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Reconstructive Techniques for the Saddle Nose Deformity in Granulomatosis With Polyangiitis

Reconstructive Techniques for the Saddle Nose Deformity in Granulomatosis With Polyangiitis ImportanceRepairing 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. ObjectiveTo examine which techniques were most successful in reconstructive rhinoplasty for a saddle nose deformity secondary to granulomatosis with polyangiitis. Evidence ReviewPubMed, 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. FindingsA 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 RelevanceRhinoplasty 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. http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png JAMA Otolaryngology - Head & Neck Surgery American Medical Association

Reconstructive Techniques for the Saddle Nose Deformity in Granulomatosis With Polyangiitis

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References (35)

Publisher
American Medical Association
Copyright
Copyright 2016 American Medical Association. All Rights Reserved.
ISSN
2168-6181
eISSN
2168-619X
DOI
10.1001/jamaoto.2016.3484
pmid
27978568
Publisher site
See Article on Publisher Site

Abstract

ImportanceRepairing 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. ObjectiveTo examine which techniques were most successful in reconstructive rhinoplasty for a saddle nose deformity secondary to granulomatosis with polyangiitis. Evidence ReviewPubMed, 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. FindingsA 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 RelevanceRhinoplasty 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.

Journal

JAMA Otolaryngology - Head & Neck SurgeryAmerican Medical Association

Published: May 15, 2017

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