History of surgical rhinoplasty[edit]

Main article:History of rhinoplasty

Plates vi & vii of the Edwin Smith Papyrus at the Rare Book Room,New York Academy of Medicine[1]

The Indian physician Sushruta developed early techniques for reconstructive nose surgery. (c. 800 BC)

Treatments for the plastic repair of a broken nose are first mentioned in theEdwin Smith Papyrus,[2]a transcription of an Ancient Egyptian medical text, the oldest known surgical treatise, dated to theOld Kingdomfrom 3000 to 2500 BC.[3]Rhinoplasty techniques were carried out inancient Indiaby theayurvedicphysicianSushruta(c. 800 BC), who described reconstruction of the nose in theSushruta samhita(c. 500 BC), his medicosurgical compendium. The physician Sushruta and his medical students developed and appliedplastic surgicaltechniques for reconstructing noses, genitalia, earlobes, et cetera, that were amputated as religious, criminal, or military punishment. Sushruta also developed theforehead flap rhinoplastyprocedure that remains contemporary plastic surgical practice. In theSushruta samhitacompendium, the physician Sushruta describes the (modern) free-graft Indian rhinoplasty as the Nasikasandhana.

The Roman encyclopaedist Aulus Cornelius Celsus.

During theRoman Empire(27 BC AD 476) the encyclopaedistAulus Cornelius Celsus(c. 25 BC AD 50) published the 8-tomeDe Medicina(On Medicine, c. AD 14), which described plastic surgery techniques and procedures for the correction and the reconstruction of the nose and other body parts.[4]

At theByzantineRoman court of the EmperorJulian the Apostate(AD 331363), the royal physicianOribasius(c. AD 320400) published the 70-volumeSynagogue Medicae(Medical Compilations, AD 4th century), which described facial-defect reconstructions that featured loosesuturesthat permitted asurgicalwound to heal without distorting the facial flesh; how to clean the bone exposed in a wound;debridement, how to remove damaged tissue to forestallinfectionand so accelerate healing of thewound; and how to useautologous skin flapsto repair damaged cheeks, eyebrows, lips, and nose, to restore the patients normalvisage.

Nonetheless, during the centuries of the EuropeanMiddle Ages(AD 5th 15th centuries) that followed the Imperial Roman collapse (AD 476), the 5th-century BC Asianplastic surgeryknowledge of theSushruta samhitawent unknown tothe Westuntil the 10th century AD, with the publication, inOld English, of the Anglo-Saxon physicians manualBald's Leechbook(c. AD 920) describing the plastic repair of acleft lip; as a medical compendium, theLeechbookis notable for categorizing ailments and treatments asinternal medicineand as external medicine, for providingherbal medicalremedies, and for providing supernatural incantations (prayers), when required.

The Ottoman rhinoplast physician erafeddin Sabuncuolu (13851468).

In the 11th century, at Damascus, the ArabphysicianIbn Abi Usaibia(12031270) translated theSushruta samhitafromSanskrittoArabic. In due course, Sushrutas medical compendium travelled fromArabiatoPersiatoEgypt, and, by the 15th century, Western Europeanmedicinehad encountered it as the medical atlasCerrahiyet-ul Haniye(Imperial Surgery, 15th century), byerafeddin Sabuncuolu(13851468); among its surgical techniques featured abreast reductionprocedure.[5][6]

In Italy,Gasparo Tagliacozzi(15461599), professor ofsurgeryandanatomyat the University of Bologna, publishedCurtorum Chirurgia Per Insitionem(The Surgery of Defects by Implantations, 1597), a technicoprocedural manual for thesurgicalrepair and reconstruction of facial wounds in soldiers. The illustrations featured a re-attachment rhinoplasty using abiceps musclepedicle flap; the graft attached at 3-weeks post-procedure; which, at 2-weeks post-attachment, the surgeon then shaped into a nose.[7]

In time, the 5th-century BC Indian rhinoplasty technique featuring afree-flap graft was rediscovered by Western medicine in the 18th century, during theThird AngloMysore War(17891792) of colonial annexation, by the British against Tipu Sultan, when theEast India Companysurgeons Thomas Cruso and James Findlay witnessed Indian rhinoplasty procedures at the British Residency in Poona. In the English-languageMadras Gazette, the surgeons published photographs of the rhinoplasty procedure and its nasal reconstruction outcomes; later, in the October 1794 issue of theGentleman's Magazineof London, the doctors Cruso and Findlay published an illustrated report describing a forehead pedicle-flap rhinoplasty that was a technical variant of the free-flap graft technique thatSushrutahad described some twenty-three centuries earlier.[8]

In 1815, Dr. Karl Ferdinand von Grfe wrote a book about rebuilding the human nose.

Pre-dating the IndianSushruta samhitamedical compendium is theEbers Papyrus(c. 1550 BC), anAncient Egyptianmedical papyrusthat describes rhinoplasty as theplastic surgicaloperation for reconstructing a nose destroyed by rhinectomy, such a mutilation was inflicted as a criminal, religious, political, and military punishment in that time and culture.[9]In the event, the Indian rhinoplasty technique continued in 19th-century Western European medicine; in Great Britain,Joseph Constantine Carpue(17641846) published theAccount of Two Successful Operations for Restoring a Lost Nose(1815), which described two rhinoplasties: the reconstruction of a battle-wounded nose, and the repair of anarsenic-damaged nose. (cf.Carpues operation)[5][10]

The polymath Johann Friedrich Dieffenbach contributed one of the foundation texts of the plastic surgery specialty. (1840)

In Germany, rhinoplastic technique was refined by surgeons such as the Berlin University professor of surgeryKarl Ferdinand von Grfe(17871840), who publishedRhinoplastik(Rebuilding the Nose, 1818) wherein he described fifty-five (55) historical plastic surgery procedures (Indian rhinoplasty, Italian rhinoplasty, etc.), and his technically innovative free-graft nasal reconstruction (with a tissue-flap harvested from the patients arm), and surgical approaches to eyelid,cleft lip, andcleft palatecorrections. Dr. von Grfes protg, themedicalandsurgicalpolymathJohann Friedrich Dieffenbach(17941847), who was among the first surgeons to anaesthetize the patient before performing the nose surgery, publishedDie Operative Chirurgie(Operative Surgery, 1845), which became a foundational medical andplastic surgicaltext. (seestrabismus,torticollis) Moreover, the PrussianJacques Joseph(18651934) publishedNasenplastik und sonstige Gesichtsplastik(Rhinoplasty and other Facial Plastic Surgeries, 1928), which described refined surgical techniques for performing nose-reduction rhinoplasty via internal incisions.[11]

In the United States, in 1887, the otolaryngologist John Orlando Roe (18481915) performed the first modern endonasal rhinoplasty (closed rhinoplasty), about which he reported in the articleThe Deformity Termed Pug Nose and its Correction, by a Simple Operation(1887), and about his management of saddle nose deformities.[12][13]

In the early 20th century, Freer, in 1902, and Killian, in 1904, respectively pioneered theSubmucous Resectionseptoplasty (SMR) procedure for correcting a deviatedseptum; they raised mucoperichondrial tissue flaps, and resected thecartilaginousandbonyseptum(including thevomer boneand the perpendicular plate of theethmoid bone), maintaining septal support with a 1.0-cm margin at the dorsum and a 1.0-cm margin at the caudad, for which innovations the technique became the foundational, standardseptoplasticprocedure. In 1921, A. Rethi introduced the open rhinoplasty approach featuring an incision to the columella to facilitate modifying the tip of the nose.[14]In 1929, Peer and Metzenbaum performed the first manipulation of the caudal septum, where it originates and projects from the forehead. In 1947, Maurice H. Cottle (18981981) endonasally resolved a septal deviation with a minimalist hemitransfixion incision, which conserved the septum; thus, he advocated for the practical primacy of the closed rhinoplasty approach.[9]In 1957, A. Sercer advocated the decortication of the nose (Dekortication des Nase) technique which featured a columellar-incision open rhinoplasty that allowed greater access to thenasal cavityand to thenasal septum.

Nonetheless, at mid20th century, despite such refinement of the open rhinoplasty approach, the endonasal rhinoplasty was the usual approach to nose surgery until the 1970s, when Padovan presented his technical refinements, advocating the open rhinoplasty approach; he was seconded by Wilfred S. Goodman in the later 1970s, and by Jack P. Gunter in the 1990s.[15][16]Goodman impelled technical and procedural progress with the articleExternal Approach to Rhinoplasty(1973), which reported his technical refinements and popularized the open rhinoplasty approach.[17]In 1982, Jack Anderson reported his refinements of nose surgery technique in the articleOpen Rhinoplasty: An Assessment(1982).[18]During the 1970s, the principal application of open rhinoplasty was to the first-time rhinoplasty patient (i.e. a primary rhinoplasty), not as a revision surgery (i.e. a secondary rhinoplasty) to correct a failed nose surgery. In 1987, in the articleExternal Approach for Secondary Rhinoplasty(1987), Jack P. Gunter reported the technical effectiveness of the open rhinoplasty approach for performing a secondary rhinoplasty; his improved techniques advanced the management of a failed nose surgery.[19]

Hence does contemporary rhinoplastic praxis derive from the primeval (c. 600 BC) Indian rhinoplasty (nasal reconstruction via an autologous forehead-skin flap) and its technical variants: Carpues operation, the Italian rhinoplasty (pedicle-flap reconstruction, aka the Tagliocotian rhinoplasty); and the closed-approach endonasal rhinoplasty, featuring exclusively internal incisions that allow the plastic surgeon to palpate (feel) the corrections being effected to the nose.[20]

Non-surgical rhinoplasty[edit]