Open Journal of Stomatology, 2013, 3, 354-358 OJST Published Online October 2013 (
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
Received 9 August 2013; revised 9 September 2013; accepted 24 September 2013
Copyright © 2013 Jiawei Zheng et al. This is an open access article distributed under the Creative Commons Attribution License,
which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
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
Keywords: Oral and Maxillofacial Surgery; Education
System; China; Stomatology
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.
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.
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.
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
Copyright © 2013 SciRes. OPEN ACCESS
J. W. Zheng et al. / Open Journal of Stomatology 3 (2013) 354-358
Stomatological Medicine (S.M.M) after graduation. The
8-year undergraduate education awards students the
Doctor of Stomatological Medicine (S.M.D) at gradua-
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 +
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
Copyright © 2013 SciRes. OPEN ACCESS
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.
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-
Copyright © 2013 SciRes. OPEN ACCESS
J. W. Zheng et al. / Open Journal of Stomatology 3 (2013) 354-358
Copyright © 2013 SciRes.
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.
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].
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).
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