Correction of the deviated septum: From ancient Egypt to the endoscopic era

Abstract

Background: Obstructed nasal breathing can occur due to deviation of the nasal septum. When the external nose appears grossly normal and cosmesis is not the focus, septoplasty has been the procedure used to straighten the septum with the goal of improving nasal airflow. Septoplasty has evolved over time. Methods: A historical literature review was conducted to look for primary source journal articles and medical conferences proccedings addressing the evolution of the septoplasty procedure. Results: Early techniques involved forcible fractures and splinting. Submucous resection was the first major advancement in surgical technique. Once the complications resulting from this technique were observed, it was subsequently revised with attempts to better address the caudal septal deviation. Attention was then turned to better incorporating the role surrounding support structures, such as the upper lateral cartilages. The premaxilla-maxilla approach attempted to address the overall nasal structure to best improve nasal breathing. The advent of endoscopic technique has been the most recent shift in surgical technique with improved visualization allowing for targeted septoplasty and reoperation on complicated cases including pituitary and skull base surgery. Conclusion: This paper discusses the evolution of septoplasty techniques over time from the initial undertakings of the ancient Egyptians to the modern-day septoplasty. While the principles behind septoplasty have remained much the same, experience has allowed for refinement of surgical technique. No doubt new instrumentations and innovations will further help to tailor the practice of septoplasty to the anatomy and functional needs of each individual patient.