Page 56 - Read Online

Page 6 of 8 Hegazy et al. Vessel Plus 2021;5:46 https://dx.doi.org/10.20517/2574-1209.2021.52

certain circumstances. Staphylococcus aureus is a common nasal commensal bacteria and is an independent
risk factor for relapses in GPA (7-fold relative risk of relapse in chronic nasal carriers). Therefore long-term
[32]
prophylaxis with sulfamethoxazole and trimethoprim is recommended .

The need for endoscopic sinus surgery (ESS) is exceedingly rare. The main role for ESS remains mainly
managing complications or intolerable manifestations after exhaustion of all other possible medical
therapies. Surgery is extremely difficult given the expected alteration of anatomy by extensive scarring,
structural destruction, and previous surgeries.

Sino-nasal GPA can lead to recurrent dacryocystitis, indicating endoscopic dacryocystorhinostomy,
mucocele, or pyocele, indicating endoscopic drainage, and/or bone necrosis indicating endoscopic
debridement. In cases of saddle nose deformity, rhinoplasty with structural bone grafting can improve the
cosmetic and functional outcome after systemic control of disease for at least 12 months [33,34] .

On the other hand, the role of surgery is crucial in cases of laryngeal involvement. Life-threatening airway
compromise calls for urgent surgical intervention mainly tracheostomy as cricothyroidotomy will not
bypass the subglottic obstruction.

Long-term management of airway narrowing utilizes a combination of endoscopic and open surgery.
Endoscopic laryngeal dilation with rigid or balloon dilators can achieve a satisfactory outcome. This can be
further aided by local injection of intralesional steroids or mitomycin C. Transoral carbon dioxide laser has
also been used to resect fibrous bands while ensuring safe hemostasis. Split or augmentation of the cricoid
cartilage by open surgery can help widen the narrowed subglottis. On the rare occasion of tracheal
involvement solely with mature fibrosis and inactive disease, open resection of affected segment and re-
anastomosis can lead to successful decannulation [10-12,35] .

CONCLUSION
A multidisciplinary approach for the management of cases with GPA is mandatory for proper early
diagnosis and treatment. Although immunosuppressive therapy is the keystone of management of GPA,
local therapies do improve the patient's quality of life and - in some cases - are life-saving.

DECLARATIONS
Authors’ contribution
Wrote and reviewed the manuscript: Hegazy MT, Ahmed H, Eltelety AM

Availability of data and materials
Not applicable.

Financial support and sponsorship
None.

Conflict of interests
All authors declared that there are no conflicts of interest.

Ethical approval and consent to participate
Not applicable.