Juanma de Saá / ICAL
The Spanish Society of Oral and Maxillofacial Surgery and Head and Neck (Secom-CyC) has just awarded Raúl Antúnez-Conde, 28-year-old doctor from Zamora, for the communication on the ‘Use of structured light in reconstructive surgery for craniosynostosis’, presented at the national congress that was held on the 16th and 17th of last October electronically and in which the use of new technologies in surgical interventions was specially valued.
The young doctor was in charge of presenting the work developed by the Oral and Maxillofacial Surgery Service of the Gregorio Marañón University Hospital, together with the Neurosurgery Service of the same center and the Department of Bioengineering and Aerospace Engineering of the Carlos III University of Madrid . Raúl is part of a team of a dozen doctors and six residents, with José Ignacio Salmerón as head of the Oral and Maxillofacial Service and Santiago Ochandiano, as section manager.
Did you want to be a doctor as a child?
I wanted to be many things and, among them, there was always the medical vocation, although I was not able to verbalize it until I was fourteen or fifteen years old. There were doctors who were friends of the family, and when my grandmother went for check-ups or the doctor came for cures, I liked to see how the wounds were cleaned, how they healed and how people responded to that care. I remember that, at school, when a child fell I would go to help him, wash the wound and spontaneously do a series of automated things that made me realize that what I liked was medicine and, especially , Surgery.
He sure was a good student.
Yes. I studied at the San José de Calasanz school and it had fantastic teachers. I have a relationship with most of them and, above all, with one who was very special to the whole class and who, in fact, is my godfather, whose name is Rafael Bautista. I keep a very pleasant memory of those years.
How was the journey from the Salamanca School of Medicine to the Gregorio Marañón Hospital?
I came to the Faculty with great enthusiasm, I did all the practices that they allowed, even in my free time. I was closely linked to the Department of Psychiatry, with Professor Llorca’s Chair, of which I was an internal student by opposition for four years. Despite never having claimed to be a psychiatrist, due to the humanistic background of Medicine, that enriched me a lot. I learned a lot about the relationship with the sick, relatives and colleagues. I was also academically interested in rescuing the Academia de Alumnos Internos de Medicina Salamanca, a century-old institution that had disappeared decades ago, and we managed to re-found it in 2016
What relationship do you have with Zamora?
All that I can. I admit that in certain circles they call me heavy with Zamora but I have managed to attract many friends here and I try to make this wonderful land known. I try to do the mental exercise of the opinion that I would have of Zamora if I had not been born here and it costs me because I feel very connected to Zamora and Toro, which are my favorite places in the world. But I also love Sanabria and Sayago, such diverse places, with their people and their customs, I always had an interest, since I was little, in ethnography, popular customs, I did my first steps in various traditional dance groups … I really like to show off of my land.
What sites do you show the people you bring to Zamora?
I like to distribute the visit between medieval and modernist Zamora. I love the Plaza de Sagasta, the Plaza de Viriato, the Cathedral and the Castle.
You will have seen the statue of Eduardo Barrón recently installed …
Yes, in the Plaza de Sagasta, ‘Adam, after sin’. There is some controversy about its position and location but I think it is a good recognition of this sculptor, from Moraleja, who has been quite forgotten for a long time. He is the creator of a symbol of Zamora, such as the statue of Viriato.
So that later they say that science is separated from the humanities.
Well, Medicine is dressed in science but its background is humanistic. I think that you have to develop that facet a lot because it enriches and is one of the most beautiful branches of my profession because it gives you another vision of the world and of society.
What a tough moment you have chosen to excel in your investigations.
It is very hard, especially for the family environment. There are many people who suffer, family and friends who leave and who you cannot even say goodbye to because of what this disease is like. The pandemic adds to the difficulties that we already experienced before, except in large cities. In our case, Zamora and other territories already had bad indicators before all this, with a decline, aging, a trend towards depopulation, business closures, lack of initiatives and jobs, which makes people leave. I come whenever I can and I see closed places, fewer people on the main streets of the city and that hurts me. It does not console me to think that nearby cities are the same because I want everything to be better. We are living in a gray moment but we must have hope and continue fighting.
Do you expect to continue working in Spain?
I ask myself many times. Due to my nature, my tastes and my roots in my land and in Spain, I think that, if I had to leave, I would return as soon as I could. The possibility of leaving is there but it is not only about the ambition for a certain job, but, fundamentally, the desire to develop and learn certain innovative techniques and procedures. Wherever I go, I try to adapt and I don’t usually have problems because I like to meet and join in new places. As a student, I spent several months in France and Chile, doing general surgery, and in Italy, doing head and neck surgery. In any case, as in Spain, nowhere and this is where I would like to develop my work.
Now, that we are so sensitive with the expert committees, do you think the rulers pay attention to the politicians?
I believe that the word of scientists is taken seriously and is always a sign of guarantee, something favorable for society, but I also believe that science is used as a consultant in times of need. In the end, with the routine of a situation like the one we had before the pandemic, science is in second or fifteenth rank. And I say this with some qualms because I do not consider myself a scientist in capital letters, far from it. Hopefully one day I can change my mind.
Well, the award that they have just awarded responds to an innovative work to improve the lives of babies of few months.
Well, it is scientific but in a discreet way. It is true that we do science but not to call ourselves ‘scientists’, but to facilitate and improve people’s lives. I think the team I work with thinks that way.
Couldn’t they find a closer name than ‘Use of structured light in reconstructive craniosynostosis surgery’?
(Laughs) The truth is that it is an unattractive name. Light, although one thinks of the bill or the bulb, is still a physical property that can be used in many ways. There we do a job, helped by a fantastic group of engineers from the Carlos III University and, thanks to that technology, we use light as an emitting and receiving source of information. One is projected onto a surface, in this case, the head of a child with a developmental problem of the cranial vault, an early suture of the fontanelles and the bones of the skull, and, at the same time that it is emitted, a reception of the known light pattern distorted by hitting that surface. Thanks to light, without irradiating, we can obtain a 3D image of the surface of the patient’s head. The usual thing is a CT, which has high radiation but, considering the risk and the benefit, it is done but it is great to be able to get an image without irradiating.
How many operations have this technique taken?
We have operated on nine patients and the result has been favorable, to the best of our ability, in all cases. It is a very satisfying feeling to have done such successful interventions. It is comforting to see the patient’s parents and you go home thinking that all the effort has been worth it. Untreated craniosinososis has not been shown to have neurological effects, but cranial deformities do occur with significant social and psychological repercussions due to the irregular growth of the skull.
What are the most frequent problems you face in your discipline?
The most common, in a reference center such as Gregorio Marañón, are cancer patients. We operate on a very high percentage of advanced head and neck cancers, doing primary reconstructions. For example, we usually reconstruct the mandible with fibula, it is evaluated whether a radial flap of the forearm can be made in an intraoral defect… The free flaps are adapted to the defect and arteries and veins are anastomosed with microsurgery, with a special microscope.
How does a surgeon prepare for a possible mistake?
Let’s say that, in our training, it is implicitly knowing how to deal with stressful situations, desperate and unpleasant situations. Within that, is the error. Sometimes you get big scares. Fortunately, in most cases, everything is just a scare. If you read the leaflet of a common medicine, you may find that there are chances of dying from taking it, although it is rare to find such adverse reactions. Logically, the best way to solve a complication is not to have it and we try to minimize all possible errors so as not to face an irreparable error.
How is the work of the team you are part of structured?
It is a service that addresses practically all the subspecialties of the specialty itself. In general, all adjunct doctors master a wide variety of techniques and procedures, although there are some who are super-specialized in more specific branches. The training of the residents, among whom I am, consists of making a progressive learning of the most frequent pathologies, especially oral surgery, and then complementing all this with more complex processes of orthognathic surgery, oncological surgery, rehabilitation of implants in cancer patients that, in fact, we are one of the few centers in Spain where it is done and where we can have a specific consultation for it and, in the end, it is a progressive learning, sequences and each time expanding the field of action.
What research projects are you working on now?
We have several: one for monitoring the microsurgical reconstructions that we do with various imaging tests; another, on characteristics of cervicofacial infections and we are developing some more.