- Email: [email protected]
Highland Hospital Oral and Maxillofacial Surgery Training Program
FROM THE TEACHING CENTERS J Oral Maxillofac Surg 69:833-839, 2011
University of the Pacific/Highland Hospital Oral and Maxillofacial Surgery Training Program James M. Michino, DMD,* Felice O’Ryan, DDS,† Alexis Kleinman, DMD,‡ and A. Thomas Indresano, DMD§ The Roaring Twenties was a time of great economic and technologic expansion in the United States, particularly in California. Oakland, California, was the site of many manufacturing industries, including shipbuilding, aircraft, and automotive. Once known as the “Detroit of the West,” Oakland was host to 3 major automobile factories churning out sedans, coupes, convertibles, and roadsters.1,2 The automobile boom of the 1920s forever changed the way Americans worked, played, and even hurt themselves. Commutes became longer; recreational road trips became the norm, and complex new traumatic injuries challenged surgeons of the day. San Leandro’s Fairmont Hospital, the leading East Bay hospital of the day, was unequipped and ill situated to manage these complex motor vehicle accidents. The Alameda County supervisors recognized the need for an acute care trauma facility in close proximity to major roadways. So planners sited Highland Hospital adjacent to what is now known as Interstate 580 to reduce transport time for the rapidly increasing numbers of injured motorists. In December of 1926, Highland Hospital opened its doors as a comprehensive acute care medical and teaching facility. In response to the rising need for specialized facial trauma care, Dr Sadi Fontaine was recruited to Highland Hospital, where he established the Department
of Dentistry and Oral Surgery in 1926. Dr Fontaine was born in Oakland, CA, and graduated in 1909 from the College of Physicians and Surgeons of San Francisco, predecessor to University of Pacific School of Dentistry. He completed his oral surgery internship at French Hospital in San Francisco in 1910. He continued his training with dual degreed oral surgeons, Drs George Brown, Milwaukee, and Robert Ivy, Philadelphia, both frontline World War I surgeons and regarded as among the forefathers of oral surgery and plastic surgery in the United States. Dr Robert Ivy, an especially revered oral and plastic surgeon, coauthored 2 classic books: Essentials of Oral Surgery and Fractures of the Jaws. He was also a long-time editor of the journal, Plastic and Reconstructive Surgery.3,4 The Highland Hospital oral surgery residency began as a 1-year training program with a single resident, Dr Thomas McGuire, who graduated in 1927. At the outset, there was no formal medical education and dental extractions were the mainstay. As the volume of facial trauma increased in the 1940s, the oral surgery residency expanded to 2 years. In 1940, Dr Fontaine served as the president of the Highland Hospital medical staff, a rare honor for a dentist in those days. Dr Fontaine retired in 1946, having graduated 18 residents. In 1959, The Sadi Fontaine Academy was founded by Dr Lyall Bishop to honor the work of Dr Fontaine (Fig 1). After Dr Fontaine retired, Dr James Heckman served as program director from 1946 to 1949. In 1949, Dr Lyall O. Bishop took over as the residency program director. Dr Bishop was born in Winnipeg, Manitoba, and graduated from San Francisco’s College of Physicians and Surgeons in 1931. He completed his residency at Highland Hospital in 1932 under the direction of Dr Sadi Fontaine. After graduating, he started a private practice in Walnut Creek, CA, and worked part-time with the Highland oral surgery residency program. After serving in the Navy during World War II (19431946), Dr Bishop returned with extensive trauma experience to Highland Hospital, where he became
*Resident, Division of Oral and Maxillofacial Surgery, University of the Pacific/Highland Hospital, Oakland, CA. †Director, Division of Maxillofacial Surgery, Kaiser Permanente, Oakland Medical Center, Oakland, CA. ‡Resident, Division of Oral and Maxillofacial Surgery, University of the Pacific/Highland Hospital, Oakland, CA. §Chairman, Division of Oral and Maxillofacial Surgery, University of the Pacific/Highland Hospital, Oakland, CA. Address correspondence and reprint requests to Dr O’Ryan: Kaiser Permanente Division of Maxillofacial Surgery, 280 West MacArthur Blvd, Oakland, CA 94611; e-mail: Felice.O’[email protected] © 2011 American Association of Oral and Maxillofacial Surgeons
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FIGURE 1. 1926-1946 Sadi Fontaine. Michino et al. Oral and Maxillofacial Surgery Training Program. J Oral Maxillofac Surg 2011.
chief of oral surgery in 1949. Dr Bishop assumed the helm at Highland in the beginning of a national struggle with the American College of Surgeons and the Joint Commission on Accreditation of Hospitals, established in 1953, who seemed deliberate in wishing to restrict oral surgeons’ hospital practice to teeth and deter dentists from assuming care of hospitalized patients. He played an effective role in resolving this conflict and, through his efforts, rotations on medical services were integrated into the oral surgery curriculum not only at Highland but at other hospitals nationally. Dr Bishop was certified by the American Board of Oral Surgery in 1949, where he later served as a board examiner. He became a fellow of the American College of Dentists and a founding fellow of the International College of Dentists.5 Dr Bishop served as president of the California Dental Association and, in 1962, became president of the American Society of Oral Surgeons (ASOS), all the while championing the causes of oral surgeons not only in California but across the nation during this time of building of a specialty. Several key events involving the ASOS occurred during Dr Bishop’s tenure as president. He was deeply involved in planning the first International Conference on Oral Surgery, which was held at the Royal College of Surgeons of England in London, July 1962. As president of ASOS, he was the presiding officer (master of ceremonies) at the Conference’s gala banquet, a magnificent event held at the revered Guildhall in the Old City of London. Many of the leading
movers and stewards of English health care were in attendance. This first International Conference on Oral Surgery turned out to be a seminal event in the history of oral surgery, and it led to the creation of the International Society of Oral Surgeons in 1965. In 1959, the ASOS moved its offices from Louisville to Chicago. The offices were not strongly organized at the time of Dr Bishop’s term as president and he made countless trips between California and Chicago to keep the work of the organization moving forward. Later, the ASOS became one of the best managed health care organizations because of his and many others’ extra efforts. The expanding scope of oral surgery called for additional training, and Dr Bishop extended Highland’s oral surgery program to 3 years in 1956. In 1962, he also increased the number of residents, from 1 to 2 per year, to help manage the increasing case load. Finally, in 1967, the program was extended to 4 years. The Highland oral surgery residency was the first in California, and among the first in the nation, to expand to 4 years in compliance with recently enacted requirements for board certification. During Dr Bishop’s tenure, the oral surgery residency program at Highland Hospital matured into the comprehensive and widely respected oral and maxillofacial surgery training program it is known as today (Fig 2). In 1972, Dr Bishop, preparing to retire, recruited Dr Stanley Kramer to head the residency program. Dr
FIGURE 2. 1949-1972 Lyall O. Bishop. Michino et al. Oral and Maxillofacial Surgery Training Program. J Oral Maxillofac Surg 2011.
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FIGURE 3. 1972-1985 Stanley Kramer. Michino et al. Oral and Maxillofacial Surgery Training Program. J Oral Maxillofac Surg 2011.
Kramer, the first full-time oral surgery faculty member at Highland, brought years of wartime experience to the program and became director in 1972. Hailing from Hackensack, NJ, he received his dental degree and oral and maxillofacial surgery (OMFS) training at the University of Pennsylvania. He then served in the US Army in World War II and continued his military career for another 23 years, which also included service in the Korean War. During his naval career, Dr Kramer received assignments at Bethesda, Chelsea, Charleston, and St. Albans. He was director of the oral surgery program at The Naval Hospital in San Diego, CA (1970-1971). He served as the oral surgeon on multiple naval ships, including the USS Constellation, where he acted as both an oral surgeon and an anesthesia provider. In 1984, Dr Kramer published one of the earlier papers, which appeared in the Journal of Oral and Maxillofacial Surgery, on the signs and symptoms of AIDS (Fig 3).6 Dr Kramer retired from oral surgery in 1985 and Dr Keith Marshall was appointed as interim director. Dr Marshall, also from the military, had been the oral and maxillofacial surgery program director at Tripler Army Medical Center in Honolulu, HI, from 1979 to 1982. Between 1987 and 1997, Dr Felice O’Ryan and Dr John Gilbert also served as interim program directors. In 1997, Dr Donald Devlin came out of retirement to take over as interim program director while the hospital conducted a national search for a program
director. He was to stay “a few years” but ultimately remained as chief for 5 years. He is a native San Franciscan who received his DDS from the University of California, San Francisco and his oral surgery training at the University of Oklahoma, Northwestern University, and Cook County Hospital. Dr Devlin served in the US Army during the Korean War and has a special interest in cinematography, having edited and produced multiple motion pictures on subjects including head and neck infections, fractures, orthognathic surgery, surgical pathology, and informed consent. Additionally, he spent 40 years on the clinical faculty of the University of California, San Francisco. He continues to volunteer, on a part-time basis, at Highland Hospital and University of California at San Francisco. In 2001, he retired and brought Dr Thomas Indresano aboard as program director (Fig 4). In September of 2001 the program became affiliated with the University of the Pacific School of Dentistry under the guidance of Dr Indresano, who received his BA degree from Boston University, Doctor of Dental Medicine from Harvard University (1971), and a certificate in OMFS from Vanderbilt University (1974). He is a Diplomat of the American Board of Oral and Maxillofacial Surgery (ABOMS) and served as a board examiner for many years. Dr Indresano brings 33 years of teaching experience to Highland Hospital and has graduated over 100 residents. His career in education began as associate professor at the Univer-
FIGURE 4. 1997-2001 Donald Devlin. Michino et al. Oral and Maxillofacial Surgery Training Program. J Oral Maxillofac Surg 2011.
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sity of Illinois (1974-1976), followed by appointments as Program Director and Division Chief of the Zoller Dental Clinic at the University of Chicago (19761983), Program Director at Metro Health Medical Center in Cleveland, OH (Case Western Reserve) (19831992), and Chief of the Division of OMFS at the Medical College of Wisconsin in Milwaukee (19922001). In 2005, the AAOMS awarded him the prestigious Donald B. Osbon award for outstanding OMFS educator in the United States. Dr Indresano is well versed in all aspects of oral and maxillofacial surgery, including trauma, pathology, reconstruction, dentoalveolar, orthognathic, and cosmetic surgery and is a world renowned leader and pioneer in the field of temporomandibular joint (TMJ) surgery. He has lectured and published extensively in this area. During his tenure at Highland, he established affiliations with Kaiser Permanente Oakland Medical Center (2001) and Children’s Hospital of Oakland (2008), dramatically increasing the surgical scope and volume, and resulting in a commensurate increase in the number of residents from 2 to 3 per year at a time when other programs are facing reduced surgical case loads (Fig 5).
Current Status of the Oral and Maxillofacial Surgery Residency Program The Oral and Maxillofacial Surgery training program at Highland Hospital continues its affiliation with the University of the Pacific School of Dentistry. The program is 4 years in duration and admits 3 residents per year, awarding a certificate in Oral and Maxillofacial Surgery at completion. The present group of residents includes graduates of the University of the Pacific, University of California, San Francisco, University of California, Los Angeles, University of Southern California, Temple University, University of Connecticut, Tufts University, and the University of Michigan (Fig 6).
Full-Time Faculty The training program is fortunate to have 26 fulland part-time faculty with hundreds of years of combined teaching experience. Dr Indresano has been in full-time education for 37 years, and Dr Felice O’Ryan has almost 30 years of experience in education. The faculty boasts 3 former ABOMS examiners. Most faculty are part-time volunteers providing the residents with extensive private practice training. ASSISTANT PROGRAM DIRECTOR: DANIEL A. MOBATI, DDS, MD
Daniel A. Mobati, Assistant Program Director, joined the Highland General Hospital OMFS Residency Training program as a volunteer in 2003 and became a full-time attending and assistant program director in September 2004. He earned his Bachelor of Science degree at UCLA and his Doctor of Dental Surgery degree from University of California at San Francisco. In 1997, Dr Mobati completed his OMFS training and received his medical degree at Lincoln Medical/Mental Health Center and New York Medical College, respectively. He is a Diplomat of the ABOMS and has particular interests in facial trauma and esthetic surgery. He maintains a 1-day-per-week private practice in Berkeley. FELICE S. O’RYAN, DDS (KAISER OAKLAND)
FIGURE 5. 2001--present A. Thomas Indresano. Michino et al. Oral and Maxillofacial Surgery Training Program. J Oral Maxillofac Surg 2011.
Dr O’Ryan was program director at Highland General Hospital (HGH) from 1987 to 1989. She joined Kaiser Permanente in 1989, where she served as chief of maxillofacial surgery in the Northern California region. She received her DDS from the University of the Pacific and completed her surgical training at the University of Texas Southwestern Medical School in 1983. She has published articles on orthognathic surgery and bisphosphonate-related osteonecrosis of the jaw and has lectured extensively on these topics. She
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FIGURE 6. Resident Graduation June 2009. Back row: Dan Mobati, David Poor, Vincent Farhood, Tyler Nelson, Steve Wat, Vicente Chavez, Jeff Caputo, Matt Hutchinson, Jeremy Lasseter, Bryce Williams, Sam Khoury, Robert Breckenridge, Alex Isom, Curt Cardon. Front row: Donald Devlin, Dan Martin, James Michino, Edmond Bedrossian, Felice O’Ryan, Thomas Indresano, Alexis Kleinman, Shama Currimbhoy, Kelly Dezura, Louie Limchayseng, Joan Lo. Michino et al. Oral and Maxillofacial Surgery Training Program. J Oral Maxillofac Surg 2011.
is section editor of Clinical Controversies for the Journal of Oral and Maxillofacial Surgery. DAVID B. POOR, DDS (KAISER OAKLAND)
Originally from New England, Dr Poor received his DDS from Tufts University (1982) and completed his OMFS training at HGH in 1990. He is a Diplomat of the American Board of Oral and Maxillofacial Surgery and has been on staff at Kaiser Permanente since 1992. He specializes in distraction osteogenesis and cleft reconstruction. He is currently Regional Chief of Maxillofacial Surgery for Kaiser Permanente, Northern California. DR HESHAAM FALLAH, DDS, MD (KAISER OAKLAND)
Dr Fallah is the newest member of the Kaiser Permanente Oakland Medical Center staff. He earned his dental degree at the University of California, Los Angeles (2003), completed his OMFS training at the University of California, San Francisco (2009), and finished a 1-year fellowship in orthognathic surgery at Dalhousie University in 2010 under the direction of Dr David Precious. DR ANDERS NATTESTAD, DDS/PHD (UNIVERSITY OF THE PACIFIC SCHOOL OF DENTISTRY)
Dr Nattestad began as director of undergraduate OMFS at the University of the Pacific School of Dentistry in 2007. He earned his dental degree and PhD and received his oral and maxillofacial surgery training at the University of Copenhagen, Denmark, where he also served as department chairman from 2002 to 2004. He immigrated to the United States and became director of undergraduate OMFS at the University of
Nevada, Las Vegas School of Dental Medicine (20052007). Dr Nattestad is a fellow of the American Dental Education Association Leadership Institute, a reviewer for the Journal of Dental Education and author of more than 50 published articles. He served for 5 years as secretary-general of the Association for Dental Education in Europe and in 2009 was appointed Executive Director of International Federation of Dental Educators and Associations.
Part-Time Faculty VINCENT W. FARHOOD, DDS
Dr Farhood has been on staff at Highland Hospital since 1989. He received his DDS from the University of Southern California School of Dentistry and completed his OMFS residency at the USAF at Wilford Hall Medical Center, San Antonio, Texas, in 1978. His 20 years of military service includes 4 years as the Program Director of the OMFS residency program at David Grant Medical Center at Travis Air Force Base. He presently maintains an active private practice, while continuing as teaching staff at Highland Hospital 1 day a week. He is a Diplomat of the American Board of Oral and Maxillofacial surgeons and is an active board examiner. LOUIE R. LIMCHAYSENG, DMD
Dr Limchayseng joined the surgical staff at Highland Hospital in 1993. Dr Limchayseng, a Diplomat of the American Board of Oral and Maxillofacial Surgery, received his DMD from the University of the Philippines, College of Dentistry, completed an internship
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FIGURE 7. Highland General Hospital, Oakland, CA. Michino et al. Oral and Maxillofacial Surgery Training Program. J Oral Maxillofac Surg 2011.
in anesthesiology and general surgery at Parkland Memorial Hospital, and finished his oral and maxillofacial surgery training at the University of Texas Southwestern Medical School in 1992. He is currently in private practice in Novato. EDMOND BEDROSSIAN, DDS
Dr Bedrossian has served on the staff of Highland Hospital since 1990, acting as the director of surgical implant training. Dr Bedrossian, Diplomat of the American Board of Oral and Maxillofacial Surgery, received his DDS from the University of the Pacific School of Dentistry and completed his residency in OMFS at Highland Hospital in 1990. He has published numerous scientific articles and textbook chapters on the topic of the zygomatic implants, bone grafting techniques, and immediate load reconstructions. He has lectured internationally with Professor P-I Brånemark, is a member of the Board of Directors for the Brånemark Institute, and is currently the president of the Brånemark Foundation in North America.
ORAL AND MAXILLOFACIAL SURGERY TRAINING PROGRAM
including dentoalveolar, implants, pathology, reconstruction, TMJ, orthognathic, and cosmetic surgery. They are also involved with craniofacial panels at Kaiser and Children’s Hospital Oakland. In 2009, residents participated in over 1,300 major cases among the 3 hospitals. The OMFS team also runs a busy outpatient clinic (14,000 visits per year) performing primarily dentoalveolar surgery and conscious sedation. There is a dedicated implant program supervised by Dr Edmond Bedrossian. The program is a training center for zygoma implants and more than 75 have been placed. Off-service rotations occur primarily at HGH and include Anesthesia, Internal Medicine, General Surgery, Trauma, Oral Pathology, and Plastic Surgery and Pediatric Anesthesia at Children’s Hospital of Oakland (Fig 7). Residents spend portions of their second and fourth years at the University of the Pacific School of Dentistry in San Francisco, CA. Second-year residents work in a state-of-the-art clinic in the afternoon, where they perform dentoalveolar procedures, including third molar extractions, preorthodontic extractions, uncovering/bonding impacted teeth, preprosthetic surgery, full mouth extractions, biopsies, etc, involving conscious sedation. Fourth-year residents work with students and faculty performing bone grafts, sinus lifts, and implant placement in a private practice setting. UOP has a postgraduate orthodontic training program allowing collaborative treatment planning of orthognathic surgery cases (Fig 8). Residents also spend a total of 8 months during the third and fourth year at Kaiser Permanente Medical Center in Oakland. Only a few minutes from HGH, Kaiser Oakland is a regional referral service providing care to a large portion of Bay Area health plan members. Led by Drs Felice O’Ryan and David Poor, the
Residency Features Located in East Bay just a few miles east of the Oakland/San Francisco Bay Bridge, HGH is the main campus of the Alameda County Medical Center and home to the primary training institution for the UOP/ Highland OMFS program. HGH (240 inpatient beds) is a level II trauma center for northern Alameda County and the only trauma center for the city of Oakland, receiving over 3,500 trauma activations per year. The hospital has residencies in OMFS, Emergency Medicine, General Surgery, Orthopedics, Ophthalmology, Podiatry, and Internal Medicine. Because there are no training programs in either Plastic Surgery or Otolaryngology, the OMFS residents treat all facial trauma cases 365 days a year. In addition to considerable trauma experience, residents receive a broad scope of training in all aspects of oral and maxillofacial surgery,
FIGURE 8. University of the Pacific School of Dentistry, San Francisco, CA. Michino et al. Oral and Maxillofacial Surgery Training Program. J Oral Maxillofac Surg 2011.
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residents are first assistant on hundreds of cases and receive unparalleled surgical experience. During this rotation, residents operate on more than 400 orthognathic cases per year. In addition, they are exposed to cleft surgery (as part of the craniofacial team), distraction osteogenesis, TMJ surgery, including total joint replacements, pathology, and management of facial deformities/syndromes (Fig 9). The residents receive extensive pediatric experience at Children’s Hospital of Oakland (191-bed pediatric medical center). The CHO craniofacial team meets weekly and provides surgical care to pediatric patients with cleft lip/palate and other craniofacial anomalies. The pediatric experience also includes anesthesia, orthognathic surgery, distraction osteogenesis, pathology, maxillofacial prosthetics, and facial trauma. Pediatric OMFS has become a major strength of the residency (Fig 10). In addition to the vigorous academic curriculum, the didactic curriculum includes head and neck anatomy, physical diagnosis, implantology, orthognathics, and oral pathology. Weekly implant conference and grand rounds make for rigorous debates and discussions. Journal Club, run by Journal of Oral and Maxillofacial Surgery section editor Dr Felice O’Ryan, is held monthly to review the latest articles in a formal setting. There is also a once-a-month joint orthodontic-orthognathic surgery conference with the orthodontic residents at UOP. Residents have published multiple papers and presented abstracts in the last 10
FIGURE 10. Children’s Hospital and Research Center, Oakland, Oakland, CA. Michino et al. Oral and Maxillofacial Surgery Training Program. J Oral Maxillofac Surg 2011.
years, including this year’s winner of the Laskin Award by the Journal of Oral and Maxillofacial Surgery.7 Current research topics include adverse effects of bisphosphonates, surgical and nonsurgical management of temporomandibular disorder, and outcomes of surgical treatment of obstructive sleep apnea to name a few. Completion of ABOMS certification is a routine requirement for all graduates of this program. This residency program has come a long way since the 1-year program started by Dr Sadi Fontaine 84 years ago. The program is truly in its golden years, as evidenced by a recent American Association of Oral and Maxillofacial Surgeons accreditation visit without a single recommendation. The level and variety of surgical cases, the strong leadership, the hard work and dedication of the staff, and continued support and affiliation with multiple distinguished institutions clearly make HGH/UOP one of the top 4-year programs in the nation. Acknowledgments We gratefully acknowledge Dr Donald Devlin and Dr Robert V Walker, Chairman Emeritus at the University of Texas Southwestern Medical School, Division of Oral and Maxillofacial Surgery, for their invaluable contributions to this article.
References
FIGURE 9. Kaiser Permanente Oakland Medical Center, Oakland, CA. Michino et al. Oral and Maxillofacial Surgery Training Program. J Oral Maxillofac Surg 2011.
1. Eckermann E, Albrecht PL: World History of the Automobile. SAE International, Warrendale, PA, 2001, p 129 2. Field sees great future for East Bay. Oakland Tribune, May 5 1929, p M5 3. Blair, VP, Ivy RH: Essentials of Oral Surgery. St. Louis, MO, Mosby, 1923 4. Ivy RH, Curtis L: Fractures of the Jaws. Philadelphia, PA, Lea and Febiger, 1938 5. The building of a specialty: Oral and maxillofacial surgery in the United States 1918-1998. J Oral Maxillofac Surg 56:222, 1998 (suppl 3) 6. Nickles GB, Lines C, Kramer HS: Kaposi’s sarcoma in a patient with acquired immune deficiency syndrome. J Oral Maxillofac Surg 42:56, 1984 7. O’Ryan FS, Khoury S, Liao W, et al: Intravenous bisphosphonaterelated osteonecrosis of the jaw: Bone scintigraphy as an early indicator. J Oral Maxillofac Surg 67:1363, 2009
University of the Pacific/Highland Hospital Oral and Maxillofacial Surgery Training Program James M. Michino, DMD,* Felice O’Ryan, DDS,† Alexis Kleinman, DMD,‡ and A. Thomas Indresano, DMD§ The Roaring Twenties was a time of great economic and technologic expansion in the United States, particularly in California. Oakland, California, was the site of many manufacturing industries, including shipbuilding, aircraft, and automotive. Once known as the “Detroit of the West,” Oakland was host to 3 major automobile factories churning out sedans, coupes, convertibles, and roadsters.1,2 The automobile boom of the 1920s forever changed the way Americans worked, played, and even hurt themselves. Commutes became longer; recreational road trips became the norm, and complex new traumatic injuries challenged surgeons of the day. San Leandro’s Fairmont Hospital, the leading East Bay hospital of the day, was unequipped and ill situated to manage these complex motor vehicle accidents. The Alameda County supervisors recognized the need for an acute care trauma facility in close proximity to major roadways. So planners sited Highland Hospital adjacent to what is now known as Interstate 580 to reduce transport time for the rapidly increasing numbers of injured motorists. In December of 1926, Highland Hospital opened its doors as a comprehensive acute care medical and teaching facility. In response to the rising need for specialized facial trauma care, Dr Sadi Fontaine was recruited to Highland Hospital, where he established the Department
of Dentistry and Oral Surgery in 1926. Dr Fontaine was born in Oakland, CA, and graduated in 1909 from the College of Physicians and Surgeons of San Francisco, predecessor to University of Pacific School of Dentistry. He completed his oral surgery internship at French Hospital in San Francisco in 1910. He continued his training with dual degreed oral surgeons, Drs George Brown, Milwaukee, and Robert Ivy, Philadelphia, both frontline World War I surgeons and regarded as among the forefathers of oral surgery and plastic surgery in the United States. Dr Robert Ivy, an especially revered oral and plastic surgeon, coauthored 2 classic books: Essentials of Oral Surgery and Fractures of the Jaws. He was also a long-time editor of the journal, Plastic and Reconstructive Surgery.3,4 The Highland Hospital oral surgery residency began as a 1-year training program with a single resident, Dr Thomas McGuire, who graduated in 1927. At the outset, there was no formal medical education and dental extractions were the mainstay. As the volume of facial trauma increased in the 1940s, the oral surgery residency expanded to 2 years. In 1940, Dr Fontaine served as the president of the Highland Hospital medical staff, a rare honor for a dentist in those days. Dr Fontaine retired in 1946, having graduated 18 residents. In 1959, The Sadi Fontaine Academy was founded by Dr Lyall Bishop to honor the work of Dr Fontaine (Fig 1). After Dr Fontaine retired, Dr James Heckman served as program director from 1946 to 1949. In 1949, Dr Lyall O. Bishop took over as the residency program director. Dr Bishop was born in Winnipeg, Manitoba, and graduated from San Francisco’s College of Physicians and Surgeons in 1931. He completed his residency at Highland Hospital in 1932 under the direction of Dr Sadi Fontaine. After graduating, he started a private practice in Walnut Creek, CA, and worked part-time with the Highland oral surgery residency program. After serving in the Navy during World War II (19431946), Dr Bishop returned with extensive trauma experience to Highland Hospital, where he became
*Resident, Division of Oral and Maxillofacial Surgery, University of the Pacific/Highland Hospital, Oakland, CA. †Director, Division of Maxillofacial Surgery, Kaiser Permanente, Oakland Medical Center, Oakland, CA. ‡Resident, Division of Oral and Maxillofacial Surgery, University of the Pacific/Highland Hospital, Oakland, CA. §Chairman, Division of Oral and Maxillofacial Surgery, University of the Pacific/Highland Hospital, Oakland, CA. Address correspondence and reprint requests to Dr O’Ryan: Kaiser Permanente Division of Maxillofacial Surgery, 280 West MacArthur Blvd, Oakland, CA 94611; e-mail: Felice.O’[email protected] © 2011 American Association of Oral and Maxillofacial Surgeons
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FIGURE 1. 1926-1946 Sadi Fontaine. Michino et al. Oral and Maxillofacial Surgery Training Program. J Oral Maxillofac Surg 2011.
chief of oral surgery in 1949. Dr Bishop assumed the helm at Highland in the beginning of a national struggle with the American College of Surgeons and the Joint Commission on Accreditation of Hospitals, established in 1953, who seemed deliberate in wishing to restrict oral surgeons’ hospital practice to teeth and deter dentists from assuming care of hospitalized patients. He played an effective role in resolving this conflict and, through his efforts, rotations on medical services were integrated into the oral surgery curriculum not only at Highland but at other hospitals nationally. Dr Bishop was certified by the American Board of Oral Surgery in 1949, where he later served as a board examiner. He became a fellow of the American College of Dentists and a founding fellow of the International College of Dentists.5 Dr Bishop served as president of the California Dental Association and, in 1962, became president of the American Society of Oral Surgeons (ASOS), all the while championing the causes of oral surgeons not only in California but across the nation during this time of building of a specialty. Several key events involving the ASOS occurred during Dr Bishop’s tenure as president. He was deeply involved in planning the first International Conference on Oral Surgery, which was held at the Royal College of Surgeons of England in London, July 1962. As president of ASOS, he was the presiding officer (master of ceremonies) at the Conference’s gala banquet, a magnificent event held at the revered Guildhall in the Old City of London. Many of the leading
movers and stewards of English health care were in attendance. This first International Conference on Oral Surgery turned out to be a seminal event in the history of oral surgery, and it led to the creation of the International Society of Oral Surgeons in 1965. In 1959, the ASOS moved its offices from Louisville to Chicago. The offices were not strongly organized at the time of Dr Bishop’s term as president and he made countless trips between California and Chicago to keep the work of the organization moving forward. Later, the ASOS became one of the best managed health care organizations because of his and many others’ extra efforts. The expanding scope of oral surgery called for additional training, and Dr Bishop extended Highland’s oral surgery program to 3 years in 1956. In 1962, he also increased the number of residents, from 1 to 2 per year, to help manage the increasing case load. Finally, in 1967, the program was extended to 4 years. The Highland oral surgery residency was the first in California, and among the first in the nation, to expand to 4 years in compliance with recently enacted requirements for board certification. During Dr Bishop’s tenure, the oral surgery residency program at Highland Hospital matured into the comprehensive and widely respected oral and maxillofacial surgery training program it is known as today (Fig 2). In 1972, Dr Bishop, preparing to retire, recruited Dr Stanley Kramer to head the residency program. Dr
FIGURE 2. 1949-1972 Lyall O. Bishop. Michino et al. Oral and Maxillofacial Surgery Training Program. J Oral Maxillofac Surg 2011.
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FIGURE 3. 1972-1985 Stanley Kramer. Michino et al. Oral and Maxillofacial Surgery Training Program. J Oral Maxillofac Surg 2011.
Kramer, the first full-time oral surgery faculty member at Highland, brought years of wartime experience to the program and became director in 1972. Hailing from Hackensack, NJ, he received his dental degree and oral and maxillofacial surgery (OMFS) training at the University of Pennsylvania. He then served in the US Army in World War II and continued his military career for another 23 years, which also included service in the Korean War. During his naval career, Dr Kramer received assignments at Bethesda, Chelsea, Charleston, and St. Albans. He was director of the oral surgery program at The Naval Hospital in San Diego, CA (1970-1971). He served as the oral surgeon on multiple naval ships, including the USS Constellation, where he acted as both an oral surgeon and an anesthesia provider. In 1984, Dr Kramer published one of the earlier papers, which appeared in the Journal of Oral and Maxillofacial Surgery, on the signs and symptoms of AIDS (Fig 3).6 Dr Kramer retired from oral surgery in 1985 and Dr Keith Marshall was appointed as interim director. Dr Marshall, also from the military, had been the oral and maxillofacial surgery program director at Tripler Army Medical Center in Honolulu, HI, from 1979 to 1982. Between 1987 and 1997, Dr Felice O’Ryan and Dr John Gilbert also served as interim program directors. In 1997, Dr Donald Devlin came out of retirement to take over as interim program director while the hospital conducted a national search for a program
director. He was to stay “a few years” but ultimately remained as chief for 5 years. He is a native San Franciscan who received his DDS from the University of California, San Francisco and his oral surgery training at the University of Oklahoma, Northwestern University, and Cook County Hospital. Dr Devlin served in the US Army during the Korean War and has a special interest in cinematography, having edited and produced multiple motion pictures on subjects including head and neck infections, fractures, orthognathic surgery, surgical pathology, and informed consent. Additionally, he spent 40 years on the clinical faculty of the University of California, San Francisco. He continues to volunteer, on a part-time basis, at Highland Hospital and University of California at San Francisco. In 2001, he retired and brought Dr Thomas Indresano aboard as program director (Fig 4). In September of 2001 the program became affiliated with the University of the Pacific School of Dentistry under the guidance of Dr Indresano, who received his BA degree from Boston University, Doctor of Dental Medicine from Harvard University (1971), and a certificate in OMFS from Vanderbilt University (1974). He is a Diplomat of the American Board of Oral and Maxillofacial Surgery (ABOMS) and served as a board examiner for many years. Dr Indresano brings 33 years of teaching experience to Highland Hospital and has graduated over 100 residents. His career in education began as associate professor at the Univer-
FIGURE 4. 1997-2001 Donald Devlin. Michino et al. Oral and Maxillofacial Surgery Training Program. J Oral Maxillofac Surg 2011.
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sity of Illinois (1974-1976), followed by appointments as Program Director and Division Chief of the Zoller Dental Clinic at the University of Chicago (19761983), Program Director at Metro Health Medical Center in Cleveland, OH (Case Western Reserve) (19831992), and Chief of the Division of OMFS at the Medical College of Wisconsin in Milwaukee (19922001). In 2005, the AAOMS awarded him the prestigious Donald B. Osbon award for outstanding OMFS educator in the United States. Dr Indresano is well versed in all aspects of oral and maxillofacial surgery, including trauma, pathology, reconstruction, dentoalveolar, orthognathic, and cosmetic surgery and is a world renowned leader and pioneer in the field of temporomandibular joint (TMJ) surgery. He has lectured and published extensively in this area. During his tenure at Highland, he established affiliations with Kaiser Permanente Oakland Medical Center (2001) and Children’s Hospital of Oakland (2008), dramatically increasing the surgical scope and volume, and resulting in a commensurate increase in the number of residents from 2 to 3 per year at a time when other programs are facing reduced surgical case loads (Fig 5).
Current Status of the Oral and Maxillofacial Surgery Residency Program The Oral and Maxillofacial Surgery training program at Highland Hospital continues its affiliation with the University of the Pacific School of Dentistry. The program is 4 years in duration and admits 3 residents per year, awarding a certificate in Oral and Maxillofacial Surgery at completion. The present group of residents includes graduates of the University of the Pacific, University of California, San Francisco, University of California, Los Angeles, University of Southern California, Temple University, University of Connecticut, Tufts University, and the University of Michigan (Fig 6).
Full-Time Faculty The training program is fortunate to have 26 fulland part-time faculty with hundreds of years of combined teaching experience. Dr Indresano has been in full-time education for 37 years, and Dr Felice O’Ryan has almost 30 years of experience in education. The faculty boasts 3 former ABOMS examiners. Most faculty are part-time volunteers providing the residents with extensive private practice training. ASSISTANT PROGRAM DIRECTOR: DANIEL A. MOBATI, DDS, MD
Daniel A. Mobati, Assistant Program Director, joined the Highland General Hospital OMFS Residency Training program as a volunteer in 2003 and became a full-time attending and assistant program director in September 2004. He earned his Bachelor of Science degree at UCLA and his Doctor of Dental Surgery degree from University of California at San Francisco. In 1997, Dr Mobati completed his OMFS training and received his medical degree at Lincoln Medical/Mental Health Center and New York Medical College, respectively. He is a Diplomat of the ABOMS and has particular interests in facial trauma and esthetic surgery. He maintains a 1-day-per-week private practice in Berkeley. FELICE S. O’RYAN, DDS (KAISER OAKLAND)
FIGURE 5. 2001--present A. Thomas Indresano. Michino et al. Oral and Maxillofacial Surgery Training Program. J Oral Maxillofac Surg 2011.
Dr O’Ryan was program director at Highland General Hospital (HGH) from 1987 to 1989. She joined Kaiser Permanente in 1989, where she served as chief of maxillofacial surgery in the Northern California region. She received her DDS from the University of the Pacific and completed her surgical training at the University of Texas Southwestern Medical School in 1983. She has published articles on orthognathic surgery and bisphosphonate-related osteonecrosis of the jaw and has lectured extensively on these topics. She
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FIGURE 6. Resident Graduation June 2009. Back row: Dan Mobati, David Poor, Vincent Farhood, Tyler Nelson, Steve Wat, Vicente Chavez, Jeff Caputo, Matt Hutchinson, Jeremy Lasseter, Bryce Williams, Sam Khoury, Robert Breckenridge, Alex Isom, Curt Cardon. Front row: Donald Devlin, Dan Martin, James Michino, Edmond Bedrossian, Felice O’Ryan, Thomas Indresano, Alexis Kleinman, Shama Currimbhoy, Kelly Dezura, Louie Limchayseng, Joan Lo. Michino et al. Oral and Maxillofacial Surgery Training Program. J Oral Maxillofac Surg 2011.
is section editor of Clinical Controversies for the Journal of Oral and Maxillofacial Surgery. DAVID B. POOR, DDS (KAISER OAKLAND)
Originally from New England, Dr Poor received his DDS from Tufts University (1982) and completed his OMFS training at HGH in 1990. He is a Diplomat of the American Board of Oral and Maxillofacial Surgery and has been on staff at Kaiser Permanente since 1992. He specializes in distraction osteogenesis and cleft reconstruction. He is currently Regional Chief of Maxillofacial Surgery for Kaiser Permanente, Northern California. DR HESHAAM FALLAH, DDS, MD (KAISER OAKLAND)
Dr Fallah is the newest member of the Kaiser Permanente Oakland Medical Center staff. He earned his dental degree at the University of California, Los Angeles (2003), completed his OMFS training at the University of California, San Francisco (2009), and finished a 1-year fellowship in orthognathic surgery at Dalhousie University in 2010 under the direction of Dr David Precious. DR ANDERS NATTESTAD, DDS/PHD (UNIVERSITY OF THE PACIFIC SCHOOL OF DENTISTRY)
Dr Nattestad began as director of undergraduate OMFS at the University of the Pacific School of Dentistry in 2007. He earned his dental degree and PhD and received his oral and maxillofacial surgery training at the University of Copenhagen, Denmark, where he also served as department chairman from 2002 to 2004. He immigrated to the United States and became director of undergraduate OMFS at the University of
Nevada, Las Vegas School of Dental Medicine (20052007). Dr Nattestad is a fellow of the American Dental Education Association Leadership Institute, a reviewer for the Journal of Dental Education and author of more than 50 published articles. He served for 5 years as secretary-general of the Association for Dental Education in Europe and in 2009 was appointed Executive Director of International Federation of Dental Educators and Associations.
Part-Time Faculty VINCENT W. FARHOOD, DDS
Dr Farhood has been on staff at Highland Hospital since 1989. He received his DDS from the University of Southern California School of Dentistry and completed his OMFS residency at the USAF at Wilford Hall Medical Center, San Antonio, Texas, in 1978. His 20 years of military service includes 4 years as the Program Director of the OMFS residency program at David Grant Medical Center at Travis Air Force Base. He presently maintains an active private practice, while continuing as teaching staff at Highland Hospital 1 day a week. He is a Diplomat of the American Board of Oral and Maxillofacial surgeons and is an active board examiner. LOUIE R. LIMCHAYSENG, DMD
Dr Limchayseng joined the surgical staff at Highland Hospital in 1993. Dr Limchayseng, a Diplomat of the American Board of Oral and Maxillofacial Surgery, received his DMD from the University of the Philippines, College of Dentistry, completed an internship
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FIGURE 7. Highland General Hospital, Oakland, CA. Michino et al. Oral and Maxillofacial Surgery Training Program. J Oral Maxillofac Surg 2011.
in anesthesiology and general surgery at Parkland Memorial Hospital, and finished his oral and maxillofacial surgery training at the University of Texas Southwestern Medical School in 1992. He is currently in private practice in Novato. EDMOND BEDROSSIAN, DDS
Dr Bedrossian has served on the staff of Highland Hospital since 1990, acting as the director of surgical implant training. Dr Bedrossian, Diplomat of the American Board of Oral and Maxillofacial Surgery, received his DDS from the University of the Pacific School of Dentistry and completed his residency in OMFS at Highland Hospital in 1990. He has published numerous scientific articles and textbook chapters on the topic of the zygomatic implants, bone grafting techniques, and immediate load reconstructions. He has lectured internationally with Professor P-I Brånemark, is a member of the Board of Directors for the Brånemark Institute, and is currently the president of the Brånemark Foundation in North America.
ORAL AND MAXILLOFACIAL SURGERY TRAINING PROGRAM
including dentoalveolar, implants, pathology, reconstruction, TMJ, orthognathic, and cosmetic surgery. They are also involved with craniofacial panels at Kaiser and Children’s Hospital Oakland. In 2009, residents participated in over 1,300 major cases among the 3 hospitals. The OMFS team also runs a busy outpatient clinic (14,000 visits per year) performing primarily dentoalveolar surgery and conscious sedation. There is a dedicated implant program supervised by Dr Edmond Bedrossian. The program is a training center for zygoma implants and more than 75 have been placed. Off-service rotations occur primarily at HGH and include Anesthesia, Internal Medicine, General Surgery, Trauma, Oral Pathology, and Plastic Surgery and Pediatric Anesthesia at Children’s Hospital of Oakland (Fig 7). Residents spend portions of their second and fourth years at the University of the Pacific School of Dentistry in San Francisco, CA. Second-year residents work in a state-of-the-art clinic in the afternoon, where they perform dentoalveolar procedures, including third molar extractions, preorthodontic extractions, uncovering/bonding impacted teeth, preprosthetic surgery, full mouth extractions, biopsies, etc, involving conscious sedation. Fourth-year residents work with students and faculty performing bone grafts, sinus lifts, and implant placement in a private practice setting. UOP has a postgraduate orthodontic training program allowing collaborative treatment planning of orthognathic surgery cases (Fig 8). Residents also spend a total of 8 months during the third and fourth year at Kaiser Permanente Medical Center in Oakland. Only a few minutes from HGH, Kaiser Oakland is a regional referral service providing care to a large portion of Bay Area health plan members. Led by Drs Felice O’Ryan and David Poor, the
Residency Features Located in East Bay just a few miles east of the Oakland/San Francisco Bay Bridge, HGH is the main campus of the Alameda County Medical Center and home to the primary training institution for the UOP/ Highland OMFS program. HGH (240 inpatient beds) is a level II trauma center for northern Alameda County and the only trauma center for the city of Oakland, receiving over 3,500 trauma activations per year. The hospital has residencies in OMFS, Emergency Medicine, General Surgery, Orthopedics, Ophthalmology, Podiatry, and Internal Medicine. Because there are no training programs in either Plastic Surgery or Otolaryngology, the OMFS residents treat all facial trauma cases 365 days a year. In addition to considerable trauma experience, residents receive a broad scope of training in all aspects of oral and maxillofacial surgery,
FIGURE 8. University of the Pacific School of Dentistry, San Francisco, CA. Michino et al. Oral and Maxillofacial Surgery Training Program. J Oral Maxillofac Surg 2011.
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residents are first assistant on hundreds of cases and receive unparalleled surgical experience. During this rotation, residents operate on more than 400 orthognathic cases per year. In addition, they are exposed to cleft surgery (as part of the craniofacial team), distraction osteogenesis, TMJ surgery, including total joint replacements, pathology, and management of facial deformities/syndromes (Fig 9). The residents receive extensive pediatric experience at Children’s Hospital of Oakland (191-bed pediatric medical center). The CHO craniofacial team meets weekly and provides surgical care to pediatric patients with cleft lip/palate and other craniofacial anomalies. The pediatric experience also includes anesthesia, orthognathic surgery, distraction osteogenesis, pathology, maxillofacial prosthetics, and facial trauma. Pediatric OMFS has become a major strength of the residency (Fig 10). In addition to the vigorous academic curriculum, the didactic curriculum includes head and neck anatomy, physical diagnosis, implantology, orthognathics, and oral pathology. Weekly implant conference and grand rounds make for rigorous debates and discussions. Journal Club, run by Journal of Oral and Maxillofacial Surgery section editor Dr Felice O’Ryan, is held monthly to review the latest articles in a formal setting. There is also a once-a-month joint orthodontic-orthognathic surgery conference with the orthodontic residents at UOP. Residents have published multiple papers and presented abstracts in the last 10
FIGURE 10. Children’s Hospital and Research Center, Oakland, Oakland, CA. Michino et al. Oral and Maxillofacial Surgery Training Program. J Oral Maxillofac Surg 2011.
years, including this year’s winner of the Laskin Award by the Journal of Oral and Maxillofacial Surgery.7 Current research topics include adverse effects of bisphosphonates, surgical and nonsurgical management of temporomandibular disorder, and outcomes of surgical treatment of obstructive sleep apnea to name a few. Completion of ABOMS certification is a routine requirement for all graduates of this program. This residency program has come a long way since the 1-year program started by Dr Sadi Fontaine 84 years ago. The program is truly in its golden years, as evidenced by a recent American Association of Oral and Maxillofacial Surgeons accreditation visit without a single recommendation. The level and variety of surgical cases, the strong leadership, the hard work and dedication of the staff, and continued support and affiliation with multiple distinguished institutions clearly make HGH/UOP one of the top 4-year programs in the nation. Acknowledgments We gratefully acknowledge Dr Donald Devlin and Dr Robert V Walker, Chairman Emeritus at the University of Texas Southwestern Medical School, Division of Oral and Maxillofacial Surgery, for their invaluable contributions to this article.
References
FIGURE 9. Kaiser Permanente Oakland Medical Center, Oakland, CA. Michino et al. Oral and Maxillofacial Surgery Training Program. J Oral Maxillofac Surg 2011.
1. Eckermann E, Albrecht PL: World History of the Automobile. SAE International, Warrendale, PA, 2001, p 129 2. Field sees great future for East Bay. Oakland Tribune, May 5 1929, p M5 3. Blair, VP, Ivy RH: Essentials of Oral Surgery. St. Louis, MO, Mosby, 1923 4. Ivy RH, Curtis L: Fractures of the Jaws. Philadelphia, PA, Lea and Febiger, 1938 5. The building of a specialty: Oral and maxillofacial surgery in the United States 1918-1998. J Oral Maxillofac Surg 56:222, 1998 (suppl 3) 6. Nickles GB, Lines C, Kramer HS: Kaposi’s sarcoma in a patient with acquired immune deficiency syndrome. J Oral Maxillofac Surg 42:56, 1984 7. O’Ryan FS, Khoury S, Liao W, et al: Intravenous bisphosphonaterelated osteonecrosis of the jaw: Bone scintigraphy as an early indicator. J Oral Maxillofac Surg 67:1363, 2009