Violence in paradise: Cranial trauma in the prehispanic population of Gran Canaria (Canary Islands).

OBJECTIVES: This paper addresses the prevalence and pattern of physical violence in the prehispanic society of Gran Canaria and discusses its link with the social structure and insular context in which that people lived. MATERIALS AND METHODS: 347 prehispanic crania from Guayadeque Ravine (575-1415 AD) have been examined in order to determine the frequency, types, location, and timing of trauma. RESULTS: Craniofacial injuries are present in 27.4% of the crania examined. Only 2% display perimortem trauma. Most of the injuries (84.3%) correspond to depressed blunt force trauma, with an ellipsoidal or circular shape. Most of these are in the anterior aspect of the cranium. Males are significantly more affected than females. DISCUSSION: The aboriginal population of Gran Canaria show a high frequency of traumatic injuries to the skull compared to other archaeological groups. Their frequent location in the anterior aspect suggests regular face-to-face confrontations. However, the lethal injuries typically occurring in large-scale combat are scarce. Practices such as ritualized combat, mentioned in ethnohistorical sources, would help to channel and mitigate inter-group conflict. The predominance of depressed blunt force trauma is in accordance with the weapons used by those populations: hand-thrown stones, clubs and sticks. The higher frequency in males indicates that they took part in direct violence more than females did. The hierarchical organization of their society may have led to frequent situations of conflict. The insular nature of a territory barely 1,500 m2 in size was a determining factor in competition for access to food resources, especially at times of climate crises or population growth.

Use of Fat Grafts in Facial Reconstruction on the Wounded Soldiers From the First World War (WWI) by Hippolyte Morestin (1869-1919).

INTRODUCTION: During the Great War of 1914 to 1918, spectacular progress was made in the field of facial reconstruction. The sheer number and severity of facial lesions inflicted during the fighting obliged French and German surgeons to take a close interest in the treatment of patients wounded in such a manner. As head surgeon of the fifth division "blessés de la face" at the hospital of Val-de-Grace, Hippolyte Morestin was responsible for one of the largest surgical departments specializing in facial surgery and reconstruction during the war. During his time of service, he developed various surgical techniques such as autoplasties using cartilaginous and adipose grafts to reconstruct tissue defects. This study focuses primarily on the adipose graft techniques and their aesthetic outcome used by Morestin during and in the aftermath of World War I. METHODS: This is a historical descriptive study. Our research is based on documents available at the museum and archives of the Val-de-Grace Army Health Service (hospital activity reports, pre- and postoperative patient photographs, newspaper clippings, documented accounts of ward nurses, wax anatomy models). Thirty-four clinical cases published by Hippolyte Morestin dealing with facial reconstruction during the World War I were studied. RESULTS: Fat was mainly used to fill craniofacial substance losses after carrying out often complex reconstructions. The surgical technique is well documented and subdivided into 3 succeeding procedures. Most of the time, the grafts were of autologous origin but sometimes heterologous samples were used. Although the primary objective was to increase volume, an improved quality of skin healing and better skin flexibility were observed. The fat thus allowed the filling of substance losses, and its positive effects on scarring were noticed even before the regenerative properties of the stem cells present in body fat were discovered. CONCLUSIONS: Hippolyte Morestin can be named one of the pioneers of facial reconstruction. A retroperspective analysis of his work with adipose grafts proves interesting because even though not being the first to apply this technique, he contributed, by means of experimentation and reproduction to proving it an innovative and useful method in facial reconstruction. It was not until the 1990s that adipose grafts were again applied under the name of lipostructure. Nowadays, they are commonly used in cosmetic and restorative surgery.

[Alberic Pont, the great war and the "broken faces"]. / Albéric Pont, la grande guerre et les gueules cassées.

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]. / La prise en charge a Marseille des blessés au visage pendant la première guerre mondiale.

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.

[The disfigured men represented by the great painters (O. Dix - G. Grosz - R. Freida.) Disfiguration in the history of art]. / Les gueules cassés représentées a par de grands peintres (O. Dix - G. Grosz - R. Freida) la défiguration en histoire de l'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.

Facial trauma in the Trojan War.

PURPOSE: The Iliad and Odyssey of Homer represent the cornerstones of classical Greek literature and subsequently the foundations of literature of the Western civilization. The Iliad, particularly, is the most famous and influential epic poem ever conceived and is considered to be the most prominent and representative work of the ancient Greek epic poetry. We present the injuries that involve the face, mentioned so vividly in the Iliad, and discuss the aetiology of their extraordinary mortality rate. METHODS: We recorded the references of the injuries, the attacker and defender involved, the weapons that were used, the site and the result of the injury. RESULTS: The face was involved in 21 trauma cases. The frontal area was traumatized in 7 cases; the oral cavity in 6; the auricular area in 4; the orbits and the retromandibular area in 3; the mandible and the nose in 2; and the maxilla, the submental and the buccal area in 1, respectively. The mortality rate concerning the facial injuries reaches 100%. CONCLUSION: Homer's literate dexterity, charisma and his unique aptitude in the narration of the events of the Trojan War have established him as the greatest epic poet. We consider the study of these vibrantly described events to be recreational and entertaining for everyone but especially for a surgeon.

The 13th Stationary/83rd (Dublin) General Hospital, Boulogne, 1914-1919.

Casualties from the Western Front during the First World War were often evacuated to base hospitals on the northern coast of France for more advanced and specialist care. These temporary base hospitals frequently had more than 1,000 beds and were typically staffed by older, more senior doctors than were present nearer the front line. The 13th Stationary Hospital opened in October 1914 on the Boulogne docks and became the main specialist unit for the treatment of eye, face and jaw injuries. In May 1917 it was renamed the 83rd (Dublin) Hospital when the staff was augmented by volunteer staff from Irish hospitals. The hospital subsequently housed an innovative 'physical medicine' or rehabilitation unit. The hospital remained open for the duration of the War, moving to Langenfeld in the Ruhr following the Armistice.

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.

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.

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.

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.

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.

[History of the treatment of fractures of the face]. / Contribuiçao para a história do tratamento das fracturas da 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.

British dental surgery and the First World War: the treatment of facial and jaw injuries from the battlefield to the home front.

When Britain went to war in 1914, the British Expeditionary Force was deployed without a single dentist. Initially considered combatants, the only dental professionals who could serve at the Front were medically qualified dental surgeons in the Royal Army Medical Corps. In treating the traumatic facial and jaw injuries caused by trench warfare, the dental surgeons of this era earned their place on specialist surgical teams and established the principles of oral and maxillofacial surgery. This article will examine the contribution of specialist dental surgeons to the management of facial and jaw wounds in the First World War along the chain of evacuation from the battlefield to the home front, using illustrative examples from the Hunterian Museum at the Royal College of Surgeons of England.