Department of Otolaryngology Head and Neck Surgery, Prince Sultan Military Medical City, Riyadh.
Department of Otolaryngology Head and Neck Surgery, Prince Mohammed Medical City, Jouf.
J Craniofac Surg. 2023;34(8):2347-2351. doi: 10.1097/SCS.0000000000009721. Epub 2023 Sep 4.
Granulomatosis with polyangiitis (GPA) is a vasculitis that affects respiratory and kidney vessels. It primarily involves the nose and sinuses but can progress systemically. Granulomatosis with polyangiitis causes severe nasal deformities, impacting aesthetics and breathing. Literature focuses on rhinoplasty for saddle nose deformities in non-GPA patients, but its suitability for GPA patients remains uncertain.
Our study aims to assess the effectiveness and safety of rhinoplasty in GPA patients by analyzing the existing literature.
Four databases were searched; 2 reviewers independently screened the retrieved references, then relevant data for our study were extracted. Categorical outcomes were analyzed using pooled proportions and 95% CI. Statistical heterogeneity was assessed using the I2 statistics χ 2 test with a P -value lower than 0.1 indicating heterogeneity.
In our systematic review and meta-analysis, we incorporated 16 studies encompassing 136 patients who underwent nasal reconstruction as part of their treatment for GPA. The collective findings indicate a favorable success rate for rhinoplasty, with a pooled ratio of 89% (95% CI: 84%, 95%). The rate of revision surgeries was relatively low, with a pooled rate of 19% (95% CI: 12%, 26%). Furthermore, rhinoplasty demonstrated comparatively lower rates of recurrence (pooled rate: 22%, 95% CI: 3%, 42%) and complications (pooled rate: 12%, 95% CI: 7%, 18%).
Rhinoplasty benefits GPA patients with saddle nose deformity and septal perforation with high success rates and low recurrence, revision, and complication outcomes. However, more research is needed for validation and refinement.
肉芽肿性多血管炎（GPA）是一种影响呼吸道和肾脏血管的血管炎。它主要累及鼻子和鼻窦，但也可以全身进展。GPA 会导致严重的鼻畸形，影响美观和呼吸。文献主要集中在非 GPA 患者的鞍鼻畸形的鼻整形术，但其在 GPA 患者中的适用性仍不确定。
通过分析现有文献，评估 GPA 患者鼻整形术的有效性和安全性。
检索了四个数据库；两名审查员独立筛选检索到的参考文献，然后提取与我们研究相关的数据。使用汇总比例和 95%置信区间分析分类结果。使用 I 2 统计量 χ 2 检验评估统计异质性，P 值低于 0.1 表示存在异质性。
在我们的系统评价和荟萃分析中，我们纳入了 16 项研究，共纳入 136 例接受鼻重建术的 GPA 患者。综合研究结果表明，鼻整形术的成功率较高，汇总比率为 89%（95%CI：84%，95%）。修复手术的比率相对较低，汇总比率为 19%（95%CI：12%，26%）。此外，鼻整形术的复发率（汇总率：22%，95%CI：3%，42%）和并发症发生率（汇总率：12%，95%CI：7%，18%）也相对较低。
鼻整形术有利于 GPA 患者治疗鞍鼻畸形和鼻中隔穿孔，成功率高，复发、修复和并发症发生率低。然而，还需要更多的研究来验证和改进。
