Development of oral and maxillofacial surgery in Russia

Origins of the scientific approach in the 19th century

In the nineteenth century, reports of complex oral cavity interventions began to be actively published. Among the pioneers were E.V. Kade and K.F. Hepner, who performed uranoplasty, as well as M.S. Subbotin, who operated on cancer of the mandible and studied the impact of cleft palate on nutrition and speech. Simultaneously, the theoretical base was accumulating: significant dissertations were defended, such as A.H. Pander's work De dentium structure, V.M. Antonewitsch's works on transplantation, and A.K. Limberg's on caries therapy.

The foundation of domestic scientific dentistry was laid by the prominent surgeon N.V. Sklifosovsky. In 1879 at the Congress of Natural Scientists, he lobbied for the creation of independent privatdozent positions in dental diseases. His personal contribution to facial surgery is colossal: he was the first in the world to use a cocaine solution for local anesthesia during palatoplasty, developed his own apparatus for maintaining anesthesia, and performed a unique resection of both halves of the maxilla combined with orthopedic treatment.

Institutionalization and education

In the late 19th century, specialists began to unite: the first professional societies opened in St. Petersburg and Moscow, and in 1885 the journal «Zubovrachhebny vestnik» began publication. At the same time, the first educational institutions emerged — F.I. Vazhinsky's private school in St. Petersburg and the Moscow School of Dentistry led by I.M. Kovarsky.

The opening of the first privatdozent position in odontology in 1885 was of great importance for academic science. It was headed by N.N. Znamensky, the founder of domestic implantology, who not only introduced the term «implant» into circulation, but also conducted experimental tooth implantation. Another important step was the development of forensic dentistry: G.I. Wilga's doctoral dissertation remained the primary guide for experts for many years.

During the Soviet period, personnel training reached the state level. In 1920, departments of odontology were established at medical faculties, and by 1935 the Moscow Institute of Dentistry (MID) was formed. In 1937, the disciplines were finally differentiated: a department of surgical dentistry was created at the MID, headed by A.I. Evdokimov. His work on the topographical anatomy of the oral cavity laid the foundation for the clinico-anatomical approach in purulent surgery.

Formation of military field maxillofacial surgery

World War I revealed an acute shortage of facial trauma specialists. In response, specialized maxillofacial infirmaries and hospitals began to open en masse. A real breakthrough was the system for fixing jaw fragments using bent aluminum splints proposed in 1915 by dentist S.S. Tigerstedt. Nevertheless, the percentage of wounded returning to service remained low (about 21.7%), and mortality reached 53%.

By the beginning of the Great Patriotic War, the system had been radically restructured. The experience of conflicts at Khalkhin Gol and in Finland made it possible to reduce mortality in the army area to an incredible 0.4–1.1%. This was made possible by organizing a clear system of phased care delivery, including:

• pre-medical and first medical aid;
• qualified intervention;
• specialized treatment in the rear.

The heads of the service were such prominent figures as D.A. Entin (in the Red Army) and V.M. Uvarov (in the Navy). Collective analysis of injuries led to revolutionary changes in tactics: surgeons began to actively use local plasty directly during primary surgical debridement of wounds, and the timeframe for mandibular bone grafting was reduced from a year to 2–4 months.

Briefly: answers to topical questions

Class and exam questions

What else to study on this topic

• Organization of medical evacuation support and medical sorting of maxillofacial wounded.
• A.I. Evdokimov's contribution to the development of the clinico-anatomical approach in purulent surgery.
• Development of anesthesia methods in domestic maxillofacial surgery.
• Evolution of diagnostics and treatment of maxillofacial oncopathology (works of S.N. Weisblat).

Other topics in the section «Chapter 1. History of the Development of Surgical Dentistry (K.A. Pashkov, A.V. Belolapotkova)»

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