Oral and maxillofacial surgery in China: Past, present and future

doi:10.4236/ojst.2013.37060

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Open Journal of Stomatology, 2013, 3, 354-358 OJST

http://dx.doi.org/10.4236/ojst.2013.37060 Published Online October 2013 (http://www.scirp.org/journal/ojst/)

Oral and maxillofacial surgery in China:

Past, present and future

Jiawei Zheng1*, Bing Fang1*, Shanyong Zhang1,2, Chi Yang1, Guofang Shen1, Weiliu Qiu1,

Zhiyuan Zhang1

1Department of Oral and Maxillofacial Surgery, Ninth People’s Hospital, College of Stomatology, Shanghai Jiao Tong University

School of Medicine, Shanghai, China

2Shanghai Key Laboratory of Stomatology and Shanghai Research Institute of Stomatology, Shanghai, China

Email: [email protected], [email protected]

Received 9 August 2013; revised 9 September 2013; accepted 24 September 2013

which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

ABSTRACT

China is the most highly populated developing coun-

try. As with other scientific disciplines, dentistry (sto-

matology) is progressively growing since 1949 when

the new China was founded. Due to the closing of the

country to internationa l discourse for several decades,

international counterparts know very little about

dentistry or stomatology, including the sub-discipline

oral and maxillofacial surgery. This paper is aimed to

introduce the scope, give a brief history, update clini-

cal and basic research, and discuss the future of oral

and maxillofacial surgery in China. It will hopefully

help international colleagues to have an insight into

the developmental history, education system, clinical

and basic research achievements, as well as the pro-

spective future of oral and maxillofacial surgery in

China.

Keywords: Oral and Maxillofacial Surgery; Education

System; China; Stomatology

1. INTRODUCTION

Oral and maxillofacial surgery (OMS) focuses on the

prevention and treatment of diseases, injuries and de-

formities of the mouth, facial soft tissue, the maxillofa-

cial bones temporomandibular joint (TMJ), salivary

glands, and for certain diseases, neck pathology. OMS

gradually developed into a division of general medicine,

and an important part of stomatology. OMS in China

includes oral and maxillofacial plastic and reconstru ctive

surgery, orthognathic surgery, microsurgery, head and

neck surgical oncology, and traditional parts of oral sur-

gery as well which includes dento-alveolar surgery, pros-

thetic surgery, TMJ disease, maxillofacial trauma, sali-

vary gland disease, etc. All these sub-disciplines are

combined with traditional Chinese medicine to form

OMS with Chinese features.

Due to the long time closing of the country to the in-

ternational discourse, international OMS counterparts

know very little about Chinese OMS. This paper is aimed

to introduce the scope, give a brief history, update clini-

cal and basic research, and discuss the future of OMS in

China. The information should help international col-

leagues better understand the development of OMS, the

educational system, clinical and basic research achieve-

ments, as well as the future prospect of Chinese OMS.

2. BRIEF HISTORY

A review of Chinese medical history reveals that Chinese

medical scientists made important contributions to the

development of OMS with respect to treating maxillofa-

cial diseases and deformities. The Chinese medical book

named Xi Jin Zhi Shu (265 to 316) provided detailed

records of a particular case of cheiloplasty, including not

only the patient’s name, but also a detailed description of

the surgical procedure and postoperative care. It is rec-

ognized as the world’s first reported case of cheiloplasty.

The famous American plastic surgeon, Dr. David Ralph

Millard, Jr. collected this case in his monograph Cleft

Craft and made various marginalia. Bei Ji Qian Jin Yao

Fang (AD 652) written by Dr. Si Miao Sun of the Tang

dynasty kept detailed records of the immobilization of an

acute TMJ dislocation using a technique that is still in

use. The approach is very scientific and corresponds with

the requirements of modern anatomy and physiology.

Another example of Chinese medicine is the application

of acupuncture to analgesia and the treatment of Bell’s

palsy, which has more th an 4000 years of history and h as

been adopted in other countries.

*Bing Fang and Shan Yong Zhang contributed equally to this work.

OPEN ACCESS

J. W. Zheng et al. / Open Journal of Stomatology 3 (2013) 354-358 355

The development of OMS in China is wave-like, for-

ward spiral. Dentistry gave birth to oral surgery; maxil-

lofacial surgery combined with oral surgery and formed

a new subject called OMS. The development of modern

OMS has been inextricably linked with other disciplines,

such as plastic surgery, head and neck surgery, and mi-

crosurgery. At the same time, other branches were estab-

lished on this basis; namely, maxillofacial plastic surgery,

craniofacial surgery, maxillofacial trauma surgery, and

TMJ surgery, etc. These frontier branches of medical

science, in turn, promote further development of OMS.

Before 1949, diseases now in the realm of OMS were

scattered within the fields of dentistry, general surgery

and otolaryngology. In 1951, the former West China

Union University first established an OMS ward. Also,

the former Shanghai Second Medical University and the

Beijing Medical University established OMS wards in

1953 and 1955. So far, more than 30 colleges of stoma-

tology, as well as many provincial and municipal stoma-

tological hospitals, have established independent de-

partments and wards of OMS. Due to the destruction and

interference of the Cultural Revo lution in China, the first

national oral and maxillofacial surgery symposium was

not convened independently until 1981. In 1986, the

OMS group was established and affiliated with the Chi-

nese Stomatological Association. It held three symposia

separately at Shanghai, Xi’an and Wuhan in 1986, 1990

and 1994. Since then, professional Chinese teams of oral

and maxillofacial surgeons have not only been formed,

but have also gradually increased in size.

Since the implement of the policy of refor m and open-

ing up to the world, Chinese oral and maxillofacial sur-

geons have given receptions for many of their foreign

counterparts. They have also hosted international con-

ferences of OMS, and gone abroad to participate in a

variety of academic conferences around the world, giv-

ing reports and lectures to share their experiences. Since

1978, many institu tions have train ed hundreds of docto rs

majoring in OMS, and many young doctors have been

sent abroad to study and do scientific research. These

doctors have become the core of Chinese OMS. Chinese

surgeons are active in not only dental conferences, but

also the conferences of related disciplines such as: plastic

and reconstructive surgery, head and neck surgery, cos-

metic surgery, and other surgical disciplines. China’s

large population and plethora of cases provide more op-

portunities for practice among oral and maxillofacial

surgeons, objectively. All of these factors promote the

further development of OMS in China.

The development of OMS in China can be separated

into three stages, namely: the initial stage, growing stage

and maturity stage [1].

1) Initial stage (1950-1960): since the former Huaxi

University (1951), Shanghai Second Medical University

(1953) and Beijing Medical University (1955) had sepa-

rately established OMS wards, in 1956, the Ministry of

Education issued a formal OMS syllabus and the first

textbook Oral and Maxillofacial Surgery was edited by

Professor Liang Cai Xia (1957) and published in 1965.

This creation laid a solid foundation for the dev elopment

of OMS.

2) Growing stage (1960-1990): the pioneers of OMS

followed one after another, and made lots of exchanges

to improve their level of scientific research and clinical

skills. With the graduate system restored in 1978, scien-

tific research in OMS was promoted to a higher level.

The second generation of pioneers had fully taken the

responsibility of boosting the development of OMS.

3) Maturity stage (since 1990): the significant effect of

this stage is that OMS in China is catching up with the

world’s development and has won high praise. More

importantly, the third-generation team of OMS has been

formed, and the fourth-generation is emerging.

Among these three stages, the last 10 years of the

growing stage, as well as nearly 20 years of th e maturity

stage, occurred 30 years afte r China’s Reform a nd Open -

ing-up, which yielded many achievements. The devel-

opment and progress of OMS is a living testimony to the

noteworthy achievements made by Chinese medicine

after the reform and opening up to the outside world.

Considering the development of OMS in China, there

are three major milestones which need to be memorized.

First is the establishment of the initial OMS academic

organization in 1986—the OMS Group, Stomatological

Branch, Chinese Medical Association. Second, the Chi-

nese Society of Oral and Maxillofacial Surgery, Chinese

Stomatological Association formally joined the Interna-

tional Association of Oral and Maxillofacial Surgeons

(IAOMS). Third, the 19th International Conference on

Oral and Maxillofacial Surgery (which was hosted by

IAOMS and undertaken by the Chinese Society of Oral

and Maxillofacial Surgery (CSOMS) and Hong Kong

Society of Oral and Maxillofacial Surgery) was success-

fully held in Shanghai in 1999. Professor Wei Liu Qiu,

member of Chinese Academy of Engineering won

IAOMS’s highest honorship—The Distinguished Fel-

low Award.

3. EDUCATION SYSTEM

At present, the higher education system of stomatology is

divided into three different levels, namely: a 5-year,

7-year and 8-year undergraduate education system. The

5-year education system is based on general oral medi-

cine lessons, and a Bachelor’s degree in oral medicine is

granted at the students’ graduation. The 7-year education

system is a long-term undergraduate education, and stu-

dents of this system are trained as specialists (in areas

such as OMS) and are awarded the degree of Master of

J. W. Zheng et al. / Open Journal of Stomatology 3 (2013) 354-358

356

Stomatological Medicine (S.M.M) after graduation. The

8-year undergraduate education awards students the

Doctor of Stomatological Medicine (S.M.D) at gradua-

tion.

According to the provisions of the National Stomatol-

ogy Professional Licensing Examination, dentists must

master the basic knowledge and skills of OMS in order

to obtain a practicing license: 1) the basic knowledge and

technology of OMS; 2) anesthesia and analgesia; 3) den-

tal and alveolar surgery; 4) dental Implant surgery; 5)

oral and maxillofacial infections; 6) oral and maxillofa-

cial trauma; 7) oral and maxillofacial tumors and tu-

mor-like lesions; 8) salivary gland diseases; 9) temporo-

mandibular joint diseases; 10) oral and maxillofacial

nerve diseases; 11) congenital cleft lip and cleft palate;

12) oral and maxillofacial imaging; 13) dentofacial mal-

formations; and 14) oral and maxillofacial acquired de-

formities and defects.

OMS specialist training has not yet begun in China,

even though the guideline for training and education of

Chinese oral and maxillofacial surgeons [2] was pub-

lished in 2006. Five-year undergraduates of stomatology

can pursue the Master’s degree of oral and maxillofacial

surgery (3 years, 5 + 3) after graduation, or get 3-year

residency training (general oral medicine) at a general or

stomatological hospital which contain a department of

oral and maxillofacial surgery, according to their per-

sonal interests. After training, qualified doctors can en-

gage in OMS clinical work. Oral and maxillofacial sur0

geons with a Master’s degree may continue into a PhD

program (3 years, 5 + 3 + 3), which is mainly focused on

scientific research. Therefore, oral and maxillofacial

surgeons, in general, have graduated with: a Bachelor’s

from the 5-year program; a Master’s from the 7-year

program for Bachelor and Master Degrees in succession,

or the 8-year program (5 + 3); a Doctorate from the

8-year program for Bachelor’s, Master’s and Doctorate

Degrees in succession or the 11-year program (5 + 3 +

3).

Colleges of stomatology in China are now offering

students courses of OMS which differ from each other in

teaching hours (about 120 hours on average). In order to

make the teaching content more scientific, reasonable

and standardized, these institutions all use the textbook

Oral and Maxillofacial Surgery published by the Peo-

ple’s Health Publishing House. The textbook, which

lasted more than 30 years, has been updated to its 7th

version since publication in 1979. In 2010, the People’s

Health Publishing House launched Oral and Maxillofa-

cial—Head and Neck Oncology, Oral and Maxillofacial

Trauma Surgery, Orthognathic Surgery, Lip and Palate

Cleft and Facial Cleft Deformity as training guide books

for postgraduates of oral and maxillofacial surgery. In

2011, Chinese Society of Dental Education, Chinese

Stomatological Association organized experts to draft the

Clinical Internship Standard of Oral and Maxillofacial

Surgery as a reference book for colleges of stomatology.

The teaching content of OMS include: lecture courses,

pre-clinical laboratory practice, clinical probation and

clinical internship, which each last for 12 weeks. In

terms of teaching methods, in addition to the traditional

theory lectures, advanced teaching concepts and methods

such as problem and case based learning are also en-

couraged. Bilingual education and full English teaching

are advocated, aiming at improving the overall quality

and ability of students for future competitions.

Update of Clinical and Basic Research

China has been among the most advanced countries in

the world in the clinical diagnosis and treatment of dis-

ease through OMS. In addition to routine surgeries, ad-

vanced techniques are practiced, such as: using pedicle

or vascular tissue flaps to reconstruct soft and hard tissue

defects, orthognathic surgery, CAD/CAM, rapid proto-

typing techniques, and endoscopic techniques. The

Shanghai Jiaotong University School of Stomatology,

Department of OMS has 230 beds, and is the largest oral

and maxillofacial surgery center in Asia. It has also been

designated the International Training Center for the

IAOMS Oral and Maxillofacial Oncology and Recon-

structive Surgery Training Fellowship Program. Toge-

ther, with the Beijing University School of Stomatology,

Department of Oral and Maxillofacial Surgery, both have

become AOCMF international and AOCMF Reference

Center-Asia Pacific. In recent years, the Department of

Oral and Maxillofacial Surgery, Shanghai Jiao Tong

University College of Stomatology has carried out a se-

ries of complex surgeries, such as carotid artery re- sec-

tion and reconstruction, combined craniomaxillofacial

resection, total glossectomy, laryngectomy and mouth

floor resection and reconstruction [3]. Treatment guide-

lines for hemangiomas and vascular malformations of the

head and neck [4] and treatment guidelines of lymphatic

malformations of the head and neck were formulated and

published internationally [5]. The development of OMS

is highly uneven regionally, and no more than 20 hospi-

tals are capable of diagnosing and treating extremely

complex oral and maxillofacial diseases, or carrying out

delicate surgeries. Most of these hospitals are affiliated

with medical universities or college s of stomatology, and

90% of these hospitals can only carry out conventional

surgeries. Simple surgeries are performed by general

dentists in hospitals at th e county-level b ecause there ar e

no departments of OMS.

In the field of scientific research, China has made sig-

nificant progress, whether in clinical research or basic

research, compared to 20 years ago. The number of pa-

pers published in SCI by scholars of OMS has increased

J. W. Zheng et al. / Open Journal of Stomatology 3 (2013) 354-358 357

yearly, and has grown rapidly in recent years, as has their

influence. But there is still a large gap when compared

with the advanced countries in the world. Even though

China is a populous cou ntry, there is no implant wh ich is

widely used or recognized nationally and overseas. A

large quantity of advanced medical devices, equipment

and reagents are dependent on imports. The most basic

research often consists of follow-up studies or even re-

peating work of others. There is little original research in

this area [6], and no work is recognized as a break-

through in OMS by international OMS community. In

clinical studies, there are no large samples or multi-cen-

ter prospective studies [7]. All of these facts show that

we must identify the gaps and shortcomings, and we

should make unremitting efforts toward cooperation in

order to yield greater achievements.

Academic journals are an important means of showing

the quality of academics and research. There are two

domestic professional academic journals, the China

Journal of Oral an d Maxillofacial Surgery and Oral and

Maxillofacial Surgery. These two journals, with English

abstracts, are bimonthly, and nearly 200 papers are pub-

lished per year. These publications play a positive role in

promoting the development of OMS by disseminating

new theories, new knowledge and new technology. At

present, the degree of internationalization of these two

magazines is not high, and they are not included by

PubMed. Since their influence is relatively limited, con-

tinuous efforts are needed to improve their academic

level and the degree of internationalization. In recent

years, too much emphasis was laid on the importance of

SCI-cited papers, and a large number of outstanding sci-

entific research papers were published in international

journals in English. This results in problems of quantity

and quality of original papers for domestic academic

journals, and it is not conducive to the sustainable de-

velopment of Chinese academic journals.

One measurement of the degree of internationalization

of a subject is the number of specialists serving as editors

of international journals. 81 Journals in Dentistry, Oral

Surgery and Medicine were cited by SCI in the year of

2011. After verification, there are 11 Chinese oral and

maxillofacial surgeons (including implantology) serving

on the Editorial Board s of SCI cited dental journals, they

are: Wei Liu Qiu (Shanghai, International Journal of Oral

Science), Zhi Yuan Zhang (Shanghai, Oral Diseases),

Nabil Samman, (Hong Kong, International Journal of

Oral and Maxillofacial Surgery), Xu Chen Ma (Beijing,

Dentomaxillofacial Radiology), Lim Kwong Cheung

(Hong Kong, Journal of Oral and Maxillofacial Surg ery),

Song Ling Wang (Beijing, Journal of Oral Rehabilitatio n,

International Journal of Oral Science), R. Zwahlen

(Hong Kong, O ral Oncology), Jia Wei Zh eng (Shanghai,

Journal of Oral and Maxillofacial Surgery), Jing Hu

(Chengdu, International Journal of Oral Science), Lian

Ma (Beijing, British Journal of Oral & Maxillofacial

Surgery), Hong Chang Lai (Shanghai, Clinical Oral Im-

plants Research). Serving as the international academic

editor is not only a very important job, but also one of

the hallmarks of a particular country’s academic influ-

ence and status. It can also help other advanced countries

in the world to appreciate the knowledge, strength, and

development of OMS in China, thus increasing China’s

influence on international academic affairs.

4. FUTURE PROSPECTIVE

Currently, there are many issues to be resolved in the

field of OMS. There is also a need to improve the level

of prevention and treatment, especially in the fields of

basic theory studies and emerging scientific technologies

(molecular biology, biomedical engineering, etc.). These

areas still have large gaps compared to the advanced

countries throughout the world. Hard work is needed to

correct this situation.

The 21st century is an age of life science, and an age of

molecular biology, which is based on the study of hered-

ity and genetics. Diseases related to the field of OMS

need the in-depth study with the help of modern tech-

nologies and methods.

The treatment style of surgical diseases in the 21st

century will chan ge into comprehensive, sequ ential multi-

disciplinary treatment based on a team approach. The

goal will be to better ensure patients’ quality of life by

improving patients cure rates and survival rates.

Medical science in the 21st century has changed from

pure biological treatment to a medical model combined

with “environment, society, biology, psychology and

engineering.” Apart from noble medical ethics and su-

perb medical skills, doctors of OMS also need to know

the art of service and the psychological demands of pa-

tients. What’s more, in order to adapt to this change, doc-

tors must learn about psychosomatic medicine and men-

tal health.

The 21st century is also an age of the 4Ps in medical

science, which means preventive, predictive, personal-

ized and participatory medicine. With the development

of preventive medicine, even new infectious diseases can

be better controlled. People will live longer, and the

number of old people will increase. Therefore, the de-

velopment of geriatrics related to OMS is inevitable.

It is an age of high technology. Advanced medical

equipment brings about innovation in surgical technol-

ogy. Functional surgery, minimally invasive surgery and

digital surgery have become the mainstream in the de-

velopment of OMS in the 21st century. Minimally inva-

sive surgery has been used for TMJ surgery, salivary

gland surgery, neurosurgery, trauma surgery, orthog-

J. W. Zheng et al. / Open Journal of Stomatology 3 (2013) 354-358

358

nathic surgery, tumor surgery and paranasal sinus sur-

gery, etc. With the rapid development of biomedical en-

gineering, and the progress in regenerative medicine,

especially in the studies and applications of biological

materials, artificial organs (artificial teeth, artificial

bone), and tissue engineering, the treatment of oral and

maxillofacial surgery will be greatly influenced.

OPEN ACCESS

Human beings are a group, but individual differences

(genetics, personality, reaction, etc.) still exist. The main

task of clinical medical treatment is to focus on th e indi-

vidual, except in the case of group diseases. The diagno-

sis and treatment of individuals varies under the guide-

lines. With the progress in research of genes and signal

transduction, digital technology (especially the applica-

tion of CAD/CAM), rapid prototyping, and reverse en-

gineering are applied in the field of OMS. “Individual-

ized treatment” or the concepts of “custom made” and

“custom design” will further improve in the 21 st century.

From a molecular biology perspective, gene polymer-

phism will enrich disease prediction and prevention

methods, and yield highly sophisticated individualized

treatment regime.

In the 21st century, medical science will pay more at-

tention to the transfor mation and application of scientific

achievements. Applying scientific achievements to clini-

cal work and making an in-depth study of clinical queries

in the lab are ways to achieve a virtuous circle of transla-

tional medicine [8].

5. ACKNOWLEDGEMENTS

This study was supported by the Third Higher Education Project in

Shanghai for Undergraduates (Grant Number. 2008-73), Shanghai

Jiaotong University School of Medical Education Research Projects

(YB120913) and “085” Project from Shanghai Municipal Education

Commission (2013).

REFERENCES

[1] Qiu, W.L. (2011) The third milestone in the development

of oral and maxillofacial surgery in China. China Journal

of Oral and Maxillofacial Surgery, 8, 195-198.

[2] Chinese Society of Oral and Maxillofacial Surgery (2006)

Guideline for training and education of Chinese oral and

maxillofacial surgeons. China Journal of Oral and Max-

illofacial Surgery, 4, 304-306.

[3] Qui, W. and Zheng, J. (2003) Development of oral and

maxillofacial oncology in China. Chinese Medical Jour-

nal, 116, 1567-1573.

[4] Zheng, J.W., Zhou, Q., Yang, X.J., Wang, Y.A., Fan,

X.D., Zhou, G.Y., Zhang, Z.Y. and Suen, J.Y. (2010)

Treatment guideline for hemangiomas and vascular mal-

formations of the head and neck. Head Neck, 32, 1088-

1098. http://dx.doi.org/10.1002/hed.21274

[5] Zhou, Q., Zheng, J.W., Mai, H.M., Luo, Q.F., Fan, X.D.

Su, L.X., Wang, Y.A. and Qin, Z.P. (2011) Treatment

guidelines of lymphatic malformations of the head and

neck. Oral Oncology, 47, 1105-1109.

http://dx.doi.org/10.1016/j.oraloncology.2011.08.001

[6] Zheng, J.W. (2011) On innovative study in dentistry in

China. Chinese Journal of Sto matological Researc h (Elec-

tronic Version), 5, 115-117.

[7] Qiu, W.L. (2006) Sustained development and keep pace

with the times: Prospective of development of oral and

maxillofacial surgery in China. China Journal of Oral

and Maxillofacial Surgery, 4, 242-245.

[8] Qiu, W.L. (2008) Oral and maxillofacial surgery. 6th Edi-

tion. People’s Medical Publishing House, Beijing.