RIPAS Seminar In Maxillo Facial And Facial Plastic And Reconstructive Surgery

28 Nov 2004

By Dr Balaji Sadasivan, Senior Minister Of State For Information, Communications And The Arts and Health

Venue: Gleneagles Hospital Lecture Theatre

Speech By Dr Balaji Sadasivan, Senior Minister Of State, Ministry Of Information, Communications And The Arts & Ministry Of Health At The Ripas Seminar In Maxillo Facial And Facial Plastic And Reconstructive Surgery On Sunday, 28 Nov 2004 At Gleneagles Hospital Lecture Theatre

Pehin Abu Bakar

Minister for Health

Ministry of Health, Brunei Darussalam

Dr Haji Affendy

Director General of Medical Services

Ministry of Health, Brunei Darussalam

Dr Ravindranathan

Chairman, Organising Committee

Invited Speakers

Distinguished Guests

Ladies and Gentlemen

Introduction

It is my pleasure to be here today at this RIPAS Seminar in the presence of distinguished guests and invited speakers. I understand that this is the first time that the RIPAS seminar has been held overseas and this reflects well on the cordial ties between Brunei and Singapore.

I congratulate the organising committee i.e. Dept of Maxillo Facial and Facial Plastic and Reconstructive Surgery, RIPAS Hospital and the co-sponsors, the Academy of Medicine and Parkway Group Healthcare for all the effort put in, to hold this seminar in Singapore.

Maxillo Facial Surgery As An Evolving Surgical Specialty

The theme of the conference, Maxillo Facial Surgery as an evolving surgical specialty is an apt topic especially when in the last two decades various technological advances including virtual reality, simulators and "robotics" have further enhanced the capabilities of surgeons. I recall the movie "Face Off" where the two main characters (one a cop and the other a crook) played by John Travolta and Nicholas Cage are involved in an operation where they have a face transplantation and end up switching places to assume each other's identity. You can imagine the thrill and excitement of this action movie when the audience is never sure if the good guy is really the good guy or just the bad guy with the good guy's face.

This once remote possibility does not seem too far fetched, as a recent article (April 2004) in Plastic and Reconstructive Surgery, a journal of the American Society of Plastic Surgeons entitled, "Face Transplantation : Where do we stand," suggests that face (allo) transplantation could be the next step to benefit patients whose conditions cannot be addressed by conventional techniques of reconstructive surgery using autologous tissues. However the 3 major issues quoted in the article are:

the surgical challenge of the procedure,

the risk of graft rejection and the long term side-effects of immuno-suppression and;

the ethical debates and the effects of the procedure on the population.

Ethics and Medico-Legal Perspectives

Ethics becomes a very pertinent issue in this era of reality shows which show men and women undergoing major cosmetic surgical procedures to look "good". There is immense peer pressure and media publicity given to looking "good", which enables such reality shows to glamorise surgical and cosmetic procedures as if it was an everyday norm to go "under the knife", if one is dissatisfied with one's looks or has a poor body image. It is up to the experts in the field like yourselves to ensure that in offering patients surgical alternatives and procedures, ethical practices and norms are not compromised. We must always be mindful of ensuring patients clearly understand not only the procedure, the side-effects and but the various consequences including possible adverse events. Our patients then are able to make informed choices before signing the consent form for the surgical procedures.

This is not only an issue of ethical importance but also vital in an era where patients increasingly want to be part of the consultative process of treatments received. It is also in the best interest of surgeons performing intricate and risky operations, (who are already subject to rising medical indemnity insurance and potential risks of medical litigation), to ensure that patients, are adequately counselled and have realistic expectations of the outcome of the surgical procedures to be performed.

Coming back to this Seminar, I am pleased to note that there has always been an informal and vibrant spirit of mutual cooperation and camaraderie between the health professionals in the various countries in ASEAN and beyond, as clearly illustrated by the presence of delegates from Brunei, Malaysia, Indonesia, Singapore as well as invited speakers from as far as USA and India, at this seminar, today. It is this spirit of professional and inter-regional collaboration that will bring our individual surgical specialty, further into its next stage of evolvement.

This seminar also serves to highlight the importance not only of regional cooperation but the multi-disciplinary effort between dental, medical and surgical experts in addressing the complexities in the field of maxillo-facial, plastic and reconstructive surgery. The issue of fragmentation of care by sub-specialisation need not be a potentially contentious issue if all centres adopt an integrated multi-disciplinary team approach (e.g. involvement of specialists, psychologists and therapists) to the management of patients undergoing such complex procedures. The varied and interesting topics which are part of today's programme speaks volumes about the depth and breadth of evolvement in this field.

Conclusion

In conclusion, I wish to again welcome Pehin Abu Bakar, Dr Haji Effendy, invited speakers and all delegates, to Singapore. I wish you all a fruitful seminar with ample opportunities for networking and sharing of expertise. Thank you.