[Alberic Pont, the great war and the "broken faces"]

The First World War and the number of facial injuries made specialized trauma centers necessary. Alberic Pont was trained both in medicine and dentistry. He founded in Lyon one of the first French specialized wards, which received more than 7000 soldiers overall. Through his charisma, his skills, his creativity and his generosity, he must be considered as a symbol among the pioneers of maxillo-facial surgery, which was then at its early stage. The centenary of World War I is the occasion to shed light on this man who dedicated his career to those who were renamed "broken faces".

[The management in Marseille of facial injuries during the First World War]

World War I is still present for its millions of dead and wounded soldiers. New types of wounds came unexpected, and the military services were necessarily unprepared. Wounds in the face were so frequent and awful that new wards had to be organized and new methods to be invented. Among great persalities in the field are to be listed Morestin, Dufourmentel, Ginestet, Gillies, Joseph, and Kazandjian.

Broken faces: reconstructive surgery during and after the Great War

Amongst the most terrifying injuries experienced by the soldiers during the First World War (1914-1918) were facial wounds. The French Medical Corps took photographic portraits of these wounded men, the so-called gueules cassées, with a view to conducting reconstructive surgery. However, other groups were quick to use the images they produced for their own political, social or artistic purposes. These photographs then, with their many meanings, capture the diversity of attitudes towards the Great War in its aftermath.

[The disfigured men represented by the great painters (O. Dix - G. Grosz - R. Freida.) Disfiguration in the history of art]

Sophie Delaporte's book, Philippe Paillard's, Chantal Roussels's novels and Dupeyron's movie underline the difficulties of repairing physical and moral sufferings of the "disfigured men" wounded during the Great War. Beside medical and technical didactic aimed drawings the exhibition of wasted, mutilated or out of repair faces remains little known. In France, Germany or Great Britain there are many artists who took part in war. Among the artists the French painter Raphael Freida and some German expressionists like Otto Dix, Max Beckmann or George Grosz are the most famous. Their works are often confidential, set apart in the museums and showed in rare exhibitions in Great Britain and the United States of America. The sight of ruined faces inspired such horror that the artists depicted it only exceptionally and with discretion, before 1914. Without doubt it is the fear of touching the privacy of the face which is a part of the human identity. There are no "disfigured men" in the countless religious paintings of torture, neither in the Disasters of Warfrom painters or engravers like Goya or Jacques Callot.

The dawn of plastic surgery in Mexico: XVIth century

An aspect of early Mexican surgery in the sixteenth century is presented. The treatment of facial wounds by Alonso Lopez de Hinojosos and Agustin Farfán is reviewed. Farfán proposed total nose reconstruction, with a cutaneous arm flap, 18 years before its description in De Curtorum Chirurgia, by Tagliacozzi, in 1597 in Venice, Italy. The chapter on facial wounds by Lopez de Hinojosos and Farfán shows their concern for the final aesthetic results and should be considered the first Mexican publication in the field of plastic surgery.

The scientific development of maxillofacial surgery in the 20th century and an outlook into the future

Maxillofacial surgery is a relatively young speciality of medicine and it was not established as an organized specialty until the second half of the 20th century. At first it was supported by general surgeons with particular interest in this field, and also by inspired, extremely talented dentists. During the past few years modern techniques have brought decisive progress also in maxillofacial surgery, leading to rapid further development of diagnostic and therapeutic possibilities. The development of our specialty in the past century is discussed on the four main points of our scope, traumatology, orthognathic, cleft and tumour surgery. Considering the future prospects of our specialty one should realize that in the near future maxillofacial surgery will also be influenced by further medical-technical progress in the field of micro-robots, by percutaneous endoscopic techniques and by minimal invasive or laser surgery. Basic research will also cause a more profound change in our specialty, especially in the field of tumour therapy. Molecular biological research shows some good signs, which could already be transmitted to the prevention, diagnosis and also the therapy of tumours. In the field of tissue transplantation it is no longer utopia that autogenous tissue sampling can be almost completely be avoided. By further developing 'tissue engineering' it will be possible to cultivate bones as well as soft tissue with the aid of gene technology and transplant them into the face using relevant carrier substances. Altogether, the complexity of maxillofacial surgery in the coming century will increase, necessitating the best and widely trained maxillofacial surgeons for successful accomplishment.

[History of the treatment of fractures of the face]

Throughout most of recorded human history, facial fractures have received either no treatment what so ever or only rudimentary surgical attention. The treatment of facial fractures has made more progress over the past two decades than in the entire two millenia before that. The authors describe how facial fractures have been treated since the New Kingdom in Ancient Egypt until today, with the methods of Stable Internal Fixation.

The influence of Paul Tessier on our current treatment of facial trauma, both in primary care and in the management of late sequelae

This article describes Paul Tessier's influence on craniofacial surgeons and their treatment of facial trauma. It also outlines his direct contributions to primary and late treatment of facial fractures.

[Reconstruction of the nose in deep extensive facial burns]

The nose is in the medial portion of the face and is frequently injured in trauma of this area. Due to its situation its structure and shape, and its essential function, this organ is particularly exposed in the case of facial burns. These injuries, are usually associated with larger injuries, and frequently with systemic problems, such as respiratory problems. The authors describe nasal burns in the larger context of facial burns, and summarize recent data on this topic. They then recall the fascinating story of rhinopoiesis through the ages. The third part is devoted to their personal approach to reconstruction of the nose in severe panfacial burns, using a forehead flap with one or several tissue expanders.

The Macalister archive: records from the Queen's Hospital, Sidcup, 1917-1921

The Queen's Hospital opened in 1917 to care for soldiers receiving facial injuries in Western Front trenches, usually as a result of a gunshot wound. Some 8000 patients were treated by the medical teams of the UK, the Dominions and the USA. The wartime records were removed by their respective sections in 1921, but Queen Mary's Hospital has recently reacquired those of the New Zealand section, rescued from imminent destruction by Professor A.D. Macalister, late Dean of the Dental School at Dunedin, and kindly donated by him. There are 282 sets of case-notes containing typescript summaries, clinical photographs and radiographs, drawings, 77 watercolor paintings and a life-size wax model of head and upper torso illustrating some of the surgical techniques. The archive is a fine example of medical illustration 75 years ago, and provides invaluable detail on the plastic surgery and dental reconstructive methods that were developed at Sidcup.

Mona Lisa: the enigma of the smile

The Mona Lisa, painted by Leonardo Da Vinci, 1503, pictures a smile that has been long the subject of conjecture. It is believed, however, that the Mona Lisa does not smile; she wears an expression common to people who have lost their front teeth. A closeup of the lip area shows a scar that is not unlike that left by the application of blunt force. The changes evident in the perioral area are such that occur when the anterior teeth are lost. The scar under the lower lip of the Mona Lisa is similar to that created, when, as a result of force, the incisal edges of the teeth have pierced the face with a penetrating wound.

A case of cheiloplasty--1864

Six hundred twenty thousand American soldiers were killed in the Civil War--almost as many fatalities as in all wars from the American Revolution through Vietnam. Those soldiers who did not immediately succumb to their wounds often had injuries that taxed the skills and imagination of the surgeon. A case of extensive destruction of the lower face is presented.

A forgotten innovator in facial reconstruction: Pietro Sabattini

Pietro Sabattini (1810-1864), a creative surgeon from Bologna, Italy, first had the idea of repairing a posttraumatic upper lip defect using a flap taken from the lower. The flap contains the three elements--skin, muscle, and mucosa--and is based on a specific vessel, the circumlabial artery. Therefore, it anticipates the musculocutaneous flap concept of today. Sabattini published his paper in 1838, 60 years before Abbé. This paper provides the first English translation of the original text and a biography of this forgotten innovator in facial reconstruction.

[From ostracized to facially-injured subjects -- an example of social discrimination from the history of medicine]

The historical social situation and medical treatment of facially injured individuals is briefly summarized. Facially injured individuals were ostracized from society as a result of legal punishment, fear of contamination; or, because one believed that their injuries reflected a character-deficiency or even possession by evil spirits. In 1975, the term "defaced" (Entstellter) was replaced by the value-neutral description "facially injured" (Gesichtsversehrter).

[A contribution to the history of the treatment of middleface-injuries (author's transl)]

The first descriptions of facial injuries, especially about hurts of the nose, their diagnosis and their treatment are found in the writings of the old cultures. There are already corresponding references in the Papyrus Edwin Smith and in the Papyrus Ebers. There exist descriptions of the surgery of India and in the papers of Hippocrates, which contribute details to these injuries and their treatments. Here it is pointed to the splinting of the septum by inserting open tubes. A careful bandage, respecting the rebuilding of the nose, and the reposition of lower jaw fractures are remarked. In the Middle Ages there were some innovations in wound-treatment, especially in the technique of suture, but no important innovations in the medical care of middleface-fractures. There are only some modifications in the special treatment, but the surgeons always refer to the already available therapy-methods, mainly to those of Hippocrates. Only towards the end of the 18th century and the beginning of the 19th century, these themes, particularly the treatment of upper jaw hurts, got new impulses by Graefe, Lang and Le Fort, who also worked out new methods of the external and internal fixation by wire.