Prof. Hugo Lorenz Obwegeser ([Fig. 1]) was a pioneering surgeon who was the first to describe the bimaxillary osteotomy
in 1969. Born in Hohenems, in the Austrian part of the Rhine Valley, on October 21,
1920, he is known as the Father of Modern Orthognathic Surgery.
Fig. 1
Prof. Hugo Lorenz Obwegeser, M.D., D.M.D, Prof.em., DDr.h.c., Hon.F.R.C.S.(Engl.), Hon.F.D.S.R.C.P.S.(Glas.),
Hon.F.F.D.R.C.S.(Ire.).
Dr. Hugo had degrees in medical and dental specialties and was dual-qualified. How
Prof Hugo becomes a craniomaxillofacial surgeon is an exciting and inspiring story.[1]
[2] He obtained his basic medical degree in Austria and started working with a surgeon
in 1945. He learned many surgical and orthopaedic procedures after working in two
different places for a year. His uncle, an orthopaedic surgeon, advised him to learn
pathology and pathophysiology as an essential foundation for future medical practice.
He then moves to Vienna, helped by the grandmother of a young refugee patient once
treated by him.
Dr. Hugo joins the renowned Rockitansky Institute of Pathology at the University of
Vienna, where Landsteiner and Wiener had identified the four blood groups. He worked
with Prof Hermann von Chiari, a pathologist, for two years. He even taught ‘tuition’
to students of pathology and microbiology to support him with some money for himself
during the initial year. The pathology was exciting to him, reminiscent of a crime
story, in reaching a final diagnosis through autopsies. Though he wished to continue
working, he had to move out due to a prevailing Tuberculosis outbreak, which was fatal
and affected many staff members.
Dr. Hugo was eager to pursue internal medicine or obstetrics and gynecology, but did
not receive a paid position. He then met Prof. Richard Trauner, a well-known maxillofacial
surgeon at the University Hospital in Graz, Austria, which defined his career in this
field. It was a rather accidental meeting to help him with Photomicrographs for his
publication, which Dr Hugo had familiarity with in pathology. Prof Trauner offered
him a paid position in training in maxillofacial surgery; though he was not keen to
become a maxillofacial surgeon, took it as it was the fastest-growing option for his
career. Working with Prof Trauner, he understood the broad scope of the speciality
and undertook a formal dental training course for two years, which was then a subspecialty
of medicine. Dr Hugo worked with Prof Trauner for six years, who then sent him to
Sir Harold Gillies to learn reconstructive surgery at the Plastic and Jaw unit at
Rooksdowne, House, London.
Dr. Hugo spent five months with Sir Harold Gillies from October 1951 to February 1952,
and, learned several applicable principles of reconstructive surgery, including planning
and handling soft tissues. Fascinated by his work, he mentions, “From Sir Harold I learned so many principles and techniques that without the training
with him, I could not have treated so many difficult cases as successfully as I did.”. While staying at Rooksdowne House, he met Ralph Millard and Ivo Pitanguy, two pioneers
in plastic surgery. Sir Harold had invited Dr. Hugo to join along with Millard to
write his book on Principles and Art of Plastic Surgery; however, he could not continue
due to his professional commitments. He affectionately called Gillies ‘Sir Harold’
and described him as ‘the most important pioneer of modern plastic surgery’.
The milestones in Professor Obwegeser's professional career are largely reflected
in the progression of modern orthognathic surgery.[3]
[4] In 1953, he described a sagittal split osteotomy for the mandible using an intraoral
approach. The invention was revolutionary because the procedure was done intraorally
without the need for a bone graft and without scars. In 1957, he performed the first
osseous genioplasty. He then performed the first Le Fort 1 osteotomy in 1965, which
demonstrated the total mobilization of the maxilla with emphasis on pterygomaxillary
disjunction. He paved the way for modern orthognathic surgery by performing bimaxillary
osteotomy in a single sitting, intraorally, in 1969.
Paul Tessier described and demonstrated Le Fort 3 osteotomy and other craniofacial
procedures in the same era in 1967, which was very useful to Prof. Hugo. Dr. Paul
and Dr. Hugo met in 1968, and they remained friends with mutual admiration, respect
and professional interaction. Hugo and Paul were pioneers in their fields; Hugo worked
extensively on the mandible and maxilla, while Paul worked on the maxilla, orbit,
and cranium. The relation was so remarkable that, when Dr. Hugo retired after 40 years
of extensive clinical work, he wrote a book on “mandibular growth anomalies” and requested
Tessier to pen a foreword.[5] Paul Tessier writes in the foreword, “Was ever a foreword requested for God's words? It is not indecent to write a preface
for Hugo's “Growing Mandible”? After training in the Jaw's Old Testament, Hugo is
writing the New One that he taught for 40 years long”!
Between 1958 and 1987, Professor Obwegeser's Zurich School of Cranio-Maxillofacial
Surgery became a hub for surgeons worldwide, eager to learn these innovative and challenging
procedures. Many around the world admired him as a mentor. At the American Society
of Oral Surgery meeting in Washington, District of Columbia, in 1966, Obwegeser introduced
his orthognathic surgery techniques to North American surgeons.
Prof. Obwegeser was responsible for founding the European Association for Cranio-Maxillo-Facial
Surgery (EACMFS) and leading craniomaxillofacial surgery with great commitment. He
set up the “Hugo Obwegeser Travelling Scholarship” to aid young trainees. He made
a significant impact on the development of maxillofacial surgery. He was the Chief
Editor of the Journal of Oral and Maxillofacial Surgery and served as president of
the German Society of Oral and Maxillofacial Surgery and the European Association
of Maxillofacial Surgery.
Professor Obwegeser passed away peacefully on September 2, 2017, at the age of 97.
His legacy will live on through the many trainees he trained and the knowledge he
has imparted, which has impacted innumerable lives worldwide.
