Intranasal Dermoplasty for Hereditary Hemorrhagic Telangiectasia.

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Recurrent epistaxis as a manifestation of hereditary hemorrhagic telangiectasia (HHT, Rendu-Osler-Weber disease) is usually difficult to control. Although no treatment is regarded to be completely efficacious, intranasal dermoplasty (ID), originally described as septal dermoplasty by Saunders, is considered to be the most effective means of management. ID, however, is not well established in Japan. During the last 2 years we performed ID on 2 patients with HHT to reduce the incidence of epistaxis by protecting the fragile vessels from trauma through the application of a split thickness skin graft over the abnormal superficial nasal vessels.The technical keypoints of ID in our experience are:a. In order to avoid septal perforation, ID should be performed on only one side of the septum at each procedure with preservation of the septal perichondrium.b. Exacerbation of bleeding after ID can be attributed to four factors. 1) telangiectasia develops in mucosa not covered by the graft, that is in the posterior half and anterosuperior tip; 2) abnormal mucosa can regenerate in a denuded area or in the portion where the graft fails to take; 3) the graft contracts over time exposing areas initially covered by the graft; 4) telangiectasia develops within the graft. Therefore, after the graft has been sutured anteroinferiorly to vestibular skin it should be attached to the perichondrium with fibrin glue, and the area of the anterosuperior remnant of the septal mucosa for suturing should be minimized. The intranasal skin graft should be as large as possible to cover all the denuded areas and to compensate for graft contracture.c. The graft is usually a split thickness graft. The thicker the graft, the later occurs the development of telangiectasia in the graft, and nasal stuffiness is common. If patients have nasal stuffiness in the preoperative period, the thicker graft will produce the desired effect.
耳鼻咽喉科臨床学会の論文

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