What are the most effective techniques for reconstructive rhinoplasty in the setting of granulomatosis with polyangiitis disease?
In this systematic review, the success rate of rhinoplasty was similar to published rates, but the overall complication rate was higher. The use of autologous tissue and L-shaped struts for reconstruction had the lowest complication rate; complications appear to increase as the number of individual grafts increases.
Reconstructive rhinoplasty techniques should focus on the use of autologous tissue and L-shaped struts over individual grafts in patients with granulomatosis with polyangiitis disease.
Repairing the saddle nose deformity in the setting of granulomatosis with polyangiitis disease is a rare but challenging situation for any surgeon. Given that the available data in the literature is based on case reports and small case series, there is little evidence available to help delineate which reconstructive techniques are optimal.
To examine which techniques were most successful in reconstructive rhinoplasty for a saddle nose deformity secondary to granulomatosis with polyangiitis.
PubMed, MEDLINE, Cochrane Collaboration Databases, and Web of Science were searched using the terms Wegener’s granulomatosis or granulomatosis with polyangiitis cross-referenced with saddle nose deformity or acquired nasal deformity. These databases were supplemented with 2 cases from Boston Medical Center. Databases were queried from inception of article collection through December 14, 2015, to identify publications reporting the repair of a saddle nose deformity and granulomatosis with polyangiitis.
A total of 10 studies met inclusion criteria yielding a cohort of 44 patients. The overall success rate for rhinoplasty, both primary and secondary, was 84.1% (37 of 44 patients), with a complication rate of 20%. The use of a single L-shaped graft fared better than individually placed grafts. An increased risk of graft failure was noted as the number of overall grafts increased and if nonautologous tissue was used.
Conclusions and Relevance
Rhinoplasty for saddle nose deformity is a safe and effective procedure in the setting of granulomatosis with polyangiitis. In the face of this disease, reconstruction should focus on placing a robust, L-shaped strut graft with autologous tissue over individual grafts. Additionally, the use of split-calvarial bone appears to have a slightly lower complication rate over costal cartilage.
Ezzat WH, Compton RA, Basa KC, Levi J. Reconstructive Techniques for the Saddle Nose Deformity in Granulomatosis With PolyangiitisA Systematic Review. JAMA Otolaryngol Head Neck Surg. Published online December 15, 2016. doi:10.1001/jamaoto.2016.3484