Establishment of maxillofacial surgery in the USSR

Military field surgery and organizational milestones

The foundations of Russian maxillofacial surgery were laid during military conflicts and required a well-organized healthcare delivery system. An important milestone was the establishment of the first maxillofacial hospital, with F.A. Zverzhkhovsky appointed as its first chief physician. The formation of the educational base was marked by the opening of the specialized Department of Surgical Dentistry at the Moscow Dental Institute in 1937.

The Great Patriotic War gave a significant impetus to the development of the discipline. In 1941, Professor D.A. Entin, in his manual «Military Maxillofacial Surgery», not only systematized the principles of trauma management but also for the first time substantiated the use of local anesthesia as an independent therapeutic intervention during the surgical debridement of injuries. A fundamental contribution to reconstructive surgery was the 1946 publication of the monograph «Mathematical Foundations of Local Plastic Surgery on the Human Body Surface».

Evolution of anesthesia methods

Historically, the issue of pain management was a central focus for Soviet researchers, including N.N. Bazhanov, Yu.I. Bernadsky, S.N. Vaisblat, G.A. Vasilyev, and M.M. Vaisbrem. The development of anesthesiology progressed in several directions:

• Local anesthesia: In the 1950s–1960s, M.P. Zhakov proposed trigeminosympathetic facial block with novocaine for the treatment of trauma and diseases. To prolong the effect, M.V. Datsenko (1958) recommended using oil solutions, while D.A. Entin (1945) and S.N. Vaisblat (1962) recommended alcohol solutions. Gradually, new drugs entered clinical practice: xylocaine, oxycaine, lidocaine, and trimecaine.
• General anesthesia (narcosis): Inhalation anesthesia (nitrous oxide, trilene, halothane) was adapted for outpatient settings. In 1968, N.N. Bazhanov and V.N. Alexandrov proved the efficacy of a combination of nitrous oxide, halothane, and oxygen.
• Outpatient service: In 1969, at the 5th All-Union Congress of Dentists, the issue of establishing a specialized anesthesiology service directly within dental clinics was officially raised.
• Physical methods: In the 1960s, pain relief using microgalvanic currents (G.M. Ivashchenko, T.V. Nikitina, M.A. Smirnov), diadynamic currents (P.A. Batievsky), and electrophoresis (N.A. Mukhin, G.S. Mironenko) was actively developed.

State regulation and rulemaking

The development of the service was strictly regulated by USSR state acts aimed at systematically improving care for the population:

1. Post-war years: USSR Ministry of Health Order No. 549 addressed shortcomings in the service and stimulated research.
2. 1961–1970: Resolutions of the USSR Council of Ministers were issued, and the «Fundamentals of the Legislation of the USSR on Public Health» were adopted.
3. 1984: Order No. 670 mandated the universal implementation of modern local and general anesthesia methods.
4. 1988: Order No. 830 approved the development program up to the year 2000, focusing on the widespread introduction of anesthesiology, the establishment of centers for patients with congenital malformations, and the early diagnosis of malignant neoplasms of the maxillofacial region.

Transition period and the reforms of the 1990s

The collapse of the USSR led to a fundamental restructuring of healthcare. In the early 1990s, the transition to market relations occurred, driven by the inefficiency of the budgetary model and the need for additional funding sources. The activities of medical institutions were divided into free care (within the framework of state guarantee programs) and commercial services.

Key changes:

• Introduction of the Compulsory Medical Insurance (CMI) system (1991), guaranteeing a specific scope of free care. Full care was preserved for children under 18, students, WWII veterans, and pregnant women.
• Formation of the legal status of private practice and Voluntary Medical Insurance (VMI).
• Establishment of the Dental Association of Russia in 1993 (first president — Professor E.V. Borovsky, since 1996 — RAMS Academician V.K. Leontiev).
• Development of new technologies: in 1993, the production of domestic screw implants began, and in 1994, the first Department of Faculty Surgical Dentistry and Implantology was organized at MSMSU under the leadership of Professor S.Yu. Ivanov.

Class and exam questions

What else to study on this topic

• History of pre-revolutionary dentistry and the establishment of private schools (1892)
• Development of domestic dental implantology in the 1990s
• Physical methods of pain relief (electrophoresis, diadynamic currents)
• The contribution of N.I. Pirogov and I.V. Buyalsky to maxillofacial surgery
• Organization of CMI and guaranteed volumes of dental care

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

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