To the сentenary of the department of maxillofacial surgery and dentistry of the Pirogov Russian National Research Medical University

Natalya M. Khelminskaya; Хелминская Наталья Михайловна; Aleksandra V. Posadskaya; Посадская Александра Владимировна; Viktor I. Kravets; Кравец Виктор Иванович; Dmitriy A. Eremin; Еремин Дмитрий Анатольевич; Elisaveta S. Pakhomova; Пахомова Елизавета Сергеевна

doi:10.17816/medjrf321675

To the сentenary of the department of maxillofacial surgery and dentistry of the Pirogov Russian National Research Medical University

Authors: Khelminskaya N.M.¹, Posadskaya A.V.¹, Kravets V.I.¹, Eremin D.A.¹, Pakhomova E.S.¹
Affiliations:
1. Pirogov Russian National Research Medical University
Issue: Vol 29, No 3 (2023)
Pages: 242-248
Section: Historical Article
URL: https://medjrf.com/0869-2106/article/view/321675
DOI: https://doi.org/10.17816/medjrf321675
ID: 321675

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Abstract

The article is devoted to the transformation of the scientific directions of the Department of Maxillofacial Surgery and Dentistry of the Pirogov Russian National Research Medical University over a 100-year period of development, the history of the creation of the first department of this profile in Russia, modern work on clinical bases.

Keywords

history of medicine, maxillofacial surgery, Pirogov Russian National Research Medical University, traumatology of the maxillofacial region, purulent-inflammatory diseases of the face and neck

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The Department of Maxillofacial Surgeons and Dentistry of the Faculty of Dentistry of the N.I. Pirogov RNIMU celebrates the centenary of its creation. Thanks to the deep scientific and educational traditions created by generations of professors, associate professors and assistants, the basis for multilateral modern activities has been developed. Today, the clinical bases of the department, which, by the decision of the Academic Council, has been transformed into the dental Faculty of the University since 2008, are the oldest medical institutions in Moscow, this is the city clinical hospital of the State N.I. Pirogov Clinical Hospital No. 1 of the Department of Health and the Maxillofacial Hospital for War Veterans of the Moscow Department of Health, as well as the outpatient dental department recreated by the University Medical Center.
Currently, the Department of the CFS and dentistry of Dentistry is teaching for students of dental and medical faculties. Students studying in the direction of dentistry according to the curriculum, in addition to general and clinical disciplines of the educational program, study dental disciplines. Students in the preparation of the specialty medical business master the discipline "dentistry". The department carries out postgraduate training of specialists in postgraduate professional education in residency in the specialty "Surgical Dentistry" and "Maxillofacial surgery" and postgraduate studies in the specialties "Dentistry" and "Maxillofacial surgery". A lot of work is being done on professional retraining of specialists in the specialties "Surgical Dentistry" and "Maxillofacial surgery".
Since its foundation, a student scientific circle has been working at the department on a regular basis, which helps students of the dental, medical and pediatric faculties of the university in obtaining in-depth knowledge on particular issues of surgical direction in dentistry and maxillofacial surgery. Often the work of the circle practices joint multidisciplinary meetings with the Department of Otorhinolaryngology, Physics, therapeutic Dentistry, the simulation center of the University.
Scientific work has been carried out for a number of years in a traditional direction for the department – improving the quality of emergency care for patients with facial and neck pathologies. The priority is the treatment of patients with facial skeletal injuries, combined bone injuries, with purulent-inflammatory diseases and their complications. Developments are underway to improve the quality of specialized medical care for patients of these nosologies by developing a scientifically based approach to the correction of rheological blood parameters, as well as the analysis of errors, complications and deaths in patients with purulent-inflammatory diseases of the head and neck. The staff of the department conducts scientific and clinical research to study the clinical and functional features of the diagnosis and treatment of patients with fractures of the bones of the lower facial area and the features of rehabilitation of patients with functional disorders of the temporomandibular joint in violation of the integrity of the bone tissue of the lower jaw of various localization and etiology. Within the framework of the scientific topics of treatment of patients with purulent-inflammatory diseases of the face and neck of various genesis, research is being conducted to assess the risks of developing osteonecrosis of the jaws in patients with oncological diseases taking bisphosphonates, anticipation of the severity of complicated osteonecrosis of the jaws in patients with comorbid pathology, optimization of diagnosis and treatment of pathological scars in patients with purulent-inflammatory diseases of the face and neck.
Also, the scientific interests of the department include such areas as the introduction into practice of surgical methods for the treatment of patients with congenital malformations and developmental anomalies of the craniofacial region, where work is being done on the clinical and pathophysiological justification of the use of blood plasma rich in growth factors in combination with osteoplastic material for the replacement of limited bone defects of the jaws and rehabilitation of patients with inflammatory diseases and post-traumatic deformities and defects of the maxillofacial region, anomalies and malformations of the face and neck, diagnosis and treatment of patients with neoplasms and diseases of the oral mucosa, including idiopathic.
Continuity in science and the formation of a scientific school plays an important role in obtaining high results of the activities of the cathedral staff, therefore, the department in its current activities and in the development of promising areas relies on the practical and scientific directions of its predecessors and teachers.
After the transformation of the Moscow higher women's courses into the 2nd State University by the Decree of the People's Commissariat of the RSFSR of October 16, 1918, the Department of Odontology was organized in 1922 under the leadership of Gilyari-Zdislav Ivanovich Vilga. G.I. Vilga was the founder of forensic dentistry, the author of the scientific and practical work "On the casuistry of teeth in the role of foreign bodies" (1901), reports "On the issue of dental replantation" and "Local anesthesia during tooth extraction", "On the issue of the irregularities of the second teething" (1902). G.I. Vilga's doctoral dissertation "Teeth in forensic medicine" for a long period was the only guide to expert activity for forensic physicians and dentists. During the First World War, the department under the leadership of G.I. Vilga managed to organize the first maxillofacial hospital in Moscow to provide assistance to the wounded in the face at the clinic of Moscow University. The experience of clinical work in maxillofacial traumatology is summarized in the manual for doctors and students "Assistance at the front to the wounded in the jaw" (1919), which determined the main directions of work of the scientific staff of the department for the entire century-long history [1]. (Figure 1)

Further development of the department under the leadership of Professor Karl Ivanovich Kogan is inextricably linked with the 2nd City (later 1st city) hospital, in which the main clinical base is located to this day. The following areas of the department, which still exists today, arose in connection with the creation in 1925 of the laboratory of experimental dentistry to study the morphology of the tooth and parotid tissues, the etiology and pathogenesis of periodontitis. The result was the work of K.I. Kogan in collaboration with the staff of the department N.I. Stepanov, G.L. Feldman, Ya.I. Gutner "On the resorption of dentin by pulp tissue in chronic pulpitis" (1924), "On the injection method of treatment of trigeminal neuralgia" (1929), "Development of the Department of Odontology 2 of Moscow State University" (1927), "Results and prospects of the Moscow Odontological Society" (1927).
In the 30s, the department was headed by Professor G.L. Feldman, whose efforts organized the inpatient surgical dental department in the 1st city Hospital named after N.I. Pirogov, where our team still works today. Studies of the properties of pulp and periapecal tissues in various inflammatory processes continued, published in the monographs "The effect of formalin and tricresol-formalin on periodontal disease" and "The current state of conservative dentistry in the light of experimental data", which received the first prize at the All-Union Competition of the People's Commissariat of Health (1930) [2].
With the arrival at the department (1934) of Alexander Ivanovich Evdokimov, the formation of the dental hospital of the 1st city hospital as the only specialized city emergency service continued. During the years of work at the department, A.I. Evdokimov worked on the creation of the vascular concept of alveolar pyorrhea, which is reflected in the publications "Alveolar pyorrhea as a septic focus", "Odontome Clinic", "Marginal periodontitis". It was within the walls of the 2nd Medical Institute in 1941 that A.I. Evdokimov successfully defended his dissertation for the degree of Doctor of Medical Sciences – "Clinic and pathogenesis of periodontal disease". Work was underway on the creation of reconstructive operations on the face, the staff of the department created scientific papers "Issues of pulp biology", "Surgical technique for the treatment of dental caries", "Problems of filling infected roots", "Long-term results of treatment of acute and chronic inflammatory processes", "Clinic and topography of purulent-inflammatory processes in the parotid tissues", "Albrecht's method in clinical and experimental consecration", "Revision of some provisions in the doctrine of pulp biology". (Figure 2)
After the transfer of A.I. Evdokimov to the Moscow Medical and Dental Institute, the department was transformed into a course at the hospital surgery clinic of the medical faculty under the guidance of associate Professor Yakov Iosifovich Gutner, who continued to study methods of diagnosis and treatment of complicated forms of periodontitis and developed a special course of military maxillofacial traumatology. The result of the work was the publication of monographs "Surgical technique of dental caries treatment", "Clinic and treatment of pulp and periodontal diseases", "Workshop on therapeutic dentistry", "On buccal supramandibular processes", "Further observation of the treatment of roots with apical foci".
During the Great Patriotic War, the staff of the department were on the front line. Major of the medical service associate Professor Ya.O. Gutner was awarded the diploma of the Military Council of the Siberian Military District, the Commendation of the People's Commissariat of Health of the RSFSR, the medal "For Victory over Germany" and "For Labor Valor". Assistant S.I. Sheftel was awarded the medal "For the Defense of Moscow". Assistant R.O. Feldman was in charge of the Maxillofacial Surgical department evacuation hospital.
In the post-war period, Professor Joseph Mikhailovich Starobinsky, who headed the department in the post-war period, continued the scientific direction of military field surgery and clinical and experimental study of the effects of medicines and the use of biological stimulants in a dental clinic (Figure 3).
As part of the generalization of the experience of the Great Patriotic War, the work of I.M. Starobinsky "Maxillofacial wounds and their treatment", Ya.I. Gutner - "Transport immobilization of gunshot fractures of the jaws", "Gunshot osteomyelitis of the jaws and their features", "Salivary fistulas of gunshot origin", "Methods of removing foreign bodies in blind wounds of the jaws" was published, "Dental injuries and oral cavity sanitation in jaw wounded." These works dealt with topical issues of wartime jaw injury and gave new original methods of operative technique and treatment of jaw wounds [3].

A great contribution to Russian science was the dissertation research of Ya.I. Gutner "Root treatment in the light of clinical and experimental data" (1946-1947), R.O. Feldman "Morphological changes of peripheral nerve trunks during novocaine injections" and S.I. Sheftel "Experience of using incompatible blood in dentistry".
Published under the editorship of I. M. Starobinsky, the textbook "Dentistry" (1947) became a great public event and was repeatedly republished, becoming the leading textbook for medical universities for many decades. Iosif Mikhailovich worked in the Committee for Higher School Affairs at the SNK of the USSR as deputy head of the Department of medical schools, participating in the development of new ways of teaching dentistry in higher educational institutions.
After the transition in 1952, I.M. Starobinsky to the head of the Department of Dentistry of the Central Institute of Advanced Medical Training, the department was divided into two docent courses with two teachers and a reduction in the bed stock to 15 beds in the 2nd city hospital. Two years later, both courses were combined under the guidance of Associate Professor Claudia Alexandrovna Molchanova. With the expansion of the bed fund to 40 beds in 1957, the course was headed by Doctor of Medical Sciences, Professor, Lenin Prize Laureate Fyodor Mikhailovich Khitrov, a well-known specialist in the field of reconstructive and reconstructive surgery of the face and neck. The leading areas of scientific work of the department for a long period are indicated in the work of F.M. Khitrov "Plastic replacement of defects of the face and neck with Filatov stem", "Defects and scarring of the pharynx, cervical esophagus, larynx, trachea and methods of their elimination" and the dissertation of his student K.A. Molchanova "Gaping defects of the walls of the laryngeal part of the pharynx and the cervical esophagus after laryngeal removal surgery and the method of their elimination" [4, 5]. (Figure 4).
Only in the autumn of 1969 Professor K.A. Molchanova managed to restore the status of the department. Along with the plastic surgery of the esophagus, the topics devoted to the trauma of the bones of the facial skeleton and inflammatory diseases began to develop again.
Within the framework of this direction, the department conducted a study of the lymphatic system of the maxillofacial region and neck with its various lesions using indirect radioisotope lymphography.
In addition to lymphography, complications of the healing of fractures of the lower jaw were studied, studies were conducted using the radioisotope strontium 85 and strontium 87. The study of the interstitial blood flow in the areas of fractures of the mandible with iodine-hypuranom131 allowed us to prove the regularities of microcirculation of the masticatory muscles, restoration of the function of the masticatory muscles during injury.
A new scientific direction was the rehabilitation of patients with trauma to the maxillofacial region, work was carried out to find the most balanced food rations for splintered patients with jaw fractures using enpits, homogenized canned meat and vegetables. These studies have improved the healing time of bone wounds in this category of patients.
Then in 1984, the department was headed by Vladislav Petrovich Zuev, a student of K.I. Molchanova, who defended his doctoral dissertation on the topic "Pathogenesis, clinic and treatment of purulent-inflammatory complications of facial skeleton fractures". In the sphere of scientific interests of Zuev V.P. The issues of immunodiagnostics and immunotherapy of inflammatory diseases and complications, the study of blood flow and lymph flow in the pathological process, radioisotope diagnostics of the osseointegration of the bones of the facial skeleton, the development and implementation of surgical methods for the treatment of jaw fractures, a rehabilitation system for patients with traumatic injuries and purulent-inflammatory diseases of the maxillofacial region.
With the participation of Vladislav Petrovich, a textbook "Dentistry" was prepared for students of medical and pediatric faculties, sections of the monograph "Trauma of the maxillofacial region" and "Guidelines for medical gerontology".
At the dawn of the era of osteostimulators, V.P. Zuev was one of the first authors and developers of a drug based on ultrafine hydroxyappatite "Ostim100", and also developed and implemented it in everyday surgical and dental practice. This drug is still successfully used in medicine in our country and European countries. These works continued under the leadership of Andrey Georgievich Prityko, who assumed the leadership of the department in 1999. The subject of the department's work has expanded due to the scientific direction associated with the use of the method of acoustics in the diagnosis and prediction of inflammatory processes in the area of wounds of the maxillofacial region. Developments continued on the introduction of methods of rigid fixation of fragments in the treatment of jaw fractures, which was reflected in the doctoral dissertation of A.S. Pankratov "Improvement of methods of surgical treatment of patients with fractures of the lower jaw and their complications". From 2010 to 2020 . the head of the department was Professor Viktor Alekseevich Belchenko, author of 20 inventions, monographs "Craniofacial surgery. A guide for doctors" (2006) and "Craniofacial surgery in 3D format. Atlas" (2010); textbooks "Neonatal Surgery" (2006), "Maxillofacial surgery" (2018) and "Maxillofacial Surgery: a national guide" (2019). From 2020 to the present, the department is headed by Associate Professor Dmitry Anatolyevich Eremin.

Today, professors, associate professors, assistants and laboratory assistants work at the department. 5 employees have a scientific degree of candidate of medical sciences, 2 of them are associate professors with an academic title, 1 employee with a scientific degree of doctor of medical sciences and an academic title of professor, two employees of the department have been awarded Honorary diplomas of the Ministry of Health of the Russian Federation and badges "Excellent Health Worker".
In recent years, the department has defended PhD theses on the following topics: "Analysis of acoustic properties of soft tissues as a method of functional control of the condition of wounds of the maxillofacial region"; "Rehabilitation of patients with purulent-inflammatory diseases of the maxillofacial region in a megalopolis"; "EFT laser therapy in the complex treatment of patients with purulent-inflammatory diseases of the maxillofacial region";inflammatory diseases of the maxillofacial"; "Clinical characteristics of odontogenic maxillary sinusitis with oroantral fistula".
At the moment, the Scientific Council has approved scientific dissertations – two for the degree of Doctor of Medical Sciences and seven candidates of medical sciences, on which research is being conducted. According to two PhD studies, the approbation of dissertations has been carried out and preparations are underway for public defense.