History and Present of Oral and Maxillofacial Surgery

Historically, orthognathic surgery is not a continuous evolution process but more like a stepped advancement development. From the found literatures, the earliest orthognathic surgery primarily focused at mandibular surgery. In 1849, an American surgeon, Hullihen performed a maxillofacial surgery on an injured patient. However, the orthognathic surgery to correct in-born mandibular protrusion (underbite) was performed by Dr. Blair at 1897. Moreover, he also developed a variety of surgical approach to correct some maxillofacial deformities and attempted to categorize the different facial deformities such as mandibular protrusion, mandible retrusion, overbite facial profile, and crossbite facial profile. The first stage of development for orthognathic surgery ceased at the World War I as the surgeons during that time were focusing on treating war injured patients.
During the World War II, orthognathic surgery underwent the second developmental stage. Although there were no direct and major breakthrough, experiences with treating maxillofacial injuries at the battlefield were later applied on orthognathic surgery.

Moreover, the third developmental stage generally occurred after 1950s, which was the most vigorous stage for the overall development of orthognathic surgery. During that time, the development primarily revolved around Vienna. In 1957, Dr. Obwegeser developed the bilateral sagittal split osteotomy (BSSO) which was enhanced by many other surgeons later. Up to the present, it is still one of the most commonly applied mandible surgeries. This surgical approach allows the surgeon to freely move the mandible in 3-D (which is also one of the most common surgical procedures adopted by Dr. Hsieh).。

Before the mature development of anesthesia techniques and surgical equipments, the former orthognathic surgery was one-jaw surgery, which involved either the maxilla or mandible alone. The earliest bi-maxillary surgery was developed approximately at 1970s. Furthermore, most dentofacial deformities require the bi-maxillary surgery to acquire aesthetic and stable result.

The modern development of orthognathic surgery may regard 1995 as a borderline. Screws and plates commonly adopted for jawbone fractures were initially applied in orthognathic surgery by some surgeons (we refer this surgery approach as rigid internal fixation(RIF) as the plates are secured on the bone under the muscle, hence, it is invisible on the exterior and dental braces are not required). As a result, the necessity of wearing dental braces for 6 – 8 weeks after orthognathic surgery has been greatly reduced, or even completely eliminated (patients are not able to open mouth due to the binding of maxilla and mandible). In addition, rigid internal fixation allows the post-surgical patients to immediately consume soft foods. Undoubtedly, it is an essential breakthrough. However, there is higher technical demand for orthognathic surgeons in order to maintain and stabilize the dental occlusion at an accurate position after securing the plates and screws on the jawbones.

With the comprehensive advancement of anesthesia and general surgery, the contemporary maxillofacial plastic surgery favors the development toward bi-maxillary surgery, rigid internal fixation (RIF), same stage coupling with rhinoplasty, eye plastic surgery, facial recontouring (generally known as bone reduction), facial implants, and other multi-disciplinary treatment. Since this type of surgery will greatly change the appearance, the photo on identification cards may occasionally need to be replaced. Therefore, Dr. Hsieh would like to remind beauty-seekers to have complete psychological preparation before receiving multi-disciplinary treatment. By good communication with families, relatives, friends and doctors, attractive physical appearance and balanced soul can be obtained.