The impact of septodermoplasty and potassium-titanyl-phosphate (KTP) laser therapy in the treatment of hereditary hemorrhagic telangiectasia-related epistaxis.
BACKGROUND
A variety of modalities are available for the control of recurrent epistaxis in hereditary hemorrhagic telangiectasia (HHT). Laser ablation, in particular potassium-titanyl-phosphate (KTP), has gained popularity as it coagulates the telangiectasia with minimal peripheral tissue injury. Septodermoplasty (SDP) also can be performed in the day surgery setting. Telangiectasia recurred, necessitating repeated treatments. The frequency and interval between procedures is not well documented. The purpose of this study was to describe the frequency of surgical interventions for HHT patients and the impact of SDP.


METHODS
A retrospective review was undertaken of procedures performed in a tertiary hospital unit during a 60-month period for HHT. The incidence of KTP laser and SDP, days between treatments, total number of interventions and perioperative hemoglobin (Hb) were audited. Patient groups were identified as definite or possible HHT according to the Curaçao criteria. All suffered from epistaxis sufficient to seek medical treatment.


RESULTS
Three hundred one procedures were performed on 131 patients during the study period. In total, 33 SDPs and 268 KTP laser treatments were performed; 78.3% of patients required three or less procedures. The mean time interval between treatments was 473 (+/-515 days) days. The rate of KTP after an SDP decreased from 1.83 (+/-1.99) to 0.78 (+/-0.85; p=0.012). Hb level was not associated with treatments required.


CONCLUSIONS
Surgical interventions with laser and SDP in HHT are always time limited as recurrence of telangiectasia is inevitable. This study discusses the expectations of therapy, mainly frequency and duration of effect, along with the impact of SDP. The outcomes assist in better management of patient expectations.
Harvey
Richard J
RJ
Rhinology Research Unit, Royal National Throat Nose and Ear Hospital, London WC1X 8DA, United Kingdom. richard@richardharvey.com.au
Kanagalingam
Jeeves
J
Lund
Valerie J
VJ
D004844:Epistaxis / Q000209:etiology / Q000601:surgery*; D005260:Female; D006801:Humans; D053685:Laser Therapy; D053844:Lasers, Solid-State / Q000627:therapeutic use*; D008297:Male; D009300:Nasal Septum / Q000601:surgery*; D012189:Retrospective Studies; D013683:Telangiectasia, Hereditary Hemorrhagic / Q000150:complications / Q000601:surgery*; D016896:Treatment Outcome