The role of surgery in antineutrophil cytoplasmic antibody–associated vasculitides affecting the nose and sinuses: A systematic review

Abstract

<jats:sec><jats:title>Background:</jats:title><jats:p> The ear, nose and throat region has been reported to be one of the commonest sites involved in antineutrophil cytoplasmic antibody (ANCA)–associated vasculitis diseases and often precedes the diagnosis of ANCA–associated vasculitis by many months. Although treatment for ANCA–associated vasculitis primarily requires systemic immunosuppressive therapy, there are specific indications for sinonasal surgery during the course of the disease process. The three major roles for surgery in sinonasal vasculitis are to aid diagnosis through biopsy, enable symptom relief and nasal reconstructive surgery consideration when in remission. </jats:p></jats:sec><jats:sec><jats:title>Purpose:</jats:title><jats:p> The aim of this systematic review is to provide an overview of the surgical procedures which can be performed in patients with ANCA–associated vasculitis presenting with sinonasal involvement. </jats:p></jats:sec><jats:sec><jats:title>Materials and methods:</jats:title><jats:p> A systematic literature search was performed for scientific articles on MEDLINE (PubMed Advanced MEDLINE Search) and EMBASE. The search included all articles up to April 2020. </jats:p></jats:sec><jats:sec><jats:title>Conclusion:</jats:title><jats:p> Surgical intervention during the active phase of ANCA–associated vasculitis disease can improve the patient’s symptoms and enable histological diagnosis. The surgical decision to manage the nose requires a multidisciplinary approach involving the vasculitis specialist and the ear, nose and throat surgeon. Nasal reconstruction can be performed to restore form and function but only when the disease is in remission so as to maximise success and minimise complications. </jats:p></jats:sec>

Vaskulitis mimics

“…In diesem Stadium lassen sich in ca. 50% der Fälle keine ANCA nachweisen, häufig ist eine bioptische Sicherung notwendig, die aus Gewebe aus dem HNO-Trakt aber ebenfalls nur in 50% der Fälle gelingt 49 50 51 .…”

Ear, nose, and throat in ANCA-associated vasculitis: a comprehensive review

“…It is recommended to take multiple large biopsies (> 5 mm) from the edge of the inflamed area, in order to maximize the chance of obtaining a diagnostic biopsy [71] . It is rare to see at the same time all the typical features, including necrotizing granulomata with giant cells and neutrophil-predominant vasculitis [72] . Indeed, non-specific features, such as acute or chronic inflammation, are usually found in most head and neck biopsy specimens, which does not help in confirming the diagnosis of AAV [73] .…”

Olfactory dysfunction in antineutrophil cytoplasmic antibody-associated vasculitides: A review of the literature

“…However, while indications for oral GC for OD in AAV patients may be reviewed in light of the previously described findings[ 8 , 31 ], the use of topical GC should be weighed up in patients presenting with crusting and epistaxis due to the possibility of an increased risk of bleeding and mucosal dryness with subsequent crusting and local infections. Management of septal perforations, either conservatively or surgically[ 34 , 35 ], should be considered due to the possible relationship between airflow alteration and the consequent obstacle for odour molecules to reach the olfactory cleft. Importantly, if surgical closure of the perforation is planned, it should only be performed when the disease is in remission so as to minimise complications[ 34 ].…”

“…Management of septal perforations, either conservatively or surgically[ 34 , 35 ], should be considered due to the possible relationship between airflow alteration and the consequent obstacle for odour molecules to reach the olfactory cleft. Importantly, if surgical closure of the perforation is planned, it should only be performed when the disease is in remission so as to minimise complications[ 34 ].…”