Oral and cranio-maxillofacial surgery in Byzantium.

INTRODUCTION: Byzantine physicians (4th-7th and 8th-12th centuries A.D.), especially those interested in Surgery, developed a number of interesting concepts, views and opinions referring to the field now recognized as Oral and Cranio-maxillofacial Surgery and Pathology. MATERIAL AND METHOD: The original texts of Byzantine physicians, written in ancient Greek, and now preserved in the electronic platform Thesaurus Linguae Graecae, at the University of California, Irvine, CA, USA, were investigated in relation to Oral and Cranio-maxillofacial Surgery and Pathology. RESULTS: 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 Monachos, and Leo Medicus, in their works deal with topographic and surgical anatomy of the head and neck, and a large list of related topics, including dentoalveolar surgery, oral and cervicofacial infections, trauma of viscerocranium and neurocranium as well as the biomechanics of traumatic brain injuries, temporomandibular joints dysfunction as a consequence of mandibular dislocation, surgical oncology and reconstructive surgery of the head and neck, oral pathology, surgical pathology of salivary glands, therapeutic management of facial nerve dysfunction, preprosthetic surgery, craniofacial surgery, and deformities of the facial skeleton involving anthropologic and craniometric observations. Clinical examination of patients presenting corresponding functional and esthetic problems is considered, using recognizable orthodontic and orthognathic surgical approaches. Finally, specific bandages of the head and neck are described, for treating traumatic injuries of the viscerocranium and neurocranium, diastasis of the cranial sutures, dislocations of the mandible (unilateral and bilateral), as well as inflammatory diseases of the parotids and the neck. CONCLUSIONS: 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.

Cranio-maxillofacial injuries in Homer's Iliad.

INTRODUCTION: Homer's Iliad, being one of the oldest and greatest European epic poems, is divided into 24 "books" or "rhapsodies", in which war injuries in general, and in particular cranio-maxillofacial (CMF) injuries, are described in a unique and detailed manner. MATERIAL AND METHOD: Homer's Iliad, Loeb Classical Library, translated by A.T. Murray, and revised by W.F. Wyatt, Harvard University Press, 2nd ed., Cambridge, Massachusetts, 1999, as well as the modern Greek translation by I. Polylas of Homer's Iliad, Publishing Organization for Educational Material, 4th ed., Athens, 1975, was studied for descriptions of CMF injuries, aiming at the presentation of their total number, received area of the head and neck, outcome, cause of injuries, and the engaged warriors. RESULTS: Forty-eight references regarding CMF injuries are found in the 24 books of Homer's Iliad. Forty-four of the CMF injuries were fatal, among them five were decapitations. The causes of the CMF injuries were usually strokes with weapons, while other means such as rocks and stones were also used. In the aforementioned injuries the engaged striking warriors were 17 Greeks and four Trojans, while the fallen warriors were eight Greeks and 38 Trojans. CONCLUSIONS: One could get an idea about the practice of Medicine and particularly of Surgery, in the 10th century BC in Ancient Greece, through the epic poems of Homer. The unique description of CMF injuries leads us to the conclusion that the anatomy of the head and neck was quite well known in those very old times, since the heroes and warriors of the Iliad knew exactly where to strike to achieve a fatal outcome.