Laser Treatment of Epistaxis and Oral Bleeding in Hereditary Hemorrhagic Telangiectasia

Abstract

Background: Hereditary hemorrhagic telangiectasia (HHT) is a relatively common, albeit under-recognized autosomal-dominant multisystemic vascular disorder. Epistaxis due to telangiectases in the nasal mucosa is the most common and often the earliest symptom of HHT. As many as 90% of affected individuals eventually experience recurrent epistaxis, with a mean frequency of 18 episodes per month. Prompted by the limitations of invasive treatment, researchers have directed attention to laser photocoagulation as an alternative nonsurgical treatment modality with promising results. Purpose: The purpose of the present study was to describe our experience with the state-of-the-art 980 nm diode laser for the treatment of bleeding lesions of the skin, nasal and oral mucosa in patients with HHT. Methodology/Principal: We treated 16 HHT patients with intractable bleeding from telangiectasias using the 980-nm diode laser as an office procedure using local anesthesia. We recorded hemoglobin levels before and after treatment and used disability questionnaires. Results: All patients treated had an improvement in hemoglobin levels and disability scores. In patients with multiple lesions hemoglobin levels improved from a mean of 8.4 to 11.2 (p = 0.008). The disability index in this group improved from a mean of 5.3 to 2.8 (p = 0.007). Follow-up ranged between 4 and 12 months. Conclusions: The 980-nm diode laser is a good office based solution for bleeding in HHT.