The Making of a Specialty

Iwant to express my gratitude to the Honorary Awards Committee for bestowing the high honor of including me among the elite list of previous Hayes Martin Lecturers and by electing me to deliver this prestigious lecture. I will go on record as the last Hayes Martin Lecturer of the Society of Head and Neck Surgeons. Over the past 20 years, I have enjoyed the unique privilege of serving the Society continuously in one or another capacity on the executive council. It has been a distinguished honor in exciting times to have been an active participant in the activities and growth of the Society. This unique experience has given me the opportunity to study the origin of our speciality and its progress over the course of the past 100 years. It is a wonderful opportunity and an exhilarating process to reflect on the development of head and neck surgery in the past and to share with our future leaders the highlights of contributions from individuals and events that made our speciality what it is today. Although I did not have the privilege of having worked directly with Dr. Martin, I was fortunate enough to have known him, albeit from a distance in his postretirement days. Much of my recollection of Dr. Martin comes from the experiences and stories from my predecessors from the Head and Neck Service, the late Drs. Edgar Frazell, H. Randall Tollefsen, and Hollon Farr, as well as Dr. Elliot Strong, and our current president, Dr. Ronald Spiro, who were closely associated with him during the peak of his career. My colleagues and I now shoulder the responsibility of building on the high standards established by Dr. Martin and purveyed by his successors on the Head and Neck Service at Memorial Sloan-Kettering Cancer Center to carry its worldwide prominence in the field of head and neck surgery into the next century. It is this unique combination of opportunities and responsibilities of my association with the Society of Head and Neck Surgeons and with the Head and Neck Service at Memorial SloanKettering Cancer Center that enables me to ponder and think back as to what it took to develop the speciality of head and neck surgery and who were the founding fathers, the mavericks, the prime movers, organizers, leaders and contributors, all persons with foresight and vision, whose efforts led to the development and solidification of our specialty. Head and neck surgery has come of age. However, in comparison with other surgical specialities, it is largely a phenomenon of the later part of the 20th century. The foundations for the specialty of head and neck surgery were laid by contributors from the field of reconstructive surgery, laryngology, general surgery, thyroid surgery, surgery for oral cancer, and other pioneers who attempted surgery of the sinuses and salivary glands. The origins of reconstructive head and neck surgery go back nearly 2,000 years in the writings of Sushruta, who described the forehead flap in nasal reconstruction. In the 16th century, Tagliacozzi practiced reconstructive surgery of the head and neck using pedicled flaps. Much of the early work in laryngology came following the discovery of the laryngeal mirror by Manuel Garcia and subsequent contributions by pioneering surgeons such as Solis-Cohen in the United States, Billroth in Vienna, Morell McKenzie in England, and Alonso in Uruguay. The work of John Kirchner provided the basis for understanding the biology of laryngeal cancer spread, allowing surgeons to devise newer and newer voice-sparing surgical procedures. These advances in the field of laryngology became an integral part of the field of head and neck surgery. The awarding of the Nobel Prize to Theodore Kocher brought to light previously unforeseen advances in surgery of the thyroid gland that became a component of the field of head and neck surgery in the 20th century. In his presidential address, our former president, William Nelson, identified Henry Butlin as the first head and neck surgeon. Butlin’s contributions to surgery of oral cancer, and particularly cancer of the tongue, laid the foundations for modern concepts in the surgical management of oral cancer. As early as 1898, Butlin had proposed excision of lymph nodes in the supraomohyoid triangle for tongue cancer. Although concern about regional lymph node metastases was raised by Chelius in 1847, a systematic operation for their comprehensive removal was not described until 1906 when George Crile described the classical radical neck dissection and provided the basis for surgical management of neck metastases. Contributions by Trotter and subsequently by Hayes Martin laid the foundation for various surgical approaches to tumors of the head and neck. Pioneering contributions of Alfred Ketcham and colleagues and Walter Dandy put surgery of the skull base within the arena of head and neck surgery and further added to the richness of our specialty and its complex structure as we understand it today. These pioneers, unbeknownst to them, were laying the foundations of a yet to be identified complex, multidisciplinary specialty consolidating the anatomic contiguity of the organs and structures within the head and neck and the pathology developing in them, leading to the development of the surgical management of these disorders. The famous firsts in head and neck surgery are well known. Solis Cohen was identified as the first American head and neck surgeon by Zeitels and is credited for Am J Surg. 1998;176:398–403. From the Memorial Sloan-Kettering Cancer Center, New York, New York. Requests for reprints should be addressed to Jatin P. Shah, MD, Memorial Sloan-Kettering Cancer Center, 1275 York Avenue, New York, New York 10021. Presented at the 44th Annual Meeting of the Society of Head and Neck Surgeons, Palm Beach, Florida, May 14–16, 1998. HAYES MARTIN LECTURE