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Issue 59 / October 2019
Editor-in-Chief Javier González Lagunas
Assistant Editor Deepak Krishnan
Graphic Designer María Montesinos
Executive Committee 2018-2019 Board of Directors
Alexis Olsson, President Julio Acero, Immediate Past President Gabriele Millesi, Vice President Alejandro Martinez, Vice President-Elect Arthur Jee, Treasurer Larry Nissen, IAOMS Foundation Chair Mitchell Dvorak, Executive Director
Members-at-Large
Rui Fernandes Javier González Lagunas Sanjiv Nair
Regional Representatives
Eric Kahugu, Africa Kenichi Kurita, Asia Nick Kalavrezos, Europe Alejandro Martinez, Latin America Arthur Jee, North America Jocelyn Shand, Oceania Nabil Samman, Editor-in-Chief, IJOMS
Committee Chairs G.E. Ghali, Education Alejandro Martinez, Governance and Ethics Alfred Lau, Membership and Communications Sean Edwards, Research Luiz Marinho, 24th ICOMS-2019, Brazil David Koppel, 25th ICOMS-2021, Glasgow Ed Dore, 26h ICOMS-2023, Vancouver FACE TO FACE Registered in U.S. Patent and Trademark Office. ©Copyright 2018. I nternational Association of Oral and Maxillofacial Surgeons. Chicago, Illinois, USA. All rights reserved under international and Pan American copyright conventions.
CONTACT US
International Association of Oral and Maxillofacial Surgeons IAOMS Foundation 200 E. Randolph St., Suite 5100 Chicago, IL 60601 USA / communications@iaoms.org
Letter from the Editor AS I SEE IT LET’S make an exercise. At first, think about the long hours of surgical training, the pressure of the patients, the pressure of the institution, the exams and assesments, the competition with your peers for a hospital position, or the moral obligation of teaching and research. Next, think about high performance athletes that train to compete and to win. Now put it all together in shaker, and think if it is possible to obtain a good cocktail with those ingredients. The relationship between elite level of competition in sports and superior education or employment is not easy. Even though soft competences as leadership, teamwork and character building would reinforce both disciplines, the balance can easily be broken. In the European Union a document called “EU guidelines on dual careers of Athletes” was developed and presented in 2012. I want to present the story of four Oral and Maxillofacial Surgeons that have shown us that it is possible to achieve excellence. in both fields. High performance sports is a a demanding activity, but surgery can also be mentally and physically exhausting. It is worth reading every single word. In this issue of the magazine we will start our journey in East Africa, and receive a first greeting from the new President of AFAOMS, as well as the point of view of a Sudanese Maxillofacial surgeon who had the opportunity to receive one of the scholarships of our association. We fly to Nepal and visit a charity center dedicated to Craniofacial Surgery, and from Israel we discover some of the secrets of Nardi Casap, a good friend of IAOMS. And we will move to Mitteleurope, to Switzerland in the core of our continent, and discover one of the national associations that has a vertical relationship with IAOMS. ICOMS RIO is over but we still remember the success of the meeting organized by Luiz Marinho and his team. But now it is time to step forward and start thinking in 2021: save your Havaianas in a drawer and prepare some warmet garments. Listen to David Koppel’s first address and save those dates in your agenda. Finally, read the wel informed opinion of Dr Laskin on the changes of our conference.
It is time to start reading Face to Face, enjoy it!
Javier González Lagunas EDITOR IN CHIEF
CONTENTS October 2019 10 SPECIAL REPORT Two passions.
MISSIONS 20
Craniofacial Centre Nepal.
24 FROM PROUST TO PIVOT Nardi Casap-Caspi.
SO, YOU WANT TO WORK... 28 Switzerland.
30 NEXT GEN
Our NextGen in 2019, more for more.
Networking in conferences. The ICOMS example.
WOMEN IN IAOMS 34
A lady Oral and Maxillofacial Surgeon from Sudan.
37 AFAOMS
A message from the new president.
IN THE FIRST PERSON 40
42 COPY ME
Daniel Laskin.
Arthroscopy of the TMJ.
FATHER TO SON 46
Sergio and Gianpaolo Tartaro.
48 BEYOND THE O.R. Half and half.
EXPANDING OUR REACH
OVER the last three years, IAOMS grew our membership by 27%. We gained nearly 900 hundred members who either newly joined IAOMS or returned to the Association. We are incredibly appreciative of your continued support and involvement with IAOMS. Based on direct feedback from our members, IAOMS continues on our strategic path of digital transformation dedicated to delivering innovative, high-quality educational content. Stay tuned for details regarding our exciting new digital initiatives, including the launch of an IAOMS Podcast Series, our second Virtual Conference in January 2020, and the newest edition of the International OMF Reference Guide which will soon be available. WILL WE SEE YOU IN VIENNA? The first International Symposium on Orthognathic Surgery will take place April 30 – May 2, 2020. This scientific meeting will be held in one of the traditional hotels - Parkhotel Schönbrunn, located next to the famous castle Schönbrunn and in direct connection to the city. Learn, connect and celebrate with leading professionals in Orthognathic Surgery! A few brief notes below on what to expect in Vienna: Networking Event: Join us for our “Heurigen Evening” at the Weingut Fuhrgassl-Huber, a typical Austrian wine tavern in Vienna on Friday, May 1, 2020. Enjoy a delicious Austrian buffet and excellent local wines, while experiencing the atmosphere of a “Heurigen.” “Heurigen” can be translated to “of this year” and means a young crisp wine produced during the current wine season. Only wine producers serving their own products grown in the vineyards of Vienna may call their tavern “Heurigen.” Speakers: Attend sessions hosted by Federico Hernández-Alfaro, Alfred G Becking, Edward Ellis III, Maija Eltz, G.E. Ghali, Tae – Geon Kwon, Stanley YungChuan Liu, Alejandro Martinez, Gabriele A. Millesi, Werner Millesi, Johan P. Reyneke, Timothy A. Turvey, and more to be announced!
Corporate Workshops: The Preliminary Program for the conference is now available online. IAOMS is offering three additional opportunities, including corporate workshops from Stryker and Medartis, as well as well as the S.O.R.G Symposium. Registration is required for all corporate workshops and symposium. Be sure to visit www.iaoms.org/vienna2020 to take advantage of member rates and early bird pricing and register for the conference today! IAOMS is actively participating in global conferences to support the specialty. On September 17, the IAOMS Foundation held its second IAOMS/ AAOMS International Reception at the AAOMS Annual Meeting in Boston. The IAOMS Foundation recognized the partnership and on-going support from AAOMS, the OMS Foundation and AAOMS leaders at this reception. Later in the week, the engaging, interactive session “Global Health Café” from IAOMS returned after a successful debut in 2018. Dr. G.E. Ghali and senior OMS surgeons discussed patient cases in Cleft and Pediatrics as well as OSA, and best practices and surgical challenges of some of the most popular surgical procedures in this specialty. More highlights from the AAOMS Meeting will be featured in our next issue of inBrief, available on iaoms.org. We’re excited for the months ahead as we increase our member benefits, expand our educational offerings digitally, and prepare for a fantastic International Symposium on Orthognathic Surgery in Vienna. On behalf of the Board of Directors, Executive Committee and staff, we look forward to connecting with you soon. Thank you,
Mitchell Dvorak EXECUTIVE DIRECTOR, IAOMS
“Global Impact” Campaign: 2019 and Beyond The Campaign is nearing $2 Million in total support pledged. We need your help to reach our goal!
Campaign Priorities
Fellowship Program Expansion
Gift of Knowledge 2.0
Scholarship Growth
Networking and Events
Additional fellowships that include new areas of study and new partner institutions
Creation of a unique plan for training for each global region, developed in partnership with local leaders
Funding to award annual scholarships to ICOMS and to short-term training appointments
Funding of networking and educational events throughout the year, such as the World Café and International Reception
Your Pledge by the Numbers Campaign Pledge
Annually
Monthly
Weekly
Daily
$50,000
$10,000
$833
$192
$27
$25,000
$5,000
$416
$96
$14
$10,000
$2,000
$166
$38
$5
$5,000
$1,000
$83
$19
$2.50
To get involved, contact Dan Nielson at dnielson@iaoms.org IAOMSFoundation.org
Letter from the President REMAINING MEMBER FOCUSED THE IAOMS has been striving to deliver high quality, valuable content while remaining relevant in this digital world. This upcoming Fall and carrying into the 2020 year, we will continue to build our educational programs including the fall Scientific Webinar Series, the second annual IAOMS Virtual Conference in 2020, continued access to the online Review Course, and two brand new digital resources (stay tuned!). The next IAOMS Webinar series will be announced shortly. In the coming months, we’ll reveal the dates, speakers and topics of our fall webinars. So far in 2019, we’ve hosted webinars on topics including “Cleft Lip & Palate Management with the Asensio Method: 52 Years of Experience in Guatemala” with father and son duo Rodolfo Asensio Marmol and Rodolfo Asensio Guerrero, and “Hypoglossal Nerve Stimulator for the OSA” with Deepak Kademani. Our Education Committee is hard at work solidifying the next set of webinars to be made available on our Learning Management System. If you have missed any of the 2019 Webinars so far, visit iaoms.org/education to access previous content at any time. Alongside our strategic push towards digital transformation, the IAOMS Foundation continues to offer young, eligible trainees opportunities to learn and observe from tops surgeons and professors first hand, and on-site. If interested, visit the iaomsfoundation.org to learn more about the following programs and how to get involved: Foundation Fellowship Program: The application period for the 2020-2021 program is underway! Now in its ninth year, the IAOMS Foundation Fellowship Program offers three trainee surgeons a oneyear immersion in one of two specialty areas: Oncology and Reconstructive Surgery (offered in Beijing, China and Shanghai, China) or Cleft Lip and Palate/Craniofacial Surgery (six months in Bangalore, India and six months in Hyderabad, India). Since its inception, 24 surgeons have received Fellowships. Each year, one of these fellowships is sponsored through the ongoing support of the KLS Martin Group. The application period will run from September 3, 2019 - November 3, 2019. The announcement, application and all details will be posted here. Announcements will also be
made via e-mail. For questions about the Fellowship program, please contact Kimberly Shadle. Visiting Scholars Program: We are incredibly appreciative of the strong interest in this program, and the IAOMS Foundation is excited to award two scholarship in 2019. The application period for the Visiting Scholars Scholarship has recently closed, and applicants will be notified of the status of their application via email. We are sure that this program will contribute to the progress of the specialty worldwide by promoting the educational and human exchange between young specialists. Stay informed about application deadlines and criteria by visiting the Foundation Programs page on iaoms.org. We have an exciting few months up ahead, and I look forward to connecting with you all soon at The IAOMS just completed the successful second phase of the Mexican Microvascular Course ) in Mexico City, MX August 26-27 and I had the privilege to represent the IAOMS in celebrating the 65th Anniversary Asociación Mexicana de Cirugía Bucal y Maxilofacial Anniversary on August 28 I want to congratulate President Maria Luisa Salgado and the Mexican Association for this great milestone, and their further dedication and involvement with the IAOMS and their vertical membership. In honor of the 50th Anniversary of the Association of Oral & Maxillofacial Surgeons of India (AOMSI), I have privilege of representing the IAOMS at their Golden Jubilee from November 14-16, 2019 in Bengaluru, India. On behalf of the Board of Directors, Executive Committee and staff, we look forward to sharing more details with you soon as we continue to build member resources and programs that benefit you. Please continue to stay up to date by subscribing to our communications and following us on social media. Warm Regards,
Alexis B. Olsson IAOMS PRESIDENT 2018-2019
TWO PASSIONS 10 iaoms.org
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01
BOXING and the Art of Surgery By Praveen Ganesh Chennai. India
MY first exposure to Boxing and MMA (Mixed Martial Arts) was in school. I was fascinated by the way the fighters moved surely, fearlessly with absolute ease. Their quick cat-like reflexes intrigued me and I got myself enrolled in a boxing class. Life inside a boxing ring has taught me many things. To me, it is a miniature cosmos where I face my fears, anxieties, and habits. It is a place where I have learned a great deal in a short time about who I am and how I react in this world. After years of training, I came to realize that the deepest purpose of any Martial art is to serve as a vehicle for attaining ultimate awareness. I have felt the same whenever I entered an operating theater as a surgeon. The essence of being a fighter and a surgeon is surprisingly similar. Lessons I learned as a Boxer has inspired me in many angles to be an OMF surgeon. It’s a parallel world, which often overlaps, and interchange.
Whether it is boxing or surgery, a strong foundation in basics is the cornerstone for success. During the initial days of boxing, I was fearless and cocky, until I tasted my first knockout. That forced me to admit that I was actually at the mercy of anyone stronger, more nimble or more practiced than myself. There was no way out, but “ceaseless practice” and “endless repetition”. I could relate this to the beginning of my OMFS career, where I was so confident of taking up surgeries. Later it dawned upon me that complications can happen and only by relentless training, perfection can be achieved.
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There is a famous saying in boxing, which is “Everyone has a plan until he gets punched in the face’’. During my last fight, I had sketched an excellent strategy, studied my opponent’s moves thoroughly. All of that became null & void after that first hit on my face. I lost my confidence, lost my guard, kept on getting punched. My coach came up to me and told me that I should believe in my training, work on my strengths and keep calm. Most importantly stick to my basics. With this, I regained control in the ring and eventually won. I can relate succinctly to the day when I was a trainee and did my first retromandibular approach for a condylar fracture. I had accidentally nicked a vein and it started bleeding profusely. I panicked and lost all my planes. Suddenly I remembered that all I needed to do was to stay calm, control the bleeder and proceed. Whether it is boxing or surgery, a strong foundation in basics is the cornerstone for success. One of the key components of MMA training is “Shadow Boxing”. We are taught to visualize ourselves succeeding with the fight. It’s a way of ironing out minute movements and highly technical skills acquired through training and instruction. It
The actual process of fighting is highly mental as much as it is physical and so is Surgery. 12 iaoms.org
gives us an idea of what is, what is not, and what needs to be fixed. I had just completed my residency in OMFS, my boss was out of town and I get a call from the Neurosurgery department about a complex case of meningo-encepholocoele posted for joint surgical intervention. I was excited but nervous. I started shadow boxing the entire surgical procedure in my mind, step by step. By visualizing the possibilities repeatedly, I reduced my fear to their proper proportions. Eventually, the surgery turned out to be far less difficult than I had originally feared. The actual process of fighting is highly mental as much as it is physical and so is Surgery. There are 3 LEVELS of training in Mixed Martial arts.
1 2 3
The ability to execute any physical activity with a certain level of efficiency. The ability to execute that specific physical activity with greater ease and effortlessness. The final level of training is building and optimizing neuromuscular and kinetic chains that can last a lifetime.
As an OMF surgeon, I believe in training for a lifetime. Constant learning to evolve from a level of conscious competence to unconscious competence. Boxing and MMA have made me fit as an athlete. It’s a sport that involves the mind and body in coordination, similar to us handling a scalpel. Fitness I feel is very important to us as surgeons as it has always helped me stay mentally alert and physically enduring during long hours of the procedure. The highest form of martial arts is when you transcend the art into an artless art. I believe that one day I shall attain that highest form in surgery where I develop the intuitive skills to render better outcome. Today boxing and Mixed Martial Arts have become an aspect of my life that helps me evolve into a better surgeon, as any form of art should, by externalizing our best internal qualities. ■
October 2019
02 How I managed to balance Oral and Maxillofacial Surgery with high level SAILING REGATTAS
BALANCING the sport of sailing and maxillofacial surgery was never easy. It started when I was still a medicine student (from 1976 to 1982) that I had to choose if I wanted to fully invest myself in medicine or if I wanted to become a pro-sailor. I had always competed at a high level, but it was not until I was on my 5th year as a medicine student, the year prior choosing the specialty, that I was offered the opportunity of a lifetime. I was offered to train for the Los Angeles Olympics of the 84. I was 22 years old at the time, and motivation was not an issue, this was what I had been training for all those years and there I was, about to make a huge decision for my career.
By Juan Grau Cases Barcelona. Spain
Finn World Championship 2019 Copenhagen, Denmark.
October 2019
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That practicing sport at a high level makes you more competitive and liberates tensions, thus allowing you to start your work day with great serenity and stability. To make this decision, I took into account two main factors: on the one hand I believed it was compatible to be a first class surgeon and to sail as a hobby, however, in my eyes it was impossible to be an Olympic sailor and a first level recognized surgeon all at once. On the other hand came in the more rational reason, the financial stability of a sailor is less certain than it is for a surgeon, and I aspired to having a big family. I was mature enough to see the bigger picture and continue with my medicine studies and leave the sport of sailing as a serious hobby. During the Residential and ‘adjunct’ years at the hospital, sailing was put aside as a weekend sport, but once I had both my professional and personal life on track, I embraced this great sport with renewed energy and passion. I started back on the Laser Class competing at a national and global level. I was able, for many years, to balance the Laser Class, an individual and highly physically demanding category, with regattas on different cruises, such as J-80 class. I also participated in the team events at national and European competitions in Santander, Newport (USA), Marseille, Soto Grande and several others. One of my best memories is the Isle of White, Round the Island, in the UK, where I participated in the regatta that later on featured in the Guinness book of records for being the regatta with the biggest number of participants, 1800 boats on the water, where we finished second in our category. Several unforgettable regattas later, I am where I am today; in a more technical and physically demanding boat, the Finn Class. In this category I have participated in two world-class competitions, one in Port Balis (Spain) and the other one in Copenhagen, Denmark. Finally, I would like to conclude by saying that practicing sport at a high level makes you more competitive and liberates tensions, thus allowing you to start your work day with great serenity and stability, which without a doubt, makes me better as an Oral and Maxillofacial Surgeon. â–
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1. Juan Grau Cases Maxilofacial Surgeon. 2. Invitational Cup en Swan, New York Yacht Club (Newport, USA).
October 2019
03
Bitten by the ROWING bug By Serryth Colbert, Alice Cameron, Toby Talbot Bath. United Kingdom
I SAT in a rowing boat for the first time when I started my medical training. I was immediately bitten by the rowing bug! I rowed for my University eight every year, until eventually my crewmates graduated, and I was left alone! So I took up sculling that winter and within six weeks, I won the Galway Head of the River. I went on to become National Champion and was selected to row for my country in a double scull with another Galway oarsman. We were the first heavyweight oarsmen to race on the world stage and had to borrow a boat, as our national team didn’t have a boat big enough for us.
any other single-sport Club in the world. I combined my training at Leander with a research MSc at Oxford University and membership examinations at the Royal College of Surgeons of England. Doing your best as a Leander oarsman and surgeon sounds simple, but to make this work, I needed a complex mix of factors.
When I finished my undergraduate training, I moved to Leander Club, Henley on Thames, England - the most successful Olympic sports club in the world. Leander Club is home to Olympic Champions of the past, present and future, with more Olympic medals than
Winning in the single scull, Henley, England.
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Today, Serryth Colbert, Consultant Oral and Maxillofacial Surgeon, Royal United Hospitals Foundation NHS Trust, Bath, England.
When I won in the quadruple scull, I learned how to expect the best every time. I was persistent and I did not allow frustration to undermine confidence and focus. I controlled any negative self-talk in this crew and ensured we refrained from ‘stinking thinking’. We were not affected by anything but what was going on in our race. We could block out what was not important. We displayed composure and could let go of mistakes quickly, if things did not go the way we wanted. We raced to win as opposed to having a fear of making mistakes. I led this crew to victory along the Tideway in London. We won at Henley Royal Regatta – taking the gold medal with very last stroke of our race. This was a true test of our character and belief. These are skills that I have taken to surgery and have passed on to my junior team of doctors. I show them Selected to represent my country (left to right Serryth Colbert and Owen Diviney).
To be successful, I had to be optimistic, focused and in control, knowing what I needed to improve and highly motivated. I had to develop holistically as a surgeon as well as an oarsman, seeing upward progression, and having a sense of belonging. I won numerous gold medals on the world stage while I rowed at Leander in all boat types – single, double scull, quadruple scull and eight. Internalised drive and self-belief were key for my performance when I won gold in the coxed four at the Commonwealth Games in Manchester, England in 2002– the only heavyweight crew from England to win at the Games that year.
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Winning Gold at the Commonwealth Games in Manchester, England 2002 (left to right Richard Egington, Serryth Colbert and Colin Smith).
how to think and learn differently compared with their less successful peers. My aim for the highest performance in a rowing boat was inspired by my crewmates at Leander, including Sir Matthew Pinsent, Steve Williams and James Cracknell, and having an objective goal that none had already achieved. I brought this aspiration to my workplace, and continue to row internationally while working as a full-time consultant in Oral and Maxillofacial Surgery, winning the master World Championships in Copenhagen 2017). What I brought with me to Leander was a mental toughness that enabled me to cope better than others with the many demands I faced. I could condition my mind to overcome frustration, i.e. not to allow frustration to undermine confidence or focus. When rowing in the eight, I made our crew focus on being positive… ‘the more adversity, the more positive we must be’ I managed stress and developed a skill of pulling my ‘A game’ out when it was required. Performing under pressure and managing stress is vital if you are to succeed, whether in sport or surgery. High quality relationships and the support of your family and a coach all help with this. Its hard to say which single factor is the most potent, or to be able to assert confidently that altering some of the conditions or enablers of thriving could bring about a change in performance. But bottom line, the key indicator to thrive as an elite oarsman or surgeon is sustained high-level performance. How and on what you concentrate is important, and so is the quality and depth of
October 2019
your concentration. People get distracted very easily by things and fail to be in the moment. Life slips through your fingers if you lose your focus and get distracted. To concentrate on being a champion, your mind has to be developed to such an extent that you can really stay very tuned in to what you're doing. Motivation was the foundation of all my rowing effort and accomplishment. Without the determination to improve and go faster, all the other mental factors such as confidence, intensity, focus and emotions are meaningless. I recognise the prime importance of motivation and pass this on to my junior doctors. However, true motivation must come from within, it cannot be taught. World rowing and oral and maxillofacial surgery attracts talent. Both oarsmen and surgeons must make decisions in the heat of the moment. Both must be able to focus attention and eliminate distraction. Both must communicate with teammates to execute a proper race plan or patient treatment plan. Both work within broad performance systems or operational philosophies, but still often need to be spontaneous and possess creative thinking skills. Both work under the limelight of transparency and exposure. Both need to able to deal with loss. Both need passion and perseverance for sustainability. Having the desire and motivation to do well and setting challenging goals are the key factors enabling one to thrive at the highest level in surgery and in rowing. To believe in and commit to the process of development is important if one is to thrive. While surgery should not be regarded as being competitive on the same scale as rowing with the Olympians at Leander Club, I have improved my surgical performance as a result. ■
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04
MIRACLE ON ICE By Bill Baker Grand Rapids, Minnesota, United States Interviewed by Deepak Krishnan
BILL BAKER is a legend on ice. He is best known for being a part of the “Miracle on Ice “victory for the Team USA in the 1980 Winter Olympics of Lake Placid NY. He was so crucial to the winning games at that event that his jersey and hockey stick are on display at the Smithsonian museum in Washington DC. The Olympian then turned his athleticism and talent to professional ice hockey, playing in the National Hockey league for teams such as the Montreal Canadiens, Colorado Rockies, St Louis Blues and New York Rangers. The saga of their Olympic victory has been subject of Hollywood movies and shows. Over 100 professional hockey games later, Dr. Baker decided to pursue his real passion of Oral and Maxillofacial Surgery. He is now retired from both professions and found some time to introspect.
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HOW WAS IT BEING A YOUNG LAD PLAYING HOCKEY TO MAKE IT TO THE OLYMPICS AND WIN THE GOLD MEDAL? When I was growing up, I was just playing all sports for fun. I played football, hockey, and baseball in high school. Obviously I gravitated to hockey as I got older as it became evident I was better at it. I would daydream about playing in the NHL or being in the Olympics but to be honest I was only worried about making my high school team and possibly getting a college scholarship! WHAT LIFE LESSONS DID YOU TAKE AWAY FROM BEING AN OLYMPIAN? I think I learned a lot of life lessons just by playing all 3 sports all the way up and not necessarily from the Olympics .I think athletics in general teaches one many things about themselves and what it takes to be successful. I learned early on that I was going to have to outwork the next guy - this was something I've always subscribed to, especially in my OMS practice. YOU COULD HAVE TAKEN YOUR LIFE IN ANY DIRECTION YOU WANTED TO, AFTER THAT KIND OF A START. WHY OMS? Since about high school I had a desire to go into dentistry and hopefully OMS- I think it was the facial/ dental trauma that I saw when I was younger. As I was being recruited for college, I really started to focus on that. I became good friends with Dr Norm Holte, our team OMS and that just cemented my desire to try to do it. Also the ability to help people with dentofacial deformities really intrigued me!
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DO THE WORLDS OF ICE HOCKEY AND OMS INTERJECT PHILOSOPHICALLY ANYWHERE? As I alluded to before, I feel I learned a tremendous amount through sports that helped me in my practice and still helps me today. I was fortunate to have some very good coaches (especially Herb Brooks) and staff OMS (especially Dr. Jim Swift) that were very tough but fair. I learned early on the importance of dedication, time management, and most of all preparation in both sports and OMS. As an example, Coach Brooks was the first person who told our team to visualize pregame what we were supposed to do on our breakouts, defensive zone coverage, etc. I would walk through it mentally. This carried over into my OMS training and I would routinely do this for orthognathic cases. I felt more prepared that way. DOES WINNING MATTER AT THE END? I feel that in the end winning absolutely matters, I'm not a fan of "participation medals". I think athletes (or people in general) need to learn how to become better and learn from their mistakes when they lose. It gives you the drive to improve. I know the disappointment I felt when our team lost was a huge motivator to improve so we didn't have that feeling again! â–
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Missions
CRANIOFACIAL CENTRE NEPAL
By Sunil Sah Nepal
THE CRANIOFACIAL CENTRE NEPAL was established in August 2017. It was the vision of Sunil Sah, Consultant Maxillofacial Surgeon at Pinderfields Hospital in the UK, originally from Nepal 22 years ago and who did his medical and surgical training in the UK. Seeing the devastation after the earthquake in 2015, he decided to return to Kathmandu with a group of UK maxillofacial surgeons to help manage the craniomaxillofacial trauma. However, as time went on, he realised there was a great need to help in and around Janakpur, identified as one of the two poorest parts of the country.
for people who have been born with craniofacial abnormalities who cannot access the surgery they need. There is no formal provision or designated centre for cleft and craniofacial anomalies in south east of Nepal. Some uncoordinated surgery is carried out by untrained private practitioners, and for a few fortunate people, there may be access to services in other countries. For most this surgery
Our vision for craniofacial centre is to improve the lives of, and create equal opportunities 20 iaoms.org
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is not accessible, and they live with deformities affecting facial appearance, hearing, speech and psychosocial problems. This usually means not being able to participate in the normal activities of life. Often, schooling is not possible because the family do not wish to be further stigmatised or for their child to be traumatised by public appearance. It is important that a facility such as the Craniofacial Centre is established to reduce the burden of disease – a burden on the patient, their family and the state.
The aim is to establish a first class fully comprehensive and accessible centre for the treatment of people with cleft and craniofacial anomalies and associated problems. As well as providing training to the local medical and allied medical professionals. Treatment will mean the regeneration of the lives of people who have been treated, their employment status and their income contribution to their families and to the economy and community. The opportunity for children to go on to education and live normal lives will be greatly enhanced.
Our vision for craniofacial centre is to improve the lives of, and create equal opportunities for people who have been born with craniofacial abnormalities who cannot access the surgery they need. This lack of care was quantified in the Lancet Commission on Global Surgery (2015), and states that five billion people do not have access to safe, affordable surgical and anaesthesia care when needed. Access is worst in low-income and lowermiddle-income countries (LMIC), where nine out of ten people cannot access basic surgical care. Failure to access surgical and anaesthetic facilities in LMIC’s represents a major burden on the patient, the family and the state. October 2019
We had managed to secure generous funding from the Future Faces, a UK charity, enough to support the staff of two surgeons, two dentists, three nurses and admin staff, as well as consumables. The centre was well equipped in outpatients and In-patients. Having identified what was required to upgrade the operating theatre, we received a further significant donation from Future Faces to bring the facility up to the highest possible standards. This enabled some iaoms.org 21
simple but essential surgery to be performed in safe surroundings. A programme of ‘camps’ was established, visiting on a weekly basis more distant and often very rural communities, with staff from the centre being able to examine and sometimes treat many people, check for oral cancer, identify problems that needed referral to the centre and carry out some educational projects. The centre was visited in October/November 2018 by a group of Spanish doctors and a Kiwi, and Tony Markus. A meeting was held in Kathmandu with the Federal Secretary of Health, the regional DFID UK Aid Health Advisor and the former Home Minister and Founder Chairman of Janakpur University. Allimportant and, as we came to realise, successful in support of our aims. The centre confirmed an amazing upgrade of the operating theatre, with a new state of the art anaesthetic machine, two new operating tables, one electric and one hydraulic, piped gases, several monitors and excellent suction, brilliant lighting, and significant advances made on improving the recovery room, staff changing facilities and scrub and sluice areas. We see several patients daily with clefts varying in age from 3 months to untreated or poorly treated adults, Treacher-Collins syndrome with bilateral microtia in need of hearing aids (no chance of cochlear implants), severe burns scarring, patients with early signs of oral malignancies and untreated facial fractures. In aid of diagnosis and treatment, a CT scan would be a valuable investment for the centre. A conference is held every year; Attended by about 100 delegates around the country, with the headline ‘Safe High Quality Accessible Sustainable Surgery’. There are several excellent talks from visiting surgeons and round table discussions afterwards. 22 iaoms.org
Concurrently, we are able to operate on some of the patients already seen. However, although one of the young local surgeons had been to Hyderabad, it was clear that both he and the anaesthetist needed further intensive training if they were to become independent and safe operators. From a training and sustainability point of view, we have developed a ‘rota’ of visiting surgeons, mainly from the UK, but also from Spain, New Zealand, and India. This will ensure the local personnel will get regular training and also make the centre appealing to others interested in its work, including UK medical students wishing to spend their electives in a developing service and trainees across several specialities. WEEKLY CAMP IN PROVINCE 2 The camps are now on a regular and firm footing, covering the entire province. On each, a surgeon, a dentist, a nurse and our liaison officer /social worker spend a day, or if they are at a greater distance form Janakpur, two days, working. We have developed a simple database, which collects demographic data, records activities carried out and identifies people who need more specialised treatment at the centre. We ideally need a mobile dental clinic to simplify the travels and travails. We need to say a special thank to Professor Ram Kewal Shah for making the establishment of the centre possible by sharing his facilities and land. Also for his guidance, and as a consummate medical politician who seems to know everybody who matters, for introducing us to the provincial and national policy makers; which is so important if we are to ensure the long term viability of the centre. Thanks also to Professor Tony Markus, not only for his vision but also for his determination to help people in a very poor part of the world find facilities to care for them. ■ October 2019
October 2019
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icoms2021glasgow.com
From Proust to Pivot
AN APPARENTLY INNOCENT QUESTIONNAIRE FOR ORAL AND MAXILLOFACIAL SURGEONS
Nardi Casap-Caspi The Hebrew University-Hadassah School of Dental Medicine. Jerusalem
My surgical team at the OR.
What is your favorite word? Dream.
What sound or noise do you love? The beginning of the #20 Piano Concert by Mozart.
What is your least favorite word? You can’t do that.
What sound or noise do you hate? The phone call at 4:00 a.m. calling me to the OR.
What is your favorite drug? Familly, Music, Work.
What is your favorite curse word? None.
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October 2019
The Israeli delegation to the joint meeting of the Israeli and the German associations in Frankfurt 2019.
Who would you like to see on a new banknote? The Israeli BERESHEET spaceship – the smallest (2 meters in diameter, 585 kg) and cheapest ever spaceship to reach the moon. What profession other than your own would you not like to attempt? CEO of a hospital. So close to the OR and yet sooooo far away! If you were reincarnated as some other plant or animal, what would it be? An owl. If Heaven exists, what would you like to hear God say when you arrive at the Pearly Gates? I know you did your best. What is your idea of perfect happiness? Spending quality time with my family, and watching my pupils fulfill themselves.
What do you consider the most overrated virtue? Politically correct. On what occasion do you lie? The prices of my gadgets (I usually downprice). What do you most dislike about your appearance? A tired look. Which living person do you most despise? Those of take advantage of others. What is the quality you most like in a man? Honesty and loyalty. What is the quality you most like in a woman? Honesty and loyalty. Which words or phrases do you most overuse? Practice makes perfect.
What is your greatest fear? Losing my ability to think. What is the trait you most deplore in yourself? I generally try to make peace with myself. What is the trait you most deplore in others? Disloyalty. Which living person do you most admire? My parents. hat is your greatest extravagance? W Gadgets. hat is your current state of mind? W Building a better world for our children.
My dear family.
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My ward team.
What or who is the greatest love of your life? My wife Anna and my kids Adel and Daniel.
What is your most marked characteristic? Optimism.
When and where were you happiest? My wedding and the births of my children.
What do you most value in your friends? Loyalty.
Which talent would you most like to have? Playing the piano.
Who are your favorite writers? Meir Shalev, Yaji Koshinski.
If you could change one thing about yourself, what would it be? Not to have to sleep. In 24 hours a day we can do much more than in 20 hours.
Who is your hero of fiction? Korben Dallas, the 5th element.
What do you consider your greatest achievement? My students and residents success, My patient’s satisfaction. If you were to die and come back as a person or a thing, what would it be? Myself. Where would you most like to live? In my house in Jerusalem. What is your most treasured possession? Family pictures – there were times that we had actual photo albums and not just photo folders in our cellphones. What do you regard as the lowest depth of misery? Losing hope. What is your favorite occupation? Oral and Maxillofacial Surgery.
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Which historical figure do you most identify with? Janusz Korczak. Who are your heroes in real life? My teachers. What are your favorite names? Anna, Adel, Daniel. What is it that you most dislike? Liars. What is your greatest regret? No regrets. How would you like to die? In the OR. What is your motto? "He who cares for days- Sows wheat He who cares for years- plants trees He who cares for generations- educate people" (Janusz Korczak). ■
October 2019
FOUNDATION CHAIRMAN REPORT
EXPANDING THE GLOBAL IMPACT CAMPAIGN THE response we have received since publicly launching the Global Impact Campaign at the ICOMS this year has been remarkable. Both our members and corporate stakeholders are supporting this initiative at unprecedented levels, demonstrating a deep commitment to the IAOMS Foundation and our vision to enrich the OMFS specialty in all regions of the world. As the Campaign nears the $2,000,000 milestone toward our minimum fundraising goal of $2,500,000, we are expanding our efforts and transitioning to the next phase of activity which will focus on further developing our global network of leaders. From the beginning, we have witnessed veteran members answer the call and new leaders emerge, serving as ambassadors of the Foundation on the Campaign Steering Committee (CSC). This leadership team was assembled with the purpose of advocating on behalf of the Foundation and guiding the effort to success. As we look to the future of the Campaign, recruiting additional leaders and expanding our global volunteer infrastructure is ever-important. Leadership forged through this extraordinary endeavor will have a lasting impact. One of the Foundation’s goals through the Campaign is to further unify the global community of oral and maxillofacial surgeons. The strength of our specialty was evident at the recent AAOMS Annual Meeting in Boston, as we celebrated the second annual IAOMS/AAOMS International Reception. It was a truly memorable event and a reflection of how strong we are together. We appreciate all of the support and positivity we have received so far and look forward to continuing to drive this special effort forward. There is a variety of opportunities to get involved and I strongly encourage you to explore ways you can help. If you are interested in learning more about the Global Impact Campaign and ways you can participate, email Tyler Eble, Campaign Director, at foundation@iaoms.org. On behalf of the IAOMS Foundation and the Global Impact Campaign leadership team, thank you for helping to advance our specialty! ■Larry W. Nissen IAOMS Foundation Chairman
October 2019
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So, you want to work...
...IN SWITZERLAND By Raul Verdeja Friburg. Switzerland
OBJECTIVES OF THE SWISS SOCIETY OF ORAL AND MAXILLOFACIAL SURGERY The SSOMFS is a specialist association for oral and maxillofacial surgeons in Switzerland. It was founded on June 8, 1973 as the “SGKG” (Swiss Society of Maxillofacial Surgery) in Basel and is an association within the premises of Art. 60ff of the Swiss Civil Code. Since 2010, the society has been officially referred to as the “Swiss Society for Oral and Maxillofacial Surgery” (similarly to the specialist societies in Germany and Austria).
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DEVELOPMENT OF A SPECIALIST SOCIETY IN SWITZERLAND Hugo Obwegeser in Zurich and Bernd Spiessl in Basel, had a great influence on the development of this field in Switzerland. Despite the competition between their clinics - both had - a common goal, which had already been achieved in German-speaking neighbouring countries: to establish the field of maxillofacial surgery as a surgical speciality discipline based on a dual qualification. At the inaugural meeting of the Swiss Society of Oral and Maxillofacial Surgery (SGKG), held on June 8, 1973 in Basel, it was therefore stated in the Articles of Incorporation that only persons who fulfilled the conditions of dual qualification would be admitted as full members.
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of the 20th century. At that time surgeons and dentists recognised that they required knowledge of each other's field for complex reconstructions of the facial skull and the restoration of chewing, speech, swallowing and respiratory functions of seriously injured patients. Modern Oral and Maxillofacial Surgery is a very demanding field that is rapidly opening up to new treatment options in the head and neck area as a result of rapid advances in high technology (3D and 4D imaging, navigation, tissue engineering among others). Professional qualification as a specialist for Oral and Maxillofacial Surgery in Switzerland, as is the case in many other European countries, a dual qualification in human and dental medicine is required. Basic surgical examinations need to be completed before continuing with further training. As a rule, the entire course of training up to specialist level, takes about 15 years (9 years study of human and dental medicine, 2 years surgery/anaesthesia/intensive care, 4 years OMFS surgery training).
The purpose of the society is to unite Swiss oral and maxillofacial surgeons to work together on development and progress in their field. It also deals with issues of professional and political interest. The SSOMFS specialist society regularly organises advanced training in the field of oral and maxillofacial surgery for its members and guests. The annual convention of the SSOMFS is held at annually changing locations, as a specialist congress with national and international speakers and guests. Oral and Maxillofacial Surgery is a relatively young specialist discipline that grew out of experience with serious facial injuries in the two world wars
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SECURE THE FUTURE “It’s not dual study, but the applied foundations of modern surgery, which will ensure the quality and continuity of maxillofacial surgery”, explained visionary Bernd Spiessl 20 years ago. And it is also the basis for a modern route to a successful future. A demanding field of expertise that is rapidly opening up to new treatment options in the head and neck area due to rapid advances in high technology. In view of the major challenges in this field, the SGKG now has the task of strengthening synergies with the related specialist societies of neurosurgery, ENT, plastic surgery and dental societies, and networking the interdisciplinary competences of these fields for the benefit of patients. Due to the close proximity of the organ systems of the head and neck, which are often combined in diseases and injuries, interdisciplinary cooperation is an essential element of our field of expertise and requires an integrative approach that demands a high level of social competence. ■
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NextGen
Our NextGen in 2019, MORE FOR MORE By Alfred Lau Hong Kong
IT HAS BEEN more than two years ago since we established the NextGen council in 2017 during the ICOMS in Hong Kong. We have worked closely in a regular basis, created our webpage and Facebook Group, did various promotions, education and was involved in the ICOMS in Rio. Moreover, we have also designed a new logo and re-defined NextGen in IAOMS. I am very honored to work with the NextGen council, with this group of smart young people from all over the world, under the guidance of Dr Gabrielle Millesi from the IAOMS Board. We are very proud to share our promising achievements so far! 30 iaoms.org
We have a lot of optimistic plans in the future to make NextGen more exciting. The first and foremost is to expand our NextGen council. We have appointed 13 more councilors at the NextGen business meeting during the ICOMS in Rio. The basic structure of the council is the same as we aim to keep a balanced number of representatives from each region so that they can further liaise with their regional associations. However we have further subdivided the group into different committees so that we can effectively work on different things separately in addition to working within the group. I would like to take this opportunity to introduce them individually. October 2019
THE “NEXTGEN NEWS” COMMITTEE
DR SALVATORE TORE CRIMI (ITALY)
DR ZEYNEP BURCIN GONEN (TURKEY)
DR STEFANIE VAN DEN BOSCH (NETHERLANDS)
This group serves to inform news and announcements in a periodic manner through our webpage and related social media. It aims to connect and gather young and new members as well as promote our group to more people.
PROMOTION AND MARKETING COMMITTEE
DR RODOLFO ASENSIO (GUATEMALA)
DR ERI (UMEMURA) KUBOTA (JAPAN)
DR PRAVEEN GANESH (INDIA)
This group will mainly work together to promote NextGen to potentially new members, and hopefully to increase the number of IAOMS members especially in NextGen. This will be mainly through various social media. Additionally, they will help organize presentations used to introduce NextGen in various possible occasions, such as at different scientific meetings.
EDUCATION COMMITTEE
DR JAMES KIRIMI (KENYA)
DR URIEL GRUMBERG (ARGENTINA)
DR DIPESH RAO (INDIA)
This group will explore interesting perspectives for young and new members to learn via different educational materials and medium. This can range from lectures and seminars to organizing webinars, producing podcasts, building up archives of educational materials.
INFORMATION TECHNOLOGY COMMITTEE
DR PAYAM AFZALI (USA)
NISSIA ANANDA (INDONESIA)
This committee will be mainly responsible for maintaining the website of NextGen. This includes arousing and supporting conversations and various discussions in the Chatroom. Our aim is to maintain an active chatroom. This will be an exciting thing to give a try! October 2019
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FACE TO FACE AND PUBLICATION COMMITTEE Face to face is one of the most important publications for IAOMS. NextGen will have the opportunity to a designated column every issue. Topics will be mostly covering about NextGen or those related to young surgeons. Let us know if you are interested to contribute to an article. Everyone is welcome!
MONTHLY QUIZ COMMITTEE
DR ANDREW READ-FULLER (USA)
ABIR BEN OUAGHREM (TUNISIA)
DR ZHONGLONG EDDIE LIU (CHINA)
Monthly quizzes have been posted on the website. It serves as an enjoying game for readers to assess themselves on the relevant articles. The committee will be responsible to make up these quizzes that are all related to the articles in IJOMS.
COMPETITION AND GAMES COMMITTEE
DR NATALIA ALVAREZ (ARGENTINA)
DR LILIS ISKANDAR (UNITED KINGDOM)
DR WEBER HUANG (AUSTRALIA)
This is an exciting group who will innovate ideas for games and various kinds of competition. Some examples are: article competition, design competition, photography competition etc. Stay tuned and join us!
FELLOWSHIP AND SCHOLARSHIP COMMITTEE
DR MARTIN RACHWALSKI (GERMANY)
DR BENJAMIN FU (AUSTRALIA)
DR ANA OTERO RICO (SPAIN)
DR WAYNE MANANA (ZIMBABWE)
Organizing visiting programs and fellowship programs is one of the most important activities of the IAOMS foundation. This group will work on finding different feasible training centers from all around the world so more NextGen could participate in. Apply for yours today!
You can see how diversify we are, we are trying to do everything to suit your needs as the leaders of NextGen IAOMS. Recently we have also launch the NextGen Journal Club, stay tuned on out NextGen 32 iaoms.org
Channel. Hope we could see you all in person one day, how about the orthognathic conference in Vienna in April 2020? and why not? Let’s join us, Let’s NextGen! ■ October 2019
NextGen
NETWORKING IN CONFERENCES. THE ICOMS EXAMPLE By Payam Afzali Ann Arbor, MI (USA)
LET’S FACE IT, one of the greatest and most gratifying privileges to be an oral and maxillofacial surgeon is attending conferences; seeing our best old friends from another lifetime as well as our former colleagues. Naturally for all the conferences we attend we first look at the scientific program and speakers, which is very important. But most of us also take a little peak at the social events. I have been privileged to have participated in many different conferences and social events around the world, but without a doubt, nothing compares to the ICOMS social events. What makes it different is the exact great reason that makes the organization so different, coming together despite the beautiful diversity we all have through our day to day living. As much as we all love to travel around the world and socialize, how incredible would it be to experience all those experiences and countries from all around the world on one unique stage, at one party, with similar professional minds, but a different social component. The dances, the glamour is one thing but the wholehearted conversations October 2019
and also learning from a different perspective not only makes the social events so enjoyable, but also very educational. Speaking to the greatest maxillofacial surgeons in the world outside the classroom or operating theatre over a drink, makes it such a different experience on its own. Don’t quite understand it, but the vibe is so much more progressive, more exciting, more social and educational. The previous generation giving their legacy and experiences so the next generation an hopefully adapt and expand on it. I’m humbly involved with many organizations and events, but I will honestly tell you that the social events at ICOMS are first to none. If you haven’t experienced it, please join us for the most diverse, organized and educational social night. You will understand and I’m sure feel the same excitement as I do. ■ iaoms.org 33
Women in IAOMS
A LADY ORAL AND MAXILLOFACIAL SURGEON FROM SUDAN By Amel Eltayeb Assistant professor of oral and maxillofacial surgery, Faculty of Dentistry, Nile University-Sudan
ORAl and maxillofacial surgery has always been my passion that has grown parallel with my skill and experience. Each time I operate on a patient, I remember that oral and maxillofacial surgery is a part of their journey to a better self. I am an oral and maxillofacial surgeon (OMFS) at Hajsafi hospital in the city of Khartoum, the capital of Sudan and an assistant professor of oral and maxillofacial surgery at Nile University, Faculty of Dentistry. My journey started when I graduated from faculty of Dentistry, University of Khartoum in 2009. Immediately following the internship program, I started the residency program of oral and maxillofacial surgery at Sudan Medical Specialization Board and got my degree in 2016. I got the memberships of Faculty of Dentistry of Royal College of Surgeons, in Ireland and Glasgow in 2015 and two years later, I got the fellowship in oral surgery and oral medicine from Royal College of Surgeons, Ireland. 34 iaoms.org
October 2019
I practiced oral and maxillofacial surgery at Khartoum Teaching Dental Hospital which is the main tertiary OMS hospital in Sudan for one year. I was exploring surgeries by operated on trauma, oncology, oral medicine and oral surgery, congenital malformations, TMJ disorders and salivary glands surgeries. At the end of that year I found my real interest which happened to be the craniofacial surgery including orthognathic surgery, cleft lip and palate and congenital malformations. I started looking for international opportunities for craniofacial surgery where I found the IAOMS fellowship in cleft lip and palate and craniofacial surgery. Fortunately, I received the IAOMS fellowship 2017-2018 where I spent one year in India (6 months in Bangalore and 6 months in Hyderabad). In 2019, I obtained another fellowship in Oral and maxillofacial surgery in Universitats Klinikum-Freiburg, Germany where my main focus was on Orthognathic surgery and regional plastic surgery. When I finished the IAOMS fellowship and came back to Sudan, I didn’t have the advantage of working in a big unit with may senior consultants or more experienced surgeons. The plan of expanding the maxillofacial surgery practice in Sudan to include two more hospitals was already established. As a result, I was attached to a new hospital with two other colleagues where I had to take on the responsibility to initiate a cleft/maxillofacial unit from scratch. It wasn’t that easy at the beginning, since all my practice was somehow under some supervision, but I was so determined to succeed despite all the obstacles. My concept in life is whenever manifesting, always be positive, say it like it’s already done and the most important thing is “if it’s real in your mind, it will be real in the physical”. I aspire for this newly established unit to be a center of excellence for cleft lip/ palate and craniofacial surgery in the near future. Women have been in surgical practice throughout history. However, despite the fact that males and females are almost equally practicing medicine now, men still outnumber women in surgical practice, female surgeons are less than one third of surgeons October 2019
My concept in life is whenever manifesting, always be positive, say it like it’s already done and the most important thing is “if it’s real in your mind, it will be real in the physical”.
globally. One of the reasons is the perception that the surgical lifestyle is not compatible with the disproportional burden that women bear of caregiving responsibilities. Many women in my community are likely to be discouraged from the surgery by their peers, partners and family. As a female surgeon, I was faced with some situations where some of my colleagues and even patients questioned my ability to perform major surgeries like neck dissection, parotid surgeries and cleft surgeries. I used to think iaoms.org 35
I had to prove myself to others in my practice, but then I realized that I was just fighting my own insecurities and fears which are not real. They are just the product of our society. As women, we have power and strength just by being a woman. A role model in your life is always good idea to inspire yourself to achieve more in life. I used to look for inspiration in different women and what they did until I met Dr. Gabriele Milesi at ICOMS Hong
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Kong-2017 and I was so impressed by her career and how she used her power and influence to educate and develop the young OMS generations, then I realized I have just met my role model. Currently I am practicing oral and maxillofacial surgery in Sudan and trying my best to provide the best service I can offer to my patients despite the limited facilities. Additionally, one of my priorities is to pass all the humble knowledge and experience to my colleagues and residents. â–
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A message from the NEW PRESIDENT OF AFAOMS By Imad Elimairi Sudan
HOME of the River Nile, Shaka Zulu and these days, some incredibly motivated, smart and energetic, African oral and maxillofacial surgeons who refuse to dwell on our past and are furiously moving ahead! Africa is here... and you better believe it! From Fibrous Dysplasia to Orbital reconstruction, Aspergillosis to Pychnodysostosis, Eagle syndrome to Noonan syndrome, Africa has seen more and is now ready to give more to anyone who is hungry for the knowledge that our walking/talking atlas of oral and maxillofacial pathology presents. Our clinical case mix is anything but trivial, often challenging both experienced senior surgeons and curious, bright postgraduate students just the same. That would be the African maxillofacial way. October 2019
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We are at a crossroads of where our fascination is intersecting with our passion and our zeal to explore, to examine and heal. The philosophy of the African OMS has shifted from providing simply the urgent basic and necessary treatments, to pioneering a globally desirable pathway of science in our specialty and mentoring the next generation of African oral and maxillofacial surgeons to a paradigm much different than what the previous generations experienced. Our goals have evolved from providing the basic (financially resource limited) treatments, to delivering Michelin star care, all over our continent. It is no wonder that our current preparations for the 7th international Pan African OMS conference in Seychelles has been met with an unprecedented interest and that the event appears to be poised to be 38 iaoms.org
a much greater success than its recent predecessor meetings, including but not limited to, South Africa, Nigeria, Kenya, Egypt and Sudan. In the recent past, African OMS education has focused on topic based workshops in areas such as advanced trauma, surgical oncology and facial reconstruction, geriatric rehabilitation and microvascular surgery. These workshops have been exceptionally efficient in their content delivery and have been met with tremendous recipient gratitude. Africa has seen three-times more OMS education in the last few years than it has in all of the last century. New formats of education and technological platforms for the same - whether it is virtual or hands on training, web-based learning, continued professional October 2019
Africa is here.... It is brimming with curiosity for knowledge and has big aspirations.
development, clinical focus sessions and of course, research, have all paved new paths for improving the knowledge and skill of the African OMS and given them a world stage in return to exhibit their talent. Peer reviewed journals based in Africa have exploded on to a previously scanty space - the topics published are strong, relevant, non-repetitive and the message clear - Africa is not behind anyone to teach us the best in OMS. Training pathways have evolved immensely. They are now widespread, but more uniform and unified. Curricula across the continent have been standardized and calibrated against each other, in order to meet the best possible form of successful vision and meet the distinct needs of the African patient. More and more OMFS surgeons are seeking international board certification with their African training, and succeeding, highlighting and validating the strength of our OMS training programs globally. At the end of the day, our training programs are also fulfilling to the trainee and their families, providing not only a meaningful and strong source of income but also a respectable professional support system. We have seen our OMS trainees have a better quality of life, starting families earlier, all while continuing with their African OMS dream. For those that do wish to continue their education elsewhere, opportunities are also endless for OMS graduates from Africa. Concepts of multidisciplinary care, evidence based approaches, clinical audits, integrity in research, international networking and national partnership have all become the hallmarks of African OMS. October 2019
Ultimately, it is our patients in Africa who now have access to the best diagnostic modalities, treatment (both surgical and medical) and also have the opportunity to be included in the top randomized controlled trials and class 1 evidence research. Indeed, it is prudent to mention that OMS in Africa is a segment of a larger multidisciplinary collaboration with sister specialties - oral pathology and oral medicine, a feature unique to African OMS in recent years. Africa is here and you better believe it. It is brimming with curiosity for knowledge and has big aspirations. As President of AfAOMS I am hoping to make African OMS one step closer to fulfilling those aspirations. â– iaoms.org 39
THE PAST, PRESENT AND FUTURE of the International Conferences on Oral and Maxillofacial Surgery By Daniel Laskin USA
ON A RECENT long flight home from Rio de Janiero after the 24th International Conference on Oral and Maxillofacial Surgery (ICOMS), I began to reminisce about my long involvement with the IAOMS and the various International Conferences I had attended. It was hard to believe that I started at the 3rd ICOMS in New York City in 1968 and since that time I have been at all except the conference in Shanghai in 2009 – 21 in all. I began to recall some of the great personal experiences I had had at various times at these conferences. Of course, there was the conference in Dublin (1980) when I first became a member of the Executive Committee and the conference in Vancouver in 1986 at which I was the president. But there were other interesting situations that also came to mind. For example, it had been the policy of IAOMS to provide the organizing national society with an initial loan to help it in the planning stages and this was to be repaid after the conference. Following a successful meeting in Buenos Aires in 1992, as the Secretary General of IAOMS I was asked by the organizing chairman if I would like to receive repayment then or have it sent to our headquarters. Recalling the old adage about “a bird in the hand
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is worth two in the bush” I took the cash back with me in my attaché case. Looking back, I am glad that I made it safely through customs without being arrested as a potential drug dealer. There was also the time of the conference in Kyoto, Japan (1997) when at an outdoor opening ceremony there was a dazzling fireworks display. I didn’t see skyrockets – I saw dollars burning up in sky. After all, as Secretary General I was concerned about the financial state of our Association, which depended on the profits of the
ICOMS Opening Budapest 1995.
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Walker, Coob, Laskin. Budapest 1995
ICOMS. No need to worry. The meeting was both a great social and financial success. As time passed, I began to think about more serious things. How have things changed with the ICOMS over the years? Fortunately, many of the highlights have remained the same. The scientific program has greatly expanded but is still of high quality, with expert clinicians speaking about the latest advancements in the field as well as sharing their experiences in improving the diagnosis and treatment of the more common conditions that we frequently encounter. There is also still the opportunity for those not on the major programs to give brief talks in the various free paper sessions or to present an electronic poster (no longer the need to transport log tubes on an airplane). However, there are now preconference courses and hands-on workshops that increase the available educational opportunities. The social programs are still an important part of the conference and a wonderful time to meet and greet old friends and to make new ones. The opening ceremonies continue to acquaint attendees with the highlights of the host nation and the rollcall of nations remains an opportunity to recognize the attendees from the various countries and for them to express their national pride. But things have also changed over the years. Certainly, oral and maxillofacial surgeons from more and more nations continue to participate, particularly from less developed areas, so that now IAOMS is truly an international organization. There were 82 nations represented in 2019. The entire scope of our specialty is now also represented on the program so that everything from dentoalveolar surgery to oral cancer to face transplantation is being discussed. What was most gratifying was seeing the large number of young
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.
nos Aires 1992.
D. Laskin, M Bell (New Zealand) Bue
oral and maxillofacial surgeons and trainees who now attend the ICOMS. They represent the future of our specialty and one could sense their hunger to learn as much as possible. Providing such opportunities is one of the major goals of the ICOMS. In this regard, another major change has been the use of the ICOMS for initiating fund-raising campaigns and to obtain contributions. As an international association, one of its major goals is to provide didactic and clinical educational experiences for the membership, with particular emphasis on those areas with greater need and less opportunity. But such efforts require funding as well as volunteer participation. The ICOMS provides an excellent opportunity to provide detailed information about these ongoing activities to a wide group of attendees, with the hope that they will not only contribute, but also that they will become ambassadors who return home and relay the message of need to their colleagues. My final thoughts, as the plane was about to land, were about what changes the future may hold for our international conferences. Travel to an international conference is more difficult than to a national or regional meeting. However, various means of electronic telecommunication now make it possible for surgeons off-site to present talks or surgical demonstrations to a conference audience. Likewise, it is also possible for parts of the conference to be transmitted to distant sites for those who may be unable to attend in person. Video recordings of the various symposia is another way in which important educational information can be preserved and disseminated. I am confident that in the future, as in the past, positive changes in the ICOMS will continue to occur. As the saying goes, “Nothing remains constant except change itself”. ■
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Copy Me ARTHROSCOPY OF THE TMJ Arthroscopy was first adapted to the temporomandibular joint (TMJ) by Onishi in the late 70s. Since then, it has been an exclusive skill of Oral and Maxillofacial surgeons. This minimally invasive procedure has a high rate of success when performed in the correct patients, improving pain, decreasing joint noises and increasing range of motion in up to 85% of patients with a minimal and quick recovery. Multidisciplinary management with additional physical therapy, splints and restriction of diet is mandatory along with this procedure for maximizing outcomes.
RAFAEL MARTIN-GRANIZO Hospital Clinico San Carlos, Madrid. Spain
The procedure can be simply done for lysis & lavage under direct visualization of the joint or as a more complex operative technique, where many therapeutic interventions can be performed arthroscopically within this small joint. These procedures include disc repositioning and discopexy, lysis of adherences, electrocoagulation of synovitis, biopsy and intraarticular injection of platelet rich plasma (PRP), steroids, hyaluronic acid or stem cells. These advanced techniques may require a steep learning curve as well as an advanced instrumentation. Here we briefly present the basic procedure with some common findings and the way to treat them.
1 Arthroscopy of the TMJ needs a specific designed instrumentation that include cannulas, trocars and lenses. We recommend 1.9 mm and 30ยบ optics for adequate vision. Also, a standard arthroscope with light source, video-printer and screen is mandatory.
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Patient with a TMJ disorder prepared for arthroscopy of the right TMJ. Notice nasal intubation, draping and drawing the puncture sites down the tragus-external canthal line: posterior (10 mm anterior, 2 mm inferior), middle for drainage (20 mm anterior, 7 mm inferior) and anterior for triangulation (30 mm anterior and 10 mm inferior).
Arthroscopy of a normal right TMJ in the posterior recess of the upper compartment. Notice the whiteness and brightness of the tissues with low vascularity and a normal fossa-disc relationship (100% roofing); A, anterior; P, posterior; d, disc; rt, retro-discal tissue; e, eminence.
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Arthroscopy of the right TMJ with lysis & lavage. The arthroscope is in the posterior portal pointing forward with closed mouth as it is placed in the anterior recess of the upper compartment. Notice the drainage green 22G needle in the middle portal. A continuous lavage is essential for a proper view.
Arthroscopy of a pathologic right TMJ. Notice the redness and inflammation of the tissues with high vascularity (synovitis II) and an abnormal fossadisc relationship (0% roofing). This corresponds to a TMJ dysfunction Wilkes III stage.
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7 Four specific basic instruments for operative arthroscopy. From above to below: calibrated scalpel (to detach and cut tissues), hooked probe (to palpate tissues and isolate adhesions), straight probe (to pull and maintain disc back) and basket forceps (for biopsy and suture grasping).
Triangulation technique for operative arthroscopy. This is the most critical part for operative and needs ongoing training. The second working portal is inserted in the anterior recess perpendicular to the first cannula under direct view. Notice the light of the arthroscope visible through the skin.
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View of the hooked probe to test the inflammation of the anterior capsule in the right side arthroscopy. Note the white disc below. Synovitis is the most common pathologic finding inside the joint. It can be divided in four stages and is directly associated with overloading and pain.
Manipulating the straight probe through the working anterior portal to pull disc back after a standard pterygoid myotomy.
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Right side arthroscopy. Adherence isolated with a hooked probe in the anterior recess before cutting it with RF; note the white bended disc below. They are casual findings, may have vessels inside and can impair normal disc motion.
Left side arthroscopy. Sequence of coagulation of a synovitis grade II with radiofrequency (RF). This device is very useful in operative arthroscopy and can work in a liquid medium.
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Sequence of images in a case of chronic disc perforation in a right side joint. Note the probe touching the soft edges of the perforation as well as the deformed fibrocartilage covering the condylar head. There is no way to repair the disc through arthroscopy and open surgery is mandatory in some cases.
13 Sequence for arthroscopic discopexy with resorbable pins (1.5 mm width x 16 mm length): a, inserting a third cannula; b, cannula with double window in place retaining disc in position in the posterior band; c, drilling through disc and condylar head; d, hole after drill removal; e, tip of the resorbable transparent pin in place; f, insertion of the pin with an impactor and hammer; g, pin in place; h, checking disc retention with the pin. October 2019
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Father to Son
CONTINUING A LEGACY
IN ORAL & MAXILLOFACIAL SURGERY By Gianpaolo Tartaro Campania. Italy
MY NAME is Gianpaolo Tartaro. I am a Professor of Maxillofacial Surgery at the University of Campania. I am also the Director of the Department of Craniomaxillofacial Surgery of the same hospital and Director of its graduate school. But today I am writing this paper because I am the son of Sergio Tartaro, who is now 83 years old and was the only true maxillofacial surgery surgeon in Naples, Italy for about 50 years. In the 70s, he understood that he had to keep current and be updated and that it was not enough to be a good dentist to be a good oral surgeon. He started working with ENTs and general surgeons who taught him to know the neck and the oncological surgery techniques of that time. It was the era in which the defects were fixed in the simplest way either by amputating and hardly replacing the defect.
No matter how many times you fall. What matters is how quickly you get back on your feet.
I started to discover the ability of my father to be human and at the same time to be able to make clever decisions. Intuitively, he pushed me to have solid foundations in aesthetic surgery. It was the 90s - a time when plastic surgery was expanding in Italy. So, I had to concentrate on the bones and soft tissues of face but a sixth sense and confidence in him led me to believe he was right in his orientation.
My father had no medical ancestors. As a matter of fact, his passion was initially restrained by my grandparents who wanted him to continue my grandfather’s career as an accountant. But in the end he succeeded and despite many hurdles, he began his career as a dentist. His passion to push the limits of his knowledge was a natural conduit for his evolution as a Maxillofacial Surgeon. When I thought about what I would do when I grew up as a surgeon, I started to understand what the dynamics of the muscles meant or how to replace the bone. It was the era where it was believed that a biomaterial could fully replace bone.
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He was one of the chiefs of the oral and maxillary facial surgery community of Italy. From there he was able to command with his innate charisma. This is a part of his personality that I envy and I know that I can never reach his level. Being one of the Directors of the Maxillo-facial Surgery faculty of Italy, he managed to convince me to go to Zurich and visit Professor Herman Sailer’s unit for some time, where I absorbed the knowledge and philosophy of the prestigious school of Zurich. When I returned to Naples I tried to convince everyone of the necessity of being open-minded and international. It was not easy at all, and I have to say that only my father believed in me. Growing up with a father with such a long shadow was not easy. I had to prove every day that it was right that I was there. It was my daily challenge to learn from him and it was not easy at all. It is difficult to make people understand that sometimes techniques and knowledge evolve. If I think about discussions and absurd conflicts, it was only the ability of my father to understand the insights of his son that allowed me to grow up as a person and as surgeon. Finally, I could show everyone that being there was not just because I was his son. Certainly, I was lucky to work with him shoulder to shoulder. But his greater ability was that he left me follow my intuitions or make my own mistakes, so I could learn from my errors and celebrate my merits. As he says “surgery is 80% knowledge and 20%
October 2019
Surgery is 80 % knowledge and 20 % fantasy... fantasy”. Surgeons are people who use techniques without fully understanding how the human body functions. I was fortunate to have a father like him who gave me the right advice at the right moment. He always gave me confidence, he gave me blows when I deserved them and affection when I needed it. I conclude with his sentence “No matter how many times you fall. What matters is how quickly you get back on your feet.” ■
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Beyond O.R.
Half and half By Javier González Lagunas (follow me on
@golagunas)
YOU have all heard about the digital natives, basically those born with a tablet in their hands....Also know as the Gen Z, they were born after 1997. But what about us? We are the so-called digital immigrants.
I will take myself as an exemple. I studied my Medical Degree in the early 80,s when computers were huge science fiction devices. While preparing my dissertation for my PhD I used those huge volumes of Index Medicus. I still remember that during an stage as a trainee in St Thomas Hospital in London, I spent my afternoons in The British Library physically looking for some papers that explained the history of Orthognathic Surgery. My first oral presentations were done with slides (blue pattern and white typewriter fonts...). But suddenly, it all started to change. It was the late 80s and I bought my first computer, an Amstrad (or was it a Commodore?): green text on black background. A new program called Harvard Graphics allowed us to do amazing presentations that included images!!. A word processor called Word Perfect dominated the market in that period. We discovered the email, and still today I remember my first adress hosted in Compu-Serve.
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I have never had much interest on how computers and other gadgets worked, and obviously never wanted to learn to program. I started to read about a company that made some special products, easy to understand for people like me, that hardly ever got infected by virus, and that never hunged up. That was Apple, and in the mid 90s I bought my first Power Mac. At that time I was not following the mainstream, and some friends of mine thought that I was some kind of Martian, spending so much money in a computer that was not compatible. And then came the beatiful iMacG3, and later the Mac Book Air and and the MacBook Pro, and ...you say it. I also saw first my first cellphone while in London. It had the size of Maxwell Smart Shoe Phone, and its price was only affordable for Gordon Gekko. I had the Motorola Star Tac, a Nokia, and of course several models of Palm Pilot. But in 2008 it all changed: I bought my first IPhone. It seems it has been there forever, but that was hardly 10 years ago... So, I am half and half. The first half of my life was strictly analogic, and the second one was basically digital. And I definitely think I have experienced the best of both worlds. I still feel the pleasure of stroking the good quality paper of some publications. But I can´t help being an early adopter. I am not dogmatic, nor resistant to change, and I easily adopt new technologies. Considering that 15 years ago we did not have Iphones, Ipads, Spotify or Facebook, I feel absolutely unable to predict what we will be playing with in 2030. I can only tell you one thing: I am sure I will not mind changing the title of this paper to 33-3333 One third analogic, one third digital and one third whaterer happens in the future. ■
October 2019
October 2019
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FACE TO FACE ASPIRES TO BE A COLLABORATIVE MAGAZINE. That means that we are seeking your suggestions, proposals, projects, and ideas, regardless of where you are from, your scope of practice or your current position. We invite enthusiastic Oral and Maxillofacial surgeons with the drive to take our association and our specialty one step forward. Feel free to contact us, and join us on our path of improvement. Dr. Javier Gonzรกlez Lagunas Dr. Deepak G Krishnan
International Association of Oral and Maxillofacial Surgeons IAOMS Foundation 200 E. Randolph St., Suite 5100 Chicago, IL 60601 USA 2019 50 iaoms.org October www.iaoms.org