**11. Nasal base surgery**

The nasal base is a triangular view of the nose that is formed by two nostrils, nasal columella that separates these two nostrils and nasal lobule or the area above the nostrils. Nasal base surgery is usually based on thorough preoperative evaluations. It should be kept in mind that this stage of rhinoplasty is quite irreversible and any mistake in design or incision line will result in valve incompetency, nasal base deformity and visible scars (Figure 16).

#### **11.1. Suturing and taping**

After finishing the operation the skin flap is turned back to its proper place and all the details are checked several times. When the surgeon is sure that the desired result is achieved, suturing is done. As a rule, all the incisions must be closed by sutures to avoid unfavorable scars or dead spaces. It is suggested to irrigate the wound during suturing to avoid clot formation over incision lines. The incisions are immediately covered by antibiotic ointment. Taping helps to control dead spaces and edema; after suturing, a one centimeter tape is applied to re-drape the skin flap over newly formed cartilaginous and bony structure. This taping is applied imme‐ diately after suturing and is continued for one month or longer after operation.

#### **11.2. Intranasal splint fixation**

Internal splints usually have small tubes that help the patient breathe through the nose in the first post-operative days. It's believed that internal splints prevent intranasal edema and

**Figure 16.** Nasal base surgery

synechia. Internal splints may be removed after 24 hours; however, it is possible to preserve it for one week or longer according to septal or turbinate manipulations done during surgery. **Suturing and taping** After finishing the operation the skin flap is turned back to its proper place and all

**Figure 16: Nasal base surgery**

**External splint application**

#### **11.3. External splint application** the details are checked several times. When the surgeon is sure that the desired

External splints are usually thermoplastic stents softened in warm water and trimmed to provide suitable protection. The splint is gently placed over the taped nose. Irrigation with cold water will fix the splint in place. The splint is held for 5 days to one week. It is believed that external splints will hold the bony segments in their new position and will help the skin envelope re-drape over its new structure [33-35]. result is achieved, suturing is done. As a rule, all the incisions must be closed by sutures to avoid unfavorable scars or dead spaces. It is suggested to irrigate the wound during suturing to avoid clot formation over incision lines. The incisions are immediately covered by antibiotic ointment. Taping helps to control dead spaces and edema; after suturing, a one centimeter tape is applied to re‐drape the skin

flap over newly formed cartilaginous and bony structure. This taping is applied

#### **11.4. Post-operative care** immediately after suturing and is continued for one month or longer after

Careful post-operative care will help the operated nose achieve its ideal shape in a predictable period of time. Sutures are usually removed in 5-7 post-operative days. Internal and external splints are usually removed on the same day though in some cases due to some specific indications such as extensive septoplasty splints may be preserved for a longer period of time. Clot and debris are gently cleaned in periodic postoperative visits. Frequent normal saline rinse by the patient and phenylephrine drops (only for three days after operation) may help the patient breathe better in the immediate post-op period. Taping is continued for one month. Patients are asked to avoid moderate sport activities for one month though vigorous activities such as contact sports or professional exercises are best postponed for three months. .operation **Intranasal splint fixation** Internal splints usually have small tubes that help the patient breathe through the nose in the first post‐operative days. It's believed that internal splints prevent intranasal edema and synechia. Internal splints may be removed after 24 hours; however, it is possible to preserve it for one week or longer according to septal or .turbinate manipulations done during surgery

#### **11.5. Important points**

**1.** Diluted corticosteroids (triamcinolone) may be beneficial to control the edema and granulation tissues post-operatively. External splints are usually thermoplastic stents softened in warm water and trimmed to provide suitable protection. The splint is gently placed over the taped

nose. Irrigation with cold water will fix the splint in place. The splint is held for 5

