title: The Young's procedure for severe epistaxis from hereditary hemorrhagic telangiectasia.
abstract: BACKGROUND
  Surgical treatment of epistaxis in hereditary hemorrhagic telangiectasia (HHT) has historically been managed with the laser procedure or the septodermoplasty procedure. For transfusion-dependent patients with severe epistaxis we have been performing the Young's  procedure or surgical closure of the nostrils. The objective of this study was to report treatment of severe epistaxis related to HHT with the Young's procedure and assess patient outcome.
  
  
  METHODS
  Patients with severe iron or blood transfusion-dependent epistaxis  who underwent a Young's procedure in three otolaryngology HHT centers were reviewed. Patients were evaluated for postoperative epistaxis and subjective outcome.
  
  
  RESULTS
  Forty-three patients underwent a Young's procedure for severe epistaxis and were observed for a mean  of 34 months. The procedure was well tolerated by all patients and 30 of 36 patients (83%) experienced complete cessation of bleeding after the Young's procedure. Patients had a mean increase in hemoglobin of 4.68 g/dL after the procedure. The average Glasgow Benefit Inventory score after  surgery was 43.56. No patients requested a reversal of the procedure.
  
  
  CONCLUSIONS
  The Young's procedure is a safe and efficacious procedure with complete cessation of epistaxis in most patients with severe epistaxis and HHT.
authors.affiliation: Department of Surgery, St. Vincent's Medical Center, Bridgeport, Connecticut 06606, USA. sara.richer@stvincents.org
authors.forename: Sara L
authors.initials: SL
authors.lastname: Richer
authors.forename: Urban W
authors.initials: UW
authors.lastname: Geisthoff
authors.forename: Nancy
authors.initials: N
authors.lastname: Livada
authors.forename: P Daniel
authors.initials: PD
authors.lastname: Ward
authors.forename: Leland
authors.initials: L
authors.lastname: Johnson
authors.forename: Alexander
authors.initials: A
authors.lastname: Mainka
authors.forename: Katharine J
authors.initials: KJ
authors.lastname: Henderson
authors.forename: Steffen
authors.initials: S
authors.lastname: Maune
authors.forename: Robert I
authors.initials: RI
authors.lastname: White
authors.forename: Douglas A
authors.initials: DA
authors.lastname: Ross
mesh_terms: D000328:Adult; D000368:Aged; D004844:Epistaxis / Q000209:etiology* / Q000601:surgery*; D005240:Feasibility Studies; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D059747:Nasal Surgical Procedures; D057605:Natural Orifice Endoscopic Surgery / Q000379:methods*; D012189:Retrospective Studies; D013683:Telangiectasia, Hereditary Hemorrhagic / Q000150:complications*; D016896:Treatment Outcome