Hereditary hemorrhagic telangiectasis treated by the harmonic scalpel.
BACKGROUND
Hereditary hemorrhagic telangiectasis (HTT) is a familial autosomal dominant genetic disorder that causes abnormalities of the wall of peripheral blood vessels. Severe nosebleed often is the dominant symptom. A variety of therapies have been proposed for epistaxis control in HHT but with limited success.


METHODS
We report two cases of HHT in which recurrent nasal bleeding was successfully controlled using the Harmonic Scalpel.


RESULTS
Use of the Harmonic Scalpel avoids the carbonization and incrustation of the nasal mucosa that commonly results from electrocautery and laser irradiation. Even during active bleeding, hemostasis can be achieved by repeated applications of the scalpel blade.


CONCLUSIONS
This method can be performed quick and reliably on an outpatient basis. The Harmonic Scalpel may be the treatment of choice for recurrent epistaxis in HHT.
Ishibashi
Toshio
T
Department of Otolaryngology, Social Insurance Central General Hospital, 3-22-1, Hyakunincho, Shinnjuku-ku, Tokyo, 169-0073, Japan. tisibasi-oto@umin.ac.jp
Takamatsu
Shunsuke
S
D001777:Blood Coagulation; D005260:Female; D006488:Hemostasis, Surgical / Q000295:instrumentation*; D006801:Humans; D008875:Middle Aged; D009668:Nose Diseases / Q000473:pathology / Q000601:surgery*; D013683:Telangiectasia, Hereditary Hemorrhagic / Q000473:pathology / Q000601:surgery*; D014464:Ultrasonic Therapy / Q000295:instrumentation*