n the compass - oral & maxillofacial surgeons 2003.pdf · 2010-10-08 · namese oral surgeons...

TheCOMPASS

Official Publication of the California Association of Oral and Maxillofacial Surgeons

N

CompassDirection

Volume V, Issue 2, Summer 2003

LEADERSHIP AN ONGOING EVOLUTION

Leadership involves con-stantly stearing a new courseto meet the ever changingbusiness tides and winds

Continued on Page 6

For an organization suchas CALAOMS tocontinue to be relevant,responsive and viable inmeeting the needs of its

membership, its leadership structureneeds to be periodically reviewed.What in the past has worked,seemed to be appropriate and metthe needs of an organization shouldnot be taken for granted. Timeschange. People change. Needschange. Priorities change. It followsthat an organization needs to alsochange, and with it possibly theleadership structure, if it is going tocontinue to prosper and meet theneeds of its most precious asset, itsmembership.

It is with these thoughts thatcoming out of this year’s StrategicPlanning Session a need wasperceived to reevaluateCALAOMS’s leadership andorganizational structure. As onelooks back at the roots of our originin 1986, it was obvious thatCalifornia’s two oral surgerysocieties needed to have a way tospeak with a single voice in mattersof advocacy, dealing with insurancecompanies, national oral surgery

politics and the likes. Accordingly,through the thoughtful foresight ofthe leadership of NCSOMS andSCSOMS, CALAOMS wasfounded. Since that timeCALAOMS has evolved into thesingle premier organizationrepresenting organized OMS inCalifornia with the dissolution ofboth NCSOMS and SCSOMS intoCALAOMS. This transformationinto a single organization has beenmost positive for our specialty byalmost all accounts. It is not thepurpose of this article to recount

those successes, but rather visit howour current leadership structurecame into being.

Early on, and even as weamalgamated into this singleorganization, the CALAOMS Boardof Directors was set up to includemost if not all of the Officers of thetwo regional societies on an

President’s Message

Editorial Page 4

Letters To The Editor Page 5

Risk Management Corner Page 7

Teaching Centers Page 8

Teaching Centers Cont. Page 11

Calif. Trends and OMS Page 14

Management of OMS Medical

Emergencies Page 16

General Announcements Page 18

Upcoming Events Page 18

In Memoriam Page 19

AAOMS Dist. VI Update Page 20

Classified Ads Page 22

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The Compass - Summer 2003

The COMPASSpublished by the

California Association of Oraland Maxillofacial Surgeons

Board of Directors

John S. Bond, D.M.D.President (408) [email protected]

P. Thomas Hiser, D.D.S., M.S.President-Elect (619) [email protected]

Michael E. Cadra, D.M.D., M.D.Vice President (209) [email protected]

Gerald Gelfand, D.M.D.Treasurer (818) [email protected]

Murray K. Jacobs, D.D.S.Secretary (209) [email protected]

Mary Delsol, D.D.S.Past-President (949) [email protected]

Bruce L. Whitcher, D.D.S.Director (805) [email protected]

Larry J. Moore, D.D.S., M.S.Director (310) [email protected]

Ned L. Nix, D.D.S.Director (408) [email protected]

Lester Machado, D.D.S., M.D.Director (858) [email protected] CongdonExecutive Director (800) [email protected]

Corrine A. Cline-Fortunato, D.D.S.Editor (408) [email protected]

Steve KrantzmanNewsletter Production Manager(800) [email protected]

Published 3 times a year by the California Association ofOral and Maxillofacial Surgeons. The Association solicitsessays, letters, opinions, abstracts and publishes reports ofthe various committees; however, all expressions ofopinion and all statements of supposed fact are publishedon the authority of the writer over whose signature theyappear, and are not regarded as expressing the view of theCalifornia Association of Oral and Maxillofacial Surgeonsunless such statement of opinions have been adopted by itsrepresentatives. Acceptance of advertising in no wayconstitutes professional approval or endorsement.

Your CALAOMSCentral Office Staff

Executive DirectorPamela CongdonPhone Extension: 12email: [email protected]

Information Systems DirectorSteve KrantzmanPhone Extension: 13email: [email protected]

Administrative AssistantDebi CuttlerPhone Extension: 14email: [email protected]

Administrative AssistantBarbara HoltPhone Extension: 10email: [email protected]

151 North Sunrise Avenue, Suite 1304Roseville, CA 95661

Office: (916) 783-1332Office: (800) 500-1332Office: (800) 491-6229Fax: (916) 772-9220

Web Site: www.calaoms.org

Your staff is here to help you withany questions about membership,continuing education courses, certi-fication, and events. Please do nothesitate to contact us with questionsor concerns at:

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The Compass -Summer 2003

Editor’sCorner

HAPPY FISCAL NEW YEAR!

Our office functions ona fiscal calendar soJuly 1st is a little likeNew Year’s Day. It’sa time we review the

year, set or change policies andreflect on what we have learned andhow to apply it to our office-basedoral surgery practice. This year Ilearned some valuable lessonstaught at the “School of HardKnocks”. These are practical bitsof information not taught in CEcourses. I thought I’d share somewith you:

1) Complications from oralpiercings, though “rare”, do occur.I treated five this past year (threeinfections, one case of hyperplastictissue and one lingual dysesthesia).Until recently my main concern withoral piercings was the affect theyhad on the diagnostic quality of theradiographs when a patient refusedto remove their jewelry. It makessense that these types ofcomplications would present to theOMS practice. It makes even more

sense that they have become moreprevalent as the rise in home“piercing parties” increases (two ofthe infections I treated werereported to have occurred afterpiercing was performed at a party).

2) If your patient orallyconsumes a suppository medicationthere is no need for alarm (as longas the foil wrapper was previouslyremoved). The onset of action willbe delayed, but the medication willstill be effective.

3) In addition to Poison Controland the Fire Department you maywant to include Child ProtectiveServices as an easy to locateemergency phone number. You areobligated to report any case ofactual or suspected abuse or neglectas soon as you discover it (as in rightthat minute). CPS is very adamantabout this. Be prepared for CPS toarrive at your office and remove thechild (treated or not). In mostinstances they will arrive with acourt order for your records and willexpect to duplicate them at that timeso be sure they are in order.

Here’s to a happy fiscal new year!

Bill Emmerson announced hisintention to run for the 63rd AssemblyDistrict at the annual CALAOMSbreakfast during the California DentalAssociation Meeting in Anaheim inApril.

An opening in the 63rd District wascreated when Assemblyman BobDutton announced his intention to runfor the Senate seat, vacated by thetermed-out Senator Jim Brulte.

Emmerson will be the seconddentist to run for the State Assemblyin recent years, following the lead ofCALAOMS member Sam Aanestad,who was elected in 1998 to theAssembly and in 2002 to the Senate.

Emmerson, a former Californialegislative staff member and long-timevolunteer with the California DentalAssociation, Tri County DentalSociety, and various orthodonticassociations, was encouraged to run forthe Legislature by Senators Brulte andAanestad.

You can reach the Bill Emmersonfor Assembly campaign at: P.O. Box7607, Redlands, CA 92375.

Bill Emmerson forState Assembly

Corrine Cline-Fortunato D.D.S.

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Letters to the Editor

In March of this year, Itraveled to Ho Chi MinhCity, Vietnam, with col-leagues Dr. Liviu Eftimie,Dr. Brett King, and Dr.

Wade Hill, to further introduce theprinciples of orthognathic surgeryto Vietnamese oral surgeons. Thiswas my fourth volunteer assign-ment with a Washington, DC-basedorganization called Health Volun-teers Overseas (HVO) and my thirdvisit to Vietnam since 1999.

HVO has been training Viet-namese oral surgeons at theInstitute of Odonto-Stomatologyand Maxillo-Facial Surgery inimplantology since 1996. Morethan 100 implants are now beingplaced a year through this program.Prosthodontists are also participat-ing in the HVO program and havesignificantly enhanced pros-thodontic education in Vietnam.The institute’s dental clinic andadjacent maxillofacial hospital iscurrently expanding from fouroperating rooms to eight and is nowbetter prepared to handle majorsurgery cases.

The orthognathic aspect ofHVO’s oral surgery training pro-gram in Vietnam was harder toinitiate than the implantologytraining but was desperately needed.While the Vietnamese faculty at theinstitute is made up of skilled

surgeons, the HVO program pre-sented its first introduction andhands-on exposure to orthognathicsurgery. Before our training,patients with jaw deformities inVietnam simply were not cor-rected.

The introduction oforthognathic surgery in Vietnamwas compounded by the fact thatthere are very few trained orth-odontists in the country. Asprospective surgery patients typi-cally need one year to eighteenmonths of consistent orthodonticcare to be properly prepared forsurgery, we are now hoping to havepatients ready for surgery on ayearly basis. The growing level ofcooperation between Vietnameseorthodontists and oral surgeons isenhancing that process.

Our most recent volunteerassignment was a culmination ofour previous work in Vietnam.During our February 2000 visit toVietnam, we selected several of thepatients who were operated on inMarch 2003. Our week in Vietnamwas spent reviewing techniques andpreparing patients for surgeryalongside the Vietnamese practi-tioners, overseeing two and a halfdays of surgery and lecturing tomore than 20 local oral surgeonsand residents. Our last day wasspent sightseeing with our hosts inand around Ho Chi Minh City and

following up with our surgerypatients.

The goal of all HVO programsand certainly of the Oral andMaxillofacial Surgery OverseasProgram in Vietnam is to teach,train and mentor local health careproviders rather than to provideservices. With that in mind, our rolein Vietnam was to work with and tosupport the local oral surgeons whoactually performed the operations.

Our Vietnamese colleagueswere grateful for the time we spentwith them and for sharing newtechniques and skills. Patients werealso thankful for the help theyreceive through HVO’s trainingprograms and typically present agift to the doctors followingsurgery. The family of one little girlwho we operated on in 2000,continues to email me to keep meupdated on her health and schoolprogress.

Volunteering through HVO inVietnam has been a very rewardingand gratifying experience and I lookforward to returning. I wouldrecommend that anyone interestedin advancing the speciality of oraland maxillofacial surgery world-wide to get involved with HVO.Membership dues support thedevelopment of oral surgery pro-grams and volunteering is a way tocontribute to our field and to thecountless professionals and pa-tients around the world who are inneed of new skills and techniques.

Continued on Page 21

Introducing Orthognathic Surgery in Vietnamby Dale E. Stringer, DDS

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John S. Bond, D.M.D.

John S. Bond, D.M.D.President, CALAOMS

Leadership an Ongoing Evolution Continued from Page 1

alternating basis between the northand the south. Accordingly we havesix officers (President, President-Elect, Vice President, Secretary,Treasurer and Immediate PastPresident) and four Directors atLarge. Historically, the typicalascension pattern has been to comeon the Board as a Director, spendingusually 3-4 years, and then beingnominated to move on up throughthe chairs and accordingly easilyspending 10 or more years inpositions of leadership. This can bea worrisome, overbearing andunreasonable commitment to makeby many within our membershipranks that would make excellentleaders for our organization.

It is with these thoughts in mindthat an exploratory committee wasset up by myself to look into thepossibility of an alternativeleadership structure. The hopewould be that members desiring totake up positions of leadership andresponsibility would not decline thisopportunity simply out of anunwillingness to sign on for ten ormore years without really knowingthe commitment and inner workings

of the CALAOMS Board ofDirectors. It would seem that anExecutive Committee, more in linewith AAOMS’s, consisting of aPresident, President-Elect, VicePresident, Immediate Past Presidentand Treasurer would more thansuffice. It might well serve theorganization to take the Treasurerout of the typical ascension patternand have that be a long-termposition to be filled for a number ofyears by someone with an interestin the finances of the organization.The Treasurer could certainly benominated on down the line to movethrough the chairs, but it would notbe an understood obligation. TheDirectors at Large (probably threeto four) could serve staggered termsyet to be determined, certainly withthe opportunity to move on throughthe chairs, but not with the up frontexpectation that they would. Thereare undoubtedly many memberswho might wish to serve on theBoard as a Director for a few yearsbut with no interest in continuing upthe leadership ladder. This wouldbe somewhat similar to the Trusteesfrom the six districts in AAOMS.Future leadership almost alwayscomes from those within the Boardwho choose to move on, but not allthat serve on the Board may choosenor should they necessarily beexpected to continue on.

The other beneficial change inour leadership structure, whichneeds to be visited and decided on,centers around long-term delegatesto the AAOMS House of Delegates.California is lucky in that we have7-8 delegates of the one hundred

that compose the AAOMS Houseof Delegates, depending on theannual census of membership. Moststates have only one delegate whooften is around for several years andnot necessarily in a leadershipposition. Some states with morethan one delegate have seen thewisdom in having a long-termdelegate who is familiar with theworkings of the House, remembersthe history (since it often repeatsitself) and has developed over theyears a good working relationshipwith many other delegates.Politically, this offers greatadvantage when it comes to theinner workings of AAOMS and itsleadership. In the past in Californiathe delegates have all come from theBoard of Directors, starting at thetop and working down. It wouldseem that one or two long-termdelegates would serve Californiavery well, both within District VIand the AAOMS House ofDelegates. This long-term delegateshould be nominated and approvedby the membership similar to all ofour officers and directors. Thisconcept is likewise being explored.It is our hope that within the nextfew months these changes can beagreed upon by your Board ofDirectors and submitted to themembership for their approvalincorporating the necessary Bylawchanges. I would encourage anyonewith thoughts or suggestions in thisarea to either contact myself or PamCongdon, our Executive Director,with your input.

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Alter Your Records –Lose Your Case

Every medicalmalpractice suit canbe won or lost basedon the quality andcontent of the medical

records. A potentially damaging suitcan be won simply because themedical record was precise,thorough and accurate. A weakliability suit can be lost because themedical record was vague,incomplete or altered. Alteringmedical records can be the kiss ofdeath to a provider’s malpracticedefense.

In a recent California case, anoral surgeon settled a defensiblemedical malpractice claim for nearly$1 million simply because he hadlost all credibility due to additionsthat had been made to the medicalrecord. The involved surgeon facedallegations of failure to diagnose andtreat an oral burn which resulted ininfection and intracranial abscesses.The 41 year old plaintiff now suffersfrom severe asphasia andneurological deficits. Supportiveexpert reviews were initiallyobtained for the defense in thislawsuit.

During the course of thelitigation, there were obvious

disparities in testimony between theplaintiff and the defendant surgeon.The patient claimed that on a secondoffice visit she presented withobvious signs of infection and ahistory of problems manifested byprotracted pain, swelling,temperature and limited jawopening. The defendant claimed shepresented with no symptoms exceptfor a limited jaw opening which hediagnosed as TMJ problems related

to the original incident. However,significant errors in record keepingappeared to indicate an attempt ofthe defendant to cover up his failureto diagnose or treat the infection.

The doctor admitted there werenumerous errors in the chartincluding the staff stamping thechart with the wrong dates andfailing to annotate a “no show”. Inaddition, the oral surgeon misdatedtwo entries and completely re-wrotethe entire entry of a previous visit.The erroneous entries were madewith different colored inks,suggesting that they were done at

different times or in an attempt tolook like they were done in thenormal course of business.

There are situations whenadding or deleting information to achart is legitimate. However, nomatter how innocent your intention,any change, if not done properly, canbe seen as a self-serving attempt tocover a wrongdoing. For instance,a few days after a patient encounter,you may remember a detail you leftout upon reviewing your records.Never backdate an entry. Date yourentry truthfully and specify that youare adding it after the fact. Also,make the addition legible andobvious. Don’t simply try tosqueeze the new information inbetween the lines or scribble it inthe margins.

Handwriting analysts aremasters of the art of detectinginconsistencies found in records.Experts can point out variations inhandwriting, chemical contents ofinks, types of pens, etc. Examinersmay use various techniques whenmedical records alteration issuspected: 1) Infrared examinationof suspected obliterated entries; 2)Handwriting examination todetermine if the sequence of thedocuments was altered; 3)Examination of documents todetermine if any pages were insertedor removed; 4) Examination offolds, creases and stapler/punchholes to determine the history of thedocuments; and 5) Handwritinganalysis to determine who wrote theentries.

SCPIE’s Risk ManagementCorner

Continued on Page 15

Altering records is a sure wayto sabotage your defense...

...It makes a doctor looklike a liar and a cheat; the jurywill never trust what he/shesays.

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Teaching CentersMuch more than just a knife and gun club - a look at the LAC+USC

Medical Center OMS Residency Program in 2003.

At LAX+USC OMS residents are intimately involved in full scope ofOral & Maxillofacial surgical care. Here under the watchful guid-ance of the attending staff, Dr. Paul Bohman, the residents are per-forming a facial reconstructive procedure in their own dedicated ORSuite.

As the summer months slowly approach the numbersof traumatic facial injuries once again is on therise at the Los Angeles County & University ofSouthern California Medical Center in Los Angeles(LAC/USC). This phenomenon is well known to

the trauma surgeons in the County of Los Angeles. Dr. Dennis-Duke Yamashita (USC OMS’73), the current chairman of theLAC/USC Advanced Program in Oral & Maxillofacial Surgery,has a simple explanation. He jokingly relates it to the Brauniantheory of molecular motion and temperature related increase inrates of molecular collisions. As Southern California temperaturesclimb so do the numbers of “interpersonal” collisions. Perhaps itis not the most scientifically valid explanation but there just maybe something to it.

Be that as it may, the overalltrauma numbers have beendeclining, based on the ten-yearretrospective epidemiologicaldatabase study concluded thisyear by the USC OMS and ENTresidents. The concomitantdecrease in Los Angeles Countyviolent crime rates and motorvehicle accidents over the last tenyears have both been linked to thealmost 50% drop in midfaceskeletal and mandibular fracturespresenting at LAC/USC TraumaCenter. The current casenumbers are still significant withover one thousand facial traumavictims treated annually. In fact,just this year the United StatesNavy chose the LA Countyprogram to train their OMS andTrauma teams in management oftrauma and ballistic injuries. Thisyear San Diego’s Lt.Commanders Alan Schelhamer and BoCarson spent their summer with the USC OMS program treatingfacial trauma and orthognathic patients.

The OMS residents and attending staff have pleasantlywelcomed these trauma volume changes. In the last three yearsthe program has been able to greatly expand its scope of training.The increased availability of operating room time for elective

surgeries, as well as close association with the Children’s Hospitalof Los Angeles (CHLA) department of Plastic Surgery, haveallowed the development of a superb pediatric and orthognathictraining curriculum for the current cadre of residents. The USCOMS surgeons now routinely perform midfacial and mandibulardistractions in both adult and pediatric patients treatingsyndromal, cleft lip and palate, trauma and trach dependentpatients. CHLA is one of the hot beds for this therapy on thewest coast and the residents are integrally involved in all phasesof the therapy. As a result of decreased insurance coverage fororthognathic case benefits in the private practice sector theprogram has seen well over a hundred referrals from privateorthodontists for delivery of orthognathic care at our publiclyfunded institution.

The program, which startedin 1964 under the guidance ofMarsh Robinson, is currently oneof the largest OMS residencyprograms in North America. Theprogram currently has fifteenresidents in two separate tracks.There are also two internshippositions available annually. Theinternship is highly sought after,as most of its graduates have beenable to gain entry into high profileresidency programs. The currentfour-year graduate track offers theOMS certificate while the six-yeartrack graduates residents with anMD degree from Keck USCSchool of Medicine and an OMScertificate.

Anyone familiar with the“County Hospital” will vouch that,unlike in many other medical

centers, one of the greatest attributes of this grand facility is theexceptionally friendly and collegial relationship between the threespecialty programs treating cranio-facial and head and neckproblems. OMS, ENT and Plastics residents routinely providecare to patients in a team approach with multi-specialty staffcoverage. This atmosphere has allowed the residents from allthree specialties to develop an understanding of how positiveprofessional interactions, mutual respect and varied clinical

9


2003 crew of LAC+USC Residents with their Chairman Dr. Dennis-Duke Yamashita. USC has currently thelargest training program on the West Coast and third largest program in North America.

Continued on page 10

backgrounds can yield optimal care for their patients. As a result“The County” is a very pleasant working and learningenvironment. It is hoped that the positive relationships cultivatedhere will continue and influence the residents in future interactionwith other cranio-facial and head and neck services in theircommunities.

The current program has a very diverse blend of individualsfrom various cultural and academic backgrounds. This isappropriate as the residents and staff are involved in provisionof surgical care to the very culturally and ethnically diverse, butlargely under-served, Los Angeles County community. In one ofthe busiest outpatient clinics in the country, the OMS residentsprovide outpatient surgical care to over 14,000 patients annually.The annual admissions to the OMS service alone amount to over500 patients a year with approximately 400 major surgicalprocedures delivered at its surgical facilities.

Although this year’s three senior residents have quitedifferent personalities and backgrounds, they have worked verywell together to lead the 2002/03 OMS team to one of the mostsurgically active years in the history of the program.

Andy Afshar (Case Western DDS’97, USC Keck MD’00),famous for his TV appearance on the reality show “Blind date”,has an uncanny flavor for fashion and physical fitness. Andy isplanning to enter into private practice in Arizona at thecompletion of his training. His medical school partner, Alex Kim(Columbia DDS’97, USC Keck MD’00), has spent his fewminutes of spare time building a supercharged Mustang he hopeswill avoid CHP’s radar due to its stealthy body-kit and low ridersuspension. Alex is also quite a computer/multimedia wizard whoplays a mean guitar. His career plans include staying in SouthernCalifornia, where the rest of family resides.

The lone four year residentPeter Krakowiak (UBCDMD’95) is one of fourCanadians currently in theresidency program (makingUSC one of the largest“Canadian” training programsin the world). Peter is planningto make the West Coast hishome as well. And just in caseanyone out there is looking foran associate all three of theseniors can be contactedthrough their program.

The USC OMS program isnot only involved in surgicalventures but has embraced the

areas of clinically relevant research with animal studies indistraction osteogenesis, human nerve injury research, oral cancerscreening methodology development, diabetes and odontogenicinfections in humans and socio-economical impact studies of thetrauma population. Residents, under the guidance of theirindividual staff research mentors, have been repeatedly selectedto present their research at several notable national andinternational forums. The Marsh Robinson Academy of OMSFoundation has been there to offer its strong financial supportfor their research pursuits technological advancement. This wellestablish program is funded by the USC OMS alumni and theirongoing support continues to be of great value to the residencyprogram.

Of special note is the research accomplished by Dr. Yen (ourstaff PhD orthodontist) and Dr. Yamashita in the area ofmandibular distraction. Numerous residents have assisted inthis grant-funded effort to develop an animal model for thecorrection of anterior open bite deformities with mandibulardistraction therapy. The distraction research has focused ondeveloping protocols for implant anchored distractionosteogenesis, as well as internal maxillary distraction applicationsin cleft lip and palate patients. These efforts have led to thedevelopment of a USC designed distractor prototype for mass-market production by KLS-Martin.

Dr. McAndrews (one of the newest attending staff and USCOMS grad 2000) and Dr. Yamashita have also been successful atarranging for a funded clinical trial of fluorescent light baseddevices for detection of pre-malignant lesions in the oro-pharynx.The appliances are based on techniques that have provedsuccessful in the detection of cervical lesions in obstetrics andgynecology.

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From left to right are Doctors Schmidt, Lee, Pogrel, Hatcher, Chigurupati, and Reddy.

UCSF Ground Rounds in May

On May 13, 2003 the University of California, San Francisco held its Com-bined Ground Rounds. David C. Hatcher, DDS, MSC, MRCD(C), a radi-ologist who specializes in images for the head and neck region, was thefeatured guest speaker. He spoke about the latest in radiological technol-ogy including the Newtom Scan and their application in the Oral and

Maxillofacial specialities. Pictured below are Dr. Hatcher, Dr. Tony Pogrel (head of theUCSF OMS Department), along with residents.

CALAOMS members are always encouraged to attend these short but informativelectures and rounds. One hour of dental and medical CE credits are available to attend-ees. The UCSF Department of Oral and Maxilorfacial Surgery puts on these meetingswith CALAOMS on a quarterly basis. We hope to see you at the next meeting in theseries in September of this year. It will feature Arun Sharma, DDS, MSc, Assistant Pro-fessor of Prosthodontics, UCSF. Dr. Sharma will lecture on “Implant Considerations forthe OMS”. The date is Tuesday, September 30th, at 6:00 p.m. in room C-701.

Knife and Gun ClubContinued from Page 9

Dr. Bach Le (USC DDS 1994 andOregon OMS’00) has been involved inmentoring the research in the area ofnerve injury and its recovery inmandibular fractures. In addition he hasco-authored several articles in the area ofimplants, bone grafting and alveolardistraction.

Dr. Joseph Anselmo, Col. USAF(R)and Temple OMS’64, is the new directorof the hospital’s department of dentistry.He has been busy over the last two yearsstudying the relationship between diabetesand the incidence of severe spaceoccupying infections.

The academic curriculum is alwaysimproving, most recently with thedevelopment of a comprehensive didacticand clinical implant module by Dr. TedTanabe (USC OMS’97), Dr. Ken Fortman(staff prosthodontic guru) and Dr. BachLe. The residents are exposed to severaldifferent implant systems, all currentlyavailable at the hospital as well as theUSC School of Dentistry. Recently thenewly developed undergraduate implantprogram has involved the OMS residentsin treatment planning and placement ofendosseous implants for USC School ofDentistry patients. The dental schoolbased OMS curriculum is predominantlymentored by Dr. David Hochwald (LoyolaOMS). Overall, the current residents aregetting large volumes of cases and a fullystructured didactic implant curriculum.

This year brought the return ofmonthly Cranio-Facial Deformity Forumswith the orthodontic faculty and residentsat the USC School of Dentistry. Thesefriendly CDC forums encourage Orthoand OMS residents to present and discussinteresting cases for mutual treatmentplanning input.

The USC program’s mission has notonly been to train skilled surgeons but alsoto serve the needs of the community. Inthe past few years the program directors

allowed the USC residents the opportunityto deliver oral surgical care to under-served children in the communities ofLong Beach and Catalina Island.Residents venture to these communitieswith their specialized skills and providecare to children who would otherwisehave no avenue for treatment. Severalresidents have also ventured to the EastLos Angeles school district to promoteoral health and spark youngsters interestsin health care professions during careerdays.

As the academic year approaches anend and a new crew of residents enters

the program they will inherit a broadscoped and balanced training program.The two certificate tracks offer differentpaths, however over the last few years theyhave proven to give fairly even and ampleexposure to oral surgical care. Theprogram continues to turn outexceptionally knowledgeable and talentedsurgeons with the ability to performexpanded scope Oral & MaxillofacialSurgery. The program’s future looksbright as it is continues to expound itsdidactic and research curriculum whilecontinuing to have case volumes secondto none.

By Peter Krakowiak, D.M.D.

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The Fortieth Annual Congress of the Sadi FontaineAcademy was held on March 15 and 16 at the beautiful Western Saint Frances Hotel in San Francisco.The speaker for this year’s congress was Dr. RobertCampbell, Professor of Oral Maxillofacial Surgery

at the School of Dentistry, as well as Professor of Anesthesiologyat the School of Medicine; Medical College of Virginia in Rich-mond, Virginia. The presentation was entitled “Office Based An-esthesia: New Technologies and Review of the Past, Present, andthe Future”.

Dr. Campbell’s outstanding presentation began on Saturdaymorning and ended Sunday afternoon. Topics covered were, NewAnesthetic Technologies including the use of Sevoflurane andIsoflurane in the out patient office setting. He also discussed theuse of Propoful, Ketamine and infusion pumps in delivery ofgeneral anesthesia in the private practice. Dr. Campbell wenton to discuss in detail management of anesthetic complicationsas well as the use of nonendotracheal anesthesia for adults andchildren. An extensive review of anesthetic complications suchas malignant hyperthermia, as well as laryngeal spasms werealso presented. Dr. Campbell concluded by discussing the LMA-Classic. The use of the laryngeal masks made the audience awareof this unique device, which provides for a secure and a reliableairway without the use of a laryngeal scope in blind insertions.The limited risk of esophageal or bronchial misplacement wasalso presented using the device. Dr. Campbell’s presentationended with a question and answer session, which lasted wellbeyond the allocated time. We are extremely grateful for hisgenerous donation of time and knowledge to our members.

The Fortieth Congress was dedicated to our dear colleague,Dr. John C. Dittmer. As you all are aware, John practiced inLafayette, California. In September of 1997, John suffered acerebral aneurysm which forced him to leave his private practice.John was honored along with his beautiful wife Kate, and hisdaughter, Dr. Franziska Dittmer-Duton, who graduated from theUniversity of the Pacific School of Dentistry in the year 2000.Also present was Mr. Matthew Duton, Franziska’s husband.

At the Dinner Banquet on Saturday evening, our own alumni,the Honorable California Senator, Dr. Sam Aanestad, presentedJohn with a “California Senate Resolution” for his years ofdedication to our profession and to his patients.

Prior to the conclusion of an elegant evening, Dr. ThomasIndersano, Chairman of the UOP-Highland Oral andMaxillofacial Residency Training Program, introduced theResidents and their spouses and welcomed distinguished guests,including Drs. Kramer and Packard, past chairmen of theresidency program.

The Sadi Fontaine’s Forty First Annual Congress is in itsplanning stages. The tentative date is planned for March of 2004.A brochure of the upcoming meeting will be sent to the SadiFontaine CALAOMS Membership in January of 2004. For furtherinformation or any questions, please contact Dr. Ed Bedrossianat 415-956-6610 or [email protected].

Edmond Bedrossian, DDS, FACD, FACOMSPresident, Sadi Fontaine Academy

Senator Samuel Aanestad D.D.S. Presents the Senate Resolution toCALAOMS Member John C. Dittmer D.D.S

Dr. Edmond Bedrossian(center) with 1999 Graduate Dr. Okezie (left), and2002 Graduate Dr. Far (right)

The Sadi Fontaine Academy;UOP-Highland Hospital’s Oral & Maxillofacial SurgeryResidency Training Program Alumni Association 2003

14


There are three keytrends that will mattermost to oral andm a x i l l o f a c i a lsurgeons over the

next twenty years and into thedistant future. Demographers areconfident of these predictionsbecause all of the elements that willform these trends are alreadypresent.

1. People, People, People

The sheer number of people willincrease dramatically. The 2000Census showed that the UnitedStates had 280 million people at theend of the last decade. We areexpected to gain 70 million peopleover the next two decades. Severalstates, especially those in the NorthEast, are facing a net loss inpopulation. Several states(especially in the Midwest) areexpected to stay about even. The bignews for California Oral Surgeonsis that the majority of the growthwill occur in three states: California,Texas, and Florida. Nevada,Arizona, and Utah will tend toattract large populations to majormetropolitan areas such as LasVegas, and Phoenix; but these aremore regionalized growthphenomena.

This uneven distribution ofpopulation means that rather than anice, even 25% growth in

population, California may increasein population by 40%. Everycommunity and county in Californiais going through an increase.

2. Diversity is King

The complexion of California ischanging. There is a myth that themajority of new residents in the stateare from Mexico. It is true thatwithin 25 years the Hispanicpopulation nationwide will increase

to 70 million from 35 million today.But the Hispanic market isextremely diverse. Mexico is justone of several countries thatcontribute large numbers of citizensto the State. It is possible that anoral surgeon in Los Angeles mayappeal to one of the many subgroupsof the Spanish speaking population(i.e., Guatemalan, Salvadoran,Columbian, etc.). While they havea common language, they considertheir cultures to be quite differentand tend to live in neighborhoodsof their previous national origin.

The ethnic growth will continuefor Asians. Their numbers areexpected to double from 12 millionto about 24 million for the nation.As much as ½ of their total numbersmay move to California.

All of this means that Californiais becoming much more diverse thanit previously was. There is a debateamong demographers andmarketers about how to promotebusinesses. Some say that we must“micro-market” to very small,diverse groups. Others say weshould look for a new “AmericanMelting Pot” that will express itselfas a new amalgamated AmericanCulture. Based upon America’shistory, this seems like the mostlikely scenario.

It is likely, for instance, that theexpectations for third-molarextractions may be different fromculture to culture. We have observedthat non-symptomatic treatmentsare deemed much less important byfirst-generation Americans than bytheir descendents. The question is,“How long will dental-acculturationtake for these new residents?”.

3. The Graying of America

This is a poorly understoodtrend. In short, it means that thenumber of older Americans willincrease. Their percentage will alsoincrease. The reasons are complex.

California Trends and Oral Surgeons:Demographic Changes that will Matter to Oral Surgeons

The big news for CaliforniaOral Surgeons is that themajority of the growth will occurin three states: California,Texas, and Florida.

15


For one, the American lifeexpectancy has greatly increased.For another, there are fewer childrenbeing born per American woman(referred to as the “Fertility Rate”).It is also true that older Americansare healthier than their counterpartsin previous generations. A personmay have considered themselves“Old” when they reached 60. Now,“Old” is a relative term.

It is expected that there will betwice as many seniors in 2025 asthere are African American’s today.Their money and their tendency tocontrol political issues (they aremajor voters), will make them apowerful force. The percentage ofadults 85+ will increase by 110%within 25 years.

The profession will probablyhave to redefine “geriatricdentistry.” Rather than consideringservices that plague older adults, itwill probably become the servicesto eliminate the results associatedwith aging.

California, especially with itsinland deserts (and golf courses) willaccelerate faster than the rest of theNation as more seniors from out ofstate discover California. These newCalifornians will likely come fromthe Northwestern and CentralUnited States that have colderwinters. While the cost-of-livingmay be higher for these seniors, theyconsider it to be a worthwhile trade-off in quality-of-life.

4. Changing California

California has always beenpolitically driven by two non-contiguous regions: The Bay Areaand The Los Angeles/OrangeCounty Area. While they are likelyto continue to add population, themost significant growth projectionsare associated with the CentralValley. These include Madera,Imperial, Calaveras, Kings, and SanBenito. All of these had more than30% growth in the last five years.Nearly all of the counties on theeastern side of the state, fromImperial County through SutterCounty, are expected to have themost dramatic growth in the State.This is not due to an exodus fromthe more urban, coastal cities.Rather it is a migration of younger,more “family-oriented” householdswith children. This growth is fueledby less expensive housing, increasedjob availability, reduced commutes,and perceived quality of life.

By Scott McDonald

To find out about thedemographics in your area ofCalifornia, please call ScottMcDonald & Associates (DentalDemographics) at (800) 424-6222or [email protected].

The primary reason for keepingany medical record must be toimprove patient care. If defendinga possible lawsuit is an obviousrecord keeping motive, credibility ofthe record is lost. Everyone makesmistakes but the methods forcorrecting mistakes in recordsshould be clear to avoid suspicion.

Changes necessary to protect apatient from possible harm arealways appropriate. For example,erroneously writing that a patient isallergic to penicillin when you reallymeant tetracycline could endangerthe patient. This entry should bechanged to avoid an injury. Acommon question asked is, ”Howlong after writing a record, is it stillappropriate to make changes?”. Ifthe record needs to be changed forpatient care purposes, it may bechanged at any time thereafter. Ifthe record change is not necessaryfor patient care, it should not bemade at any time.

Altering records is a sure wayto sabotage your defense. Plaintiffattorneys always hope that doctorshave altered their records becauseif they can prove it, the suit is over.It makes a doctor look like a liarand a cheat; the jury will never trustwhat he/she says.

By Barbara Worsley, head of the RiskManagement department at The SCPIECompanies.

Alter Your Records – Lose YourCase

Continued from Page 7

16


Lecturers at the Mangement of Emergencies in the OMS Practice pictured from left toright Doctors Beckley, Silegy, Podlesh, Limchayseng, Nix, Krey and Emison.

On March 12, 2003 atthe PleasantonHilton, CALAMOSonce again presented“Management of

Emergencies in the OMS Practice”.This semi-annual meeting providesparticipants (surgeons and theirstaff) with current practical

For the first time in severalyears the “old guard” turned thereins over to a new crop of courseorganizers who put together anexcellent program. In addition toDr. Nix, the presenters includedLouie Limchayseng, Wes Emison,Michael Beckley, Scott Podlesh,Bryan Krey and Tim Silegy. Credit

was given to Dr. Richard Robinson,former chairman of this program, forhis assistance to these newpresenters. Topics includedmanagement of complications of thefollowing systems: cardiovascular,respiratory, immune, nervous andendocrine. Presentations were givenby lecture, computer-based slidesand live simulated emergenciesutilizing the lectures’ staff membersto demonstrate the team approachto treating office emergencies.Equipment and supplies for thedemonstrations were provided bysome of the meeting sponsors. Asimilar program is planned forOctober in southern California somore members can benefit from thisinformative and very useful course.

Editor’s noteA special thanks to the following

sponsors who made this eventpossible:

Dexta, Xemax, Criticare,Little, KLS Martin,McKesson andHALS Med-Dent

information for handling the difficultsituations we may encounter in ourday-to-day practice of office basedoral and maxillofacial surgery andis a good update for preparing forthe Dental Board’s onsite anesthesiaevaluation. As always, this was awell-attended meeting. CourseChairman and Moderator, Ned Nix,informed the audience that somemembers had to be deniedregistration because the number ofparticipants was at full capacity.

March Continuing Education: “Managementof Emergencies in the OMS Practice”

By Eric Eklund

Dr. Limchayseng delivers his presentation on a stage that is set up as a mock surgeryroom, including equipment, assistant and patient.

18


General Announcements

Upcoming Events2003

PALSAugust 16, 2003 San Francisco

Effective Organization of Office EmergenciesOctober 1, 2003 Burbank

Fall Meeting - Resort At Squaw CreekOctober 10-12, 2003 Lake Tahoe

OMSA (Assistant’s Course)October 25-26, 2003 Irvine

ACLS - CALAOMSNovember 1, 2003 Solano

SCPIE/Risk Management SeminarNovember 5, 2003 TBA South Area

SCPIE/Risk Management SeminarNovember 12, 2003 Pleasanton

2004

Palm Springs Meeting - Anesth. Symp. 2004January 16-18, 2004 Palms Springs

CALAOMS 4th Annual MeetingApril 30 - May 4, 2004 Monterey

Fall Membership MeetingNovember 5-7, 2004 Silverado

Cancele

d

CALAOMS would like to thank allof the general anesthesia and conscioussedation evaluators who have beenworking diligently to make us currentwith on-site inspections. Due to theefforts of our evaluators, by the end ofSeptember we will be current. We aregrateful to the evaluators for volunteeringtheir time and energies to help theprofession in this way. Evaluators donatetheir personal time or take time awayfrom their own practices in order toperform these duties. Their effortsprovide maintenance of professionalstandards, and saftey for our patients, inaddition to keeping permit renewal feesto a minimum.

CALAOMS and the Dental Boardare grateful to these doctors who giveback to their profession.

Thank you Evaluators Equipment SalesMcKesson Medical Corporation has

been working in conjunction with specificequipment suppliers to make equipmentavailable to the membership at volumediscount prices. As many of you areaware we started with MRL AEDs whichwere a tremendous hit, and we sold over150 units. Even though the promotion isover we are still receiving calls request-ing these units. Although no longer avail-able at these prices, we can still purchasethem for you.

We have sold numerous Atlas Moni-tors as well as Midmark Auotclaves andSterilizers. Both of these promotions willbe over by the time of this publication.

If you would like to take advantageof the savings offered by these promo-

tions, you need to make your purchasesby the end of the deadline. The manufac-turers control these deadlines, and oncethey are up we will not be able to receivetheir special prices.

These promotions are going out bymail and fax. If you have not receivedask you office staff to make sure theyplace them on your desk. Look to thefuture for great prices on Midmark chairsdesigned for the OMS office.

If you have questions about ourequipment promotions call the CentralOffice at (800) 500-1332.

19


In Memoriam

Dr. Thomas Seaton, 74, passed away on March 17, 2003.Tom was born in Berea, Ohio to Ethel and Paul Seaton D.D.Son November 8, 1928. In his youth, Tom was an excellentathlete and played in the position of center on his high schoolfootball team. After graduation, Tom spent several years inthe Marine Corps. He then decided to follow in his father’sfootsteps and graduated from the Ohio State School ofDentistry in 1954.

Wanting to further his career Tom graduated from theUniversity of Pennsylvania in 1958 with his degree in OralSurgery. He completed his residency at Parkland MemorialHospital in Dallas Texas in 1959. Upon completion, Tommoved to Sacramento California, where he spent a year beforesettling down in San Diego.

It did not take Dr. Seaton very long before he became anintegral part of San Diego’s dental community. Tom took avery active role in his professions by becoming a member inmany dental and specialty societies which include, San DiegoCounty Dental Society, CDA, ADA, the former SCSOMS,CALAOMS, AAOMS, ACOMS, and ADSA.

Tom spent considerable effort to improve his knowledgeand the profession of Oral Surgery. Early in his career he servedas the Chief of Staff of OMS at Mercy Hospital. He served onthe Board of SCSOMS for many years, which culminated withhis Presidency in 1987. Tom was also honored in 1996 withour organization’s Dr. Adrian Hubbel Distinguished ServiceAward, for his life long commitment to OMS. Tom was alsoawarded with a fellowship in the American College of Dentistsin 1999.

When Tom was not in the office, he could be foundpursuing a lower handicap on the golf course. He loved towatch the ponies run “where the surf meets the turf” at theworld renowned Del Mar Racetrack. In the fall, Sundays werespent rooting for his favorite football team, the San DiegoChargers.

Tom remained active in OMS until his sudden death. Heis survived by his wife Jo Ann Fine of San Diego, his sonScott Seaton, stepdaughter Lori Winenberg, stepsons, Andrewand Larry Fine, his sister Martha Ann McGerry, and twograndchildren.

Thomas A. Seaton, D.D.SNovember 8, 1928 to March 17, 2003

Phuc Vinh Le, D.D.SMay 4, 1967 - June 8, 2003

Born on May 4, 1967, Dr. Phuc Vinh Le died in a tragicscuba diving accident at the age of 36, on June 8 2003. Dr. Lewas born in Saigon, Vietnam. He was a graduate from McgillUniversity, School of Dentistry, Class of 1992. He latergraduated from Boston University in 1997 with his degree inoral surgery.

Dr. Le moved out west to California where he settled inHuntington Beach, and set up practice in Westminster. Phucwas an upstanding member of his community and thisassociation.

It is always sad when one of our own pass on, but it iseven much more difficult to accept when they are young, witha full life and practice ahead of them. Dr. Le will surely bemissed.

20


AAOMS District VIUpdate

Richard A. Crinzi, D.D.S., M.S.AAOMS District VI Trustee

The AAOMS Board ofTrustees held a verysuccessful meeting June1 – 4, 2003 inRosemont, Illinois.

Subsequent to considerabledeliberation, and several weeks ofclose monitoring, the Board decidedto cancel the 2003 AAOMS AnnualMeeting in Toronto, Canada and movethe meeting to Orlando, Florida. Thisdecision was made in response tomember concerns and a growingbelief that the Severe AcuteRespiratory Syndrome (SARS)outbreak in Toronto presented apotential risk to those planning toattend the meeting. The health andwelfare of AAOMS members, theirstaff and families have been theprimary concern of the Board ofTrustees, and this concern was themotivating factor in the decision tochange the location for the 2003Annual Meeting.

Although the site is different, the dates, September 10 – 13 remain the same.Utilizing the hotels and conventioncenter in Orlando, we anticipate thesame high quality educational

program, the unparalleled exhibitionand the enjoyable special events thatare the hallmarks of the AAOMSAnnual Meeting.

There is one remaining concern. Asmost of you are aware, the AAOMSselects an Annual Meeting site andsigns binding agreements five to sixyears in advance. The decision tomove the Annual Meeting a short 13weeks before its scheduled start datewill likely result in a financial loss tothe Association. Therefore, we askthat you make plans to attend theOrlando meeting with your staff andfamily. Find complete registrationinformation at www.AAOMS.org andcome to Orlando!!

2003 Annual Audit Report

Representatives of the accountingfirm, Grant Thornton, LLP, havecompleted the annual audit ofAAOMS financial statements. Theauditors praised AAOMS for itscareful financial policies andprocedures. They noted they oftenhold AAOMS up as an example of awell-run organization for other clientsto emulate.

2004 Proposed Budget

Your Board worked diligently to bringforward a balanced 2004 budget thatfunds priorities of the Association asoutlined in the Strategic Plan, andreturns over $200,000.00 to AAOMSreserves. Funding was provided to

such priorities as the final year of theThird Molar Study, the FacultyEducation and Development Awards,Outcomes Research on dentalimplants and orthognathic surgery,state dental board and scope ofpractice advocacy and a host ofcontinuing education activities,including our Annual Meeting. TheBudget and Finance Committeesubmitted an initial budget, whichwas refined by the Board, and will besent forward to the House ofDelegates for final ratification inSeptember.

As you may be aware, AAOMSrealizes approximately $500,000 ayear from the lease of the second flooroffice space in the headquartersbuilding. Recently the current tenantgave notice that they intend to vacatethe space by the end of 2003. Sincethere is a surplus of vacant corporatespace in the Chicago area, the Budgetand Finance Committee assumed asix-month vacancy when preparingthe budget. Staff will continue toadvertise and market the space withthe hope that a tenant may beidentified as soon as possible.

Other Items of Interest:

� The Board reviewedrecommendations from the FacultyRecruitment and Retention WorkshopReport. A special task force will beappointed to prioritize therecommendations emanating from theworkshop.

� The Board met withrepresentatives of Discus Dental,developers of the new OMSVisionpractice management software. The

21


Board reviewed the software andapproved version 1.0 of theOMSVision for release. OMSVisionwas developed with input fromAAOMS and practicing oral andmaxillofacial surgeons, and willprovide state-of-the-art technology forAAOMS members.

� Dr. Clark Taylor, an AAOMSfellow and current President of theAmerican Academy of CosmeticSurgery (AACS), proposed possibleavenues of collaboration betweenAAOMS and AACS. The Boardinvited Dr. Taylor to give commentsat a 2003 AAOMS House ofDelegates session in Orlando, Florida.

� Dr. Donny Quick, chairmanof the AAOMS ResidentOrganizations (ROAAOMS), alsomet with the Board to discuss themany successful ROAAOMSprograms and activities. He stressedthe vitality and commitment of ourresidents to the specialty.

In addition to these important reportsand actions, your Board:

� Reviewed and updated theAAOMS Strategic Plan.

� Reviewed and approvedprogram outlines for the 2004 AnnualMeeting and Dental ImplantConference

� Reviewed and approvedAnnual Reports from all committeesof the Association

� Heard a report and update onthe JOMS from our Editor

Health Volunteers Overseas(HVO) was founded in 1986 toimprove global health througheducation. More than 3,800 healthprofessionals have been sent to 50training sites in more than 25developing countries to teach, trainand mentor local health careworkers. HVO’s programs aredivided into specialities and includeoral surgery, anesthesia, dentistry,nurse anesthesia, internal medicine,nursing, hand surgery, ortho-paedics, pediatrics and physicaltherapy.

The Oral and MaxillofacialSurgery Overseas division of HVOis currently recruiting volunteersfor one to two week assignments inCambodia, India, Peru and Viet-nam. For more information aboutthese volunteer opportunities, con-tact the HVO Program Department(202) 296-0928 or by email [email protected]. The HVOweb site is www.hvousa.org.

See HVO’s Ad on Page 3

Orthognathic Surgery inVietnam

Continued from Page 4

� Heard reports on AAOMSinvolvement with the JCAHO WrongSite Surgery Workshop

� Reviewed and approvedappointments to committees for 2003– 2004

� Updated information on theguidelines for credentialing OMFS inFacial Cosmetic Surgery

� Approved a new diversitystatement

� Discussed policyamendments, additions and deletions,which will be referred to the HOD forconsideration. A significant issuebeing considered is e-mailcommunication within the association

� Closer to District 6, the Boardof Trustees did not support last yearsResolution B-11 to allow AAOMSmembers to serve as voting delegatesin the AAOMS HOD

Your AAOMS Board of Trusteescontinues to work diligently in the bestinterest of the specialty and ourmembers. It is an honor and pleasureto represent you as your District 6Trustee. As always, if you have anysuggestions, comments or concerns,please feel free to contact me. I alsohope to see many of you at theWestern Society Annual Meeting inWhistler, July 18 – 23, 2003. It’ll bea great time, so try to attend.

In good health,

Rick Crinzi

22


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A PRACTICE? Place an ad in theclassified section of The Compass. Wereach over seven hundred OMSsthroughout the state. If you are a mem-ber there is no cost to you, it is a ben-efit of membership. If you are a non-member, the cost is very reasonable.Call (800) 500-1332 Ext. 13 to getrates, or to place an ad.

tors wanting to work on a limited basis.Call the central office and let us knowwhen and where you are willing to work,or when you would need a relief OMS,and we will try to help you make a con-nection.

MRL Portapulse-3 SN 2781 Defibrilla-tor (connects to CritiCare 407-E) New:$1,950 - Asking: $1,500.Plan Mecca 2002 Prolive Exam Chair SNSED215590. Powder Blue/White, FullyAutomatic New: $6,177 - Asking: $4,300Call (559) 447-0544EVERY OMS SHOULD READ THIS.

Are you retired, but would like to keepyour hands active on a very limited basis?Are you in a full time practice but look-ing to expand your horizons? Are you inneed of an OMS to provide your officecoverage while on vacation or jury duty?If you answered yes to any of these ques-tions, CALAOMS would like to hear fromyou. We would like to put doctors in needof vacation relief staff in touch with doc-

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CO2 LUXAR LASER LX20 advanced unitwith Novoscan Surfacing Kit, two LAUPkits, 45 degree turbinate and straight kits,several extra fibres and many tips, straightand angled handpieces for intraoral use.Service certified for surgicenter use withintwo years. Excellent new condition stillwith box. Price $26,400 OBOAlso available, Endoscopic cosmeticsurgical instrument set and Richardszero and 30 degree, 5 mm diameterscopes. Make offer individually or onwhole setup. Call and leave contactnumber at: 760-635-1446

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