Biography of Professor Cornel Tiberiu Opriş. Professional maturity.

Professor Cornel Tiberiu Opris was the founder and Chair of the Clinic and University Department of Oral and Maxillofacial Surgery in Cluj, after the Education Reform of 1948. The article illustrates how the founder of these institutions led a valiant struggle for obtaining and arranging a location for the newly established Faculty of Dentistry, within the Institute of Medicine and Pharmacy. Professor Cornel Tiberiu Opriş established himself as the most prodigious researcher at the Faculty for over a quarter-century, until his retirement, introducing his original conception in the therapeutic and surgical field. He created in Cluj-Napoca a specialist medical school by imposing national prestige for the institution that he led.

1948 was a year of great changes for the dental education in Romania. The same goes for the professional life of Professor C. T. Opriş.

The absolute novelty of this year for the Romanian medical education was the establishment of the Faculty of Dentistry which, following the Soviet model, was part of the Institute of Medicine and Pharmacy in Bucharest, Cluj, Iasi, Timisoara and Târgu Mureş. Then, the disciplines like Conservative Dentistry, Orthopaedic Dentistry and Oral and Maxillofacial Surgery became specialized departments within the Faculty of Dentistry [1,2].

Starting with 1949, the Clinic and the Department of Oral and Maxillofacial Surgery in Cluj were led by Dr. Cornel Tiberiu Opriş who was appointed associate professor, and promoted to Professor in 1962.

Before taking over these functions and responsibilities, Dr. C. Opriş worked as a researcher at the Institute of Physiology, recently returned to Cluj, together with the Faculty of Medicine, from the refuge in Sibiu.

His appointment at the helm of the mentioned Department and Clinic was based on several major considerations:

- after graduating from the Faculty of Medicine he had been specializing in Dentistry [3];

- he attended specialized courses in oral and maxillofacial surgery in Vienna, under the guidance of Prof. H. Pichler and in Berlin, under the guidance of Prof. M. Wassmund [4].

- the experience in the field of surgical pathology, oral and maxillofacial surgery, during the Second World War in Hospital Area Indoor 303 in Craiova, and after the war, by volunteering to deal with the problems of this pathology, in the Centre for Preservation of Children Cluj, ENT and Ophthalmology Clinics etc [5].

- surgical dexterity that he has developed in the Institute of Physiology.

After his appointment as Head of Department and Clinic, the task of recruiting employees, teachers and health experts was in his job description, but then, under pressure from subservient politicians, supervised by Soviet occupants, political responsibility and leadership echoed ideologically, and things developed in an unnatural way [6]. From his accounts, we find out that he was presented by the “upper fora” a list of doctors and teachers who would work under his leadership, a list in which he could not intervene. Everything was held under the authority of the Office of Human Resources and Party structuresof the Medical-Pharmaceutical Institute [5].

The mentioned list included: Doina Cosma, Gheorghe Herman, Curt (Cornel) Mild, Ervin Csapo, Ioan Geleriu, Ştefan Turcu, Vera Andriosatos, Lucia Popescu, Celestin Cherebeţiu and Iosif Iffiu.

One of those on the list was appointed Lecturer although he only recently graduated from the Faculty of Medicine and had no specialization in dentistry or in Oral and Maxillofacial Surgery. His appointment was made by his cousin «Comrade» Köpich who was Director of the Studies in the Medical-Pharmaceutical Institute. He was brought to the clinic of maxillofacial surgery from the countryside, where he had made a number of serious surgical mistakes.

Later, that person just wanted to take the place of professor Opriş, by compiling a file of about 2,000 pages in which he was arraigned. Fortunately, this issue was rejected by a panel of judges consisting of professional celebrities from the university, including Florian Stefanescu Goangă and Grigore Benetato, the future academician [5].

The list of teachers proposed by Associate Professor Dr. Opris was submitted to the Rector but was not taken into consideration, although it had been drafted following responsible counsel [4,5].

The curriculum was the same for all faculties of dentistry in the country and it was decided at the Ministry of Education level. Oral and Maxillofacial Surgery was a subject meant for students in the last three years of study at the Faculty of Dentistry and in the fifth year of study at the Faculty of Medicine.

For the latter, the subject was called Dentistry, but the thematic content of Oral and Maxillofacial Surgery overwhelmingly dominated, comprising trauma, infection, tumors, maxillofacial congenital malformations etc. Only tangentially other issues were contained, with strictly specific dental problems and only those that interfered with the general practitioner, including odontogenic pain, infection and bleeding of dental origin.

Once appointed the team of doctors and teachers, as well as the theme of the work, C. Opriş started his work. He developed and organized courses and specialized healthcare in the Clinic.

At first, these activities were conducted in poor conditions due to lack of space and clinical teaching staff. He used the clinical-based hospital and education inherited from Prof. I. Aleman but it had become insufficient after switching from the status of Dentistry Department to the Faculty of Dentistry, with more profiled disciplines.

Therefore, another space and another endowment was needed, with equipment and materials. Consequently, local officials intended the Faculty of Dentistry to be allocated current building of the Institute of Fine Arts in Mărăşti district, on the eastern outskirts of the city. For the Faculty of Dentistry that building did not meet the necessary conditions, for at least two major reasons:

- the offered space was insufficient and inadequate for faculty purpose, limiting their development;

- it was located far away from clinical institutions of medical education with which the faculty was connected and integrated.

In his struggle to obtain the necessary clinical and teaching conditions, Cornel Opriş proved to be formidable [4,5,7].

During a political event, which was attended by the Head of State, Gheorghe Gheorghiu-Dej and Prime Minister Ion Gheorghe Maurer, professor Cornel C. Opriş, by an unexpected intervention, asked state officials to approve an “appropriate location for the faculty.” Due to such direct intervention in front of those officials, the most important issue was resolved, and the building was assigned. It was a building on Motilor Street, No. 33, where the Rescue Service of the town and Department of Medical Girls Secondary School functioned before.

Therefore, getting this building for the Faculty of Dentistry was linked to Professor Opriş’s name, the way the building on V. Babes street No. 1 links to Gheorghe Bilascu and the nearby amphitheater to Ioan Aleman.

The approach of senior officials by C. T. Opriş injured the egos and of local town officials, university Party people, who had another option for this space. But due to his audacious personality C. T. Opriş passed over this hurdle, but not without a stain on his image the local officials had of him.

Following the intervention of Dr. Opris, local forums in Cluj were forced to accept the orders coming from their superiors in Bucharest and thus, entirely new perspectives were opened for the Faculty of Dentistry in Cluj, followed by the development of conditions for specialty teaching and health services. The place was close to clinics, and Oral and Maxillofacial Surgery could develop professional relationships with other clinics or departments.

Also, in terms of teaching, students of the Faculty of Dentistry, who had to move from one clinic to another, withing their daily schedule, could commute faster than if the faculty were established to 4–5 km, as city officials originally intended.

The organization of clinical work and teaching of oral and maxillofacial surgery, developed by Prof. C. Opriş in the building on Motilor Street No. 33, comprised two sections:

- one outpatient department - for consultations and surgical treatments which, at the same time, served as a basis for specialized education to students from IV, V and VI grade of the Faculty of Dentistry, activity similar to the one they were to practice after graduation;

- one hospital department - with wards and operating rooms for patients with severe oral and maxillofacial surgery afflictions that required long time hospitalization. This section was intended for students of V and VI year of study in Dentistry, and doctors who were in their training or specialization.

Prof. C. Opriş required medical students a surgical attire and behavior, which were strictly adhered to. The professor repeatedly stressed that in dentistry, having a surgical profile, students need to have created their surgical skills, which were to be observed in the offices, where the respective doctors will work.

For the theoretical courses, the current amphitheater in Lucian Blaga Square was usually used, next to the former dental clinic, furnished at the time by Prof. Bilascu and developed by Prof. I. Aleman.

Many courses held by Prof. Opriş were illustrated with clinical cases of those admitted to the inpatient clinic of Oral and Maxillofacial Surgery or from the patients who came to the clinic in the outpatient department, and whose pathology coincided with the course of that day.

The courses were also illustrated with sketches drawn at the Drafting Service of Medical-Pharmaceutical Institute. In addition to that, as iconographic material, Prof. Opriş used facial masks from real cases. They were prepared and stored in the collection of the clinic, and their pathology was evident for the course content.

The theoretical concepts taught in the course of clinical internship were was checked and reinforced at the practical lessons. Students were assigned to wards. At the bedside they had to know everything related to the pathology for which the patients were admitted, starting from complementary examinations, continuing with symptoms and diagnostic elements to conduct therapeutic and postoperative evolution.

Once a week, the professor did his round on the wards and each student had to present the clinical cases that he cared for. The presentation was followed by questions and the student had to demonstrate preclinical knowledge about the case. If the student could not answer those questions, they returned to the internship doctor, then to the assistant and if no one could respond, the assistant professor had to do it.

Thus, a great sense of professional responsibility was created that caused an increase in the quality of education and, at the same time, a self-selection of teachers, for those who did not resist these pressures left, giving up the teaching career.

Prof. C. Opriş examined his students with remarkable objectivity. He was one of the few professors who did not claim to see the students’ notebook before the examination in order to find out the quality of student that he had to examine. He was not interested in the grades the student got before. He did not want to be influenced neither positively nor negatively in assessing the response. He had his own opinions about the quality of student response given to the theme of the ticket examination, and he graded the student accordingly. One can assume that the same conduct was adopted as a result of injustice that was made to him, as a student, and to some colleagues who, risking consequences, he defended [7].

In this context, it is remembered that from Professor Iuliu Moldovan he learned not only the medical knowledge but also how to review and grade the students in exams. He had the same consideration for Professors Iuliu Haţieganu, Iacob Iacobovici and Marius Sturza [4].

The clinic’s pathology comprised the whole range of oral and maxillofacial surgery. Therefore, in the clinic headed by him, educational conditions were made not only for students, but also for physicians attending training courses and those who were attending the training center.

Professor Opriş was a great surgeon, so that in almost every field of oral and maxillofacial surgery he had personal intervention methods. But most of all, he loved working in the field of congenital malformations of the face. In this area he was trained during his internship in maxillofacial surgery services, as Humboldt fellowship, in hospitals of Vienna and Berlin.

Until he reached his professional maturity in solving this pathology, he was led by Pichler’s principles, which seemed more appropriate for tissues than those of Wassmund. Then, he preferred those of the French professor Victor Veau, a leading world authority in the field of plastic correction of facial malformations. Over time, as he added personal experience he has adapted Veau techniques to suit his personal conceptions.

His skills, and adequacy of mind in dramatic surgical situations have placed him among the biggest personalities in the field of surgery. This statement can be illustrated, among others, during a tense episode that took place in the operating room, to which I was present. He was extirpating a tumor that was progressing to the skull base. He could not know, going further, what he would find a few millimeters beyond the tumor tissue remaining. It went further under pressure and temptation to suppress all pathological tissue. It damaged the internal jugular vein that was weakened by the tumor. Consecutive bleeding was rampant and the life of the patient would have been finished on the table, if the professor, with an impressive skill and speed, did not apply hemostatic forceps in the right place before the abutment vessel retracted to the skull base. Due to this unusual reflex, the vessel could be ligated and the life of the patient was saved. After vessel ligation mental relaxation settled upon the entire surgical team. At that time, the professor’s aura filled the sacred space of the operating theater.

The personality of Professor Opriş marked all the chapters of oral and maxillofacial surgery such as trauma, tumors, inflammatory and suppurative processes, congenital malformations of the face, plastic surgery and transplantation immunology etc. All infused with his views and personal contributions. His views set forward 20 to 30 years, made known during congresses or in the journals, were overlapping with the subsequent ideas published in journals or books of international circulation, thus demonstrating the depth of his thinking [8,9,10,11]. If they had been published in their time in the international journals, it could have been the objective recognition of Romanian priorities.

The scientific work of Professor C. T. Opriş was a prodigious one. Coming to the Department of Maxillofacial Surgery from Institute of Physiology, he brought with him not only the interest and the high standard research but also the scientific probity required for such topical issues. Besides all this, he brought a particularly extensive range of fundamental research - covering almost all areas of Dentistry and Surgery. Examples of this are numerous. Some of them are:

- contributions to the study of etiopathology of dental cavities;

- correlation between dental cavities and endemic tireopathic dystrophy;

- periodontitis treatment with placental extract;

- sterile plaster mixed with antibiotic used in the surgical treatment of periodontitis and maxillary cysts. In fact, this material is currently used as tricalcium phosphate in bone reconstruction of the maxillary cysts, gum disease and jaw bone;

- the role of thymus in cutaneous transplantation immunology;

- röentgenotherapy side effects of hard and soft tissue;

- salivary gland role in maintaining acid-base balance;

- etiopathogenesis of noma was the subject of publications in Archier für Kinderneilkunde (Figure 1) [12]

Figure 1

Noma.

- bleeding diatheses and surgical act etc.

He kept the link and scientific collaboration with the Institute of Physiology even after taking the chair’s leadership and credentials in the Clinic of Oral and Maxillofacial Surgery, up to the 60’s. In this time, he realized the “cross, isolated head” experiment presented in Brussels (1956), which was reported in the preceding article [13].

Regarding the clinical research, it is worth noting that Prof. Opriş addressed all areas of oral and maxillofacial surgery, but he had stated preferences and personal contributions in the field of plastic surgery and restorative oro-facial surgery. Plastic surgery of the anomalies and malformations of the face was the field in which he worked with passion until the end of his professional life. In oro-facial clefts, he took into account the ideas and guiding principles of French professor Victor Veau, but later on he adapted the methods using personal proceedings. (Figure 2) [14].

Figure 2

Cleft lip and palate. A- Preoperative image, extraoral view; B - Preoperative image, intraoral view; C - Postoperative image, extraoral view; D - Postoperative image, intraoral view.

For oral and maxillofacial soft tissue reconstructions he used, depending on the size of defects, skin flaps or free transplants of skin, fascia, muscle, cartilage or bone. The Filatov flap he used often when the soft tissue defect demanded a higher intake of tissue both in surface and in depth (thickness) as, at that time, was the case with nasal pyramid collapse, especially after congenital syphilis, large facial trauma or other inflammatory or tumor processes (Figure 3) [15,16].

Figure 3

Saddle nasal deformation. A - Congenital syphilis; B - Posttraumatic; C - Filatov flap prepared for the reconstruction of the nose; D - Postoperative image.

In inflammatory pathology, especially in suppurations of deep spaces of the face, he distinguished himself by having a personal outlook on diagnosis and treatment. He did not agree with the large incisions preferred by Vassmund, considering them unnecessary due to inevitable functional and aesthetic sequels. In such situations, as a method of diagnosis, among others, he used the exploratory puncture. If this was positive, it was used as a disposal method of the septic content of the space affected, followed by placing antibiotic solutions. It is worth mentioning that at that time, antibiotics had a very different efficiency than today. The above-mentioned method not only located the collection, but it also became the method of treatment.

At the time, he conceived the method it presented numerous advantages over the traditional method of treating abscesses by incision and drainage. The process has been endorsed by all employees and has established itself as conduct by the clinic for this pathology. Of course, that method has not been used in cases of diffuse infections requiring large incisions.

In traumatic maxillofacial pathology Prof. C. Opriş was the adept of rigid fixation in a time in which, at least in our country, the idea of elastic or semi-rigid immobilization was thought to be beneficial for a speedy healing. As already mentioned, Professor Opriş conception was confirmed internationally in the 20–30 years that followed and later on, it was concluded that rigid fixation of the bone fragments led to a more rapid bone healing with no complications.8 This conduct was adopted by the entire staff of the Department led Prof. Opriş and, through this, the clinic was considered very special (awarded the grade of peculiarity) among the other clinics in the country.

His scientific work was presented at various international meetings, in which he took part:

- International Congress of Physiology, Brussels, 1956;

- International Dental Federation Congress, Paris, 1967;

- IXth Meeting of Balkan Medical Union, Istanbul, 1968;

- WHO Conference, Copenhagen, 1968;

- The Vth Portuguese Congress of Dentistry, Lisbon, 1972.

During the period in which Prof. Opriş led the Department of Oral and Maxillofacial Surgery (1948–1974) the scientific work was organized according to uni- or multi-annual research plans that comprised all teachers, i.e. the head teacher and the chair was the one who was responsible for coordinating and implementing the plan. The research results were communicated and/or published in phased scientific sessions of the Union Society of Medical Sciences and “Stomatologia” journal or other journals.

Besides the papers that were part of the working plan, entering as a binding rule for the teachers, he developed the so-called extra-up, which was not part of the research plans but expressing individual interests and passions of the staff. Professor Opriş performed in this additional task. Moreover, he directed numerous PhD theses in medicine.

As for his work in administrative and management activity Prof. Opriş proved successful, just like he did in areas like clinical, teaching and research. Between 1968 and 1970 he took over the Faculty of Dentistry of Cluj. In this period he had shown a remarkable interest for dental education modernization, especially after WHO Conference in Copenhagen, in 1968, in which he took part and whose aim was to organize the dental education [2].

To optimize the teaching conditions of the faculty, he made considerable efforts in order to create a lecture room in the building belonging to the clinic, on Motilor Street No. 33. Consequently, the Faculty of Dentistry gained a new space, which has proved to be of remarkable utility until today.

He also organized space required for Biochemistry and Pathology laboratories, units that served both the clinical and research work. These accomplishments were beneficial both for the Faculty and for the clinic. In the same manner, he contributed to the enrichment of the documentary material in the library of the Faculty of Dentistry.

It is further noted as a remarkable achievement – the dental laboratory, used for pathology and clinical needs, profiled for teaching oral and maxillofacial prosthetics. In this laboratory, a rich educational material was developed, surgical and prosthetic facial masks representing a copy of real clinical situations, all used as visual aids in teaching. It is worth noting that, at that time, there was no question of media that is currently available, not only to us, but also in advanced countries.

The Radiology lab in the Clinic was also an achievement of Prof. Opriş. This medical facility became indispensable not only for clinical practice but also for teaching and research.

He periodically organized competitions for the Department and the Clinic to refresh and stimulate the staff with doctors and young teachers, aiming to contribute to the development of these units of health and education.

After a fruitful activity, in 1974, at the age of 65, he retired. He continued to coordinate scientific works for doctoral thesis until their completion. Sporadically, he worked in various hospitals and in the surgery office of Prosthetic Centre, located in Pavlov Street. He also worked in his private garden next to the Astronomical Observatory in Cluj, where he was concerned about the problem of grafting, which created moments of satisfaction and relaxation for him.

For his prodigious activity, in the educational and scientific field he was elected member of the Academy of Medical Sciences. For his stance and verticality in difficult historical moments he was awarded the title of Honorary Citizen of Cluj-Napoca.

He died in this city, to which he was tied from the first year of university studies. When he reached the age of 100 years, he still had a clear mind and he still wondered at the mysteries of life.