Hereditary Hemorrhagic Telangiectasia Albany - HHT Upstate New York

Serving Albany, Saratoga Springs, Schenectady, Capital District and Troy, New York

Understanding HHT

Dr. Arthur N. Falk, of The Center for Facial Plastic Surgery and Laser Skin Care located in Albany New York, provides comprehensive treatment of the Head and Neck manifestations of Hereiditary Hemorrhagic Telangiectasia (HHT). HHT is a genetic disorder that is characterized by malformations of tinny blood vessels, creating tangles of thin walled vessels called telangiectases, as well as, abnormal shunts between arteries and veins called arteriovenous malformations. These malformations form in many organs of the body where they can lead to problems such as troublesome bleeding or abnormal shunting of blood through the circulator system. Although a systemic disease, it is the head and neck manifestations that are the most common, and the main symptoms that prompts individuals to seek treatment. Almost all patients with HHT will develop telangiectases of the nasal lining tissue which are susceptible to bleeding with even the slightest trauma. Triggers can be something as minor as turbulent air flow through the nose during normal respiration.

Treatment of HHT

The treatment of HHT requires a unique skills set that involves a number of different modalities including medical, laser, and surgical interventions. Dr. Falk has acquired considerable knowledge and expertise in this area through his association with Dr. Stanley Shapshay, one of the foremost authorities on the treatment of the Head and Neck manifestations of this disorder.

Nosebleeds in HHT

The management of nosebleeds starts with the least invasive measures first. Nasal bleeding can be minimized by keeping the nose well moisturized with emollients such saline nasal jells, and home humidification particular during the dry winter months. These methods are helpful by preventing the drying and cracking of the delicate nasal membranes. Avoidance of the non-steroidal anti-inflammatory (NSAID) class of drugs like aspirin decrease the likelihood of persistent bleeding. Hormone therapy, such as estrogen creams applied to the nasal lining can decrease nose bleeds through thickening the tissue making it more resistant to breakdown.

Management of Nosebleeds in HHT

When nosebleeds do occur, the first step in management is to apply moderate sustained pressure to the nostrils for several minutes. Usually, this stops most bleeding caused by telangiectases. Frequently, the nose bleeds in HHT progress to require more aggressive interventions. Packing of the nose is a choice of last resort as while it can be necessary in life threatening situations, when it comes time to remove the packing bleeding generally will commence. Embolization, the intentional clotting of vessels feeding the nose, does not provide sustained relief as well, as patients will quite rapidly go on to form new telangiectases.

Laser Treatment of Nosebleeds in HHT

Lasers have achieved success for a good number of patients with HHT. At the Center for Facial Plastic Surgery, Dr. Falk is a skilled laser surgeon, with several lasers at his disposal to treat troublesome telangiectases. Successful treatment is very technique dependent, requiring meticulous attention to detail and an atraumatic handling of tissue. The lasers used in the treatment of nasal and facial telangiectases shrink blood vessels by targeting the hemoglobin content of circulating red blood cells. These blood vessels go on to clot and ultimately shrivel up. We try not to burn the tissue but actually gently heat the tissue so that it heals without scaring. Nasal endoscopes are used to visualize deep within the nasal cavity.

Septal Dermopalsty in the treatment of Nosebleeds in HHT

Septal dermoplasty is a surgical procedure that can be effective in management of more severe cases of epistaxis not controlled with laser therapy. Septal dermoplasty is a procedure where the nasal mucosa, the fragile lining tissue of the nose, is replaced with a skin graft that is taken from another body site such as the thigh. Because this skin is more resistant to formation of telangiectases, nasal bleeding often times is effectively controlled. Septal dermoplasty is performed under general anesthesia according to the following sequence. A split thickness graft is harvested form the thigh about the thickness of a piece of paper. The nasal mucosa of the nose is then scraped away using either a blade, high speed burr, or a laser. The now raw areas are grafted, suturing the skin graft in place in side the nose. The nose is then lightly packed, to provide pressure on the graft to hold it in position while healing takes place. For some patients this procedure can provide near complete remission, while others it limits the bleeding to a more tolerable level. The treatment of epistaxis in HHT can be very challenging. Using this multimodality approach, it is possible to help the majority of patients with their bleeding symptoms so that they can continue to lead productive lives. If you would like more information on the treatment of HHT and nasal bleeding, please contact Dr. Falk at the Center for Facial Plastic Surgery and Laser Skin Care.

(518) 262-7193
Albany, NY 12208