Η στοματική και γναθοπροσωπική χειρουργική στο Βυζάντιο: από τον γνόφο και την υπέρβαση της πίστης στην επιστήμη και την τέχνη της χειρουργίας

Abstract

During Byzantine millennium (330-1453 A.D.), Oral and Maxillofacial Surgery has not been mentioned as a separate medical specialty from various medical authors, as it is also the same with other surgical specialties, at least in the way they are practiced today. Byzantine physicians, especially those interested in Surgery, which includes in its general spectrum Dental Medicine as well as Oral Medicine and Pathology, along with Plastic Reconstructive and Aesthetic Surgery, and Otorhinolaryngology, have developed concepts, views and opinions describing therapeutic methods for both conservative and surgical management of diseases and injuries related to the field of Oral and Cranio-maxillofacial Surgery and Pathology.In this study, the original texts of Byzantine physicians, written in ancient Greek, were investigated in relation to Oral and Maxillofacial Surgery, aiming at identifying opinions, techniques, surgical instruments, pharmacologic treatments, conservative and interventional management referring to the various entities of Oral and Cranio-maxillofacial Surgery and Pathology. The most eminent physicians of the Early (4th-7th century A.D.) and Middle (8th -12th century A.D.) Byzantine Period, in particular Oribasius Pergamenus, Aëtius Amidenus, Alexander Trallianus, Theophilus Protospatharius, Paulus Aegineta, Meletius, and Leo Medicus, in their works give their attention to various subjects concerning Oral and Maxillofacial Surgery. These references include topographic and surgical anatomy of the head and neck, dentoalveolar surgery, oral and cervicofacial infections, trauma of viscerocranium and neurocranium as well as biomechanics of traumatic brain injuries, temporomandibular joints dysfunction as a consequence of mandibular dislocation, surgical oncology of the head and neck [warts, carcinomas, cervical lymphadenitis (scrofula)], reconstructive surgery of the head and neck [reconstruction of skin or tissue defects in the eyebrows, forehead, cheeks, nose (middle, tip, ala, septum), and ears], oral pathology (fissured lips, thickened and swollen lips, hypertrophic, tumefying, decomposed, eroded and ulcerated gingivae, parulis and epulis, aphthae, tongue roughness], surgical pathology of salivary glands (ranula, inflammatory diseases and tumors of the parotids), therapeutic management of facial nerve dysfunction (paresis of lips and jaws), preprosthetic surgery (lingual frenectomy), craniofacial surgery (diastasis of cranial sutures, hydrocephaly, cranial exostoses), deformities of the facial skeleton, and particularly anthropologic and craniometric observations, determining clinical examination in the frame of orthodontic and orthognathic surgical approach of patients presenting corresponding functional and esthetic problems, and finally specific bandages of the head and neck for treating traumatic injuries of the viscerocranium and neurocranium (lacerations, fractures, etc.), diastasis of the cranial sutures, dislocations of the mandible (unilateral and bilateral), as well as inflammatory diseases of the parotids and the neck.Taking into account that Oral and Maxillofacial Surgery, being a dental and medical specialty as well, is decisively based on both Dental Medicine, from which it originated, and Surgery of which it consists an important branch in the area of mouth, jaws, face, and head and neck in general, after searching the relevant sources and texts it was found that, the surgical instruments used by Byzantine physicians for performing various oral and craniomaxillofacial surgical operations, are general and specific, basically used in the practice of Dental Medicine and Surgery. Furthermore it is noteworthy the description by Aetius Amidenus (6th century A.D.) of a self-invented iron file, for filing of the hypererupted teeth, as well as the application by the same physician of a particular method of local anesthesia for teeth removal, using a tube and conveying a narcotic gas to the affected tooth, produced by the combustion of river helminthes.The investigation of various available sources (medical, theological, historical, literary) of Byzantine literature reveals that, the practice of medicine in Byzantium had to do with four major and basic specialties with a wide range of medical spectrum, i.e. internal medicine, surgery, gynecology, but also and ophthalmology, which were practiced in the corresponding separate wings and departments of the famous ―Xenons‖, consisting the remarkable public medical institutions or Hospitals of the Byzantine Empire. In view of the fact that there is an evident absence of a separate and specific specialty of Oral and Maxillofacial Surgery, and considering that Byzantine physicians had been particularly interested in various subjects of the mouth, jaws, face, and head and neck in general, in the frame of course of their general surgery practice, someone could reasonably suggest that Oral and Maxillofacial Surgery was practiced in the Surgical Departments of the Byzantine ―Xenons‖, at least from the 6th century A.D. and afterwards, whereas earlier it was also practiced in the frame of General Surgery, but on a private basis through the chief physicians ‗archiatroi‘, or even by ordinary surgeons.The contribution of the Orthodox Christian Church to the health care and treatment of surgical patients, including those suffering from oral and maxillofacial diseases and injuries, was determinant with the establishment of hospitals, the famous ―Xenons‘, mainly attached to Monasteries, where the possibility for offering systematic and organized medical care was available.