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President’s Message Volume VII, ISSUE VI, 2015

In This Issue:

From the President

Membership

Residents Mee ng

Upcoming Events

Stay Sharp—Resident Abstract

Prac ce Management Tips

This Month in OOOO

The American College of Oral and Maxillofacial Surgeons Surgical Excellence Through Education REVIEW

ACOMS

Dear Colleagues and Friends,

Summer has come, and as always, so too has the busiest season of the year for most oral and maxillofacial surgeons. At the same me, for those of you involved in the academic aspect of OMS, gradua on season is also upon us. More than 200 new OMS graduates should be entering our ranks in the U.S. some me around July 1. In fact, for the next few months, as new graduates of OMS programs join our private prac ce colleagues, this me period is o en the point when the training

acquired in an academic program suddenly has to be put into rapid‐fire prac ce. While I think that we can always be proud of the educa on our new professionals have received, o en it is the senior partners at their new sites of employment that are relied upon to provide the “finishing school.” Even then, there remains a need for con nuing educa on for all to stay current, to stay sharp, and to stay safe. ACOMS is here to provide and support the surgeon in their con nuing educa on needs.

Although summer is a compara vely quiet period for the College, in deference to the aforemen oned busy season, we highly recommend that you look to the coming year to start planning your new educa onal experiences:

In the fall, residents need look no further than our highly successful 4th Annual ACOMS Residents Mee ng November 14—15 in Philadelphia, PA. An

excellent opportunity to present abstracts and case reports and for fellowship with other young doctors, this mee ng has drawn excellent a endance and strong reviews year a er year. Under the directorship of ACOMS Immediate Past President Dr. Robert Strauss, this mee ng promises to be another knock‐out, with dynamic guest speakers. Everyone is welcome—even prospec ve employers.

In February, we are proud to bring to our members, and their referring orthodon sts and prosthodon sts, the ACOMS/Faces 29th Winter Mee ng in Snowmass, Colorado. For years, Dr. Myron Tucker and Co. brought you the FACES course that spoke to both the OMS and their referring doctors.

In that same spirit, directed by Drs. Bryan Bell, Brian Farrell, and Chuck Hasse, this course boasts an outstanding faculty speaking on cu ng‐edge innova ons in contemporary OMS, which is prac cal for all dental professionals. The skiing and small group se ng is ideal for renewing old friendships or making lifelong new ones. See you on the slopes!

(Con nued on page 2)

President’s Message (continued) March will bring a course that is near and dear to my heart, the ACOMS Hands‐on Profile‐plasty Course. Located in the heart of New Orleans, this course provides one day of didac c training focusing on rhinoplasty and genioplasty, with a second day available for interested par cipants to head to the cadaver lab for “hands‐on” instruc on. This is also a great course for residents, with reduced tui on available. The venue for this course is truly world‐class, and spots are limited. Registra on will open in July.

Although s ll far‐off in April of 2016, you will not want to miss out on bringing yourself and your family to sunny Puerto Rico for the ACOMS 37th Annual Scien fic Conference and Exhibi on. Mee ng me is generously spaced to provide free me for you and your family to explore and enjoy this unique island. Chaired by Drs. Stephanie Drew and ACOMS President‐elect Pedro Franco, this looks to be a truly world‐class scien fic and prac cal mee ng that our members will long remember.

As always, keep an eye on the ACOMS website. New in‐person and online educa onal content will be announced on a monthly basis, including the ques on of the week, member discussion forums, real‐ me and on‐demand webinars, and hands‐on courses in TMJ and Orthognathic Virtual Surgical Planning. Addi onally, ACOMS Fellows should be sure to download the ACOMS logo to proudly display on their own web page—addi onal informa on is available on the following page.

Sincerely,

Jon D. Perenack, DDS, MD

Keep in Touch With ACOMS—Follow Us on Social Media and Download our Mobile App:

View pictures from recent ACOMS events on Facebook and Instagram.

Get the latest up‐to‐the‐minute news on Twi er.

Stay in touch with your colleagues across the globe on LinkedIn.

Get news, mee ng informa on and much more in our mobile app.

Catch up on sessions from our Annual Conference in the ACOMS Learning Center.

Show Your ACOMS Pride Here are just a few ways that Fellows and Members can show their ACOMS Pride:

1. Display the ACOMS Logo on Your Professional Marke ng and Communica ons Collateral

Members of the College are encouraged to adver se their affilia on with ACOMS in their

professional adver sements and communica ons using the ACOMS logo and phrase. ACOMS

Fellows and Members may reproduce the logo and iden fy themselves as members on:

Professional sta onary

Le erhead

Business and referral cards

Business and personal websites

E‐mail signatures

Interior and exterior doors and windows

Plaques

Visit www.acoms.org/logo to read the full terms of use and to download high‐resolu on files.

2. Display Your Cer ficate of Fellowship or Membership

We encourage you to display your cer ficate proudly in your

prac ce. Newly redesigned membership cer ficates and frames

have been sent to our newest members, and will soon be

available for all members. You may con nue to display your

original cer ficate for as long as you remain a member, and

informa on about upgrading to the new design will be available

in July.

3. Wear Your ACOMS Fellow or Member Pin

Whether you are a ending an ACOMS event, another

conference or mee ng, or just seeing pa ents, make it a

habit to wear your membership pin. Don’t have a pin?

Contact ACOMS to receive a replacement at

info@acoms.org.

4. Add ACOMS to Your CV and Biosketch

Please review your CV and biosketch to ensure that your Fellowship or Membership in ACOMS is

referenced as one of your affilia ons.

Welcome New Members

Please join us in welcoming the following new Fellows and Members of the College:

Congratula ons to New Diplomates

ACOMS congratulates the more than 200 new Diplomates who received their ABOMS cer fica on

in 2015. If you are an Associate Member of ACOMS who has become Board‐cer fied, you are now

eligible for Fellowship in the College. You do not need to reapply—simply send an email to

info@acoms.org reques ng that your status be changed.

A en on Gradua ng Residents

New this year, ACOMS is pleased to offer complimentary ACOMS Associate Membership to new

OMS in the first year a er comple on of residency. If you are a current Resident Member and will

be gradua ng this summer, please log‐in to your member profile and update your contact

informa on. To claim your Associa on Membership, you will simply need to provide proof of

gradua on. You will be contacted to do so in July.

Program Directors and other academicians: please

share this news with your gradua ng residents!

Membership

Dina Amin

James Arnold

Reza Bolourian

Eric Carlson

Patrick Duffy

Sean Edwards

Christopher French

Reed Gibbins

Jasjit Gill

Avery Goldberg

Preston Gomez

James Habashy

Daniel Harris

Jerri Hine

Robert Hinkle

James Homrighausen

David Kang

Rick Kapitan, Sr.

Sarah Lawson

Jerome Lindeboom

David Lustbater

Michel Matouk

Leonard Merlo

Gayle Miranda

Linda Miyatake

Kevin Monteleone

Brandon Newell

Joseph Novak

Blair Ota

Donald Phillips, Jr.

Vidya Ra an

Steven Reck

Peter Reich

Steven Roser

Daniel Sampson

Aaron Sarathy

Howard Schare

Marc Serra

Sinan Tozoglu

Gary Wayne

At the Fourth Annual ACOMS Residents Mee ng, a endees will have a chance to:

Learn From the Best with keynote lectures by world‐renowned speakers.

Present Their Research in the Resident Research Forum.

Make Connec ons with peers from other OMS residency programs to foster collabora on, bolster, professional networks and make friends.

The Resident Research Forum at the Residents’ Mee ng is an outstanding opportunity for any resident, from PGY‐1 through Chief, to:

Gain Speaking Experience by presen ng a scien fic abstract or interes ng/unusual case in a low‐pressure environment.

Get Feedback from your peers in a endance to fine‐tune your presenta on and hone your speaking skills.

Win Prizes including travel awards to a end next year’s Annual Conference.

Get Published Scien fic abstracts will be published in OOOO Journal

The deadline for submission of abstract and case presenta ons for the Resident Research Forum is Wednesday, October 21, 2015.

Resident registra on is only $29.

Please save the date, spread the news, and start planning your abstract or case presenta on now. Learn more at www.acoms.org/residents.

Stay Sharp

Ar cles submi ed to the ACOMS Review are not subject to scholarly peer‐review. Author(s)

maintain responsibility for the contents of their ar cle.

This abstract was presented as a poster at the ACOMS 36th Annual

Scien fic Conference and Exhibi on, April 18‐20, 2015.

Does Accutane (Isotre noin) Therapy Put Pa ents at Risk for

Developing “Dry Socket” (Alveolar Ostei s) A er Dental Extrac on?

James B. Han, DDS, MD and Christopher F. Viozzi, DDS, MD

Division of Oral and Maxillofacial Surgery, Department of Surgery

Mayo Clinic, Rochester, MN

Purpose: To assess the incidence of alveolar ostei s in pa ents

undergoing dental extrac on while on ac ve and within 30 days of

comple ng isotre noin therapy.

Method: We retrospec vely reviewed all pa ents using the Mayo Clinic EMR from 01/01/2000 to

09/22/2014 and iden fied those who had “Accutane” or “isotre noin” men oned in their medical record

within 180 days prior to the surgical procedure.

Results: Twenty‐six pa ents (median age 17.5, range 13‐33) underwent dental extrac on while on ac ve

isotre noin therapy. The average cumula ve dose of isotre noin to date of surgery was 4424 mg (range

40‐10080 mg). Out of 96 teeth extracted (D7210 = 7; D7220 = 18; D7230 = 46; D7240 = 25), only one

pa ent (female, on OCP, 320 mg cumula ve dose of isotre noin at the me of surgery) developed alveolar

ostei s in one site (extrac on site no. 17, D7240). There were no known smokers in this group and 3 out of

the 4 total female pa ents were on OCP. In twelve pa ents (median age 16.5, range 16‐18) who

completed isotre noin therapy (average 10910 mg, range 6800‐15880 mg) within 30 days of surgery, none

developed alveolar ostei s. This group had three females (2 on

OCP), one known male smoker, and a total of 49 dental

extrac ons (D7220 = 3; D7230 = 26; D7240 = 20).

Conclusions: The incidence of alveolar ostei s in pa ents on

ac ve or recently completed isotre noin therapy is 3.8% or

2.6%, respec vely. These are within the range of previously

published reports and suggest that isotre noin does not confer

added risk of developing alveolar ostei s in pa ents undergoing

dental extrac on. The cumula ve dose of isotre noin therapy at

the me of surgery does not appear to be related to occurrence

of alveolar ostei s. View the full poster online.

ATTENTION RESIDENTS:

This new monthly segment in the ACOMS Review is your opportunity to share a case report or literature review with a nationwide audience. Articles must be 500 words or less and may not have been previously published. Residents whose articles are accepted in the newsletter will receive a royalty payment of $100.

Visit www.acoms.org/articles to learn more or submit your article.

Prac ce Management

Medical Protective is proud to collaborate with ACOMS as an affinity partner to provide members with a solution for their dental liability insurance needs. MedPro’s120,000+ insureds have benefited from its unmatched financial strength, market commitment and claims expertise for over a century.

Congratula ons to the 2015 Class of New OMFS Jennifer Gibson, OMFS Specialist, Medical Protec ve

MedPro’s OMS Preferred Program extends congratulations to those oral and maxillofacial surgeons completing their residency. As you reflect on the completion of your residency, many of you will inevitably think about the responsibilities of entering private practice. One of many important decisions you will make is choosing your malpractice insurance coverage. It’s wise to make that choice based on the carrier’s financial strength ratings and the coverage details that best suit your needs including policy limits, consent clause and policy type. First, to assess a company’s financial strength, you should consult an independent rating agency such as A.M. Best. (www.ambest.com) A rating agency like A.M. Best offers an unbiased evaluation and labels companies ‘secure’ if they have a Superior (A++, A+), Excellent (A, A-) or Good (B++, B+) rating. This approach takes things into consideration such as balance sheet strength, long-term operating performance, and other factors that are critical to an insurance carrier’s longevity and ability to provide a strong defense if a claim is filed against you.

Once you know about a carrier’s financial strength, you should assess the coverage details. Policy limits reflect how much indemnity a company can pay on behalf of an insured. Limits for oral surgeons range between $1M /$3M and $5M/$7M. Many oral surgeons select limits of $2M/$4M or higher, given the history of claims in this specialty. The first number is the per claim limit, meaning the most an insurance company will pay for any single claim filed against you. The second number is the aggregate limit; this is the maximum an insurance company will pay for all claims filed against you in a given policy period. In addition to policy limits, each policy contains language regarding the handling of malpractice claims. Here you’ll find the policy’s consent clause, one of the most important provisions for you to fully understand. The strongest consent clause – often called ‘pure’ consent – gives you the authority to refuse to settle any claim. You must be careful, as many insurance companies have qualifiers in their provision allowing them to settle without your consent or providing other penalties if you choose to refuse consent. Another critical decision is choosing the best policy type given your specific needs. There are two options available to oral surgeons: occurrence and claims-made. With occurrence coverage, you need not worry about securing tail coverage for any change in your life or practice. Plus, in retirement, each occurrence policy provides a distinct set of limits for each year, potentially offering more protection if claims are filed against you over separate years. As you can see, there are significant choices to make about your malpractice coverage. Too often healthcare providers purchase a policy, make the annual payments, and don’t think about the details of coverage until they’ve been notified of a claim. We encourage you to make an informed purchasing decision upfront so you are best prepared in the unexpected even a malpractice claim is filed against you in the future.

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This Month In

Please visit www.OOOOJournal.net/Current to access the journal online.

Featured in this month’s issue:

Management of fractures of the atrophic mandible: a case series

Andres Flores‐Hidalgo, Mehmet Ali Altay, Isabel C. Atencio, Ashley E. Manlove, Keith M. Schneider, Dale

A. Baur, Faisal A. Quereshy

Objec ve: This study aims to report the outcome of pa ents with atrophic mandible fractures.

Study Design: Atrophic mandible fractures in 11 pa ents (7 females and 4 males) were approached with

a transcervical incision, and bone segments were stabilized with 2.7‐mm reconstruc on tanium plates

and locking screws placed at the lateral border of the mandible. In 6 of the 11 cases, autogenous cancel‐

lous bone was used to repair a con nuity defect or to augment the ver cal height of the bone in the re‐

gion of the fracture(s).

Results: No major intraopera ve or postopera ve complica ons were encountered in any pa ent. Two

pa ents presented with postopera ve infec ons that resolved with incision–drainage and an bio cs,

and removal or replacement of the reconstruc on plates or the bone gra s was not required.

Conclusions: Treatment of atrophic mandible fractures can be performed safely and effec vely with reconstruc‐

on plates, with or without bone gra ing. The most conserva ve and predictable treatment in the long term is

the defini ve reconstruc ve surgical procedure to restore form and immediate func on.

OOOO is the official

journal of ACOMS

and a complimentary

benefit for our

members.

Also in this month’s issue:

Complica ons related to surgically assisted rapid palatal expansion

Guhan Dergin, Sertac Aktop, Altan Varol, Faysal Ugurlu, Hasan Garip

Fracture of mandibular condyle—to open or not to open: an a empt to se le the controversy

Sanjay Rastogi, Siddharth Sharma, Sanjeev Kumar, Mahendra P. Reddy, B. Niranjanaprasad Indra

Trea ng maxillofacial trauma for over half a century: how can we interpret the changing pa erns in e ology

and management?

George Rallis, Panagio s Stathopoulos, Dimosthenis Igoumenakis, Christos Krasadakis, Constan nos

Mourouzis, Michalis Mezi s