The History of Oral and Maxillofacial Surgery

In 1915, while at a national dental meeting, a prominent exodontist from Denver, Colorado, Dr. Menifee Howard, met with a group of other dentists whose main areas of practice were also related to the extraction of teeth, anesthesia, and the ethical aspects of such. They theorized that a new organization would be beneficial to advance their burgeoning areas of expertise. After acquiring the names of other dentists with similar interests from files provided by dental supply houses, a list of interested parties was assembled. Letters were sent out to 125 dentists throughout the country regarding a potential future meeting. On August 6, 1918, in conjunction with the annual meeting in Chicago of the National Dental Association (a circuitous precursor to the modern American Dental Association), a seminal meeting was held, which lasted for 3 days. The deliberations were mostly related to administrative structuring to meet the needs and types of committees desired and the membership of these committees. Also discussed were declarations regarding the advancement of standards, the present status of exodontia and other closely related fields, and imagined future areas of interest. A short time thereafter, a subcommittee met with the trustees of the National Dental Association to petition them for formal recognition of their now conceived specialty. Indeed, recognition was quickly granted, and the nascent group became the American Society of Oral Surgeons and Exodontists.

The pieces of the pie, relative to an officially recognized organization, were starting to fit together. It is important to recognize the enormous scientific and administrative contributions of previous historical giants that led to such a memorable and significant chain of events.

A new specialty was being established that was deeply rooted in dentistry. It initially was associated with the correction of traumatic facial injuries and abnormalities and the treatment of terminally diseased dentitions while using ambulatory anesthetic agents. Like many noteworthy events, a significant number of very dedicated persons along with the timing of certain circumstances, some planned, some serendipitous, turned the concept of the specialty into a reality. Who were some of these prophetic individuals and how did they lay the foundation for such a timely and influential organization?

Simon Hullihen (1810-1857) is considered the first recognized oral surgeon. He designed many instruments and performed a number of operations involving the correction of cleft lips and palates, jaw deformities, and the repair of fractured jaws.

James Garretson (1825-1895) is generally thought of as the father of oral surgery because he named the specialty by writing a book titled Diseases and Surgery of Mouth, Jaws and Associated Parts, which later was published as A System of Oral Surgery.

Robert Ivey (1881-1974) was instrumental in the development of the multidisciplinary team to treat cleft palates.

Varaztad Kazanjian (1879-1974), who had a dental degree and a prosthetic laboratory background, designed many ingenious devices to aid in the treatment of maxillofacial injuries, especially those sustained during World War I. Later, with an additional medical degree, he made important contributions in the formation of the specialty of plastic surgery.

Truman W. Brophy (1848-1928) was instrumental in determining the educational path for the profession of dentistry. With these rudimentary concepts, the teaching of advanced basic sciences for the study of oral surgery was initiated.

Mathew Cryer (1840-1921), an inventor of many oral surgery instruments, established the first hospital dental service in America at the Philadelphia General Hospital in 1901.

Many other pioneers followed or were contemporaries of the aforementioned individuals. However, there are two other individuals who were noteworthy because of their exceptionally prodigious contributions to the literature—Theodor Blum (1883-1962) and Kurt Thoma (1883-1972).

Blum was very involved with many aspects of oral surgery (107 published articles), but he is most noted for his deep involvement with the New York Institute of Oral Pathology and his discovery that some watchmakers were using their tongues to paint the dials of watches with radium for dial illumination. This exposure to radiation later caused them to develop cancer.

Kurt Thoma, with all due respect to other persons of historical note who helped create the specialty in this era, could probably give new meaning to the words quintessential and Renaissance man in terms of his immense contributions to the specialty. He was the author of about 300 articles and 8 textbooks. His books encompassed a panoramic range of subjects, including the following titles: Oral Anesthesia (1914); Oral Abscesses (1916); Oral Roentgenology (1917); Teeth, Diet and Health (1923); Clinical Pathology of the Jaws (1925); Oral Diagnosis (1936); Oral Pathology (1941); and Oral Surgery (1948). The enormity of his involvement with the specialty is illustrated by the broad range of his accomplishments, starting with periodic revisions of his texts. Oral Surgery, for example, is a two-volume set, and in 1970, the book was in its fifth edition. In addition to the large number of articles he authored, he edited the oral surgery section of the monthly publication, Oral Surgery Oral Medicine Oral Pathology. He attended to his professorial duties at the Massachusetts General Hospital (MGH), Harvard School of Dental Medicine, and later Boston University Graduate School of Dentistry. He still casts a shadow on the field through his students and other colleagues. The author of this paper had the privilege of being one of his students during the years 1966 and 1967.

As a corollary to the process of establishing and defining the specialty, the use of chemical agents to eliminate the pain of surgical procedures was slowly evolving from theory to practice. Four individuals were instrumental in making this happen.

Horace Wells (1815-1848) was a dentist who practiced in Hartford, Connecticut. He practiced, lectured, and demonstrated the use of nitrous oxide during the extraction of teeth. Although he attempted the removal of a tooth under nitrous oxide in the MGH famed domed surgical suite, the procedure failed when the patient muttered during the extraction. Nevertheless, Wells has been credited by the American Dental Association and American Medical Association as the person most closely associated with the discovery of anesthesia.

William Morton (1819-1868), a dentist who later attained a medical degree (although there is a question as to whether he ever obtained dental or medical degrees), worked with Horace Wells in his Hartford office and later in his own in Boston, Massachusetts.

Charles T. Jackson (1805-1880) was a chemist and physician in the Boston area who taught at Harvard. He mentored Wells in the use of ether compounds.

Crawford W. Long (1815-1878) was a physician in Georgia who used ether on a number of his patients while operating.

Morton quickly became frustrated with the use of nitrous oxide because he was unable to achieve the results he hoped for. With the help of Jackson, he started to work with ether compounds, and together they developed the use of sulfuric ether. Later, in front of a medical student group at the MGH in the same room where Wells tried to extract a tooth with the aid of nitrous oxide, Morton gave a patient ether anesthesia while Dr. John C. Warren, a senior surgeon at MGH, painlessly removed a vascular tumor from a patient’s neck. After the procedure and with reference to the consistently suitable level of general anesthesia, Dr. Warren uttered his now famous medical phrase, “Gentlemen, this is no humbug.” The domed room thereafter became known as the “ether dome.” A little over 100 years later in the same city, an anesthesia course was given by Adrian Hubble and Harold Krogh, both oral surgeons, regarding the merits of intravenous barbiturate anesthesia. When the course was over, the chair of the anesthesia department at Tufts University went up to the board and wrote the phrase, “Gentleman, this is no humbug.” Today other compounds are used, such as propofol (Diprivan), midazolam (Versed), and ketamine (Ketalar).

Independently, other national and world events gave the nascent specialty a greater scope. Newer methods to treat soft and hard tissue injuries to the face were developed during the American Civil War. Up to that time, maxillofacial wounds, to include the soft and hard tissues, were treated with craniofacial bandages for stabilization. However, Confederate dentists J. B. Bean and C. N. Covey, based upon their knowledge of the occlusion, devised intraoral splints that were successfully used to stabilize maxillomandibular fractured segments. Also, Thomas B. Gunning, a New York City dentist, developed splints that stabilized fractures of the maxillofacial complex. Some of the splints had openings to allow food consumption during the stabilization period. William Seward, Secretary of State in the Lincoln cabinet, fractured his jaw when he fell from his carriage. He was successfully treated by Gunning using one of his splints, after much reluctance on the part of Seward’s medical staff, which caused a 1-month delay.

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Jun 4, 2016 | Posted by in Oral and Maxillofacial Surgery | Comments Off on The History of Oral and Maxillofacial Surgery
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