3500 BC: The Ebers Papyrus, which contains the first known mention of rhinologic surgery, was written around this time in Egypt. Most of the procedures depicted in it were reconstructive because rhinectomy was a frequent form of punishment.
1757: Quelmatz was one of the earliest physicians to address septal deformities. His recommendation included daily digital pressure on the septum.
1875: Adams recommended fracturing and splinting of the septum.
Late 19th century: The most common operation in the United States was the Bosworth operation to correct nasal obstruction from nasal septal deviation. Using a specialized saw, the deviation was removed along with the corresponding mucosa. Results were suboptimal.
1882: Ingals introduced en bloc resection of small sections of septal cartilage. Because of this innovation, he is credited as the father of modern septal surgery. Around the same time, cocaine was becoming widely used in surgery. With its advent, anesthesia and hemostasis for nasal surgery improved significantly. Longer and more technically refined operations became feasible.
1899: Asch was the first to suggest altering the tensile curve of septal cartilage instead of resecting it. He proposed the use of full-thickness cruciate incisions.
1902 and 1904: Freer and Killian described the submucous resection (SMR) operation. This procedure is the foundation of modern septoplasty techniques. They advocated raising mucoperichondrial flaps and resecting the cartilaginous and bony septum (including the vomer and perpendicular plate of the ethmoid), leaving 1 cm dorsally and 1 cm caudally to maintain support.
1929: Metzenbaum and Peer were the first to manipulate the caudal septum, using a variety of techniques. The classic SMR was less effective in correcting this area of deviation. In addition, Metzenbaum advocated the use of the swinging door technique, and in 1937, Peer recommended removing the caudal septum, straightening it, and then replacing it in the midline position.
1947: Cottle introduced the hemitransfixion incision and the practice of conservative septal resections. Long-term follow-up studies of patients who had undergone SMR occasionally revealed dorsal saddling, retraction of the columnella, and alar widening; therefore, conservative resections during septoplasty were designed to avoid these complications.
