Aesthet Surg J. 2024 Aug 20;44(9):NP620-NP628. doi: 10.1093/asj/sjae114.
Granulomatosis with polyangiitis (Wegener's granulomatosis) causes progressive nasal collapse, nasal obstruction, and central face deformity. It is not known whether cartilaginous nasal reconstruction should be performed immediately or delayed until after disease "burnout."
The aims of this research regarding nasal collapse due to Wegener's granulomatosis were to (1) assess the functional and aesthetic outcomes following immediate vs delayed nasal reconstruction; and (2) measure the impact of psychosocial well-being (anxiety, depression, social isolation) in immediate vs delayed nasal reconstruction.
Wegener's patients with either immediate or delayed nasal surgery (n = 61) were compared. Functional and aesthetic severity were compared with the validated Standard Cosmesis and Health Nasal Outcome Survey (SCHNOS) score (t test). In addition, Patient-Reported Outcomes Measurement Information System (PROMIS) perioperative and 1-year follow-up surveys were analyzed.
At initial consultation, SCHNOS score severity types were similar for both groups (immediate vs delayed): mild 15% vs 15%; moderate 59% vs 60%, and severe 26% vs 25%. Over a 30 ± 4 month period, delayed surgery patients' conditions deteriorated, with a shift from mild to more severe SCHNOS scores, from 25% severe at initial consultation to 85% before surgery. PROMIS scores at presentation were high compared to the general public; by the time of delayed surgery, patients had significantly worsened: anxiety from 28 to 73; depression from 18 to 62; and social isolation from 20 to 80. Although both immediate and delayed groups improved after surgery in functional and psychosocial scores, the immediate surgery group's improvement was superior.
Data showed superior functional and aesthetic scores and superior psychosocial indicators with immediate cartilaginous nasal reconstruction, compared with waiting until disease burnout to undergo surgery.
肉芽肿性多血管炎（韦格纳肉芽肿）可导致进行性鼻塌陷、鼻阻塞和中面部畸形。目前尚不清楚是否应立即进行软骨鼻部重建，还是应延迟到疾病“缓解”后再进行。
本项针对韦格纳肉芽肿导致的鼻塌陷的研究旨在：（1）评估即刻与延迟鼻部重建后的功能和美学结果；（2）评估即刻与延迟鼻部重建对心理社会健康（焦虑、抑郁、社会孤立）的影响。
比较了 61 例接受即刻或延迟鼻部手术的韦格纳患者。使用经验证的标准美容和健康鼻部结局调查（SCHNOS）评分（t 检验）比较了功能和美学严重程度。此外，还分析了患者报告的结局测量信息系统（PROMIS）围手术期和 1 年随访调查。
在初次就诊时，两组患者的 SCHNOS 评分严重程度类型相似（即刻组与延迟组）：轻度 15%比 15%；中度 59%比 60%，重度 26%比 25%。在 30±4 个月的时间内，延迟手术患者的病情恶化，SCHNOS 评分从轻度转变为更严重的程度，从初始就诊时的 25%严重转变为手术前的 85%严重。与普通人群相比，PROMIS 评分在初次就诊时较高；但到了延迟手术时，患者的评分显著恶化：焦虑从 28 分增至 73 分；抑郁从 18 分增至 62 分；社会孤立从 20 分增至 80 分。尽管即刻和延迟两组患者在术后的功能和心理社会评分上均有所改善，但即刻手术组的改善效果更好。
与等待疾病缓解后再行手术相比，即刻软骨鼻部重建可获得更好的功能和美学评分，以及更优的心理社会指标。
