Evolution of Rhinology

“The longer you look back, the further you can look”

—W. Churchill

Summary

The study of the nose is as old as civilisation. Various conditions affecting its structure and function has been documented in Edwin Smith Papyrus in hieroglyphic script, an Egyptian writing system of the mid −4th Millennium BC.The major contribution for the complete reconstruction of the nose originated in India by Sushruta in around 600 BC. Writing in Sanskrit in the form of verses he described in detail the technique of total reconstruction, which is still being practiced today as Indian Rhinoplasty. This surgical reconstruction paved the way to modern plastic surgery in Europe and United States in 18th century. Sushruta contributed not only to the plastic surgery of the nose, but described entire philosophy of Head and Neck and other surgery as well. Other notable contributors were Greek physicians, Hippocrate and Galen, and at the birth of the Christianity, Celsus wrote eight books of medical encyclopaedia, which described various conditions affecting nose.

Septal and Sinus surgery, in comparison to rhinoplasty did not develop until 17th century. Septal surgery began with total septectomy, sub mucous resection by Killian & Freer in early 20th century and later septoplasty by Cottle in middle of 20th century.

Sinus surgery probably originated in Egypt, where instruments were used to remove brain through the ethmoid sinuses as part of the mummification process. In 18th century, empyema of the maxillary sinus was drained through the tooth socket or anterior wall of the sinus, which lead to the evolution of radical procedures of removal of mucous membrane and inferior meatal antrostomy. In the late 20th century, improved understanding of the mucociliary mechanism described by Prof. Messerklinger and Nasal Endoscopy described by Prof. Draf with the development of fibre optics and CT imaging, heralded a new era, which evolved in functional endoscopic sinus surgery. New technology further enhanced the scope of endoscope being used “around and beyond” the nose.