15 Nose and Nasal Skin Changes Associated With Rosacea and Autoimmune Conditions

5. Granulomatosis with Polyangiitis - Saddle Nose Deformity

Granulomatosis with polyangiitis (GPA), formerly known as Wegener's granulomatosis, can cause devastating nasal and sinus manifestations, with saddle nose deformity representing one of the most characteristic and severe complications. This deformity results from chronic granulomatous inflammation affecting the nasal cartilage and bone, leading to destruction of the nasal septum and loss of structural support for the nasal bridge. The pathophysiology involves necrotizing granulomatous inflammation with giant cells, epithelioid cells, and areas of necrosis that progressively destroy normal tissue architecture. Early nasal symptoms may include persistent rhinorrhea, epistaxis, nasal crusting, and anosmia, which can precede the development of obvious external deformity by months or years. The progressive nature of cartilage destruction means that early diagnosis and aggressive immunosuppressive treatment are crucial for preventing irreversible structural damage. Advanced cases may require complex reconstructive surgery to restore nasal function and appearance, though the underlying inflammatory process must be controlled before surgical intervention. The presence of nasal involvement in GPA often indicates more severe systemic disease and may be associated with pulmonary and renal manifestations. Regular monitoring with nasal endoscopy and imaging studies is essential for detecting early changes and adjusting treatment accordingly to prevent progression to saddle nose deformity.