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May 2017

Reconstructive Techniques for the Saddle Nose Deformity in Granulomatosis With Polyangiitis: A Systematic Review

Author Affiliations
  • 1Department of Otolaryngology–Head and Neck Surgery, Boston University School of Medicine, Boston, Massachusetts
  • 2Department of Otolaryngology–Head and Neck Surgery, Tufts University School of Medicine, Boston, Massachusetts
JAMA Otolaryngol Head Neck Surg. 2017;143(5):507-512. doi:10.1001/jamaoto.2016.3484
Key Points

Question  What are the most effective techniques for reconstructive rhinoplasty in the setting of granulomatosis with polyangiitis disease?

Findings  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.

Meaning  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.


Importance  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.

Objective  To examine which techniques were most successful in reconstructive rhinoplasty for a saddle nose deformity secondary to granulomatosis with polyangiitis.

Evidence Review  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.

Findings  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.

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