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President’s Message Volume VII, ISSUE XII, 2015
The American College of Oral and Maxillofacial Surgeons Surgical Excellence Through Education REVIEW
ACOMS
With the holidays close at hand, I would like to take a moment to wish peace and goodwill to you and your loved ones and to thank you for another fine year with the College. I would also like to extend a sincere personal thank you to our volunteers, especially the officers, Regents, and commi ee members, as well as the ACOMS staff, for their hard work keeping ACOMS running smoothly all year.
2015 has been another fantas c year for the College. This year we offered seven high‐quality live educa onal events, including another amazing Annual Mee ng, which I had the privilege of chairing, and our membership has grown for the second consecu ve year. We have launched several exci ng new programs for the benefit of our members, including: our monthly online Clinical Review exercise; a program to offer complimentary malprac ce coverage to new OMS prac oners; and a partnership to assist residents with student loan refinancing.
I am confident that 2016 is going to be an even be er year. We already have five events planned through June (which you can read more about in the ensuing pages), and our Commi ee for Con nuing Educa on is hard at work planning as many as ten more events through spring of 2017! We will con nue to offer the Clinical Review,
which I encourage you to take advantage of as an opportunity to earn CDE on a monthly basis, and will launch our Ques on of the Week in January to provide an addi onal resource for you to stay current across the breadth of our specialty. We will also increase our online educa onal opportuni es with new live and on‐demand webinars. I encourage you to contact me if you have an educa on need that is not being met; we are happy to explore new course topics and learning formats to be er serve you.
The mission of ACOMS is twofold: to enhance surgical excellence through educa on, and to promote fellowship amongst oral and maxillofacial surgeons. We strive to excel at the former by con nuing to improve our educa onal programs and developing new ones to meet your professional needs. We could not accomplish the la er without you. You are what makes this organiza on great, and I thank you for being a part of ACOMS and for allowing me to serve as President. I wish you and your family a joyful holiday season and a happy new year.
Best regards,
Jon Perenack, DDS, MD President, American College of Oral and Maxillofacial Surgeons
Membership Display Your Membership With Pride
ACOMS memberships run from September 1 through August 31. Membership
dues for 2016 were due on August 31, 2015. You can s ll renew online by
following these steps:
1. Visit h p://www.acoms.org/login.aspx and sign in with your username
and password. If you forgot your password, you may select "Click here
to reset your password" and new informa on will be emailed to you.
2. Click on the ***Renew Your Membership Now*** link.
3. Select your membership and enter your credit card informa on.
4. Click on the "Submit Securely" bu on.
A final membership dues invoice will be mailed in early January 2016 with
instruc ons on how to pay by check.
It’s Not Too Late to Renew Your Membership!
ACOMS is happy to announce the
release of newly‐redesigned
membership cer ficates. Be sure to
display your ACOMS pride through these
professional, scholarly cer ficates at
your home or office. Members wishing
to purchase a new cer ficate may do so
online. Reduced‐price framing services
for cer ficates are also available. Please
visit the ACOMS website for more
informa on and to purchase a cer ficate today!
Support Education: Donate Today As 2015 draws to a close, please consider making a
dona on to ACOMS. Dona ons of all sizes and
payment plans are appreciated. Whether it's a one‐
me gi , a monthly contribu on, or part of a matching
gi s program, your dona on helps sustain ACOMS
opera ons and supports educa on and research to
advance the specialty of oral and maxillofacial surgery.
Donors will be recognized in the program at our 37th
Annual Scien fic Conference and Exhibi on.
You may choose to donate to any of the following funds:
ACOMS General Fund
Dona ons support the daily opera ons of ACOMS.
Resident Travel Fund
Dona ons are used to fund travel opportuni es for OMS residents to a end our Annual
Conference and educa onal courses.
ACOMS Founda on
A donor advised fund (DAF) of the Oral and Maxillofacial Surgery Founda on. Dona ons
support educa on and research to advance the specialty and improve pa ent care.
Please visit acoms.org/donate to learn more and to make your dona on!
Your dona on is tax deduc ble!
ACOMS is a 501(c)(3) non‐profit organiza on incorporated in the United States. Dona ons are
tax deduc ble as charitable contribu ons for federal income tax purposes. Please contact your
tax advisor for guidance. ACOMS federal tax ID number is 11‐2420729.
Stay Sharp This case report was recognized with Honorable Men on dis nc on when it was presented at the
ACOMS Residents Mee ng, November 4‐15, 2015 in Philadelphia, PA.
Rhabdomyolysis in a Pa ent with Panfacial Fractures
Jason Sheikh DMD, MD and Maryam Akbari DMD, MPH, Mount Sinai Hospital
Pa ents with panfacial fractures o en present with mul system injuries including damage to skeletal
muscle. These injuries increase risk for rhabdomyolysis and acute renal failure following the ini al
injury.1
Case Report:
A 48‐year old male was brought to the emergency department following a motorcycle collision with a
tree. CT imaging demonstrated facial fractures including frontal sinus, bilateral LeFort III, and bilateral
mandible fractures as well as a compound right femoral fracture. (Figure 1)
On hospital day 2, the pa ent’s urine output was noted to be minimal. Labs included CK of 12485 U/L,
BUN 18 mg/dL, and Cr of 1.5 mg/dL. The pa ent’s crea nine con nued to rise from 3 to 4.5 mg/dL,
and CK peaked on hospital day 3 at 37090 U/L with elevated urine protein. The elevated CK,
proteinuria, and tea‐colored urine (free of red blood cells) confirmed a diagnosis of rhabdomyolysis.
While receiving sustained low‐efficiency dialysis (SLED), the pa ent was taken to the opera ng room
for repairs of his facial fractures. The pa ent had an uneven ul post‐opera ve recovery. On hospital
day 16 UOP began to increase. Over the following week, normal urine output returned.
Discussion:
Rhabdomyolysis (RD) is defined as
dissolu on of striated muscle fibers.
Causes include extremity vascular
interrup on, compression, torso crush
injury, pa ent posi oning during
surgery, infec on, electric current, and
excessive exercise.2 RD can be measured
and diagnosed by plasma levels of
crea ne kinase (CK) released from
injured myocytes.3, 4
(Con nued on next page)
Stay Sharp (ctd) Urine discolora on is o en the first sign of RD. Tea
‐colored urine that is dips ck posi ve for blood
despite the absence of red blood cells should raise
suspicion for RD. Although crea ne kinase is an
effec ve screening test for muscle injury, no
specific value has been shown to be completely
predic ve of acute renal failure.2, 3, 5 Serial CK levels
remain useful, however, in the assessment of
pa ent’s response to treatment.
With ischemia, me is muscle. Inadequate blood supply to the skeletal muscle a er 2 hours has
minimal ultrastructural damage; skeletal muscle injury, however, is irreversible a er 7 hours. 6
Development of oxygen free radicals as well as increased intracellular calcium lead to cellular
dysfunc on. Cell death ul mately releases myoglobin, potassium, and other cellular contents into
circula on.7, 8
Treatment of RD centers on rehydra on. Large volumes of crystalloid are necessary to dilute the
myoglobin load delivered to the kidney. Mannitol has also been used in the treatment of RD as an
intravascular volume expander, renal vasodilator, and hydroxyl radical scavenger. Alkaliniza on of
the urine has also been proposed as an adjunct to RD treatment.9 Slow low‐efficiency dialysis has
been shown to be effec ve in filtering myoglobin as well as potassium released with muscle injury to
allow for renal recovery. 10
The presented case illustrates a typical progression of rhabdomyolysis triggered acute renal failure
with early increases in CK with a peak in CK at 2‐3 days followed by decrease in UOP and GFR.
Resolu on typically develops within a period of a few weeks with return of renal func on.
References:
1. Hammon K, Assael L, Buchbinder D,Rhabdomyolysis in a pa ent with a mandibular fracture, 1987;45:627.
2. Ellinas PA, and Rosner F. Rhabdomyolysis: report of eleven cases. J Natl Med Assoc 1992;84:617–624.
3. Hess JW, MacDonald RP, Frederick RJ, et al. Serum crea nine phosphokinase ac vity in disorders of heart and skeletal muscle. Ann Intern
Med 1964;61:1015.
4. Slater M, Mullins R: rhabdomyolysis and myoglobinuric renal failure in trauma and surgical pa ents: A review. J Am Coll Surg, 1998;186:693‐
716.
5. Ward MH. Factors predic ve of acute renal failure in rhabdomyolysis. Arch Intern Med 1988;148:1553–1557.
6. Harris K, Walker PM, Mickle DA, et al. Metabolic response of skeletal muscle to ischemia. Am J Physiol 1986;250:H213–H220
7. Poole‐Wilson PA,Harding DP, Bourdillon PDV, andTones MA. Calcium out of control. J Mol Cell Cardiol 1984;16:175–187.
8. Duncan CJ, and Jackson MJ. Different mechanisms mediate structural changes and intracellular enzyme efflux following damage to skeletal
muscle. J Cell Sci 1987;87:183–188.
9. Be er OS, and Stein JH. Early management of shock and prophylaxis of acute renal failure in trauma c rhabdomyolysis. N Engl J Med
1990;322:825–829.
10. Braun SR, Weiss FR, Keller JR, et al. Evalua on of the renal toxicity of heme proteins and their deriva ves: a role in the genesis of acute
tubular necrosis. J ExpMed 1970;131:443–460.
ATTENTION RESIDENTS: This 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.
Join us in New Orleans for the latest installment in our Hands-on Surgical Education Series, providing in-depth didactic and cadaver training for cosmetic procedures of the nose and chin. Attendees rave about the cutting-edge facilities of the LSU Health Sciences Center and our 6:1 attendee to instructor ratio ensures that you will get the guidance that you need to excel. Featuring: Jon D. Perenack, MD, DDS Tirbod Fattahi , MD, DDS, FACS James R. Koehler, MD, DDS John P. Neary, MD, DDS, FACS Kevin L. Rieck, DDS, MD, FACS
This one‐day course is structured around both didac c and hands‐on cadaver laboratory
experience that will offer up‐to‐date informa on and techniques rela ng to advanced
treatment of the temporomandibular joint. Clinicians will have an excellent opportunity to gain
valuable insights and hands‐on experience in these very
important modali es of treatment.
The one‐day format and convenient loca on near Jacksonville
Interna onal Airport make this an easy in‐and‐out learning
opportunity with minimal me away from your family and your
prac ce.
Dr. Larry Wolford will discuss the
contemporary approach to surgical
treatment of the TMJ with emphasis
on custom total joint replacement.
Dr. Michael Proothi will offer technical
advice on all aspects of arthroscopy,
focusing on the use of in‐office
arthroscopy, and will provide a
comprehensive review on the use of
this modality for diagnosis and therapy.
Saturday, January 30, 2016 | Zimmer Biomet Institute, Jacksonville, FL
Only FIVE Spots Remain
Don’t Miss Your Chance—Register Today!
Chair: Joel Rosenlicht, DMD
Faculty: Larry Wolford, DMD and Michael Proothi, DMD, MD
Course Chair Dr. Joel Rosenlicht
demonstrates arthroscopy
techniques with Dr. Karim Hussein.
Earn 4.5 Hours of Anesthesia CE in the Pediatric Anesthesia Mini‐Symposium
Pediatric Risk Assessment
Jeffery Benne , DMD Anesthe c Technique and Pharmacology for
the Pediatric Pa ent Deepak Krishnan, DDS
How Would You Manage this Pa ent? Patrick Vezeau, DDS, MS
Management of Pediatric Emergencies Deepak Krishnan, DDS
Pediatric Technique: LMS Steven Thomas, DDS, MD
ADA CERP is a service of the American Dental Associa on to assist dental professionals in iden fying
quality providers of con nuing dental educa on. ADA CERP does not approve or endorse individual
courses or instructors, nor does it imply acceptance of credit hours by boards of den stry. The
ACOMS 37th Annual Scien fic Conference and Exhibi on has been approved for 19 hours of Con nuing Dental Educa on (CDE) credits.
Share Your Research by Presen ng an Oral or Poster Scien fic Abstract Any registered a endee may submit an oral or poster abstract for presenta on at the mee ng. All accepted oral abstracts will be published in OOOO Journal and abstracts from residents will be enrolled in a compe on to win prizes of up to $1,000. The deadline to submit your abstract is February 5, 2016.
Party Island Style
Our 2016 conference will feature two exci ng new evening social events that you will not want to miss. Full details will be available soon.
Bring Your Family to Enjoy Fun in the Sun
The Ritz‐Carlton San Juan is the perfect des na on to bring your family to relax poolside or at the beach, be ac ve with water and adventure sports, or explore Old San Juan, El Yunque, the Bioluminescent Bay and much more. The hotel offers an on‐site tour company with daily ou ngs to make it easy to plan your trip for the whole family. Be sure to book your room by March 18, 2016.
What Are You Wai ng For?
Register Today at acoms.org/2016!
Earn CDE on Your Schedule, at Home or On‐the‐Go
In November we launched a new, monthly member benefit: the ACOMS Clinical Review. Each month
the Clinical Review will feature a new textbook chapter or ar cle. Visit our Learning Center,
complete a pre‐ and post‐ assessment, and read the ar cle to earn one credit of Con nuing Dental
Educa on (CDE) per month. New chapters will be added monthly and you can access them
whenever and wherever you like.
Please visit the Learning Center to complete our first two Clinical Review exercise:s Brow Li ing by
Dr. Tirbod Fa ahi and Computer Planning for Orthognathic Surgery, by Dr. Stephanie Drew. We
thank Drs. Drew and Fa ahi for their assistance with this new member benefit. Our third monthly
ar cle will be posted the first week of January.
These con nuing educa on ac vi es u lize text from The Atlas of Oral and Maxillofacial Surgeons
by Deepak Kademani and Paul Tiwana. Copyright, Elsevier 2015.
ADA CERP is a service of the American Dental Associa on to
assist dental professionals in iden fying quality providers of
con nuing dental educa on. ADA CERP does not approve or
endorse individual courses or instructors, nor does it imply
acceptance of credit hours by boards of den stry. Brow Li ing has been approved for one (1) hour of
Con nuing Dental Educa on (CDE) credit. Planning for Orthognathic Surgery has been approved for one (1)
hour of Con nuing Dental Educa on (CDE) credit.
Stay Connected with
ACOMS!
Not following ACOMS on social media
yet? Click our various handles to keep
up to date, interact with your fellow
Oral and Maxillofacial Surgeons, and
share your professional news
with the College.
Student Loan Refinancing from SoFi
Terms and Condi ons Apply. SOFI RESERVES THE RIGHT TO MODIFY OR DISCONTINUE PRODUCTS AND BENEFITS AT ANY TIME WITHOUT NOTICE. To qualify, a borrower
must be a U.S. ci zen or permanent resident in an eligible state and meet SoFi's underwri ng requirements. Not all borrowers receive the lowest rate. To qualify for the
lowest rate, you must have a responsible financial history and meet other condi ons. If approved, your actual rate will be within the range of rates listed above and will
depend on a variety of factors, including term of loan, a responsible financial history, years of experience, income and other factors. Rates and Terms are subject to change
at any me without no ce and are subject to state restric ons. This informa on is current as of September 15, 2015 and is subject to change. SoFi loans are originated by
SoFi Lending Corp., NMLS # 1121636. For terms and condi ons, visit sofi.com/legal.
Should you refinance your student loans?
If you’re looking into refinancing your student loans, SoFi may be able to significantly reduce the cost of
that debt. SoFi is the leading provider of student loan refinancing and has funded $5B+ to over 80,000
borrowers na onwide – saving their average den st borrower around $39k.* Their compe ve rates
and member benefits are what have made SoFi the go‐to student loan refinancing company for
thousands.
When it comes to refinancing student loans, SoFi offers the ability to refinance and consolidate both
federal and private student loans into either a fixed or variable rate loan. SoFi offers fixed rates star ng
at 3.50% APR (with autopay) and 1.90% APR (with autopay)* with no applica on fees, origina on fees
or pre‐payment penal es. The online applica on allows applicants to receive an instantaneous pre‐
approval in under 10 minutes and populates the rates that applicants are qualified for on each loan
term offered ‐ 5, 7, 10, 15 and 20 year terms.
To add to SoFi’s compe ve rates, flexible loan terms and an easy applica on, SoFi provides member
benefits that differen ate it from other lenders. All SoFi borrowers receive access to Unemployment
Protec on, Career Services, SoFi’s Entrepreneur Program and member events hosted across the
country. Not only is SoFi looking to provide a be er solu on to student loan debt repayment, SoFi
strives to create a community that helps its members succeed in various areas of their professional
careers.
Consider Refinancing
Is refinancing right for you? For some borrowers, it’s a no‐brainer. For others, it might be an op on later
on. The bo om line is that you can benefit from giving your loans a second glance every so o en,
because the rate you were originally given isn’t necessarily the rate you’re stuck with for life. Visit
SoFi.com/ACOMS to qualify for a 0.125% rate reduc on.
ACOMS and FACES PRESENT
29th Annual Winter Mee ng
February 22‐27, 2016 Snowmass, Colorado
Invite your OMS colleagues and friends, your family, and your referring den sts and orthodon sts to join us this February to enjoy cu ng‐edge
con nuing educa on, and the spectacular ac vi es that have made Aspen/Snowmass world‐famous.
Register online or learn more
about the mee ng at
acoms.org/faces
REGISTER TODAY!
Tara Aghaloo, PhD, MD, DDS
UCLA School of Den stry Department of OMS
Eric Carlson, DMD, MD
University of Tennessee Medical Center
Stephanie Drew, DMD
The New York Center for Orthognathic and Maxillofacial Surgery
Edward Ellis, DDS, MD
UTHSC San Antonio School of Den stry Department of OMS
Antonia Kolokythas, DDS University of Rochester OMFS
Deepak Krishnan, DDS University of Cincinna Division of OMFS
Joseph McCain, DMD
Miami Oral and Maxillofacial Surgery
Suzanne McCormick, DDS
Pacific Center for Jaw and Facial Surgery
Steven Roser, DMD, MD, FACS
Emory University Division of OMFS
Michael Will, MD, DDS, FACS
Will Surgical Arts
Boot Camp Co‐Chairs Stephanie Drew, DMD and Eric Carlson, DMD, MD Present Our 2016 Faculty:
Risk Management by Jennifer Gibson, MedPro’s OMS Preferred Insurance Program
MedPro’s OMS Preferred program is specifically designed to serve the unique needs of oral and maxillofacial surgeons across the country. With OMS Preferred, you leverage all the advantages of Medical Protective, the nation’s oldest and largest malpractice insurer – including unmatched risk management expertise.
What is Clinical Risk Management?
Risk management is a process by which an individual or organiza on assesses their environment to iden fy
challenges that could poten ally lead to a “loss.”
Every prac ce needs a sound risk management program — one that focuses on pa ent safety and
sa sfac on. MedPro is commi ed to suppor ng its customers with risk management products and
services that support this approach and reduce the possibility of financial loss, professional liability
exposure and damage to their reputa ons.
Why is Risk Management Important?
Newly graduated oral and maxillofacial surgeons o en underes mate the importance of risk management
services. When a pa ent is in the chair and you are faced with a serious concern, it is too late to realize the
value of specialized risk management services.
How Would I Use Risk Management?
Many mes, oral and maxillofacial surgeons call their malprac ce companies’ risk management teams
when an area of concern presents itself. Here are a few scenarios in which a risk management team
should be able to provide you with guidance:
Dealing with an Adverse Event
While performing a rou ne fully impacted third molar extrac on, a por on of the tooth breaks off and
cannot be located. How should this be handled from a risk management standpoint?
Records Management
An oral and maxillofacial surgeon is running out of storage space and wants to dispose of records for some
inac ve pa ents. Can this be done, and if so, how should it be completed?
Child Custody and Treatment
An oral and maxillofacial surgeon is trea ng an 8‐year‐old child for an orthognathic condi on. The mother
has been compliant with instruc ons, including keeping all appointments. The father of the child has called
the office and stated he does not want the child to receive any further treatment. May the child con nue
to be treated?
Noncompliance with Recommenda ons
An oral and maxillofacial surgeon has a pa ent with a worsening oral infec on as a result of his poor oral
hygiene and noncompliance with the recommenda ons. The oral and maxillofacial surgeon wishes to
discharge this pa ent from the prac ce even though he needs con nuing care. How can this be
accomplished without the poten al of abandoning the pa ent?
14
This Month in
OOOO is the official
journal of ACOMS
and a complimentary
benefit for our
members
Featured in this month’s issue:
Long‐term morbidi es of coronectomy on lower third molar
Yiu Yan Leung, BDS, MDS, PhD; Lim Kwong Cheung, BDS, PhD
Objec ve: To monitor the long‐term morbidity of retained roots up to 5 years following lower third
molars coronectomy with close proximity to the inferior alveolar nerve (IAN).
Study Design: A prospec ve study on long‐term morbidi es a er lower third molar coronectomy.
Results: This study included 612 lower third molar coronectomies in 458 pa ents. The prevalence of
IAN injury was 0.16% (1/612) and was temporary. Long‐term postopera ve infec on occurred in 1
case at 6 months following surgery and another at 12 months. No infec on was found a er 12
months. The incidence rates of pain at 6 months, 12 months, 24 months a er surgery were 0.50%
(3/596), 0.38% (2/529), 0.49% (2/411), respec vely. Root exposure was noted in 2.3% of cases
(14/612). Reopera on to remove the exposed root did not cause any IAN deficit.
Conclusions: Lower third molar coronectomy is safe in the long term.
Also in this month’s issue:
Predictors of mortality, hospital u liza on, and the role of race in outcomes in head and neck trauma Mark Jesin, Stephanie Rashewsky, Michael Shapiro, William Tobler, Suresh Agarwal, Peter Burke, Andrew Salama
The influence of intraopera ve frozen sec on analysis in pa ents with total or extended maxillectomy James Murphy, Amal Isaiah, Jeffrey S. Wolf, Joshua E. Lubek
Tracheostomy and infec on prolong length of stay in hospital a er surgery for head and neck cancer: a popula on based study Joseph McDevi , Marianna de Camargo Cancela, Maria Kelly, Harry Comber, Linda Sharp
Please visit www.oooojournal.net/current to read more.