Septal Perforation Repair in a Patient With Medically Managed Granulomatosis With Polyangiitis Using Temporoparietal Fascia With Polydioxanone Sheet

Granulomatosis with polyangiitis (GPA) is a systemic vasculitis with frequent otolaryngologic manifestations, including nasal septal perforation (NSP) secondary to ischemic necrosis of the septal cartilage. While conservative therapy is often first-line, surgical repair may be indicated in patients with symptomatic or refractory perforations. Limited literature exists regarding septal perforation repair in patients with GPA. We report 1-year postoperative results on the case of a 19-year-old male with a 5-year history of GPA, medically controlled on immunosuppressive therapy, who presented with progressive nasal obstruction, crusting, epistaxis, and whistling. Nasal endoscopy demonstrated a 1.5 × 1.5 cm septal perforation with surrounding mucosal ulceration. After conservative management failed to provide adequate symptom relief, the patient underwent open septorhinoplasty with nasal septal repair using a free temporoparietal fascia (TPF) graft wrapped around a polydioxanone sheet (PDS). The use of a free TPF-PDS composite graft offers structural support, promotes mucosal healing, and has shown promising success rates in non-vasculitic perforations. This case represents the first comprehensive report of successful septal perforation repair utilizing this technique in a medically-managed GPA patient on immunosuppression. TPF-PDS grafting may represent a viable and durable reconstructive option for septal perforation repair in GPA patients with controlled disease. This may also be a promising option for patients with nasal septal perforation in the context of other rheumatologic conditions.