title: The gunner with the silver mask: observations on the management of severe maxillo-facial lesions over the last 160 years.
abstract: We would like to present a case of severe maxillo-facial trauma occurring over 150 years ago. The case involves a French artillery gunner, Monsieur Alphonse Louis, who received shrapnel injuries from an exploding shell at the Siege of Antwerp in 1832. He sustained near fatal injuries. The fact that he survived is probably due to his rapid evacuation from the battle site, as the French did not like to leave their wounded lying in 'no man's land', prompt surgery and subsequent expert medical and nursing care. M. Louis' maxillo-facial injuries included loss of the entire mandible. As a consequence, the patient had a grotesque appearance and was unable to eat or talk properly. At this time the surgeons of the day had no specialist knowledge of how to reconstruct the lower jaw. Where specialist knowledge or facilities were absent, then as now, improvisation was called for. A silversmith was duly approached and asked to construct a mask to act as a replacement for the deficient lower face. We describe here what an excellent cosmetic and functional result the mask gave, and how it led to the patient being successfully rehabilitated. Almost a century later, during the First World War, pioneering work by Major Harold (later Sir Harold) Gillies and his colleagues led to the first attempts at anatomical mandibular reconstruction. His patients, like M. Louis, were soldiers injured in battle. We will describe his techniques and compare them with how this problem is approached in the modern era, although most reconstructive surgery to the maxillo-facial region these days follows the removal of comparably extensive areas of soft tissue and bone as a result of invasive tumour.
authors.affiliation: Department of Anatomy, University Medical School, Edinburgh, UK.
authors.forename: M H
authors.initials: MH
authors.lastname: Kaufman
authors.forename: J
authors.initials: J
authors.lastname: McTavish
authors.forename: R
authors.initials: R
authors.lastname: Mitchell
mesh_terms: D005060:Europe; D049672:History, 19th Century; D006801:Humans; D008297:Male; D008446:Maxillofacial Injuries; D008889:Military Personnel; D019651:Plastic Surgery Procedures; D014857:Warfare