my friend and my teacher, all together and at the same time. It was a wonderful experience, intense and very demanding. As a father, he was an example. He always emphasized, as a good Italian, the values of “the united family”. He made sure to advise and guide me in the best possible way. As with all of his friends, he was a considerate and loyal friend to me. A great human being. There is no one who has known him that does not have a great memory of his human quality, and his multiple life stories. As a teacher, he was the most generous, demanding and severe professor. All of his students have, without exception, stressed how he didn’t hold back any knowledge he had, he shared and taught everything he knew. He did not keep anything for himself. He wanted his students to be better than himself. So much was his desire to be surpassed in the professional area that he encouraged me to travel and train with people who had different backgrounds than he had. He always wanted me to have the best training I could get. He was very exacting on all occasions with all of his students, and even more with me. Today I repeat to my students many of the phrases that my father taught me. Perhaps the most important has been: “always take care of your patient as if he was the most beloved person in your life, that way you will always make the best decision”. ■
A BRIEF HISTORY OF ORAL AND MAXILLOFACIAL SURGERY IN
By Sandeth Phan Oral and Maxillofacial Surgeon. Cambodia
he Ministries of Health and Education in 2011 approved a 4- year master program in Oral Maxillofacial Surgery for the first time in Cambodia. Since then, five oral and maxillofacial surgeons have graduated from this training program (national residency program) at the International University in Phnom Penh, Cambodia.
Trainees with Stefen Cox, Dean from Sydney University.
The five of us (including myself) took the national exam in November in 2017 at the International University, which included an individual thesis defense. External faculty from overseas examined us. Beside the five of us, there are two other oral and maxillofacial surgeons, who practice in Cambodia. One of them graduated from Seoul National University from South Korea and the other from Mahidol University in Thailand. We are in the process of seeking new recruits and formalizing the training October 2018
“Oral and Maxillofacial surgery is a new specialty in Cambodia. We are committed to serve and promote this specialty in our country and to its people.” With John Kelly.
pathway at the University Health Sciences government school. Our final curriculum included participation in a few local and regional symposia held at the Faculty of Dentistry at the University of Health Sciences. Australian and New Zealand Association of Oral and Maxillofacial Surgeons (ANZAOMS) helped create this course curriculum. We had the good fortune of hosting several prominent dignitaries at these meetings. These include - Prof. Stephen Cox, dean at Sydney University, Drs. John Arvier and Barbara Woodhouse, the overseas aid committee of ANZAOMS, Prof. Nabil Samman, representing the Asian Association for OMS and Dr. Peace Indravachagram and her colleagues from university of Malaysia, our local university representatives, and 2 heads of human resource department from MoH and MoE.
1. Inaugural graduation ceremony for OMFS training in Cambodia (Drs. Arvier and Woodhouse, from Australia, presenting). 2. Local mentors and trainees.
The CAOMS- Cambodian Association for Oral and Maxillofacial Surgeons, our national association, is in its nascent stages. The Ministry of Interior requires specialist associations such as ours, to meet certain qualifications for registration. We are hoping to be registered by the end of this year. We will keep IAOMS members and leadership updated. Oral and Maxillofacial surgery is a new specialty in Cambodia. We are committed to serve and promote this specialty in our country and to its people. ■
ANZAOMS: COMMITTED TO VOLUNTEER
By John Arvier Oral and Maxillofacial Surgeon. Auchenflower Queensland, Australia
a formal degree program commenced at Dhaka University, and Shaheed Suhrawardy Hospital and Bangladesh Institute of Child Health were added to the participating teaching hospitals.
The Overseas Aid Committee of ANZAOMS began formal overseas activities in 1990, under the chairmanship of Dr. Barry Fitzpatrick. The initial emphasis was in Bangladesh where a collaborative project was established in partnership with an embryonic Oral and Dental Surgery Department at Dhaka Dental College Hospital, headed by Dr. Motiur Molla. In those pre-internet days, the overall concept was a series of fortnightly visits by volunteers from Australia and New Zealand, working in conjunction with local colleagues, to introduce contemporary ideas and techniques from more developed countries. Many such visits were conducted in the early 1990s, and chairmanship of the ANZAOMS Bangladesh Project passed to Dr. John Arvier in the mid-1990s. Dr. Molla and Dr. Iqbal Shaheed were also invited to Australia, where they visited several training centres and also presented at the annual ANZAOMS conferences. The principal aim of visits soon became the establishment of a structured training program in Oral and Maxillofacial Surgery. After discussions with the Health Ministry and University officials, October 2018
The first four candidates were selected from a rigourous entrance examination, and commenced the formal training in early 1998. Dr. Badiul Alam was the first graduate in 2003, followed by many others since that time.
2002. Dr Motiur Molla (L) and fellow examiners meeting for the inaugural examinations in Oral & Maxillofacial Surgery, University of Dhaka. iaoms.org 35
Papua New Guinea In 2001, ANZAOMS was invited to participate in a structured Aid Program in the Pacific Islands conducted by the Royal Australian College of Surgeons. The program was an initiative of Overseas Aid activities the Australian Government, administered through the RACS, with particular emphasis on establishing tertiary health services and specialist training in Papua New Guinea. The first volunteers visited PNG in 2001, and the formal training program in OMFS was established a few years later. Dr. Matupi Apaio became the first graduate in 2007, followed by Dr. Takovi Maga a few years later.
2006-10-16 Matupi Apaioâ€™s graduation as first ever locallytrained Maxillofacial surgeon in Papua New Guinea.
Cambodia IN recent years ANZAOMS Overseas Aid Committee has conducted an outreach program in Cambodia, largely under the direction of Dr. Barbara Woodhouse who led the Overseas Aid committee from 2008 to 2015 when Dr. Michael Schenberg was appointed Chairman. Volunteer visits commenced in 2004, 36 iaoms.org
with the aim of instituting a formal training program, analogous to the ventures conducted in Bangladesh and Papua New Guinea. The overall philosophy of ANZAOMS overseas surgical aid has always been in line with the IAOMS philosophy: training local surgeons to operate on their own patients, in their own conditions. Service-type options, or training overseas surgeons in Australia, have generally been inefficient in the short term, and ineffective in the longer term. As in many developing nations, healthcare in Cambodia has been a low priority, and there is a vast untreated pool of surgical pathology â€“ a combination of congenital deformities, facial trauma (lax workplace safety, chaotic traffic, interpersonal violence...) and a racial predisposition to benign but aggressive fibro-osseous neoplasms.
Dr. Scott Armstrong & local trainee Dr. Sandeth Phan operating under supervision in Phnom Penh.
In 2012, a formal 4-year training program leading to the degree of Masters in OMFS was commenced through the International University (IU) in Phnom Penh. Some financial support was obtained from both ANZAOMS, IAOMS and the Asian Association of Oral & Maxillofacial Surgeons. A formal curriculum was written, broadly based on the one used for training institutions in Australia and New Zealand. Dr. Barbara Woodhouse was appointed overseas coordinator, responsible for ensuring the program conformed to the expected standards. At the ICOMS October 2018
“As in many developing nations, healthcare in Cambodia has been a low priority, and there is a vast untreated pool of surgical pathology – a combination of congenital deformities, facial trauma (lax workplace safety, chaotic traffic, interpersonal violence...) and a racial predisposition to benign but aggressive fibroosseous neoplasms.”
Clinical facilities are based at a variety of government hospitals in Phnom Penh: the Khmer-Soviet Friendship Hospital, Kossamak, the Military Hospital and Calmette (the latter funded by the French Government). Other cases are often treated at Children’s Surgical Centre, funded largely by American charities, although administered by expatriate English orthopaedic surgeon Dr. Jim Gollogly. More recently, two hospitals in the northern city of Siem Reap have welcomed Australian volunteers and local trainees.
Australian OMFS registrars have often accompanied their consultants, with support from the ANZAOMS Research & Education Foundation. Drs. Ben Rahmel, Weber Huang, Owen Ellis, Stephanie Tan, Ninan Mathew, and Scott Armstrong have all visited Cambodia during their training years, and Dr. Justin Collum visited Bangladesh. The continued support of the ANZAOMS Foundation is gratefully acknowledged, and also appreciated by trainees who availed themselves of the opportunity to experience a different surgical environment. ANZAOMS was also very pleased to host one the Cambodian trainees, Dr. Sandeth Phan at the 2017 annual scientific conference, where ANZAOMS members heard first-hand from one of the beneficiaries of the program. Dr. Weber Huang conducting a practical workshop in Siem Reap, Northern Cambodia.
meeting in Hong Kong in April 2017, Dr. Woodhouse was appointed to the Overseas Aid Committee of IAOMS. In 2012 three trainees were initially selected from a field of applicants by their performance in an entrance examination, followed by a second intake of 2 more students the following year. Over recent years, their local supervision has been augmented by regular visits by both Australian volunteers, as well as a number of international surgeons from many European centres. October 2018
The first batch of Cambodian trainees sat for their final exams in November 2017. Particular thanks to Dr. Caroline Acton from Queensland who generously offered to fly to Phnom Penh just for a very brief visit, so as to fulfil the requirements for two overseas examiners for the defence of the first batch of research theses, and Dr. Paul Duke from Adelaide who performed a similar role for the second batch. It should be emphasised OMFS is still very much in its infancy in Cambodia, not dissimilar to where it was in Australia some decades ago. More teachers, tutors and mentors are always welcome and very much needed in all areas of clinical and academic activity, and more volunteers are always encouraged. ■ iaoms.org 37
Overtreatment By Javier González Lagunas (follow me on
very now and then, I like to recommend books, magazines or websites that have made an impact in the way I think, behave, practice my profession, or conduct myself. Often, they are unrelated to medicine or surgery. Let me bring your attention to the website of Social Sciences Research Network – www.ssrn.com I did not arrive there by luck, but followed a recommendation by one of the other “must listen” in my life - Malcom Gladwell and his podcast “Revisionist History”, available on iTunes. Gladwell says, “In my opinion SSRN is the greatest website on the internet”. While perusing the SSRN website I found a paper authored by a Zurich group called “Health Services as credence goods: a field experiment”. Credence goods are defined as goods whose utility impact is difficult or impossible for the consumer to ascertain. The seller of such goods or services knows this impact, creating a situation of asymmetric information. You know the feeling: when you need to have your car repaired, and you feel that you are not being presented a clear and convincing reason for repair, and you have a feeling that you are being taken for a ride! The starting point of the paper cannot be more interesting: a patient that does not require ANY dental treatment at all, was sent to a group of 180 dentists to receive a diagnosis, a treatment plan, and an estimation of costs.
The results are striking: an overtreatment recommendation rate of 28% was observed. Overtreatment recommendations were higher in patients who had lower socio-economic status. Also, a lower waiting time for appointments is associated with more overtreatment recommendations: that is, busy practices tend not to overtreat, while empty practices are keen to propose unnecessary procedures. The results of this study are surprising; primarily because the patients in the study had no pathology at all. So, how does this translate to our specialty and us? Are we guilty of choosing either a conservative or a more invasive attitude when the opposite choice would have been perfectly acceptable? Is it overtreatment to remove periodontally involved mobile teeth and restore with dental implants, or is that simply being aware of the natural course of that disease? How about the removal of asymptomatic wisdom teeth? Or the use of pharmacologic modalities in some cysts and tumors of the jaws as opposed to surgery? Let us not even tread the surface of the muddy waters of aesthetic procedures. Patients rely on us to provide the best solution for their condition, because they trust us to know better about their condition than they do. In today’s world of information overload, our patients are informed consumers who are unlikely to accept a treatment proposal without considering alternatives. Just think about that. ■
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
8618 W. Catalpa Ave., Suite 1116, Chicago, IL 60656 U.S.A. www.iaoms.org
An IAOMS quarterly publication written by and for oral and maxillofacial surgeons.