Modern Plastic Surgery was born during the WWI era... Among the most prominent surgeons running around in the trenches and the military hospitals were Dental and Oral Surgeons who were repairing facial injuries, especially broken mandibles.
Here is a great reference of Dentistry's Role, along with a few excerpts...
The Journal of Oral and Maxillofacial Surgery
Volume 61, Issue 8, Pages 943-950 (August 2003)
Maxillofacial surgery in world war I: the role of the dentists and surgeons
In the spring of 2001, the Louisiana State University School of Dentistry (LSUSD) library received a collection of World War I photographs and documents from a Baton Rouge dentist, who had received it from a patient. In the 160 photographs, pasted into a worn and brittle album, appear the mutilated faces of American soldiers who had sustained severe maxillofacial injuries from gunshots and shrapnel. These images, showing the progression of treatment and healing, reveal the skill and ingenuity of the American surgeons and dentists who not only saved the soldiers lives but also repaired and reconstructed their disfiguring wounds to restore some quality of life to the soldiers.
The collection originally belonged to Dr Thomas Mariner Terry (1889-1967), a New Orleans dentist who served in France during World War I. His niece, Margaret Shuffield, inherited the album and gave it to her dentist, Dr Kevin Hester, an alumnus of LSUSD, who then donated it to the dental school. The album has photographs and drawings of appliances and casts that were used in the patients treatment. In addition to the album, the collection includes 2 group photographs, a letter from one of Terrys patients, and Terrys discharge and military papers, which indicate that he served overseas from April 15, 1918, until February 27, 1919.
Terry graduated from the Chicago College of Dental Surgery in 1908 and practiced dentistry in downtown New Orleans on Canal Street. According to his obituary in the New Orleans Times-Picayune, he specialized in oral and plastic facial surgery.1 A life member of the American Dental Association, he was still listed in the association membership directory in 1967.
The letter in the collection from Sgt Leon Hansen, dated March 22, 1919, reveals significant details. Hansen indicates that he was Terrys patient at a hospital in Vichy, France, and that he received further treatment at a hospital at Fort McHenry. He names several prominent surgeons whom he encountered at Vichy and then later at Fort McHenry, a US military hospital where complex reconstructive surgery was performed. Among the surgeons he mentions are Vilray P. Blair, who organized the effort to treat maxillofacial injuries in the American Expeditionary Forces (AEF), and Robert H. Ivy, his assistant.
The 15-volume set, The Medical Department of the United States Army in the World War, which is in the LSUSD Library collection, details the activities of the Surgeon Generals Office (SGO) for the AEF and includes extensive information on the treatment of maxillofacial injuries.2 Volume 11, Surgery, has 3 chapters devoted to maxillofacial surgery; 2 of these chapters describe the treatment of maxillofacial injuries in the AEF in France, and the other chapter reviews cases of patients who were evacuated to US hospitals for reconstructive surgery. The latter describes procedures performed on a number of the patients in Terrys album and includes photographs showing the final result of their multiple surgeries. Among these patients is Hansen, who was one of the most severely injured soldiers in the group.
When the United States entered the war in April 1917, Europe had already been on the battlefield for more than 3 years. By the time of the armistice on November 11, 1918, more than 30,500 American physicians and 4600 dental officers had been in service of the AEF.3 In addition to the basic dental care that dentists provided for soldiers in preparation for deployment overseas, they served as assistant medical officers at the front, caring for facial wounds, assisting with the debridement and closure of wounds, administering anesthetics, and sorting casualties.4 Each hospital in the AEF had dental staff and equipment.5
Because trench warfare dominated this war, the majority of serious wounds were to the head and neck. Steel helmets saved lives but increased the number of facial injuries from shells, bullets, and other projectile fragments ricocheting off the hard helmet surface.6 Of the 8,607 total facial injuries, 316 deaths (3.67%) resulted, which was lower than the average of 7.73% of deaths for all types of injuries.7 Two thirds of the soldiers with facial and jaw injuries returned to duty after treatment, whereas the remaining patients requiring reconstructive surgery were evacuated to hospitals in the United States for further treatment.
Two principles for the treatment of maxillofacial cases were established during this war. One was to combine the expertise of dentists in oral infections and injuries and jaw fractures with the experience of general surgeons and to assign them as teams to hospitals. A second principle was to initiate early treatment and to continue it systematically. Dentists and surgeons adherence to these principles guided the injured from the battlefield to the evacuation hospitals in the United States.8
Before World War I, no formal training programs existed for the treatment of maxillofacial injuries. Early in the war, British and French soldiers with extensive facial injuries wore masks to hide their deformities. Artists often painted the masks to appear as natural as possible. Although the SGO investigated the use of masks and even trained technicians to create them, they found that patients actually preferred plastic reconstruction.9 In July 1917, Surgeon General William C. Gorgas organized a Section of Plastic and Oral Surgery and appointed Vilray P. Blair, a surgeon from Washington University in St Louis, to be the senior consultant for maxillofacial surgery and chief of the section. He named Robert H. Ivy, a dental surgeon from Philadelphia, to be his assistant. Their first task was to train general surgeons and dentists to work together to treat maxillofacial wounds.
The SGO conducted short intensive courses ranging from 3 to 6 weeks from October 1917 through March 1918, at Washington University in St Louis, University of Pennsylvania in Philadelphia, and Northwestern University in Chicago. More than 200 prominent surgeons and 800 dental school faculty members received letters from the SGO soliciting names of qualified students. At the end of each course, instructors reported to the SGO each students progress and ranking. About 86% of the 164 medical officers and 123 dental officers enrolled completed the course satisfactorily and were assigned in teams of one surgeon and one dentist to each unit overseas.8
The short courses brought dentists and surgeons together to share their knowledge and, according to Major Ivy, to review the anatomy, the principles of plastic surgery, of splinting and the treatment of infections and sepsis of the face and jaw bones. The intensive courses included lectures, dissection of cadavers, laboratory work, and seminars in which students presented abstracts of current literature. A total of 110 surgeons and dentists from private practice and local medical and dental schools taught in these courses.10 In 1918, the 3 civilian schools were replaced by a school of plastic and oral surgery at Camp Greenleaf, the medical officers training camp organized at Fort Oglethorpe in Georgia. The army conducted two 4-week sessions here in November and December.8, 11
The SGO prepared and distributed literature to enhance the training of dentists and surgeons. Publications in the library of the SGO were abstracted and reprinted in The Military Surgeon. In 1917, the SGO sponsored a revised edition of Blairs 1913 textbook, Surgery and Diseases of the Mouth and Jaws. With new information on treating gunshot wounds of the face, this book was designated the official textbook of the Section of Plastic and Oral Surgery and placed in every hospital overseas and in the United States. In addition, the SGO, from 1918 to 1919, published abstracts of current articles on maxillofacial surgery in 2 of its journals, Review of War Surgery and Medicine and Survey of Head Surgery.8
By the time the United States entered the war, the Allies had already gained significant experience in surgery and reconstruction of maxillofacial cases. A unit of 20 surgeons and 20 dentists was sent to France in April 1918 and, for several months until they were needed in their own hospitals, observed the work of prominent surgeons and dentists in hospitals in England and France. Three American dentists, George B. Hayes and William S. Davenport of the American Ambulance Hospital in Neuilly, and Varaztad Kazanjian, chief dental officer in the First Harvard Unit with the British Expeditionary Forces (BEF), had volunteered to treat the maxillofacial injuries of French and British soldiers in France several years before the United States entered the war. Sir Harold Gillies, surgeon at Queens Hospital at Sidcup in Kent; Hyppolyte Morestin, plastic surgeon in the French Army in Paris; and Auguste Valadier, dentist in the BEF in Boulogne, also shared their expertise with the AEF officers.9 In their own hospitals, the team members had the advantage of combining techniques learned in their training at home with those observed in the French and British hospitals.12
Because the AEF was not able to send all of the specially trained surgeons and dentists overseas, the original plan to staff every mobile, evacuation, and base hospital with a maxillofacial team was replaced by the decision to send a dentist to each mobile and evacuation hospital to work with the general surgeon at that hospital on patients with jaw fractures.13 The 40 specially trained surgeons and dentists were assigned to each of 10 special oral units in the intermediate and base zones. On June 30, 1918, Base Hospital No. 115, designated a special head hospital, was mobilized for overseas service with 4 surgeons and 2 dentists with training in oral and plastic surgery and sent to Vichy, France.8
Blair, now a lieutenant colonel, was named the senior consultant for maxillofacial surgery, and Ivy, now a major, the local consultant for the advance section. A local consultant, assigned to each of 7 areas in France, supervised a certain number of hospitals in his area or section and was in turn supervised by the chief consultant.14 However, because surgeons were often sent to the front, leaving hospitals with inadequate personnel, consultants were frequently required to assist the dentists in the hospitals.12
Special records created during the treatment of maxillofacial injuries included photographs, drawings, plaster and wax models, and plaster masks. The surgeon general assigned artists, photographers, and wax modelers to the hospitals designated for maxillofacial treatment overseas and in the United States. Although records of completed cases were sent to the Army Medical Museum, few of the masks, models, and photographs remain today,15 but a number of photographs of appliances and drawings of appliances, signed by A. L. Fraser, are part of Terrys collection at LSUSD (FIGURE 3, FIGURE 4.
Numerous dentists and surgeons who innovated the treatment of maxillofacial injuries during World War I also played a significant role in the development of their profession after the war. Sir Harold Gillies, from New Zealand, established the first plastic surgery unit in the British Army and originated many of the techniques later used by the AEF in the war, such as the tubed pedicle flap. Considered the founder of plastic surgery as well as a pioneer in cosmetic surgery, he is honored by plastic surgeons in the United States with the Harold Delf Gillies Award, which the American Academy of Facial Plastic and Reconstructive Surgery presents annually for the best research paper.28
Vilray Blair, who was responsible for the infrastructure of the AEF maxillofacial service during the war, was later instrumental in the creation of plastic surgery as a separate specialty. He brought the team treatment of maxillofacial injuries to Walter Reed Hospital, where he formed a multidisciplinary team with prosthetic dentists, oral surgeons, otolaryngologists, ophthalmologists, and neurosurgeons. He was also one of the first non-oral surgeons elected to the American Association of Plastic Surgeons and was a founder of the American Board of Plastic Surgery in 1938.29
Robert Ivy, Blairs assistant in the Section of Oral and Plastic Surgery and head of maxillofacial reconstruction at Walter Reed during World War I, earned both dental and medical degrees at the University of Pennsylvania. Among his accomplishments was the formation of the first multidisciplinary team for the treatment of cleft lip and palate in North America. Ivy continued to be active in both oral surgery and plastic surgery organizations throughout his long, distinguished career.29, 30
Varaztad Kazanjian, an American dentist from Harvard University Dental School, went to France in 1915 as chief dental officer for the First Harvard Unit. As the first person to treat fractured jaws and facial wounds in the British Expeditionary Forces, he was known as the miracle man of the western front. After the war, Kazanjian became professor of oral military surgery at Harvard University. In 1921 he completed medical school and in 1941 was appointed the first professor of plastic surgery at Harvard University.31
Oral surgery was relatively unformed as a dental specialty before the war. The need for treatment of maxillofacial trauma led to recognition of the unique skills of oral surgeons. Sir Kelsey Fry, the pioneer British oral surgeon, teamed with Gillies during the war to provide expertise on hard dental tissue to complement Gillies knowledge of soft tissue. Their collaboration continued for 40 years.32 After the war, Fry fought in vain until the beginning of World War II to gain recognition in Britain of oral surgeons as acknowledged specialists. In the United States, however, the American Society of Exodontists was formed at the 1918 annual session of the National Dental Association.33
Blair, Kazanjian, Gillies, Ivy, Fry, and other military dentists and surgeons published textbooks describing their experiences and innovative procedures during the war. Many of the principles and practices that these practitioners established during World War I were carried into World War II. For example, the 2 basic principles of teaming surgeons and dentists and instituting early and systematic treatment continued during the later war. The emphasis on treating maxillofacial patients at designated hospitals and evacuating them to the United States in supervised groups on specially equipped transports also proved successful in World War II.4
The LSUSD collection of photographs of World War I soldiers with maxillofacial injuries opens the door to a fascinating era in the history of medicine and dentistry. The search for historical information reveals a wealth of stories of soldiers who were devastated by these injuries, of dentists and surgeons who pioneered their treatment, and of the military operation that addressed the medical problem. During the war, the systematic treatment of maxillofacial injuries that teamed the unique skills of dentists with those of surgeons paved the way for the development of 2 new specialties: oral surgery and plastic surgery. In the 160 photographs that Dr Thomas Terry compiled, one sees evidence of the contribution of specially trained practitioners who restored a large degree of normality to the soldiers lives. Adding a poignant human interest depth to the technical reconstructive procedures, the letter from Sgt Hansen spotlights the accomplishments of those who treated maxillofacial injuries in World War I.
