Essentially, the evolution of orthognathic surgery came through management of facial fractures over a period of centuries. As Angle (1903) said, referring to Blair's operations, "For I had become convinced that orthodontia was almost powerless to work any considerable benefit in them and that double resection, could it be successfully performed, was the only alternative. Since fractures even severe comminuted fractures of both lateral halves o f this bone could be set and would firmly unite. It seemed that under the aseptic and most favourable conditions under which his proposed operation would be performed, we might expect complete success".
From the days of single combat to those of sophisticated modern warfare, the face has always been one of the most vulnerable parts of the body. The first clinical description of a fractured jaw was found in the Edwin Smith’s Papyrus considered to have been written in Egypt about 1600 B.C.
In the "Corpus Hippocratium" compiled during the fourth century B.C., there is mention of how much damage a bandage could do if used for a fractured jaw. Hippocrates advised holding the parts in a desired position by binding them to the firm teeth on each side with linen thread or gold wire. A Greek appliance for the support of loose anterior teeth, assigned to the third or fourth century B.C., is conserved in the archaeological museum at Athens.
The first historical report of maxillofacial technology, in the form of replacement of facial parts by prosthetic means, would seem to have occurred during 2613- 2494 B.C. Excavation of Egyptian tombs from this period has provided evidence of fabrication of nasal, orbital and auricle prosthesis and dental appliances. Some clinical and technical writers have reported dental splinting and facial prostheses
found in Egyptian mummies to have been used for functional and aesthetic reasons. Conversely, Egyptologists have reported that such appliances were in all probability inserted after death in order to meet the religious beliefs of the time that only those without physical defect would enter the kingdom of Osiris, so these prostheses were used solely in a post-mortem role (Gray 1967, Roberts 1988). X-ray examination of mummies, especially a mummy from 1000 B.C. in the British Museum, shows presence of metal Inserted into the orbital region which resembles an artificial eye. Very likely it was more the work of a mortician than a prosthetist (Fig.2.1.1). An artificial eye can also be clearly seen in the unwrapped mummy (Fig.2.1.2). In the Babylonian era, amputation of parts of the face such as the tip of the nose, or an ear, was used as punishment for infringement of the law by Romans, Egyptians and Indians. There is no evidence that these people got any replacement parts, except for one case of plastic surgery by Susruta in India, about 2000 years ago, to rebuild an amputated nose, whereby a flap from the forearm was raised, and moulded over two tubes inserted to replace the nostrils (Wellcome Museum).
The ancient civilisations of Greece, Thrace and Rome certainly had the aesthetic taste to appreciate the importance of form and function together with technology and material ability to be able to apply such skills to the same requirements of what we now call maxillofacial technology. Ambroise Pare in his book The Opera’ published in 1579 shows ingenious artificial limbs that he designed for amputee patients.
Pilleau (1730)*, a French silversmith, introduced a wax impression technique, and Philip Pfaff (1756)*, a German dentist to Frederick the Great, is known to have introduced plaster for casting dental models. But a plaster mask (1370 B.C.) of an official probably moulded from life and enhanced by carving, is on display in the British Museum, which indicates that impression taking and model casting techniques were probably practised as long ago as 1370 B.C. (Fig.2.1.3).
Figure 2.1.1 X-rays picture of a mummy from 1000 B.C., showing metal inserts, which resembles artificial eyes.
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Figure 2.1.2 An unwrapped mummy (1000 B.C.), illustrating a clearly visible artificial replacement for an eye.
Figure 2.1.3 A plaster mask (1370 B.C.) of an official produced from facial impression and then enhanced.
In the late eighteenth and early nineteenth century several types of combined intra-and extra-oral appliances were devised for fixation of facial fractures. Plaster models of the jaws were obtained, sectioned and re-aligned to make splints. Rutenick (1779)* and later Hill (I860)*, used similar appliances for fractured lower jaws. They cast the impressions, sectioned and re-aligned the lower model by articulating the teeth in what was thought to be the best occlusion and made a one piece splint lined with gutta percha. In the early and middle part of this century, it became a common practice to section models of cleft palate patients to make appliances for possible surgery. Simon P. Hullihen (1810-1857), born in Milton, Pennsylvania, USA, practised dentistry and oral surgery especially to the cleft lip and palate. He is known to be the first surgeon to perform a mandibular osteotomy.