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Oral and maxillofacial surgery: The mystery behind the history
G Model JOMSMP-460; No. of Pages 4
ARTICLE IN PRESS Journal of Oral and Maxillofacial Surgery, Medicine, and Pathology xxx (2015) xxx–xxx
Contents lists available at ScienceDirect
Journal of Oral and Maxillofacial Surgery, Medicine, and Pathology journal homepage: www.elsevier.com/locate/jomsmp
Review article
Oral and maxillofacial surgery: The mystery behind the history Daniel M. Laskin ∗ Department of Oral and Maxillofacial Surgery, School of Dentistry, Virginia Commonwealth University, 521 N. 11th St, Richmond, VA 23298-0566, United States
a r t i c l e
i n f o
Article history: Received 2 September 2015 Accepted 2 November 2015 Available online xxx Keywords: Oral and maxillofacial surgery History Scope of practice
a b s t r a c t The recognition of oral and maxillofacial surgery as a specialty is relatively new. Therefore, to understand the true history of the specialty one has to trace the development of the procedures encompassed by its scope. This article shows how this scope developed from the early stages in Egypt and Greece to the present time. © 2015 Asian AOMS, ASOMP, JSOP, JSOMS, JSOM, and JAMI. Published by Elsevier Ltd. All rights reserved.夽
Although one can easily define what is currently included in the scope of oral and maxillofacial surgery in the United States, tracing the specific history of oral and maxillofacial surgery as a recognized specialty does not really tell us how that scope developed because this recognition has been a relevantly recent event. Therefore, to understand the true history of what we now call oral and maxillofacial surgery one has to focus on how the various procedures now included in its scope developed and the personalities involved, irrespective of their degrees, specialty designations or countries of origin. The earliest known mention of what is now included in the scope of oral and maxillofacial surgery occurred in Egypt in the so-called Edwin Smith Papyrus (2700 BC). This document, which contains 48 case histories written by a military surgeon, mentions the treatment of mandibular fractures with bandages obtained from an embalmer and soaked in honey and egg white [1]. It also mentions empirically treating wounds with honey and fresh meat. It is now known that honey promotes autolytic debridement and that meat contains proteolytic enzymes and thromboplastin. It is of interest that 5000 years later Medihoney® is still being used for wound debridement (Fig. 1). The earliest documented treatment of oral diseases dates back to 1200 BC in ancient Greece. These treatments were administered
夽 AsianAOMS: Asian Association of Oral and Maxillofacial Surgeons; ASOMP: Asian Society of Oral and Maxillofacial Pathology; JSOP: Japanese Society of Oral Pathology; JSOMS: Japanese Society of Oral and Maxillofacial Surgeons; JSOM: Japanese Society of Oral Medicine; JAMI: Japanese Academy of Maxillofacial Implants. ∗ Tel.: +1 804 828 3547; fax: +1 804 828 1753. E-mail address: [email protected]
in temples known as asclepiads by priests who were followers of Asclepius, the Greek god of medicine. Although these treatments consisted mainly of herbal remedies, there is evidence that tooth extraction was also performed [2]. The formal practice of medicine, which at that time included dental treatment, actually began in Greece in the 4th century BC under the leadership of Hippocrates. He extracted teeth and treated dental abscesses. However, at that time the skill and/or proper forceps needed to readily extract teeth were apparently lacking since he recommended extracting only those teeth that were loose [3]. A firm tooth was either loosened by applying various substances to degrade the periodontal ligament, or the crown was intentionally broken off and the pulp cauterized to stop the pain. Hippocrates also wrote of treating mandibular fractures. However, he advised using gold wire or thread to fasten together the loose teeth in the area of the fracture rather than using bandages stating: “It should be well known that, in fractures of the jaw, dressings with bandages if properly performed is of little advantage, but occasions great mischief if improperly done” (for a detailed history of the treatment of maxillofacial trauma see Ref. [1]). Hippocrates also devised a method for manually reducing a mandibular dislocation that is still being used today (Fig. 2). It is of interest that the management of such an uncommon problem would be mentioned in his writings. The probable reason is that it was a more common condition in those days due to inept attempts at tooth extraction. Celsus (25 BC–50 BC) was a leader in Roman medicine, building upon what had been learned from the Greek medical system. He also considered tooth extraction as dangerous, to be done only as a last resort, and cited cases of resulting jaw fracture leading to death [4]. He recommended filling a carious tooth with linen thread or
http://dx.doi.org/10.1016/j.ajoms.2015.11.001 2212-5558/© 2015 Asian AOMS, ASOMP, JSOP, JSOMS, JSOM, and JAMI. Published by Elsevier Ltd. All rights reserved.夽
Please cite this article in press as: Laskin DM. Oral and maxillofacial surgery: The mystery behind the history. J Oral Maxillofac Surg Med Pathol (2015), http://dx.doi.org/10.1016/j.ajoms.2015.11.001
G Model JOMSMP-460; No. of Pages 4 2
ARTICLE IN PRESS D.M. Laskin / Journal of Oral and Maxillofacial Surgery, Medicine, and Pathology xxx (2015) xxx–xxx
Fig. 1. Current advertisement for a honey product.
lead prior to attempted extraction to prevent crushing the crown [5]. Celsus also incised and drained dental abscesses and treated jaw fractures with bandages. The fall of the Roman Empire and Arabic invasion of southern Europe led to the Islamic period of medicine. Among the leading practitioners of that time were Rhazes (865–923 AD), Albacasis (936–1013 AD) and Avicenna (980–1037 AD) [5]. Their expanded surgical scope included treating oral fistulae, ranulas and epuli, and doing frenectomies, as well as the management of infections, jaw fractures and dislocations [6]. They recommended that incisions for drainage of infections follow the lines in the skin centuries before the description of Langer’s lines of skin tension in 1861. They adhered to the earlier advice of the Greek and Roman surgeons in doing extractions only as a last resort. Rhazes advised first using a loosening agent consisting of arsenic paste or juice of boiled frog [5]. The Middle Ages saw the gradual separation of medicine and surgery. Medicine was now taught at universities but surgery, which was considered degrading, was still learned by apprenticeship and left to lay practitioners. The latter consisted of two groups – so-called lay surgeons and barber surgeons. They were ultimately united by British parliament in 1540 and their scope of practice defined. Barber surgeons were only allowed to extract teeth and lay surgeons were not allowed to operate barbershops or shave patrons [5].
The Renaissance Period (14th to middle of 17th century) saw a further expansion of the scope of what is now considered to be oral and maxillofacial surgery. Among the premier practitioners at that time was Ambroise Pare (1510–1590) (Fig. 3), who rose from an apprenticed barber surgeon to head surgeon at the Hotel Dieu in Paris. He not only treated broken jaws, mandibular dislocation, and various tumors, but also when serving as a military surgeon, improved the management of gunshot wounds and developed a technique for the localization and removal of bullets [7]. In regard to the former, it had been believed that the major destruction caused by a gunshot was due to poisons contained in the gunpowder, and to remove them the wound had to be cauterized with hot irons and boiling oil. Pare found that these wounds could be treated successfully with less aggressive therapy consisting of egg yolk, rose water and turpentine [7]. Among Pare’s other contributions was the use of ligatures instead of cautery to control bleeding. In terms of exodontia, he warned against extraction of the wrong tooth, noting that the patient often does not know which one is actually painful, and he cautioned against leaving a broken off piece of bone because it can cause fever, festering and even lead to death. Another contributor during this period was Johannes Scultetus from Padua (1595–1645). Although Carl Partsch is generally given credit for describing the operation that bears his name in 1892, Scultetus was actually the first to describe marsupialization of a cyst of the jaw (6). In describing the procedure, he indicated that
Please cite this article in press as: Laskin DM. Oral and maxillofacial surgery: The mystery behind the history. J Oral Maxillofac Surg Med Pathol (2015), http://dx.doi.org/10.1016/j.ajoms.2015.11.001
G Model JOMSMP-460; No. of Pages 4
ARTICLE IN PRESS D.M. Laskin / Journal of Oral and Maxillofacial Surgery, Medicine, and Pathology xxx (2015) xxx–xxx
Fig. 2. Illustration of the correction of a mandibular prognathism using the method described by Hippocrates.
3
he first placed the lady in her bed, tying her hands to her sides. When he cut the tumor in half, a thick yellow matter like honey flowed out and the tumor subsided. He kept the cavity open for two months, cauterized with a decoction of sarsaparilla root, until the wound healed. The first textbook on what can be considered oral surgery was written by the French surgeon Anselme Jourdain in 1778 [5]. Among the procedures he described were the management of diseases of the maxillary sinus and treatment of cleft lip and palate. Jourdain also developed special instruments for perforating the maxillary sinus via the alveolar process for drainage. In the United States in the 1800s there were a small group of physicians with dental training who practiced oral surgery as a branch of surgery. Among the outstanding members of this group was Simon P. Hullihen (1810–1857) (Fig. 4) of Wheeling, West Virginia [8]. During the last 10 years of his life, among other surgical procedures, he performed 100 cleft lip and 50 cleft palate operations, treated 100 cancers, did 200 procedures for maxillary sinus diseases, and performed 85 reconstructions of the lips, nose and mandible, a remarkable record at a time when local and general anesthesia did not exist. He also performed the first documented case of orthognathic surgery (for a detailed history of the development of orthognathic surgery see Ref. [9]). It involved a 20-year-old woman who had received a severe burn 15 years earlier that resulted in scaring that pulled her chin down toward her neck, distorted her lower lip, and led to elongation of the mandible (Fig. 5). He treated her in 3 stages. In the first operation he corrected the prognathic mandible by a combined bilateral wedge ostectomy and a subapical osteotomy (Fig. 6). He later excised the extensive
Fig. 3. Ambroise Pare (1510–1590). Fig. 4. Simon P. Hullihen (1810–1857).
Fig. 5. (A) Preoperative appearance of the patient. (B) Preoperative maxillary–mandibular relationship. From Hullihen SB: Case of elongation of the underjaw and distortion of the face and neck, successfully treated. Am J Dent Sci 1849; 9:157.
Please cite this article in press as: Laskin DM. Oral and maxillofacial surgery: The mystery behind the history. J Oral Maxillofac Surg Med Pathol (2015), http://dx.doi.org/10.1016/j.ajoms.2015.11.001
G Model JOMSMP-460; No. of Pages 4 4
ARTICLE IN PRESS D.M. Laskin / Journal of Oral and Maxillofacial Surgery, Medicine, and Pathology xxx (2015) xxx–xxx
Fig. 6. Location of the bilateral ostectomy and subapical osteotomy used to correct the mandibular prognathism. From Hullihen SB: Case of elongation of the underjaw and distortion of the face and neck, successfully treated. Am J Dent Sci 1849; 9:157.
for the first time defined the true scope of oral surgery. It was later expanded and published under the title “A System of Oral Surgery”. A review of the textbook in Dental Cosmos published in 1872 [10] stated: “Dr. Garretson’s new work furnishes the missing link needed to unite dentistry with medicine and surgery, supplying a deficiency on either side and creating a new specialty – that of oral surgery.” As the person who gave the discipline its name, Dr. Garretson is considered the founder of the specialty. At this time, however, oral surgery was still considered a part of medicine. Garretson even recommended abolishing the DDS degree, expanding the dental curriculum to include medical training and granting these graduates an MD degree and the title oral surgeon. This pressure to increase the medical content of the dental curriculum continued in the United States well into the 20th century. In the interim, many oral surgeons obtained a dental as well as a medical degree. Among the leading practitioners and educators at that time were Matthew H. Cryer (1840–1921), Truman Brophy (1848–1928), Thomas L. Gilmer (1848–1931), and Chalmers L. Lyons (1874–1935). Although most of these individuals also had a medical degree, they affiliated themselves with dental schools, firmly believing that oral surgery was a part of dentistry and not medicine. From the 1800s to the present time the scope of oral surgery gradually increased. Among the important factors contributing to this was the experience gained from the treatment of traumatic war injuries during these years. This was recognized in the 4th century by Hippocrates who stated: “War is the only proper school for a surgeon” [1]. The surgical skills and familiarity with regional anatomy gained from such endeavors, along with the gradually expanded educational experience in the training programs and advances in technology during this period, eventually led to the improvements in orthognathic surgery, temporomandibular joint surgery, the repair of nerve injuries, craniofacial surgery, oncologic surgery, cosmetic surgery and implantology that comprise the current scope of the specialty. Oral and maxillofacial surgery is a specialty that differs from any other specialty in medicine or dentistry. Originally arising from medicine, it eventually became a dentally based specialty, with both professions contributing to its ultimate scope. To this day it remains unique in that it is still the one specialty that continues to bridge medicine and dentistry in its education and training. References
Fig. 7. A. Appearance of patient after correction of the prognathism, scar excision and lip reconstruction. B. Correction of the mandibular prognathism. From Hullihen SB: Case of elongation of the underjaw and distortion of the face and neck, successfully treated. Am J Dent Sci 1849; 9:157.
scar tissue that was preventing head movement and reconstructed the area with a pedicled deltoid flap. The final operation consisted of correcting the lower lip deformity by a wedge resection and a V-Y closure (Fig. 7). Another outstanding practitioner at that time was James E. Garretson (1828–1895). His textbook entitled “A Treatise on the Diseases and Surgery of the Mouth, Jaws and Associated Parts”
[1] Rowe NL. The history of the treatment of maxillo-facial trauma. Ann Roy Coll Surg Eng 1971;49:329–49. [2] Guerini V. A history of dentistry from the most ancient times until the end of the eighteenth century. Philadelphia: Lea & Febiger; 1909. [3] Densham A. A review of the progress of dental science and literature from the earliest ages. Proc R Soc Med 1909;2:71–98. [4] Adams F. The Seven Books of Paulus Aegineta. London: Sydenham Society; 1846. [5] Garant PR. The long climb from dental surgeons to doctors of dental surgery. Chicago: Quintessence Publishing Co.; 2013. [6] Hoffmann-Axhelm W. History of dentistry. Chicago: Quintessence Publishing Co.; 1981. [7] Packard FR. Life and times of Ambroise Pare. New York: Paul B. Hoeber; 1921. [8] Aziz SR, Simon P. Hullihen and the origin of orthognathic surgery. J Oral Maxillofac Surg 2004;62:1303–7. [9] Steinhauser EW. Historical development of orthognathic surgery. J CranioMaxillofac Surg 1996;24:195–204. [10] The future of dentistry. Dent Cosmos 1872;14:608–11.
Please cite this article in press as: Laskin DM. Oral and maxillofacial surgery: The mystery behind the history. J Oral Maxillofac Surg Med Pathol (2015), http://dx.doi.org/10.1016/j.ajoms.2015.11.001
ARTICLE IN PRESS Journal of Oral and Maxillofacial Surgery, Medicine, and Pathology xxx (2015) xxx–xxx
Contents lists available at ScienceDirect
Journal of Oral and Maxillofacial Surgery, Medicine, and Pathology journal homepage: www.elsevier.com/locate/jomsmp
Review article
Oral and maxillofacial surgery: The mystery behind the history Daniel M. Laskin ∗ Department of Oral and Maxillofacial Surgery, School of Dentistry, Virginia Commonwealth University, 521 N. 11th St, Richmond, VA 23298-0566, United States
a r t i c l e
i n f o
Article history: Received 2 September 2015 Accepted 2 November 2015 Available online xxx Keywords: Oral and maxillofacial surgery History Scope of practice
a b s t r a c t The recognition of oral and maxillofacial surgery as a specialty is relatively new. Therefore, to understand the true history of the specialty one has to trace the development of the procedures encompassed by its scope. This article shows how this scope developed from the early stages in Egypt and Greece to the present time. © 2015 Asian AOMS, ASOMP, JSOP, JSOMS, JSOM, and JAMI. Published by Elsevier Ltd. All rights reserved.夽
Although one can easily define what is currently included in the scope of oral and maxillofacial surgery in the United States, tracing the specific history of oral and maxillofacial surgery as a recognized specialty does not really tell us how that scope developed because this recognition has been a relevantly recent event. Therefore, to understand the true history of what we now call oral and maxillofacial surgery one has to focus on how the various procedures now included in its scope developed and the personalities involved, irrespective of their degrees, specialty designations or countries of origin. The earliest known mention of what is now included in the scope of oral and maxillofacial surgery occurred in Egypt in the so-called Edwin Smith Papyrus (2700 BC). This document, which contains 48 case histories written by a military surgeon, mentions the treatment of mandibular fractures with bandages obtained from an embalmer and soaked in honey and egg white [1]. It also mentions empirically treating wounds with honey and fresh meat. It is now known that honey promotes autolytic debridement and that meat contains proteolytic enzymes and thromboplastin. It is of interest that 5000 years later Medihoney® is still being used for wound debridement (Fig. 1). The earliest documented treatment of oral diseases dates back to 1200 BC in ancient Greece. These treatments were administered
夽 AsianAOMS: Asian Association of Oral and Maxillofacial Surgeons; ASOMP: Asian Society of Oral and Maxillofacial Pathology; JSOP: Japanese Society of Oral Pathology; JSOMS: Japanese Society of Oral and Maxillofacial Surgeons; JSOM: Japanese Society of Oral Medicine; JAMI: Japanese Academy of Maxillofacial Implants. ∗ Tel.: +1 804 828 3547; fax: +1 804 828 1753. E-mail address: [email protected]
in temples known as asclepiads by priests who were followers of Asclepius, the Greek god of medicine. Although these treatments consisted mainly of herbal remedies, there is evidence that tooth extraction was also performed [2]. The formal practice of medicine, which at that time included dental treatment, actually began in Greece in the 4th century BC under the leadership of Hippocrates. He extracted teeth and treated dental abscesses. However, at that time the skill and/or proper forceps needed to readily extract teeth were apparently lacking since he recommended extracting only those teeth that were loose [3]. A firm tooth was either loosened by applying various substances to degrade the periodontal ligament, or the crown was intentionally broken off and the pulp cauterized to stop the pain. Hippocrates also wrote of treating mandibular fractures. However, he advised using gold wire or thread to fasten together the loose teeth in the area of the fracture rather than using bandages stating: “It should be well known that, in fractures of the jaw, dressings with bandages if properly performed is of little advantage, but occasions great mischief if improperly done” (for a detailed history of the treatment of maxillofacial trauma see Ref. [1]). Hippocrates also devised a method for manually reducing a mandibular dislocation that is still being used today (Fig. 2). It is of interest that the management of such an uncommon problem would be mentioned in his writings. The probable reason is that it was a more common condition in those days due to inept attempts at tooth extraction. Celsus (25 BC–50 BC) was a leader in Roman medicine, building upon what had been learned from the Greek medical system. He also considered tooth extraction as dangerous, to be done only as a last resort, and cited cases of resulting jaw fracture leading to death [4]. He recommended filling a carious tooth with linen thread or
http://dx.doi.org/10.1016/j.ajoms.2015.11.001 2212-5558/© 2015 Asian AOMS, ASOMP, JSOP, JSOMS, JSOM, and JAMI. Published by Elsevier Ltd. All rights reserved.夽
Please cite this article in press as: Laskin DM. Oral and maxillofacial surgery: The mystery behind the history. J Oral Maxillofac Surg Med Pathol (2015), http://dx.doi.org/10.1016/j.ajoms.2015.11.001
G Model JOMSMP-460; No. of Pages 4 2
ARTICLE IN PRESS D.M. Laskin / Journal of Oral and Maxillofacial Surgery, Medicine, and Pathology xxx (2015) xxx–xxx
Fig. 1. Current advertisement for a honey product.
lead prior to attempted extraction to prevent crushing the crown [5]. Celsus also incised and drained dental abscesses and treated jaw fractures with bandages. The fall of the Roman Empire and Arabic invasion of southern Europe led to the Islamic period of medicine. Among the leading practitioners of that time were Rhazes (865–923 AD), Albacasis (936–1013 AD) and Avicenna (980–1037 AD) [5]. Their expanded surgical scope included treating oral fistulae, ranulas and epuli, and doing frenectomies, as well as the management of infections, jaw fractures and dislocations [6]. They recommended that incisions for drainage of infections follow the lines in the skin centuries before the description of Langer’s lines of skin tension in 1861. They adhered to the earlier advice of the Greek and Roman surgeons in doing extractions only as a last resort. Rhazes advised first using a loosening agent consisting of arsenic paste or juice of boiled frog [5]. The Middle Ages saw the gradual separation of medicine and surgery. Medicine was now taught at universities but surgery, which was considered degrading, was still learned by apprenticeship and left to lay practitioners. The latter consisted of two groups – so-called lay surgeons and barber surgeons. They were ultimately united by British parliament in 1540 and their scope of practice defined. Barber surgeons were only allowed to extract teeth and lay surgeons were not allowed to operate barbershops or shave patrons [5].
The Renaissance Period (14th to middle of 17th century) saw a further expansion of the scope of what is now considered to be oral and maxillofacial surgery. Among the premier practitioners at that time was Ambroise Pare (1510–1590) (Fig. 3), who rose from an apprenticed barber surgeon to head surgeon at the Hotel Dieu in Paris. He not only treated broken jaws, mandibular dislocation, and various tumors, but also when serving as a military surgeon, improved the management of gunshot wounds and developed a technique for the localization and removal of bullets [7]. In regard to the former, it had been believed that the major destruction caused by a gunshot was due to poisons contained in the gunpowder, and to remove them the wound had to be cauterized with hot irons and boiling oil. Pare found that these wounds could be treated successfully with less aggressive therapy consisting of egg yolk, rose water and turpentine [7]. Among Pare’s other contributions was the use of ligatures instead of cautery to control bleeding. In terms of exodontia, he warned against extraction of the wrong tooth, noting that the patient often does not know which one is actually painful, and he cautioned against leaving a broken off piece of bone because it can cause fever, festering and even lead to death. Another contributor during this period was Johannes Scultetus from Padua (1595–1645). Although Carl Partsch is generally given credit for describing the operation that bears his name in 1892, Scultetus was actually the first to describe marsupialization of a cyst of the jaw (6). In describing the procedure, he indicated that
Please cite this article in press as: Laskin DM. Oral and maxillofacial surgery: The mystery behind the history. J Oral Maxillofac Surg Med Pathol (2015), http://dx.doi.org/10.1016/j.ajoms.2015.11.001
G Model JOMSMP-460; No. of Pages 4
ARTICLE IN PRESS D.M. Laskin / Journal of Oral and Maxillofacial Surgery, Medicine, and Pathology xxx (2015) xxx–xxx
Fig. 2. Illustration of the correction of a mandibular prognathism using the method described by Hippocrates.
3
he first placed the lady in her bed, tying her hands to her sides. When he cut the tumor in half, a thick yellow matter like honey flowed out and the tumor subsided. He kept the cavity open for two months, cauterized with a decoction of sarsaparilla root, until the wound healed. The first textbook on what can be considered oral surgery was written by the French surgeon Anselme Jourdain in 1778 [5]. Among the procedures he described were the management of diseases of the maxillary sinus and treatment of cleft lip and palate. Jourdain also developed special instruments for perforating the maxillary sinus via the alveolar process for drainage. In the United States in the 1800s there were a small group of physicians with dental training who practiced oral surgery as a branch of surgery. Among the outstanding members of this group was Simon P. Hullihen (1810–1857) (Fig. 4) of Wheeling, West Virginia [8]. During the last 10 years of his life, among other surgical procedures, he performed 100 cleft lip and 50 cleft palate operations, treated 100 cancers, did 200 procedures for maxillary sinus diseases, and performed 85 reconstructions of the lips, nose and mandible, a remarkable record at a time when local and general anesthesia did not exist. He also performed the first documented case of orthognathic surgery (for a detailed history of the development of orthognathic surgery see Ref. [9]). It involved a 20-year-old woman who had received a severe burn 15 years earlier that resulted in scaring that pulled her chin down toward her neck, distorted her lower lip, and led to elongation of the mandible (Fig. 5). He treated her in 3 stages. In the first operation he corrected the prognathic mandible by a combined bilateral wedge ostectomy and a subapical osteotomy (Fig. 6). He later excised the extensive
Fig. 3. Ambroise Pare (1510–1590). Fig. 4. Simon P. Hullihen (1810–1857).
Fig. 5. (A) Preoperative appearance of the patient. (B) Preoperative maxillary–mandibular relationship. From Hullihen SB: Case of elongation of the underjaw and distortion of the face and neck, successfully treated. Am J Dent Sci 1849; 9:157.
Please cite this article in press as: Laskin DM. Oral and maxillofacial surgery: The mystery behind the history. J Oral Maxillofac Surg Med Pathol (2015), http://dx.doi.org/10.1016/j.ajoms.2015.11.001
G Model JOMSMP-460; No. of Pages 4 4
ARTICLE IN PRESS D.M. Laskin / Journal of Oral and Maxillofacial Surgery, Medicine, and Pathology xxx (2015) xxx–xxx
Fig. 6. Location of the bilateral ostectomy and subapical osteotomy used to correct the mandibular prognathism. From Hullihen SB: Case of elongation of the underjaw and distortion of the face and neck, successfully treated. Am J Dent Sci 1849; 9:157.
for the first time defined the true scope of oral surgery. It was later expanded and published under the title “A System of Oral Surgery”. A review of the textbook in Dental Cosmos published in 1872 [10] stated: “Dr. Garretson’s new work furnishes the missing link needed to unite dentistry with medicine and surgery, supplying a deficiency on either side and creating a new specialty – that of oral surgery.” As the person who gave the discipline its name, Dr. Garretson is considered the founder of the specialty. At this time, however, oral surgery was still considered a part of medicine. Garretson even recommended abolishing the DDS degree, expanding the dental curriculum to include medical training and granting these graduates an MD degree and the title oral surgeon. This pressure to increase the medical content of the dental curriculum continued in the United States well into the 20th century. In the interim, many oral surgeons obtained a dental as well as a medical degree. Among the leading practitioners and educators at that time were Matthew H. Cryer (1840–1921), Truman Brophy (1848–1928), Thomas L. Gilmer (1848–1931), and Chalmers L. Lyons (1874–1935). Although most of these individuals also had a medical degree, they affiliated themselves with dental schools, firmly believing that oral surgery was a part of dentistry and not medicine. From the 1800s to the present time the scope of oral surgery gradually increased. Among the important factors contributing to this was the experience gained from the treatment of traumatic war injuries during these years. This was recognized in the 4th century by Hippocrates who stated: “War is the only proper school for a surgeon” [1]. The surgical skills and familiarity with regional anatomy gained from such endeavors, along with the gradually expanded educational experience in the training programs and advances in technology during this period, eventually led to the improvements in orthognathic surgery, temporomandibular joint surgery, the repair of nerve injuries, craniofacial surgery, oncologic surgery, cosmetic surgery and implantology that comprise the current scope of the specialty. Oral and maxillofacial surgery is a specialty that differs from any other specialty in medicine or dentistry. Originally arising from medicine, it eventually became a dentally based specialty, with both professions contributing to its ultimate scope. To this day it remains unique in that it is still the one specialty that continues to bridge medicine and dentistry in its education and training. References
Fig. 7. A. Appearance of patient after correction of the prognathism, scar excision and lip reconstruction. B. Correction of the mandibular prognathism. From Hullihen SB: Case of elongation of the underjaw and distortion of the face and neck, successfully treated. Am J Dent Sci 1849; 9:157.
scar tissue that was preventing head movement and reconstructed the area with a pedicled deltoid flap. The final operation consisted of correcting the lower lip deformity by a wedge resection and a V-Y closure (Fig. 7). Another outstanding practitioner at that time was James E. Garretson (1828–1895). His textbook entitled “A Treatise on the Diseases and Surgery of the Mouth, Jaws and Associated Parts”
[1] Rowe NL. The history of the treatment of maxillo-facial trauma. Ann Roy Coll Surg Eng 1971;49:329–49. [2] Guerini V. A history of dentistry from the most ancient times until the end of the eighteenth century. Philadelphia: Lea & Febiger; 1909. [3] Densham A. A review of the progress of dental science and literature from the earliest ages. Proc R Soc Med 1909;2:71–98. [4] Adams F. The Seven Books of Paulus Aegineta. London: Sydenham Society; 1846. [5] Garant PR. The long climb from dental surgeons to doctors of dental surgery. Chicago: Quintessence Publishing Co.; 2013. [6] Hoffmann-Axhelm W. History of dentistry. Chicago: Quintessence Publishing Co.; 1981. [7] Packard FR. Life and times of Ambroise Pare. New York: Paul B. Hoeber; 1921. [8] Aziz SR, Simon P. Hullihen and the origin of orthognathic surgery. J Oral Maxillofac Surg 2004;62:1303–7. [9] Steinhauser EW. Historical development of orthognathic surgery. J CranioMaxillofac Surg 1996;24:195–204. [10] The future of dentistry. Dent Cosmos 1872;14:608–11.
Please cite this article in press as: Laskin DM. Oral and maxillofacial surgery: The mystery behind the history. J Oral Maxillofac Surg Med Pathol (2015), http://dx.doi.org/10.1016/j.ajoms.2015.11.001