{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,29]],"date-time":"2026-05-29T02:01:42Z","timestamp":1780020102052,"version":"3.53.1"},"reference-count":6,"publisher":"Oxford University Press (OUP)","license":[{"start":{"date-parts":[[2026,5,28]],"date-time":"2026-05-28T00:00:00Z","timestamp":1779926400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/pages\/standard-publication-reuse-rights"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"abstract":"<jats:title>Abstract:<\/jats:title>\n                  <jats:p>Granulomatosis with polyangiitis (GPA) is a systemic vasculitis with frequent otolaryngologic manifestations, including nasal septal perforation (NSP) secondary to ischemic necrosis of the septal cartilage. While conservative therapy is often first-line, surgical repair may be indicated in patients with symptomatic or refractory perforations. Limited literature exists regarding septal perforation repair in patients with GPA. We report 1-year postoperative results on the case of a 19-year-old male with a 5-year history of GPA, medically controlled on immunosuppressive therapy, who presented with progressive nasal obstruction, crusting, epistaxis, and whistling. Nasal endoscopy demonstrated a 1.5\u2009\u00d7\u20091.5 cm septal perforation with surrounding mucosal ulceration. After conservative management failed to provide adequate symptom relief, the patient underwent open septorhinoplasty with nasal septal repair using a free temporoparietal fascia (TPF) graft wrapped around a polydioxanone sheet (PDS). The use of a free TPF-PDS composite graft offers structural support, promotes mucosal healing, and has shown promising success rates in non-vasculitic perforations. This case represents the first comprehensive report of successful septal perforation repair utilizing this technique in a medically-managed GPA patient on immunosuppression. TPF-PDS grafting may represent a viable and durable reconstructive option for septal perforation repair in GPA patients with controlled disease. This may also be a promising option for patients with nasal septal perforation in the context of other rheumatologic conditions.<\/jats:p>","DOI":"10.1093\/milmed\/usag236","type":"journal-article","created":{"date-parts":[[2026,5,15]],"date-time":"2026-05-15T11:42:30Z","timestamp":1778845350000},"source":"Crossref","is-referenced-by-count":0,"title":["Septal Perforation Repair in a Patient With Medically Managed Granulomatosis With Polyangiitis Using Temporoparietal Fascia With Polydioxanone Sheet"],"prefix":"10.1093","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-3326-3662","authenticated-orcid":false,"suffix":"LT","given":"Kelsey L","family":"Grolig","sequence":"first","affiliation":[{"name":"Walter Reed National Military Medical Center , Bethesda, MD 20889,","place":["United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jeffrey C","family":"Teixeira","sequence":"additional","affiliation":[{"name":"Walter Reed National Military Medical Center , Bethesda, MD 20889,","place":["United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2029-3010","authenticated-orcid":false,"suffix":"LT","given":"James J","family":"Pierre","sequence":"additional","affiliation":[{"name":"Walter Reed National Military Medical Center , Bethesda, MD 20889,","place":["United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2026,5,28]]},"reference":[{"key":"2026052821034932300_usag236-B1","doi-asserted-by":"publisher","first-page":"1121","DOI":"10.1016\/j.autrev.2014.08.017","article-title":"Granulomatosis with polyangiitis (Wegener): clinical aspects and treatment","volume":"13","author":"Comarmond","year":"2014","journal-title":"Autoimmun Rev"},{"key":"2026052821034932300_usag236-B2","doi-asserted-by":"publisher","first-page":"5","DOI":"10.1007\/s11882-018-0754-1","article-title":"Nasoseptal perforation: from etiology to treatment","volume":"18","author":"Pereira","year":"2018","journal-title":"Curr Allergy Asthma Rep"},{"key":"2026052821034932300_usag236-B3","doi-asserted-by":"publisher","first-page":"473","DOI":"10.1016\/S1081-1206(10)60373-0","article-title":"Pathophysiology and progression of nasal septal perforation","volume":"99","author":"Lanier","year":"2007","journal-title":"Ann Allergy Asthma Immunol"},{"key":"2026052821034932300_usag236-B4","doi-asserted-by":"publisher","first-page":"319","DOI":"10.1001\/jamafacial.2019.0020","article-title":"Outcomes of nasal septal perforation repair using combined temporoparietal fascia graft and polydioxanone plate construct","volume":"21","author":"Morse","year":"2019","journal-title":"JAMA Facial Plast Surg"},{"key":"2026052821034932300_usag236-B5","doi-asserted-by":"publisher","first-page":"40","DOI":"10.1097\/00006534-200001000-00007","article-title":"Temporoparietal fascia: an anatomic and histologic reinvestigation with new potential clinical applications","volume":"105","author":"Tellio\u011flu","year":"2000","journal-title":"Plast Reconstr Surg"},{"key":"2026052821034932300_usag236-B6","doi-asserted-by":"publisher","first-page":"527","DOI":"10.1177\/00034894221098704","article-title":"Endoscopic techniques for nasal septal perforation repair: a systematic review","volume":"132","author":"Gravina","year":"2023","journal-title":"Ann Otol Rhinol Laryngol"}],"container-title":["Military Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/academic.oup.com\/milmed\/advance-article-pdf\/doi\/10.1093\/milmed\/usag236\/68427787\/usag236.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/milmed\/advance-article-pdf\/doi\/10.1093\/milmed\/usag236\/68427787\/usag236.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,5,29]],"date-time":"2026-05-29T01:03:51Z","timestamp":1780016631000},"score":1,"resource":{"primary":{"URL":"https:\/\/academic.oup.com\/milmed\/advance-article\/doi\/10.1093\/milmed\/usag236\/8697635"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,5,28]]},"references-count":6,"URL":"https:\/\/doi.org\/10.1093\/milmed\/usag236","relation":{},"ISSN":["0026-4075","1930-613X"],"issn-type":[{"value":"0026-4075","type":"print"},{"value":"1930-613X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,5,28]]},"article-number":"usag236"}}