Reconstruction of Wegener's nasal deformity using bilateral facial artery musculomucosal flaps

The nasal deformity associated with Wegener's granulomatosis has been well described. As the disease progresses, there is destruction of septal cartilage, which leads to a saddle-nose deformity. Reconstruction of this defect necessitates replacement of dorsal and columellar support. These efforts are often limited by deficits in nasal lining, because the nasal mucosa is destroyed by progressive vasculitis. We present a case of a patient with quiescent Wegener's granulomatosis whose saddle-nose deformity was reconstructed using costal cartilage for support and bilateral facial artery musculomucosal (FAMM) flaps for nasal lining replacement. A second procedure was required at 3 months to debulk the intranasal pedicles of the FAMM flap.