Face to Face October 2016 (an IAOMS magazine) by IAOMS

Issue 47 / October 2016

Editor-in-Chief Javier González Lagunas

Assistant Editor Deepak Krishnan

Graphic Designer María Montesinos

Executive Committee 2016 - 2017 Board of Directors Julio Acero, President Piet Haers, Immediate Past President Alexis Olsson, Vice President Gabriele Millesi, Vice President-Elect Arthur Jee, Treasurer Larry Nissen, IAOMS Foundation Chairman Mitchell Dvorak, Executive Director

Members-at-Large Javier González Lagunas Sanjiv Nair David Wiesenfeld

Regional Representatives Abdellfattah Sadakah, 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 Chairmen Rui Fernandes, Education Committee Joseph Helman, Research Committee Deepak Krishnan, IAOMS NextGen Committee Steve Roser, COGS Committee Fred Rozema, IT Advisory Committee Mark Wong, IBCSOMS Representative Nabil Samman, 23rd ICOMS-2017, Hong Kong Luiz Marinho, 24th ICOMS-2019, Brazil David Koppel, 25th ICOMS-2021, Glasgow

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

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

A video message from the editor in chief Face to Face wants to play a key role in communication in the maxillofacial surgery universe.

If you want to contribute to the newsletter, please contact the editor in chief: jgonzalez.bcn@quiron.es

CONTENTS October 2016 10 SPECIAL REPORT

Care for our children

NEXT GEN 16 Being an OMFS trainee in EUROPE

SIGNS SAC 2016

20 WOMEN IN IAOMS

Innovation and tradition

FROM PROUST TO PIVOT 22 Alejandro MartÃnez Garza COPY ME

Customizing Le Fort 1 osteotomy

A DAY IN THE LIFE OF... 32 A maxillofacial resident in NIGERIA Dr. Azeez Fashina

34 OMS ON A MISSION

Committee on Global Surgery (COGS)

WORKING IN PARADISE 38 Hawaii

40 WHERE ARE THEY NOW? Mr. Ward Booth

BEYOND THE OR 45

From Borduria to Syldavia

“HELPING MEMBERS DEVELOP PROFESSIONALLY AND PERSONALLY”

couple of months ago, we received a call late on a Friday afternoon from a fairly new IAOMS member from an emerging country. He needed to review an IJOMS article before his Monday morning surgery. We granted him immediate online access to IJOMS and then our Membership Manager, Katie Cairns, confirmed with him the next week that the surgery was successful. Clearly, this new member recognized the tremendous resource IJOMS provides to IAOMS members and knew that IAOMS staff would respond promptly to his request. That’s one of the very real examples of why I’m so proud to be part of the IAOMS community. This organization’s commitment to delivering the best educational experiences is one of the reasons surgeons continue to join and devote their time to the IAOMS. This month, I’m pleased to update you on some educational events you will not want to miss as well as how we’ve restructured the IAOMS staff team to better serve your needs. Upcoming World-Class Educational and Networking Events I look forward to welcoming you in Medellin, Colombia, for a scientific meeting hosted by the IAOMS and ALACIBU-ACCOMF on October 14 - 15. This collaboration will be held every other year (in years when we will not be hosting ICOMS) in a different city and bring together some of the greatest minds and OMS practitioners to learn about the latest research and advances in OMS surgery. It also will provide the IAOMS with the ability to introduce prospective members to our Association and the value it provides. Finally, trainees and specialists who are just beginning their careers will participate in poster presentations. Next year, in late March and early April, we will gather in Hong Kong for the 23rd annual ICOMS as well as the IAOMS Next Level Forum (previously the Futures Conference) on March 30. The Next Level Forum’s theme, “Adapting to Lead,” will provide

leaders of the specialty with an opportunity to exchange ideas to move the profession, their own lives and the IAOMS forward with a focus on leadership and management trends. A thought-provoking half-day learning experience, The Next Level Forum is open to all Fellows. We will email IAOMS members the agenda this fall.

“Meeting member needs is one of the Association’s highest priorities.” You can find information on all of these educational opportunities (and more) at www.iaoms.org. If you have specific questions, please contact Membership Manager Katie Cairns (kcairns@iaoms.org). The IAOMS Team: Meeting Member Needs Meeting member needs is one of the Association’s highest priorities. To ensure we do that as efficiently and effectively as possible, we’ve made some staff changes. As of August 1, we promoted Katie Cairns to Membership Manager. Kimberly Shadle joined us from the Council of Medical Specialty Societies to serve as Manager of Office Administration and Governance Support and Naomi Gitlin joined us as Communications Director. Kimberly replaces Rupa Brosseau, Director of Development and Education and Naomi replaces Lisa Markovic, Director, Membership, Marketing and Communications. Additionally, the Board of Directors approved a comprehensive assessment of our education portfolio and has engaged Debra Zabloudil, President, The Learning Studio, to conduct the assessment, develop the education plan and related content strategy. I am confident that this new team will help IAOMS members build their practice and the OMS profession – whether that’s through leading education and networking

opportunities or training the next generation of OMS surgeons worldwide. And, the collective talents of this team, combined with the leadership of the Board of Directors, will provide a strong path forward for the IAOMS. If you have not yet seen it, please look for a copy of the IAOMS Foundation annual report coming soon to your in-box. True to its mission of advancing standards of care through education and training, the Foundation recently selected three trainee surgeons to participate in its one-year immersion program in a specialty area such as Oncology and Reconstructive Surgery, Cleft Lip and Palate/Craniofacial Surgery. And while the report recognizes all Foundation donors, I specifically would like to express my appreciation to a small group of particularly visionary IAOMS members who are Charter Members of the Daniel Laskin Legacy Society, a planned giving program. Dr. Laskin, a former IAOMS President, is one of the world’s pre-eminent OMS surgeons, teachers and clinicians. He has written extensively on a variety of OMS topics for both scientific and scholarly journals as well as student textbooks. And beginning in October, please look for emails reminding you to renew your IAOMS membership. Each of you plays an important role in the IAOMS and I want to thank you in advance for your continued commitment of time and treasure. As outlined in our strategic plan, we have ambitious goals to grow this organization and the services and resources it provides. I hope to count on you for your ongoing support to help us achieve those goals. The IAOMS Team looks forward to serving and working with each of you to help you improve the quality and safety of healthcare worldwide by advancing patient care, education and research in oral and maxillofacial surgery. Best. ■

Mitchell Dvorak EXECUTIVE DIRECTOR, IAOMS

Letter from the President

ith each issue of Face to Face, we profile the lives and work of IAOMS members from throughout the world. After all, we are a global organization and we have members in many, many countries. This is also an opportunity to keep members updated on the activities of the Association. It is my pleasure to inform you that we are making great progress at the IAOMS headquarters. For example, we have seen an increase in membership and our finances are stable. Additionally, we are optimistic that educational programs, e-learning, SIGNS, and new ‘mini’-ICOMS-like events will add even more positive cash flow (along with their educational value). May I thank our treasurer, Dr. Arthur Jee, for the great work that he is doing together with our Executive Director, Mitch Dvorak, and his team. This October, we will start to bring the IAOMS even closer to members through the IAOMS International Symposia. It is my great honor to introduce and invite you to this new IAOMS initiative, the IAOMS International Symposia, which we will launch in Medellin, Colombia. We are organizing the “International Symposium IAOMS-ALACIBUACCOMF,” in collaboration with the Latin American and Colombian Associations of Oral and Maxillofacial Surgery. The goal of this initiative is to bring the IAOMS closer to members in the different regions throughout the world through a series of scientific meetings, which will highlight current (and upcoming) advances within the specialty. Additionally, these events will offer a new opportunity for IAOMS (and non-IAOMS) colleagues working in different parts of the globe to participate in IAOMS activities closer to home. For the Colombia Symposium, the official language of the

event will be Spanish and we will consider, depending on the location of future Symposia, using the language of the host country as the event’s official language. These meetings will provide significant value to members and other attendees – by enhancing their clinical and scientific knowledge and helping them expand their networks by introducing them to other OMS surgeons in their region. And these Symposia are another way for the IAOMS to demonstrate its leadership in and commitment to providing educational programs to help members advance their practice and build the OMS profession. The Symposia will be held every other year (in years when ICOMS is not held), so that we provide members with an annual, signature educational offering. Finally, the International Symposia will be a great learning opportunity for trainees, who can submit cases and abstracts for discussion. I encourage you to learn more about the event and speakers from Brazil, Colombia, Mexico and Venezuela (to name a couple of countries). Visit: www.iaomsalacibu2016medellin.com/ where you can read about the entire Symposium in either Spanish or English. Preparations for the International Conference (ICOMS), our signature event, are underway. The global community of Oral and Maxillofacial Surgeons will convene in Hong Kong between March 31 and April 3, 2017. The deadline for submitting abstracts is October 1. Visit www.icoms2017.com. for more information. I look forward to seeing you in Medellin October 14-15 and in Hong Kong for ICOMS and the IAOMS Next Level Forum (formerly the “Futures Conference”). Kind Regards. ■ Julio Acero IAOMS PRESIDENT 2016-2017

special report

Care for OUR CHILDREN

01 Abused Children:

The Role of OMS

By Jesús Manuel Muñoz Caro

Attending Staff, Department Oral Maxillofacial Surgery, Hospital Universitario La Paz, Madrid

sk yourself two questions: In your professional career have you come across cases where you have been suspicious of child abuse? If you did, did you inform the concerned authorities? Think twice, because as Oral and Maxillofacial Surgeons you may have been exposed to some cases of the worst form of violence against children. VIOLENCE AGAINST CHILDREN IS A GLOBAL challenge with confirmed 41,000 deaths per year of children under 15. There is a reality that the actual numbers may be higher because of under-reporting or incorrect classification of the cause of demise. Approximately 20% of women and 5-10% of men report having been sexually abused as children. Additionally, data from developed countries suggest that physical ill-treatment of children is reported in figures as high as 25-50%. In the United States alone, more than 2,000 deaths per year are reported. The WHO definition of abuse includes all forms of physical and emotional ill-treatment, sexual abuse, neglect and exploitation that result in actual or potential harm to the child’s health, development or dignity. Five subtypes can be distinguished: physical abuse, sexual abuse, neglect and negligent treatment, emotional abuse and exploitation. Its consequences 10 iaoms.org

October 2016

are direct but also create physical and mental disabilities, poor jobprospects and social integration and tendencies to be violent as they become adults. ONE MUST APPROACH CHILD ABUSE as an illness. Just as we suspect, diagnose and treat an infectious or oncologic disease, we are obliged to suspect, diagnose and treat physical abuse or neglect. Those subtypes are the two most frequents varieties of ill-treatment that we can see in our line of work. Despite the serious, long lasting and frequently permanent sequelae, the number of reported cases is still low. Why? ✔ Lack of awareness of the problem. ✔ A benign purposeful neglect. ✔ Reluctance to get involved. Approximately 75% of physical lesions in battered children occur in the head and neck area, and 10 % happen in the oral cavity. The face is exposed and accessible. Injuries in other areas of the body are easily hidden under clothing, but the exposed sites can be explored routinely and in a nonthreatening manner, when abuse is suspected. TO CONFIRM THE POSSIBILITY of physical abuse of children, we have to address the following questions: 1. Are the injuries consistent with the history presented? 2. Is there a history of previous and continued trauma old untreated fractures or dental injuries? 3. Are there external signs of abuse? Suspicious injuries in various stages of healing, or inconsistent multiple bruises. It is not uncommon for a subject of abuse to not reveal the truth; some are simply too young to speak. Their haematomas, abrasions, lacerations, puncture wounds and fractures speak volumes, screaming - HELP! One of the most common oral findings in battered children is the tearing of the upper labial frenulum, but a great number of other traumatic lesions might be seen as a sign of children abuse, including bites, burns, dentoalveolar or mandibular fractures. Haematomas of non-prominent parts of the face are the most common lesion in the head and neck, for instance in the pinna or in mastoid region. So, what is the role of the Oral and Maxillofacial Surgeon in this clinical scenarios? Obviously, we play a key role in the detection of child abuse. Our knowledge of head and neck trauma and oral pathology trains us to suspect and detect child abuse. AS HEALTHCARE PROFESSIONALS, if we are witness to a crime we have the responsibility to report it to the appropriate agency; in some cases our testimony is the only way that battered children can have a voice. October 2016

can do u o y s thing abuse d l i h c to stop

AS RECOMMENDED BY

Child abuse is a blot on society. Any person, by law, is obliged to report it. Oral and maxillofacial surgeons as members of the healthcare community cannot remain passive in view of this reality. Data show that without any action, there is an 80% possibility of repeated abuse.

➊ Child abuse is more common than we think. Have you ever seen a suspicious case? Think about it.

➋ It affects all social classes and strata. When facing an injury or a different attitude - Suspect it.

➌ Head and neck is affected in three out of four cases of abuse. Observe it.

➍ Abused children often speak through their gestures, attitudes and injuries: hematomas, abrasions, lacerations and punctures. They ask for HELP. Listen to them.

➎ Oral cavity injuries occur in 10% of cases. It is easily accessible to clinical exploration and shows injuries associated. Inspect it.

➏A s a professional, they can go to you to avoid repetition of visits or their usual professionals, emergency services. Evaluate it.

➐Y ou are a qualified witness, often the only one. Certain injuries can disappear. Document them.

➑ Certain findings may be suggestive of previous injuries and a history of continued abuse. Ask them.

➒ T herapy for suspected or confirmed abuse is notification - Use it.

➓C hild abuse is a disease with morbidity, mortality, communicable and curable. Treat it.

There is data suggesting that 80% of children who have been victims of unreported abuse, are likely to be abused again, and the subsequent abuse and injuries are often worse. Further, 80% of abuse-related deaths could have been prevented if had been notified a healthcare professional. ORAL AND MAXILLOFACIAL SURGEONS have the responsibility of recognizing and reporting suspected cases of abuse and neglect. We must help other professionals with our knowledge about head, neck and oral trauma. We may be key players in prevention of further abuse to a child. So, again ask yourself - Have you seen cases where you have suspected child abuse? What have you done about it? ■ iaoms.org 11

special report

02 Face to face with cleft children

By Krishnamurthy Bonanthaya

He works in Bhagwan Mahaveer Jain Hospital (Bangalore, India). He is deeply involved in the Smile Train Project

left lip and palate deformities are the most common birth defects occuring in the head and neck region. Comprehensive management of these deformities take a number of years until the newborn grows up to be an adult. This will involve a multidisciplinary team of professionals intervening at different times as and when needed, working within the frame of a broadly agreed Protocol. At the Bhagwan Mahaveer Jain Hospital, in Bangalore, South India we have such a multidisciplinary cleft care team and our effort is supported by a NewYork-based NGO called the Smile Train, for more than a decade now.

Left, Bhavna pre-Op. And Bhavna with mother at 8 years

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October 2016

Run for Smile Train

EVERY YEAR WE PERFORM ABOUT 600 OPERATIONS ON CHILDREN with cleft derformities and in more than a decade of partnership with the Smile Train have performed more than 7000 surgeries. This treatment is provided free of cost in a country where a majority of the patients were left untreated in the past due to various reasons, mainly lack of financial resources as well as lack of awareness. The deformities treated include cleft of the lip both unilateral and bilateral and cleft of the palate and the alveolus.The surgical interventions include both primary surgeries in the infant and secondary surgeies both in the soft and hard tissues later on. THE CORE OF THE MULTIDISCIPLINARY TEAM CONSISTS of the orthodontist and the speech and language pathologist in addition to the Surgeon. A dedicated team of Paediatricians and Paediatric anaesthesiologists complete this goup. Feeding the newborn baby could prove difficult for the mother because breast feeding is usually not possible in these children. The team members counsel the mother and support her in helping to feed the child so normal growth occurs. However with the population of 50 million that we serve, we have a number of mothers turning up with their malnourished children, weeks or months after they are born, not knowing how to feed them efficiently. In these situations we admit the patient, devise a proper diet , feed the baby, teach the mother how to feed them and discharge after there is weight gain. We screen these babies for other congenital anomalies if not done earlier and counsel for appropriate treatment when needed. WHEREVER POSSIBLE WE PROVIDE OUR PATIENTS WITH COMPREHENSIVE CARE and adhere to protocols which are tried and tested. However, the challenge sometimes is to devise an optimal method of achieving good results with an adult who has an unoperated cleft palate or a severely hypoplastic cleft maxilla. Our protocols for older children and unoperated adults may be different, bearing in mind the need to reduce the burden of care. Those attempts have often helped us to refine our protocols for the children as well. SPEECH EVALUATION AND THERAPY, when needed, is a cornerstone of comprehensive management in cleft palate deformities. At our center, we believe that achieving good speech results takes priority over everything else, in this modern world where communication is so very important. We offer state of the art facilites in our Speech and Language department. This effort is once again fully supported by funding from Smile Train.

“Every year we perform about 600 operations on children with cleft derformities and in more than a decade of partnership with the Smile Train have performed more than 7.000 surgeries.” OUR ORTHODONTIC DEPARTMENT IS EXCLUSIVELY GEARED UP TO TREAT CHILDREN with Cleft deformities, and it carries out the whole range of therapies from pre-surgical orthopaedics to post orthognathic settling in and this too is an effort supported by the Smile Train Project. THE UNIT ALSO HAS TWO SOCIAL WORKERS who work in the large community that we serve and link us to them, providing both material and emotional support to the parents who often travel large distances from remote rural areas. THE WORK WE DO AT THE CLEFT CENTER IN BANGALORE IS VERY REWARDING, though it can be frustrating and challenging at times. The fact that we have reduced the mean age at primary surgery from 11 years to 1.6 years in this decade is a testimony to the fact that something is working for us. ■ The Jain Bagalore Cleft team

special report

03 Management of deformities: an European approach By Dr. Josep Rubio Oral and Maxillofacial Surgery Department Hospital Sant Joan de Deu, Barcelona (Spain)

work at Hospital Sant Joan de Déu (Barcelona Children’s Hospital), one of the largest children’s hospitals in Europe, where I am head of the oral maxillofacial surgery department. Since the first day I stepped into this Hospital as a young medical student, I felt that this was a unique hospital. Located in the upper part of Barcelona, it offers great views of the city (including Camp Nou, home of the Barcelona soccer team) and the surrounding hills, as far as the airport and the harbor. Hospital Sant Joan de Déu is an example of national and international excellence, not only because it excells in medical care and treats the most complex diseases, but also because of its strong commitment to ethics and patient care. For example, it’s not unusual to see clowns visiting a patient’s room or to hear a bedtime story on the sound system. And of course, there is a school on site and a travelling library. The Hospital has 300 children’s beds and 50 obstetrics & gynecology beds, and is a referring hospital for high risk pregnancies. The Hospital employs 1500 professionals and more than 14000 surgical procedures are performed annually. OUR PHILOSOPHY IS BASED ON TEAMWORK. The best treatment cannot be achieved by one professional or specialty. Inter-specialty committees meet regularly on orthognathic surgery, distraction, craniofacial malformations, velopharyngeal dysfunction, TMJ and vascular anomalies, to discuss patients and decide the best approach that’s consistent with established protocols. AS AN ADVISORY TEAM FOR CLEFT LIP & PALATE, the maxillofacial and pediatric plastic surgery units have a strong relationship and perform more than 14 iaoms.org

“Our philosophy is based on teamwork. The best treatment cannot be achieved by one professional or specialty.”

150 procedures annually on patients to correct cleft lips. We provide a complete approach: surgery, orthodontics, speech therapy and psychological support, to restore the function, aesthetics and socialization of these t patients. With an Orthodontics Department in the hospital, we see patients together, plan together the orthognathic and distraction? cases and sometimes the orthodontists join us in the operating room to discuss the occlusion of a patient. We use 3D and 4D prenatal ultrasonography to diagnose cleft and craniofacial disorders. Parents ask for information and we provide a prenatal October 2016

3D planning for a complex craniofacial cleft

consultation where we outline the problem and our approach and talk with parents about their options and support them throughout the process. Even with all of our consultations, the most useful advice happens in the waiting room, where parents can meet other parents who have or who are experiencing the same situation. And they may even encourage parents to participate in a patient’s association for additional support. We support such associations

surgeons. Unfortunately, there is an abundance of patients with complex conditions and I am the only maxillofacial surgeon in the Hospital. In my office. I use 3D technology to plan the surgical steps to achieve the best and most predictable results; 3D is also used when collaborating with the neurosurgeons for craniosynostosis and craniofacial deformities. We have evolved the use of this virtual surgery from orthognathic to craniofacial surgery and I am sure that this technology is here to stay. TEACHING IS ONE OF OUR PILLARS. This institution is a teaching hospital for Universitat de Barcelona and Universitat Internacional de Catalunya. The hospital offers a Master’s course in Orthodontics and dentofacial deformities. Because we want to ensure the quality of the treatment we offer, our Hospital has joined the International Consortium for Health Outcomes Measurement (ICHOM). This Consortium is a supranational, transcultural initiative to evaluate cleft lip/palate care in a way that is focused on the patient, by developing a standard set of measurements relevant to patients (and that are mostly self-reported).

With my collegues Drs. Bejarano (Pediatric Plastic Surgery) and Pamies (Anesthesiology) and part of the participants of the course Cleft Barcelona

because their work is very valuable: they help educate people about cleft lips and help children develop selfesteem so they can interact well with other children. My primary surgeries include restoring the hard tissues in cleft patients, craniofacial deformities and hemifacial microsomia through orthognathic surgery and distraction. Other common pediatric maxillofacial procedures are salivary gland diseases, alveolar bone grafting, facial trauma and TMJ conditions. Two days every week are the devote to outpatients. One day we work together with the orthodontists, and the other day we work closely with pediatric plastic October 2016

WE ENJOY SHARING OUR EXPERIENCE WITH TRAINEES AND SPECIALISTS THAT VISIT US FROM OTHER HOSPITALS. Our orthodontics and maxillofacial teams organized the 2015 Congress of the Spanish Cleft Society and, together with the pediatric plastic surgery team, I organized a course (Cleft Barcelona), where five participants at a time are immersed into our philosophy for cleft management and participate in all activities during one intense week, scrubbing with us in the operating room, and listening to our presentations. So, if you want to spend some time in one of the most beautiful cities in the world, participate in many procedures on cleft patients while enjoying a friendly atmosphere that only a children’s hospital can provide, we encourage you to come to Barcelona and visit us! ■ iaoms.org 15

NextGen

By Frederico Pimentel Junior Specialist in OMFS (former ex-UEMS EJD for OMFS)

Being an OM IN EUR

It is not easy to describe what it´s like to be an OMFS resident in Europe. Amongst many challenges in training (as any other medical specialty), one of the most important is to know what it requires, which varies greatly among European Union (EU) countries. à

Some require a double-degree of Medicine and Dentistry before or during training, but that is not always the rule (some require only a medical degree, while in non-EU countries it is very often a dental specialty). Double degree may add up to 16 years in training. Nonetheless, it still doesn’t mean a rightful free circulation as a professional between EU countries, despite completing the Assessment of the European Board of Oral and Maxillofacial Surgery (EBOMS) for specialists. Training in OMFS departments also differs greatly from each country, which requires variable rotations for specific competences (such as Stomatology, Plastic Surgery, ENT, General Surgery, or Head & Neck Surgery). Although for most candidates this is mostly a detail, as many aren’t willing to work in a different country, this still means a reduction in future job possibilities and a very long term commitment in training (with the associated cost increase). à

Despite those differences, there is a global consensus that European OMFS training is of a very high standard in competency, breadth, volume of training and scientific production, regardless of the respective country. à

Fellowships in foreign EU Countries are also promoted and accepted, greatly increasing the exposure and quality of the training and also enabling outside contribution for the update of the receiving departments. à

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October 2016

MFS trainee ROPE

As with the general advances in medicine, OMFS trainees/junior Specialists are usually skilled in the utmost and diverse therapies for most of the OMFS pathology, including complex and difficult cases and meaningful research. This makes OMS a unique specialty in managing all maladies of the Head and Neck region. Our ability to perform complex procedures in every type of tissue, including some of the most delicate and the organs of the senses, in such a specific and limited region, makes us quite unique – which is also the basis of the specialized medicine. Unfortunately, our expertise and competence are not being adequately recognized by other colleagues or the general population. à

However, these skills also come at a cost. Medical sponsorships and contributions are many times scarce and the high prices of courses, fellowships and congresses, especially in these advanced techniques and treatments (including cadaver dissecting courses or the use of high-end materials), add to the cost of training, creating further struggles for residents. à

Politics and economics also have an influence on training, as they both affect the standard of care and the technical means available and working environments. Oral rehabilitation for oncological patients, especially in cases of major reconstruction, is one of the examples the specialty should aim, such as other goals that enable to improve not only our results but mostly to enhance the lives of our patients. Virtual planning and models are having an enormous impact in our outcomes while reducing the risks and costs both in inpatient time and need for re-operations. Training in these areas should be stimulated by both local politics and commercial suppliers for mutual benefit. Residents should be their target, especially because of their great contribution to scientific production and publications. à

All of this is finally rewarded by what is accomplished in the end for the benefit of our patients and colleagues. Much remains to improve: EBOMFS and the IBCSOMS may be important tools to level the playing field in advanced training in OMS and universally be recognition of such training. We hope that more scholarships and sponsorships may help our residents get further than we are now. à

THE FUTURE MAY BE LONG AND HARD TO GET, BUT THAT’S WHAT THE FUTURE IS ABOUT. October 2016

iaoms.org 17

Larry W. Nissen IAOMS Foundation Chairman

2025

THE IAOMS FOUNDATION Fact or Fiction?

Face to Face October 2025

October, 2016 – REALITY

I am pleased to announce that the IAOMS Foundation has surpassed its $5 million goal for its endowment. This milestone has been made possible by the hard work and dedication of the Foundation Board, the IAOMS Board, the Foundation Envoys, our committed corporate partners and the numerous member and non-member donors.

To many of you, the above story can only be fiction: $5 million is an outrageous amount to think our Foundation needs or even wants to have. Reality is, any Foundation that is doing good deeds needs an almost unlimited supply of funds. If we break it down to show how we can achieve this $5 million goal: Current assets: $300,000

To all of you, I want to express a big, “THANK YOU” – for your efforts and our success. What does it now mean for the Foundation? Can we stop our fundraising? Will a sense of contentment begin to creep into our Board, Envoys, corporate partners and members? To the first question, achieving this monumental goal allows the Board to predictably spend up to 5% of the corpus (depending on the annual rate of return) or up to $250,000 on programs to benefit the specialty and our patients. We will be able to begin awarding meaningful research grants; not to fully fund projects, but funds that can act as seed money to launch new initiatives to be funded by larger funding organizations, government or private. This ability to fund research projects turns a new page or opens a new “line of business” for our Foundation. The Board also will be calling on IAOMS members to constitute the Grant Selection Committee (providing new volunteer opportunities) who will carefully vet proposals to achieve maximum benefit for our specialty. To the second two questions: ABSOLUTELY NOT!!!!!! Our $5 million goal is only an interim stop along the way to a $20 million endowment which can generate up to $1 million per year. With these funds available, the IAOMS educational programs will expand exponentially across the globe, Fellowships will be readily available, our on-line education will be able to select specific experts and topics to deliver live, interactive lectures that will be recorded for future use. At this point, our greatest enemy is COMPLACENCY. Yes, we have done an exceptional job in achieving our $5 million goal and all of us need to be proud of this accomplishment. By maintaining our current focus and diligence, the more substantial goal can be achieved.

KLS Martin Group Challenge Grant and member match donations $480,000 (projected) ––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Total Projected Assets 2018 $780,000 Goal $5,000,000

IAOMS members – 3,500

$4,220,000 – needed to raise Time: 9 years

Each member would need to give only $135 per year to achieve this goal!!! To be perfectly clear – If each and every IAOMS member would donate $135 per year for nine years, the goal of $5 million would be achieved by 2025. As with all organizations, some will donate more, some less. The difference is your commitment to the goals of the Foundation, that exists solely to fund projects of the IAOMS.

I ASK EACH OF YOU, FACT OR FICTION? ■

THANK YOU AGAIN for all your donations, phone calls, emails, text messages and “gentle” persuasion that it has taken to achieve this lofty goal. FACT OR FICTION????? 18 iaoms.org

October 2016

Signs

SAC 2016

he XXVI Meeting of the Argentine Society of Oral and Maxillofacial Surgery (SAC2016) took place at Hotel Panamericano in Buenos Aires from June 23 to 25, 2016. Dr Maximiliano Diamante was the President of the Organizing Committee and the Congress was held in honour of Professor Joseph I. Helman.

It was a 6 hour course with 7 worldwide renowned speakers: Piet Haers, Henning Schliephake, Florencio Monje, Sean Edwards, Luis Quevedo, Rui Fernandes and Joseph Helman. Course chairman was Victoria Pezza, IAOMS Councillor for Argentina.

IAOMS President, Dr Julio Acero participated in the Opening Ceremony with a welcome video. A social reception followed at the Colon Opera House of Buenos Aires.

View from the Hotel Panamericano, Buenos Aires.

The Scientfic Programme counted a total of 821 delegates, 168 of which were from outside Argentina and 96% of the attendees took optional charged courses.

“A SIGNs course took place for the first time in South America thanks to the initiative of past president Dr. Piet Haers, and the continuous support of IAOMS current President Dr. Julio Acero.”

Drs. Quevedo, Fernandes, Diamante, Edwards, Shliephacke, Haers, Hellman Pezza and Monje.

The course was devoted to The Excellence of Surgical Technique in the Digital Era. It focused on the enhancement of surgical techniques with the use of technology, and the potential development of OMSurgery in the near future. Emphasis was made in IAOMS leadership in the healthcare system, dedicated to improving education and training, as well as increasing the quality of life for patients around the world. October 2016

IAOMS presence in this national meeting stimulated membership and promoted recruitment. Argentina thanks IAOMS for this extraordinary educational opportunity and is committed to continue working stimulating regional bonds to IAOMS. ■ iaoms.org 19

Women in IAOMS

INNOVATION AND TRADITION went to Nagoya University Hospital Department of Oral and Maxillofacial Surgery. Among 10 trainees, two were women. I was able to manage to live on my own with the internship salary.

Dr. Eri Umemura Oral and Maxillofacial Surgeon (OMS). Aichi Gakuin University Hospital, Nagoya, Japan

et me introduce myself - I am Eri Umemura, an Oral and Maxillofacial Surgeon (OMS) and a researcher working in Japan.

I was born in Los Angeles and was raised in the United States until I was eight. During my elementary school days I went through orthodontic treatment. My orthodontist was a woman who had outstanding technical skills, but also a wonderful personality. Inspired, I wanted to grow up and be like her. That was the initial drive towards dentistry. Although no one in my family was in health care, they always supported my dream. Already in Japan, I entered Kagoshima University School of Dentistry; only 20 of my 60 classmates were women. When I was an undergraduate, I saw a documentary featuring an ophthalmologist practicing in his own hospital, and researching corneal regeneration in a University hospital. That sparked in me, the idea that one could have a career that merges the worlds of clinical OMS and research. In Japan, postgraduate internship is mandatory. I 20 iaoms.org

After internship, I had the options to work in a hospital and have more training as an OMS, work in a dental clinic and specialize in dentistry, or attend a Ph.D. program. At that time, I selected to attend a Ph.D. program, looking for that career that appealed to me. I am convinced that the training system in Japan is superb since we have the opportunity to become a specialist and to obtain a Ph.D. simultaneously. My research was on bone regeneration using mesenchymal stem cells. At that time, I studied the basics of how to design research and how to think critically. Thanks to my mentor, I experienced how interesting it is to find out what was not clear beforehand. At the same time, I worked at a private dental office including weekends. I was happy to be a dentist and wanted to improve my skills in dentistry. Those days were very fulfilling. However, as I had to look after my cells in the laboratory, I spent most of my time at the University. I worked very hard and fortunately was able to obtain my Ph.D. in three and a half years. This happened in my late twenties and early thirties. Secretly, I envied my friends who got married, but my priorities were my job and my research.

â&#x20AC;&#x153;My research was on bone regeneration using mesenchymal stem cells.â&#x20AC;? Currently, I work at two hospitals. I am a clinical fellow at Aichigakuin University Hospital Department of OMS headed by Dr. Kenichi Kurita. He is the President of Japanese Society of Oral and Maxillofacial Surgery and he attends October 2016

“Secretly, I envied my friends who got married, but my priorities were my job and my research.” conferences around the world. When I attend international conferences, I am always impressed by the camaraderie he has with many fellow doctors throughout the world. At Aichigakuin University hospital, I work in a liaison clinic and conduct research. It is a joint mission between dentists and psychiatrists to treat patients with oral psychosomatic diseases. The majority of patients are women above middle age, and the disease is often caused by stress. There are many patients afflicted in Japan – about 10% of my patients suffer this disease. I see the opportunity to be part of liaison clinic team that allows me to collaborate with many doctors of different specialties. Since 2013, I also serve as the Director of Dentistry and Oral and Maxillofacial Surgery at a general hospital. I am the only OMS in the hospital. As Japan is becoming an aging society at an unprecedented pace, we have many people who are not able to visit October 2016

dental clinics by themselves, or even worse, who are bedridden. My hospital provides 360 beds that cover acute, chronic phase, and terminal phase care. My role in the hospital is to provide dental treatment to patients with medical problems, to conduct minor surgeries, and to provide oral care for patients in the hospital. I recently decided to get married. As my marriage was late, I cannot talk about the challenges of managing both work and housekeeping. I’m not sure if I could have a child. But now I feel very happy, because at last I was able to become the OMS I wanted to be. I am blessed with people around me and I love my job from the bottom of my heart. My recommendation to young female OMS? Always imagine what kind of life you want to live and then fight for it! ■ iaoms.org 21

From Proust to Pivot

AN APPARENTLY INNOCENT QUESTIONNAIRE FOR ORAL AND MAXILLOFACIAL SURGEONS You’ve heard of the Proust Questionnaire Adapted and made famous in the back pages of Vanity Fair Magazine, it was named not for questions, but for the answers given by Marcel Proust to a set of questions asked by his friend Antoinette Faure. Then, for many years Bernard Pivot conducted a cultural program on French TV called “Apostrophes.” All his guests received the same 10 questions at the end of the interview. So, in Face to Face we thought that being oral and maxillofacial surgeons human beings as the rest, those questions were a great method to know some personality traits of our interview subjects. Enjoy, and compare their answers with those of celebrities!!!

Alejandro Martínez Garza What is your favorite word? Yes.

Who would you like to see on a new banknote? Frida Kahlo, great Mexican painter.

What is your least favorite word? No.

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

What is your favorite drug? First cup of coffee. What sound or noise do you love? Ocean waves. What sound or noise do you hate? A baby crying.

If you were reincarnated as some other plant or animal, what would it be? Recco, my dog (German shepherd).

What is your favorite curse word? Hay Guey. Difficult to translate this slang into English.

If Heaven exists, what would you like to hear God say when you arrive at the Pearly Gates? Welcome back Alex. 22 iaoms.org

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What is your idea of perfect happiness? Right now (not search for it, but experience it). What is your greatest fear? Losing my ability or my gift to love. What is the trait you most deplore in yourself? Having expectations. What is the trait you most deplore in others? Mediocrity. Which living person do you most admire? Elda, my wife. What is your greatest extravagance? Grill, red wine & Cuban cigars. What is your current state of LIFE? Work hard, stay humble. What do you consider the most overrated virtue? Individualism. On what occasion do you lie? When I tell my wife: â&#x20AC;&#x153;this bottle (red wine) was on sale.â&#x20AC;?

Elda my wife, Daniela and Mariafernanda my daugthers. They are the reason of my life

Recco is a great dog, we have training every week on obedience, EPO, dog police training

October 2016

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What do you most dislike about your appearance? My thin legs.

These archeological mask represent the culture, traditions, knowledge, of our ancesters, who were one of the great cultures.

Which living person do you most despise? Drug dealers and terrorists.

What is your most treasured possession? My home and archeological Mexican face mask collection. What do you regard as the lowest depth of misery? Lack of dignity, unworthiness.

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

What is your favorite occupation? Surgery certainly and then grill and wine.

What is the quality you most like in a woman? Intelligence and intuition.

What is your most marked characteristic? Never give up.

Which words or phrases do you most overuse? A huevo (Mexican slang for “just do it”).

What do you most value in your friends? Their happiness.

What or who is the greatest love of your life? My wife Elda and daugthers Maria Fernanda and Daniela.

Who are your favorite writers? Ildefonso Falcones, Ken Follet, Julia Navarro.

When and where were you happiest? Vacations at Playa del Carmen, Mexico with my family.

Who is your hero of fiction? Winnie The Pooh. Which historical figure do you most identify with? Jesus of Nazareth, Gandhi, Nelson Mandela.

Which talent would you most like to have? Playing piano.

Who are your heroes in real life? My dad and my father in law.

If you could change one thing about yourself, what would it be? Taking life so seriously.

What are your favorite names? Elda, Maria Fernanda, Daniela.

What do you consider your greatest achievement? My family and my practice.

What is it that you most dislike? Corruption.

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

What is your greatest regret? Not having more leisure time. How would you like to die? No way.

Where would you most like to live? At Playa del Carmen, Mexico.

What is your motto Don´t say no, tell me how it is possible. ■

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Copy Me CUSTOMIZING Le Fort 1 osteotomy Le Fort 1 type of osteotomy is very versatile procedure that has been widely used in orthognathic surgery since the late 80â&#x20AC;&#x2122;s. It has an important impact in the facial aesthetic results, but unfortunately we still lack scientific evidence and appropriate instruments to predict the soft tissue changes that occur after the maxillary repositioning. Virtual surgery is a promising tool in this difficult problem. But there is one thing we all know: soft tissues are directly related to its bony support. So, we have being working with different changes in in the maxilla architecture, and implementing different osteotomy designs while performing a Le Fort 1 osteotomy.

PROF. DR. LUIS QUEVEDO ROJAS Cirujano Maxilo Facial Profesor Titular Universidad de Chile

1 Le Fort I osteotomy design makes a difference in the end aesthetic result.

2 Different Le Fort 1 osteotomy designs.

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Copy Me

3. Different Le Fort 1 Osteotomy Designs. Also work in segmental Le Fort 1 Osteotomy. 4.A. Low and flat. No step osteotomy 4.B. Middle third Problem List: Light paranasal & upper lip deficiency, good middle third contour with excessive cheek projection specially in function vertical maxillary hyperplasia obligate for impaction and forward movement. Tough case to solve, aesthetically speaking. 5.A. Pre Surgical Facial Appearance. 5.B. Post Surgical Results. 6. Middle height and lateral extension of the step osteotomy. 6.A. Middle third Problem List: Paranasal & upper lip deficiency, excessive cheek projection specially in function, light maxillary vertical excess. 6.B. Middle height and middle lateral extension of the step osteotomy to obtain appropriate facial contour.

B 26 iaoms.org

7.A. Pre Surgical Facial Appearance. 7.B. Post Treatment Results.

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B October 2016

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Copy Me

8. Long height and lateral extension of the step osteotomy. Middle third Problem List: Severe lack of projection of the whole middle third of the face. Needs all the anterior wall of the maxilla to be mobilized forward, with high and prolonged laterally osteotomy design. 9.A. Pre Surgical Facial Appearance. 9.B. Post Treatment Results.

9 A

B 28 iaoms.org

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B 10. Double step, stair type of osteotomy. 10.A. Middle third Problem List: Concave middle third with lack of support specially in the upper part bilaterally. Facialcontour appears just when the patient smiles. 10.B. Special double step osteotomy to allows for

differentiation of the bony support weâ&#x20AC;&#x2122;ll bring forward, between the anterior and the lateral aspect of the maxillary walls. 11.A. Pre Surgical Facial Appearance. 11.B. Post Treatment Results.

B October 2016

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Copy Me

12. Facial Middle third Problem List: Excessive lateral cheek projection specially in function. High medial middle third deficiency. Augmented nasal-labial angle with strong lip deficiency.. 13. Segmental Le Fort 1 osteotomy to achieve skeletal torque of the anterior maxilla including the modified paranasal extended osteotomy. This is a higher but short laterally extended step osteotomy, to get better projection and support to the upper paranasal area. 14.A. Pre surgical facial appearance. 14.B. Post treatment results.

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15. Middle Third Prob lem List: Excessive lateral cheek projection specially in function. High and medial middle third deficiency. Good nasal-labial angle but strong lip deficiency due to severe maxillary deficiency. 16. Modified paranasal extended osteotomy. This is a higher with middle lateral extension of the step osteotomy, to get good middle third contour. 17.A. Pre surgical facial appearance. 17.B. Post treatment results.

B October 2016

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Hours A DAY IN THE LIFE OF A MAXILLOFACIAL REGISTRAR IN NIGERIA By Dr. Azeez Fashina, Department Of Oral and Maxillofacial Surgery, Lagos University Teaching Hospital, Idi-Araba, Lagos, Nigeria

fter spending 5 years in private practice, I decided to return to my alma mater in 2010 to specialize in oral and maxillofacial surgery. Selecting my line of specialization in dentistry was a very easy decision because I always had a strong interest in Oral and Maxillofacial Surgery from my undergraduate days. I am currently a 6th (final) year resident doctor in the department. The Lagos University Teaching Hospital is one of the foremost tertiary institutions in Nigeria. With Lagos state being the major commercial hub of the country, the area is densely populated and thus the hospital is quite busy. The Oral and Maxillofacial Surgery department is divided into two units with each unit running different clinics of the department daily. We run dento-alveolar clinics every weekday between 8am to 4pm, surgical-out-patient clinics every Monday and Thursday, cleft lip and palate clinics every Tuesday afternoon from 2pm. We also have a designated operating room where major surgical procedures are done under general anesthesia every Friday. Cleft lip and palate surgeries are done every Thursday. The unit is always on-call every night. My day can be a different mix depending on the unit I am in and the duties at hand, e.g. the patients assigned to me. Nevertheless, a typical day in my life goes like thisâ&#x20AC;Ś

6:45 am

First thing I do immediately when I wake up is to check my phone for reminders that will determine my routine for the day, set new reminders if need be and catch up with the news. Then I do my daily routine hygiene practices and set off for work. Luckily, I live within the hospital premises so getting to work only takes me about 5 minutes or less. If I was on-call the night before, I head to the wards to meet up with the other members of the team-on-call to do a morning 32 iaoms.org

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orthodontists) where we attend to new cleft cases, plan them for surgery and review those that have been operated on.

4:00 pm

On a day preceding any major surgery, we have a preoperative ward round with our consultant after lunch. During this period we review the cases again, explain the surgical procedures to the patients and obtain an informed consent. We also assess our preparedness to perform a successful surgery.

Lagos Universitary Teaching Hospital

round of all our patients. We attend to their presenting complaints if any, assess their charts, check their wounds and draw appropriate treatment plans.

8:30 am

On Mondays, we usually have a radiology conference in conjunction with the radio-diagnosis department to review pre-selected radiographs and scans that are of importance. On Tuesdays we hold a journal review session while we hold academic activities on Wednesdays for most of the day. These include seminars and case presentations. If my unit is scheduled to carry out a major surgery, I will be in the OR after the seminar.

5:00 pm

Time to go home! However, if I am on-call for the night, I will meet up with the other members of the team-on-call to do an evening ward round before the call starts. I will then go home, take a shower, and then proceed to the call duty room to await any OMFS emergency that may present during the night. Most days we have an average of one or two new cases during the course of the night. When I am not on-call, I usually just go home, take a nap, spend some time with my family, then probably catch some drinks with friends afterwards, watch a really good movie or do some reading. All these can however change or get truncated on days when we have emergencies that require immediate surgery, or days when we have extremely long surgeries (like microvascular reconstruction) that last into the night. Now those are the days I really look forward to! â&#x2013;

9:30 am

On Mondays and Tuesdays, I am in the dentoalveolar clinic attending to patients that require minor treatments like simple tooth extractions, trans-alveolar extractions, biopsies and other minor surgeries that can be performed under local anesthesia. On Thursdays I am either in the surgical-out-patient clinic attending to new cases and reviewing surgical cases that have been operated upon, or in the OR performing cleft lip and palate repairs.

2:00 pm

On Tuesdays we run the cleft lip and palate clinic (in conjunction with the speech therapists and October 2016

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OMS on a mission

COMMITTEE ON GLOBAL SURGERY (COGS) By Dr. David C. Hoffman and Dr. Steve Roser Sub-Chair and Chair COGS

any new things are occurring on the humanitarian and volunteer aid front. First of all, the IAOMS committee previously known as HADR has changed its name to the Committee on Global Surgery (COGS). We have been actively promoting the IAOMS to become fully involved with disaster relief and volunteer surgical programs. We represented IAOMS at the WHO meeting on the global surgery crisis held in December of 2015 in Switzerland, and have currently joined the G4 Alliance, (Global Alliance for Surgical, Obstetric, Trauma and Anesthesia care) which is addressing the needs of global surgery. The response of these multi-group specialties to the participation of oral and maxillofacial surgeons has been more than encouraging. Although the problems of global surgical need encompass a huge group of medical specialties, the role of maxillofacial surgeons is well sought after and our expertise has been welcomed on all fronts. The COGS sponsored symposium at ICOMS 2015 had a variety of speakers describing their experiences in both disaster relief and volunteer surgical programs. A presentation on the earthquake in Nepal was both provocative and compelling and almost everybody at the meeting left inspired, to make sure that our members could play an active role in the programs we were promoting. Our website will have a variety of interesting topics including live monitoring and responses to international disasters, opportunities to volunteer with a listing of international sites, guidelines for hosting a volunteer surgical team and an interactive 34 iaoms.org

Dr. Steve Roser.

blog for members to describe their own volunteer efforts. We have also weaved alliances that will become readily available for IAOMS members to partake in a variety of volunteer programs. For the past two years, IAOMS has linked its efforts with cleft surgical missions that Dr. Roser has run Bolivia and Nicaragua and with Dr. Hoffman and Dr. Franco in Colombia and Guatemala. Joining COGS will be Dr. Aziz who leads bi annual missions to Bangladesh. October 2016

The Neiva Program reflects what can be accomplished with collaboration between local surgeons, international volunteers, civic organizations and hospitals all wanting to take advantage of their desire to help children.

In May of 2016, Dr. David Hoffman and other enthusiastic surgeons participated in the 23rd Healing The Children mission to Neiva (Colombia) This program has grown from a small group of surgeons partaking in 1993 to its present day program, which included over 200 surgeries, 8 ORs and screening of close to 1,000 children. The team was composed not only of maxillofacial surgeons, but also orthopedic and plastic surgeons. Colombian surgeons, local university hospital and the chamber of commerce hosted the group. Not only did the doctors provide surgical care for children with cleft lip and palate, but have established a comprehensive cleft team. Many children are undergoing orthodontics in preparation for orthognathic surgery and several procedures were performed during that visit. In addition, a bilingual speech and language pathology group presented a program to teach Colombian speech and language specialists as well as provide speech therapy for almost 50 children affected by their cleft palate speech. The mission has also a joint project with the October 2016

Scenes from Neiva Colombia, patients waiting for treatment the day of serving, and the help of the army with healing the children.

genetists of Columbia University (USA) regarding the etiology of clefts. The Neiva Program reflects what can be accomplished with collaboration between local surgeons, international volunteers, civic organizations and hospitals all wanting to take advantage of their desire to help children. Because the qualty of care associated with healing the Children (now an IAOMS iaoms.org 35

OMS on a mission

associate), Colombians look forward to our annual visit. Last year we presented a proposal for this hospital and 2 other locations to start Cleft Clinics with funding so they can meet on a monthly basis, provide comprehensive care and set up a computer patient database. In the upcoming years, we hope that the Neiva Program will be able to invite IAOMS members who are interested in hosting their own volunteer services, to gain experience and inspiration to successfully develop their own programs. COGS has also established a relationship with several organizations, including the American College of Surgeons, Operation Giving Back, The Mercy Ships, and Operation Smile. All of these programs have opened their doors to maxillofacial surgeons. This is only a small and representative sample of some of the excellent opportunities available to IAOMS member. COGS will expand in the forthcoming year, so that it has a strong international representation. Any member interested in being considered for membership in COGS committee should contact us by emailing IAOMS HQ and expressing their desire to participate. Additionally, we anticipate establishing a comprehensive disaster relief program that will immediately contact IAOMS members in areas where a disaster has occurred and provide up-to-date web coverage and information on what role IAOMS members can. 36 iaoms.org

For those members who are planning to participate in ICOMS 2017, please attend COGS Symposium. The symposium will include among others the following topics: a primer for disaster relief and the role of OMFS, an open forum on volunteer opportunities, guidelines on how to host a volunteer team and invited guest surgeons experienced in disaster and war affected areas. â&#x2013; October 2016

Invest in your future. Join now at iaoms.org October 2016

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WORKING IN PARADISE

By Kenneth Arakawa

Private practice in Honolulu

enneth Arakawa DDS lives and practices in Honolulu, Hawaii. We asked him what it is like to practice in paradise.

Why did you choose to practice in Hawaii? I chose to practice in Hawaii because I was born and raised here. Both my immediate and extended family reside in Hawaii. I practice in Honolulu, the largest city on the most populated island of Oahu. I wanted to live and practice close to family and that meant moving back to the islands when I completed residency.

Our insurance reimbursement is low. The problem is there are so many dentists/oral and maxillofacial surgeons that it is almost impossible to survive without participating with all the big insurance companies. Â The outer island dentists/Oral Maxillofacial Surgeons may have a different view as there are less of them but Iâ&#x20AC;&#x2122;m

How long have you practiced in Honolulu? Did you train there? I have practiced here since I got out of residency in 1998 at University of Cincinnati, in Cincinnati, Ohio. I went to dental school at University of Missouri Kansas City. There are no dental schools in Hawaii. What is it like to live and work in Honolulu? Honolulu is a very large city. The cost-of-living is very high and Honolulu has the worst traffic in the nation. Â While many people living outside of Hawaii consider it to be paradise, we have our fair share of problems-- homelessness is a huge issue we are trying to deal with, I already mentioned the traffic (it can take hours to travel 10 miles in morning traffic at times) and everything costs more. Our biggest industry, tourism, is something that is largely out of our control. 38 iaoms.org

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not certain of this. As a local growing up here, there is less “aloha” than I remember as a kid-- I guess those are the pitfalls of more people/cars etc… city life! Believe me, living on Oahu-- it’s not all Mai Tai’s and grass skirts. On the plus side, my family is here-- I would never practice anywhere else because of that. I still see friends regularly. The weather is great! I grew up getting sunburns on the beach every weekend (the pre-sunblock days), so being able to go to the beach is nice-- I still go fishing, haven’t surfed or gone free-diving for at least 10 years. Honestly, I could practice anywhere if my family and friends were in close proximity. I guess as you mentioned the gist of this piece is practicing in paradise--Paradise is where you make it or how you view it! What is your work week like? I work 4 1/2 days a week, like most OMS here I work a half day on Saturday. Most patients/ parents work during the week and don’t want to take time off for a dental appointment so it is quite common for dentists to work on Saturdays to try to accommodate. As I am getting older though, I realize that it is important to have some Saturdays off. I work from 7:30 am-4:30 pm weekdays and

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What is it

I guess my opinion is that there are a lot of sacrifices an OMS makes if they want to practice in Hawaii ... The question is whether or not it is worth the sacrifice... for me there in no question it is worth it.

7:30 a-noon Saturdays. I have a very bread and butter OMS practice - no cosmetic procedures, TMJ or trauma; only dentoalveolar, implants, pathology, etc. There are a growing number of OMSs in Hawaii not doing any ambulatory anesthesia in the office anymore. Orthognathic surgery is so few and far between that I chose not to continue doing it as I feel that I cannot perform the surgery as well as I want to if I am only doing a few such cases a year... just a personal view. I guess my opinion is that there are a lot of sacrifices an OMS makes if they want to practice in Hawaii... The question is whether or not it is worth the sacrifice... for me there in no question it is worth it. ■

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WHERE ARE YOU NOW?

Today

Mr. Ward Booth, maxillofacial surgeon retired By Deepak Krishnan

ear Ward Booth

Where are you now? I live a converted Oast House (Google it if you want to know more) in Sussex UK. How do you spend your time these days? I retired completely 3 years ago at the age of 69. One of my main reasons was my daughter has a family and lives in Australia, a horrible over 24 hour flight. It’s not a trip you make regularly unless you can be away for several weeks, so it made sense to stop work. Both my children are doctors with busy lives, so it’s important and good fun to spend time with them and their children. So this takes a lot of my spare time, which of course includes recovering from the boundless energy of small children. I’ve always had a stupid interest in cars and motor racing so now I have two classic old English sports cars. They were badly built when they were made 50 years ago. So you can imagine they both need a lot of “TLC”. I entertain my friends by taking up golf at the age of 70, I think the cost of the golf balls is greater than the green fees! I do my best not to engage in maxillofacial surgery, is there anything more irritating than old retired surgeons telling the real surgeons how to do things? Do you read any OMS literature now? Not really, I’ve had “my day in the sun”. It’s time to let others innovate audit and pontificate. It is also some 40 iaoms.org

times frustrating seeing the “wheel being reinvented” again! What do you consider the single most meaningful contribution you made to the specialty of Oral Maxillofacial surgery? That’s for others to comment on. I’m glad I got involved with other members of the editorial teams, producing BJOMS & a couple of textbooks. My aim was as much as anything, to set out the scope of the modern (as it was then) scope of the specialty. I got personal pleasure from my time in Sunderland, as it was hugely rewarding introducing with my consultant colleagues, new surgical procedures to the unit. The changes stimulated amazing support encouragement and dedication from colleagues whether they be secretaries, nurses, trainees OMF colleagues or traditional “rival” surgical specialties. What is your perception of how the specialty has changed from when you started to now? It has become a surgical specialty. Education & training have become ever more important. Good quality audit of outcomes has happily replaced the October 2016

“It was largely luck and chance which got me into OMF surgery, and my career with all it´s unplanned twists and turns gave me plenty of excitement.” turns gave me plenty of excitement. I did not need a plan “B”, and so would not change much. Which technological advance in the specialty would have made a difference in your surgical activity? True interactive 3-D virtual reality for surgical training, but it’s still not available!

dogmatic pronouncements of the surgeon with the biggest ego! What do you miss the most about work? The camaraderie of good friends, and those good days when you felt you had “made a difference”. What do you not miss about work? Not much; I was lucky to have thoroughly enjoyed my career from “boy” to consultant, it was just good fun. I’m happy not to miss the odd colleague’s bullshit, and those seemly incapable of thinking more than one move ahead. Do you keep in touch with former colleagues? A few, but they were “work” colleagues and that central ingredient of retirement is the loss of “work”. Life moves on and we retirees have to do the same. What would you change about your career path if you could go back and do so? It was largely luck and chance which got me into OMF surgery, and my career with all it’s unplanned twists and October 2016

What advice do you have for the OMS trainee starting training in 2016? There is no doubt OMF surgery has to be kept as a “team”. That bond of medicine & dentistry as it makes oral & maxillofacial surgery unique. So learn to respect your “good” surgical colleagues in the specialty, whatever their background. Don’t forget your trainees will teach you a lot. Finally when you become a senior surgeon don’t hold the young ones back, and certainly don’t hang around when you retire!! Were you ever involved with IAOMS or ICOMS? How important was the association in you career? Any international association faces enormous challenges, whether it’s the U.N. or IAOMS. I have found some of its activities frustrating and conservative, but on balance the educational role of the association easily outweighs any negative politics of some individuals. I am very grateful to IAOMS for its many invitations to lecture, I particularly enjoyed the “grand debates”. It also allowed me to visit some wonderful places, but above all it allowed me to meet some wonderful people from around world. What are you currently reading? The biography of Roald Dahl, who shows us how to grasp our opportunities, whilst keeping a great sense of humour and self-deprecation, a perfect proscription for an OMF surgeon! ■ iaoms.org 41

In Memoriam

Emeritus Professor Henk Tideman

â&#x20AC;&#x153;Icon and a pioneer who has done a great service to the professionâ&#x20AC;? By Paul Stoelinga, past president IAOMS

Henk Tideman was born in 1942 in Malang, in the formerly called Dutch Indies, currently called Indonesia. He grew up in difficult times, in that his father was put in a Japanese concentration camp, while his mother, with two little boys, was put in a camp for women. They were only liberated late in 1945 and transferred to Australia. A year later the family was reunited and migrated again to Indonesia, where his father had a plantation. They were finally kicked out of the country by the Soekarno regime in 1950. Despite the relatively short period that he lived in Indonesia he was completely hooked to the tropics and always idealized his upbringing on the plantation. Henk came to the Netherlands in 1952 after another two years in Australia. He had to catch up with his contemporaries because he was somewhat behind particularly in languages. Yet, he went smoothly through his secondary education and entered the University of Utrecht, Dental School in 1960. He enjoyed a lively student time and served one year as the president of the Utrecht dental student association. He also went through the school without problems and graduated in 1966. He served one and a half years in the Dutch army as a dentist after which he became a resident in Oral and Maxillofacial surgery at the University of Amsterdam. There he became interested in preprosthetic surgery and developed his technique of doing vestibuloplasties using cheek mucosa. He successfully defended his thesis on this subject and was appointed consultant at the Municipal Hospital of Arnhem in 1972. It is there that the cooperation with Paul Stoelinga began. Both of them were convinced that a medical education was necessary to be able to expand the profession and thus, they decided to take on the challenge and enroll in the medical school at the University of Nijmegen. It took 5 years of hard work to achieve a medical degree while taking turns to do the rotations in the various departments. In 1977 both had acquired the desired degree and began to publish on their results of bone augmentation on the severely resorbed mandible and on various topics related to orthognatic surgery. They had achieved a certain reputation by that time which had resulted in rotations of residents from the University of Leuven (Belgium) and University of Washington, Seattle(USA).The scope of practice had rapidly expanded including oncologic and secondary cleft lip and palate surgery. In 1980 a truly exceptional malignant tumor in the Sartorius muscle of his right leg had to be operated and afterwards radiated. He survived but the subsequent side effects of this treatment, including some 15 operations to allow him to keep walking, had great impact on his further life. Henk took on golf in 1977 after graduating from Nijmegen University Medical School and became very successful indeed. The physical handicap that came about with the many operations to fit him a proper

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hip prosthesis did not prevent him to play golf almost untill the very last year of his life. In 1981 he went to Adelaide in Australia to lead the department of Oral and Maxillofacial surgery. His competence and fighting spirit made his stay in Adelaide very successful despite the strong competition of a neighboring specialty. His input and introduction of new techniques, that he had acquired in the Netherlands, changed the profession in that part of the world. He rightly acquired the admiration and thankfulness of the residents that he trained in that period. The next step was his move to Hong Kong in 1988, where again a department needed some fresh blood to expand and to provide the much needed service to the public. With the same energy and stamina as he had shown in Adelaide he set off to build up a department that became the shining star in the whole of East Asia. His much admired surgical expertise combined with his vast experience made him develop certain procedures that were most welcome in Hong Kong. He presented an impressive overview of his achievements at the presidential lecture at the ICOMS in Athens in 2003. His influence on the development of OMF surgery in China can hardly be overestimated. He was a much asked and appreciated teacher and advisor for several Chinese colleagues but also for colleagues of other Asian countries. His love for the tropical Asian world grew during his stay in Hong Kong which made him decide to settle in Thailand on the Island of Phuket. After his retirement in 2004, he moved permanently to his home in Phuket. But even there he remained active in that he became a consultant at several Thai universities and in Singapore at the National Dental Center. With the help of the industry and various other people he developed a modular prosthesis to replace a resected mandible. Henk, knowing what a joint prosthesis meant, was very keen to jump on the opportunity to create a prosthesis that would not require major surgery to harvest bone from a distant side. He has enjoyed the success of this endeavor by being the supervisor of four Ph.D. theses, that where defended at the University of Nijmegen in the Netherlands. With the passing away of Henk Tideman the profession has lost an icon and a pioneer who has done a great service to the profession but above all to the patients whom he treated over the years. â&#x2013;

October 2016

REMEMBER THE PLACE REMEMBER THE DATE

17 0 2 G N KO rd HONG st 3 l i r Ap / 1 3 h Marc

October 2016

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In Memoriam

William H. Bell, DDS 1927-2016 By Dr. Julio Acero, President IAOMS

DR. WILLIAM “BILL” HARRISON BELL, surgeon, scientist, author and teacher passed away on June 1, 2016 in Stowe, Vermont surrounded by family. During a career spanning more than fifty-five years that included decades at The University of Texas Health Science Center at Houston and UT Southwestern Medical School/Parkland Memorial Hospital in Dallas, Bill left an indelible mark on many around the world. Through his pioneering research, he is credited with developing the biologic basis and a clinical rationale for orthognathic surgery. He was the author and editor of many textbooks on the subject, including Surgical Correction of Dentofacial Deformities, Modern Practice in Orthognathic and Reconstructive Surgery, and Distraction Osteogenesis of the Facial Skeleton. He trained dozens of surgeon-scientists, many of whom continue to populate academic medical centers across all continents, as well as train others in Bill’s surgical methods.

By Julio Acero, president IAOMS

A memorial mass and reception was held on June 20, 2016 at Saint Monica Catholic Church in Dallas, Texas. Friends and colleagues from around the world were in attendance, including the honorary pallbearers: Drs. Richard Finn, Chawket Mannai, Timothy Turvey, Harry Schwartz, Messrs. Andy Christensen, Scott Atkins and Earle Foreman. ■

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October 2016

Beyond OR

From Borduria to Syldavia By Javier González Lagunas (@golagunas)

orduria was one of the countries where Oral and Maxillofacial Surgery originally developed. In the first years of our specialty a group of pioneers created and improved some of the surgical techniques that later on expanded all over the world, and helped to cure or improve the lives of many of our patients. For years, trainees and even faculty surgeons from Syldavia, from St Theodoros and even from Neo Rico travelled to Borduria to learn from the masters, and then establish centers of excellence in their own countries. That was 20 or 30 years ago and those surgeons who then were residents are now the leaders of the speciality in countries that are no longer underdeveloped. In Syldavia, they have achieved excellency in managing cleft patients, because of the number of newborns operated yearly. In Neo Rico they are extremely experienced in esthetic surgery of the face, because the people´s demand is so high. In Sandonesia, because of their feeding habits they treat thousand of new cases of oral cancer, and centers of excellence exist all over the country. But something elses has happened: all this expertise is not so easily available in Borduria and its neighbour countries. Prenatal diagnosis has dramatically reduced the number of deformities, regulations and legal claims greatly affect the practice in esthetic surgery, and early diagnosis has also reduced the number of cases with advanced head and neck cancer. Security measures as the obligatory use of helmets or safety belts have also affected trauma centers. And the fact that in Syldavia and Sandonesia have a centralized authority that obliges patients to go to specialized centers of management, give surgeons in those countries a practical experience that bordurians will never achieve if they remain in their comfort zone. I think that cocooning in your own practice or hospital, even though you live in mighty Borduria is not a great October 2016

idea. You are wasting a whole bunch of opportunities. Foreign rotations and training will immerse you in not only departments that are developing the new new maxillofacial surgery, but also in different health structures, and in a brand new cultural scenario. You will be exposed to cases and illnesses that will not be easily encountered in your own country, and you will face the economical limitations regarding diagnostic tests. But of course, that does not mean that medical rotations should only take a single direction from Borduria to Syldavia. Syldavians will still benefit from visiting the centers in Borduria that play a leader role in the development of the high-tech diagnostic and therapeutic media of maxllofacial surgery. Travelling and foreign rotation is win-win situation both for the host and for the guest surgeon. IAOMS is there to help. Being the only authenticaly global association for oral and maxillofacial surgery, we have the tools, the network and the contacts, to open up the windows of your professional career into the world. Our international conferences, our fellowship opportunities, our list of members converts IAOMS in a unique tool to develop the surgeons of the future, a globalized and open future that will defitely broaden your personal horizons. Take advantadge of that: we do not mind being used... (You already know it but Borduria, Syldavia and St Theodoros are imaginary countries coming from the rich mind of Hergé, the belgian creator of Tintin. But the surgeons and the scenario are as real as our five continents...). ■ iaoms.org 45