AO NORTH AMERICA NEWS

AONA North America Maxillofacial and AO Maxillofacial International

In 1988, representatives of the AO Maxillofacial faculty of Europe and North America met at a retreat in Steckborn, Switzerland. That retreat formed the basis for the first written collaborative and purposeful interactions among European and North American maxillofacial faculty with regard to new product development, educational courses and manufacturing. In 1994, representatives of the North America Maxillofacial faculty began working with AO North America, pursuing the goals of better organization, educational and research projects and product development. The North America Maxillofacial trustees adopted several goals, including pursuing sentinel clinical projects (multi-institutional clinical assessment projects) the answers to which could change for the better the way maxillofacial and craniofacial surgical treatment is delivered. The subjects were selected after a year-long process of solicitation from all maxillofacial AO faculty members, requesting their best ideas. Those projects selected for further development were then returned to the suggestors and detailed research proposals provided. The committee has evaluated the proposals and suggested that we pursue Long Term Outcome Projects in condylar fractures (open versus closed reduction), frontal sinus fractures (method of treatment yielding the best results), long- term outcome of craniofacial growth and intellectual development following synostosis correction, a study involving plate migration intracranially when placed in the growing skull, and a long-term outcome study regarding mandibular angle fractures and a long-term outcome study regarding zygomatic-orbital fractures.

These projects were approved in the 1996 and 1997 AO North America budgets, with the first projects beginning in early 1997.

This article represents the first of what will be a standard column in AO North America News for Maxillofacial Practitioners. In 1995, the AO North America Maxillofacial Practitioners desired to organize a biennial meeting and retreat at which clinical cases, product development and evaluation, "teach the teachers" programs, guest lecture programs and social time were coordinated. The faculty of AO North America Maxillofacial consists of individuals from three different disciplines: Otolaryngology, Plastic Surgery and Oral and Maxillofacial Surgery. These three disciplines have separate meeting structures, and it is not possible to hold a single function at any one of the national meetings and capture the AO practitioners with a single event, therefore, this biennial meeting is necessary for faculty development and interaction. The first retreat was held in Sagamore, New York, in August 1996, and was a success. The faculty discussed problem cases, clinical problem management, worked on new product ideas and conducted sessions with development and manufacturing personnel to improve current products and discuss where future product development efforts should be directed. We discussed ways to bring products to the clinician more rapidly. Sessions were held in which we evaluated our future product and educational needs.

The North American Maxillofacial Educational Program is also scheduled to have an evaluation by survey in 1997. We will survey both AO and non-AO Maxillofacial practitioners for an evaluation of our educational program, product appropriateness, and service.

This year the International AO Maxillofacial Trustees and Steering Committee have proposed that we establish better lines of communication for International Maxillofacial Practitioners. Again, news items and structured time at the AO Trustees meeting will be created for maxillofacial interaction. One of the principal goals of the International Maxillofacial Program will be the creation of a maxillofacial research initiative in Davos, Switzerland. The proposed venture will include individuals in Europe and North America and will develop cooperative links between the AO Development Institute, the AO Research Institute and the proposers in Europe and AO North America. Sentinel research projects have been suggested which will be studied and refined. Hopefully, they will yield answers to critical questions in research that will lead to future improvements in surgical care and products. As an example of the products necessary, a material which would be a fixative, skeletal replacement substance, a bone extender and ultimately degrade into a biologic substance like bone, is the ideal craniofacial fixation material. We are studying proposed substances; and AO clinicians from Europe and North America have recently begun the evaluation of one such substance.

We are also proposing a multi-institution development and clinical assessment project on distraction, one of the new techniques that is revolutionizing craniofacial surgical procedures. There are roles in craniofacial surgery for endoscopic fixation, bone stimulant fixatives, biologic fixatives and bone substitutes. The maxillofacial section of the Research Institute will include staff personnel for maxillofacial projects and provide research opportunities for residents and fellows.

To complete the circle of product evaluation, we propose the establishment of a product evaluation operative within the maxillofacial AOTK that evaluates unsatisfactory outcomes and makes recommendations.

We propose that international links of communication be established between AO practitioners in Asia, the Near East, Africa and South America who have been less available for standard communication. We will research the use of other metals, including those which are less expensive than the currently available Titanium.

Strong links of communication have been established between AO-International Maxillofacial Trustees, AO North America and the North America Maxillofacial Education Committee (NAMEC). Although we have identified the need for structured time for discussion for maxillofacial surgeons, we seek to maintain ties with our colleagues in Orthopedics, Veterinary and Spine and benefit from continued interaction and collaborative discussion.

The Maxillofacial Trustees are very grateful for the opportunity of identifying what we consider our needs and of working through AO North America and AO/ASIF to develop programs that will enhance our ability to develop and market current and new products and provide education to our practitioners. With the continued support of AO/ASIF and AO North America, we will achieve substantial progress.

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