Nasal reconstruction in advanced sinunasal sarcoidosis

Sarcoidosis can lead to devastating nasal deformities and impairment of nasal respiratory function. There is only very little published experience with nasal reconstruction in this disease entity. In general, a cautious attitude prevails out of fear of complications or failure due to the underlying granulomatous inflammation.

A 57-year-old lady presented to our institution with a 20-year history of sarcoidosis with sinunasal involvement. The findings included a saddle nose deformity, absent nasal septum and conchae, left-sided alar collapse and cutaneous involvement of the nasal tip with discoloration. In a first procedure, we performed a reconstructive nasal surgery with porous polyethylene grafts. In a second procedure, we used a paramedian forehead flap for a partial nasal reconstruction. The functional and asthetic improvement was very satisfactory for the patient during the 2-year follow-up period.

This is the first reported use of a forehead flap in nasal sarcoidosis. It demonstrates that major reconstructive nasal surgery and implantation of porous polyethylene grafts can successfully be performed in patients with sinonasal sarcoidosis during remission.