Portal de Periódicos da CAPES

Paul Louis Tessier, M.D., 1917 to 2008

2008; Lippincott Williams & Wilkins; Volume: 122; Issue: 4 Linguagem: Inglês

10.1097/prs.0b013e3181845b31

1529-4242

S. Anthony Wolfe,

Medicine and Dermatology Studies History

Paul Tessier was born in Heric, France, a small town near the Brittany port of Nantes. His father was in a German prisoner-of-war camp at the time, but in that enlightened age, family and conjugal visits were permitted. His education and early training in general surgery, orthopedics, and ophthalmology were at Nantes, and were interrupted by the Second World War. As his father did, he spent time in a German prison (a military hospital), where he was diagnosed with typhoid fever. After the war, he began a career that led him to become one of the outstanding plastic surgeons in the history of the specialty. Initially, he worked in a military hospital in Le Mans, under the direction of his first mentor, Maurice Virenque. Then, with Professor Virenque, he moved to the Service de Chirurgie Maxillo-Faciale de la Region Militaire de Paris, based at Hôpital Foch. After Professor Virenque’s death, Gustave Ginestet, a military general, took over the Service. He had a rather frosty relationship with Dr. Tessier, and prohibited the dental laboratory from providing any services to him (Dr. Tessier attributed the development of many of his techniques of interlocking bone fixation to this). Dr. Tessier was able to remain at Foch during this period by running the Burn Unit. Eventually, after Ginestet’s death in 1966, he became chief of plastic surgery. During this period (the late 1940s and 1950s), Tessier amassed an enormous experience in the treatment of posttraumatic deformities, particularly in the orbital area. He also made it a habit to devote 1 month per year to visiting the outstanding plastic surgery units of the world. He spent time with Sir Harold Gillies, Sir Archibald McIndoe, Rainsford Mowlem, Pomfret Kilner, James Barrett Brown, Jerome Webster, and Ralph Millard, among others. Tessier was aware of the Le Fort type III osteotomy performed by Gillies in 1942, which was reoperated on in 1949 with a number of camouflaging procedures after an almost complete skeletal relapse. After considerable thought, examination of a number of Crouzon skulls that he had uncovered in the Musee de l’Homme in Paris, and experimentation on cadavers in Nantes, he performed his first Le Fort type III osteotomy in 1958 on a patient with severe Crouzon disease named Anquetil. Tessier’s modifications of the original Gillies procedure included an osteotomy behind rather than in front of the lacrimal fossa, a pterygomaxillary disjunction rather than a transpalatal osteotomy, and, perhaps most significantly, the interposition of autogenous bone grafts into all of the surgically created gaps. A stable result was obtained, and when this and other Le Fort type III patients were presented at the International Plastic Surgery Meeting in Rome in 1967, the response of the onlookers was one of shock and awe. Plastic surgery has not been the same since. In his fruitful collaboration with the excellent neurosurgical group at Foch, including Gerard Guiot (whose famous response to Tessier’s question of whether he would be willing to collaborate on previously untried and taboo methods was “pourquoi pas?”) and Patrick Derome, Tessier went on to develop a transcranial approach to the orbits and midface that made possible the correction of orbital hypertelorism and a number of other major facial malformations. With this, the new field of craniofacial surgery was created, and a number of basic principles emerged, including wide subperiosteal exposure of the face and orbits through coronal, oral, and transconjunctival incisions; the concept of the “effective orbit” (that portion of the orbital cavity that when displaced would take the globe with it), osteotomy, and monobloc repositioning of abnormally positioned facial segments; the exclusive use of fresh autogenous bone grafts; and correction of as many of the deformities as possible during the same operation. These principles have stood the test of time and are used by surgeons of many specialties the world over. It is particularly noteworthy that virtually every procedure in the field of craniofacial surgery was developed by Dr. Tessier: (1) the Le Fort type III osteotomy; (2) the Le Fort type II osteotomy; (3) transcranial correction of orbital hypertelorism and other orbital dystopias; (4) correction of enophthalmos and exophthalmosl (5) a method of skeletal reconstruction for Treacher Collins syndrome followed by the “integral” procedure, which involved simultaneous posterior maxillary and ascending ramus lengthening; (6) the monobloc frontofacial advancement and facial bipartition; (7) a method of treating hemiarrhinia and total arrhinia; and (8) the use of calvarial bone grafts in reconstructive surgery. There were contributions in other areas of plastic surgery as well, including (1) the “mask lift,” or subperiosteal face lift; (2) a classification of facial clefts, presented in 1976, that is now used worldwide; (3) lower eyelid reconstruction with a nasojugal flap; and (4) the supraclavicular platysmal island flap (“Barron-Tessier” flap). The list could go on for pages; many of his contributions were never published. In 1983, the International Society of Craniofacial Surgery was founded. Dr. Tessier was initially opposed to the formation of “one more society” and said he would have preferred an informal travel club, but went along with the formation of the Society, and served as its honorary president for its first two meetings. Virtually everyone performing craniofacial surgery in 2008 was trained by Dr. Tessier or by someone who had trained under him. For more than 25 years, beginning in 1971, he would come to the United States for 2 to 4 weeks per year to operate with interested plastic surgeons in a number of centers, including New York, Philadelphia, Boston, Norfolk, Houston, Dallas, Kansas City, Louisville, San Francisco, Los Angeles, and Charlotte. The number of craniofacial cases that he treated was certainly greater than that of any American surgeon. He was always ready to give useful advice to any surgeon who asked. His contributions were certainly recognized, and he was made an honorary member of the American Society of Plastic and Reconstructive Surgeons, the American Association of Plastic Surgeons, the American College of Surgeons (which also awarded him the Jacobson Prize), and the Royal College of Surgeons of both London and Edinburgh. He was awarded an honorary doctorate by the University of Lund, Sweden. His own country awarded him the Legion d’Honneur. He won the James Barrett Brown Award, issued by the American Association of Plastic Surgeons for the best article published in Plastic and Reconstructive Surgery, twice: once for his article on the Le Fort type III osteotomy and once for the supplement on the harvesting of bone grafts. A meeting was held in Dr. Tessier’s honor in London in 2006, with the faculty composed of his previous trainees. He was uncertain whether he would be able to make the trip because of back trouble, but he did manage to attend and enjoyed seeing all of his old friends. After the meeting, he returned to Paris and had a number of medical problems, none of which diminished in the slightest his willingness to discuss difficult cases facing other plastic surgeons. His experience was vast, and he had a phenomenal recall of the patients he had treated over the years. His advice was invariably of great value; he wrote a letter to a young colleague outlining a treatment plan for a patient with severe and complex facial clefts several weeks before his death. On June 5, 2008, he entered Clinique Bizet in Paris with intestinal problems, promptly went into ventricular fibrillation, and died at 5:30 pm. A ceremony was held for him at the Chapel of Val de Grace Hospital (where Hippolyte Morestin had worked) in Paris on June 10, and his body was then taken by train to be buried in the family plot of the cemetery of the town of his birth, Heric. He is survived by his daughter Claude and grandson Gilles, his wife Mireille, his daughter Laurence, and his son Jean Paul. Plastic surgery as a specialty was blessed to have this great man as a member, and tens if not hundreds of thousands of patients owe their faces and even their lives to his contributions.Figure: Professor Tessier in September of 2006. A long PowerPoint (Microsoft Corp., Redmond, Wash.) presentation of Dr. Tessier’s work over a 50-year period has been put together and is available at the Plastic Surgery Archives, at the Countway Library, Harvard Medical School, Boston.