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We perform nose reconstruction following (nasal) nose collapse from vasculitis such as Wegener’s (Granulomatosis with Polyangiitis (GPA) or other rheumatological conditions.

The first important point to make is any intervention must be made in conjunction with your Consultant Rheumatologist. Surgical intervention is timed for a period of inactivity ‘remission’ or when the disease process has gone into long-term remission ‘burnt out’.

Inflammation of the Blood Cells in the Nose

The vasculitis such as Wegener’s or otherwise known as Granulomatosis with Polyangiitis (GPA) causes an inflammation of the small and medium sized blood vessels. In the nose this causes inflammation in the muscosa. This results in a cycle of inflammation and healing with granulation (healing) tissue and that results in scarring. This process can be modified by the bacteria you contain within your nose amplifying this process.

Symptoms and Signs of Active Vasculitis

As this process continues there is often a stepwise progressive injury to the nose; mucosal bleeding, nasal stuffiness and crusting in the nose and occasionally nasal pain. Other systemic symptoms may include weight loss, shortness of breath, coughing up blood, blood clots, and skin rash if the lungs and kidneys or other organs are affected. These are all signs of disease activity and should initiate a medical review from your Rheumatologist. Endoscopic examination of your nose and white blood cell test, such as cANCA, PR3, and MPO, all of which are useful in monitoring disease activity.

How Saddle Nose Deformity Develops

As the cycle of inflammation and healing continues the cartilage in the septum is weakened secondarily to the inflammatory process. This can lead to a septal perforation (hole). As this perforation (hole) enlarges it can in some instances cause weakening of the support of the middle portion of the nose and can result in a saddle nose deformity in your nose.

If the septum is progressively damaged the saddle nose deformity worsens and the nose can become shortened and the tip of the nose rotates upwards.

Severe Damage to the Nose and Affected Blood Vessels

With further damage from a cycle of inflammation and healing, the inner lining of the nose begins to shrink through scarring and further shortening of the nose occurs.

The end result is a shortened upturned nose with deficiencies in the inner lining of the nose and cartilage framework. Please note only a small proportion of vasculitic patients develop saddle nose deformity.

In a very small minority of patients this inflammation can extend full thickness (all three layers of the nose) and results in a hole (fistula) between the skin and the nose (nasal cavity). These patients will then have deficiencies in all three layers of the nose (skin, cartilage, lining).

Nose Reconstruction for Vasculitis Patients

The type of reconstruction will change depending on the severity of the deformity for correction of Saddle Nose Deformity to Moderate Nose Reconstruction to Major Facial And (Nasal) Nose Reconstruction. But these deformities can be repaired when the patient is in remission.

See our article for Vasculitis.org.uk

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Nasal collapse from a vasculitic process which has produce a severe septal saddle nose deformity, reconstructed with rib cartilage in one operation.

Nose Vasculitis FAQs

What is vasculitis of the nose, and how does it affect nasal structure and function?

Vasculitis of the nose is when there is inflammation of the blood vessels in the nose and nasal passages. When left untreated, the vasculitis and inflammation can lead to damage to the nasal cartilage and the bone, resulting in impaired breathing and structural deformities to the nose, including full nasal collapse.

What are the common symptoms or signs that someone may need nasal reconstruction due to vasculitis?

Some of the common signs that you may need nasal reconstruction due to vasculitis include the collapse of the bridge of the nose (saddle nose deformity), nasal pain, perforation of the septum, difficulty breathing, and persistent crusting and bleeding. Dr. Faris will take your symptoms and concerns into consideration before deciding if nasal reconstruction is right for you.

How is a diagnosis of nasal vasculitis confirmed before considering surgery?

To diagnose nasal vasculitis, Dr. Faris will start by reviewing your medical history and list of medications, and then he will examine your nasal symptoms. We may also take a biopsy of the nose and run multiple tests before we finally diagnose and confirm vasculitis. If you are diagnosed with vasculitis, then surgery can be considered

At what stage in vasculitis treatment is nasal reconstruction typically recommended?

Dr. Faris typically recommends you wait until your vasculitis is in remission and there is no further inflammation for six months to two years before nasal reconstruction is recommended. By waiting until your vasculitis is in remission, we ensure you’re better able to heal and recover after surgery.

What types of nasal deformities are commonly treated in vasculitis patients?

Some of the types of nasal deformities commonly treated for vasculitis patients include saddle nose deformity, septal perforation, and full nasal collapse. The type of treatment and reconstruction needed will depend on the deformity you’re struggling with.

What surgical techniques are used to reconstruct the nose after vasculitis-related damage?

Some of the most common types of surgical techniques used to reconstruct the nose after vasculitis damage include septal perforation repair, saddle nose deformity repair, cartilage grafts, and soft tissue reconstruction. Which one is right for you will depend on the deformities you’re struggling with.

Is cartilage grafting always necessary for reconstruction in vasculitis cases?

Whether you need cartilage grafting will depend on the extent of your vasculitis and where the damage is on the nose. Generally, if there is significant cartilage loss, cartilage grafting is usually necessary. It may also be necessary if further support is needed for a more extensive nasal reconstruction.

How long is the recovery period following nasal reconstruction for vasculitis?

The initial recovery period after nasal reconstruction is about two weeks. During this time, it’s normal to experience bruising, swelling, and some discomfort. After a few months, your final nasal shape will become more obvious, but it can take up to a year for the nose to fully heal.

Will I need more than one surgery to achieve full correction?

It depends on the level of your nasal deformity. Some patients may need multiple surgeries to achieve the results they’re looking for. Dr. Faris will discuss your surgical plan during your appointment.

How does ongoing vasculitis or autoimmune disease management impact surgical outcomes?

Ongoing vasculitis and autoimmune diseases can increase the risk of infection after surgery, delay how long wound healing takes, and affect the results of your surgery. It’s why we recommend that your vasculitis be in remission before we perform nasal reconstruction surgery.

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EXECUTIVE DOCTOR

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CALLUM FARIS

ENT specialist and specialist in facial plastic surgery

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