Hereditary hemorrhagic telangiectasis treated by the harmonic scalpel

Background. Hereditary hemorrhagic telangiectasis (HTT) is a familial autosomal dominant genetic disorder that causes abnormalities of the wall of peripheral blood vessels. Severe nosebleed often is the dominant symptom. A variety of therapies have been proposed for epistaxis control in HHT but with limited success. Methods. We report two cases of HHT in which recurrent nasal bleeding was successfully controlled using the Harmonic Scalpel. Results. Use of the Harmonic Scalpel avoids the carbonization and incrustation of the nasal mucosa that commonly results from electrocautery and laser irradiation. Even during active bleeding, hemostasis can be achieved by repeated applications of the scalpel blade. Conclusion. This method can be performed quick and reliably on an outpatient basis. The Harmonic Scalpel may be the treatment of choice for recurrent epistaxis in HHT. © 2003 Wiley Periodicals, Inc. Head Neck 25: 333–336, 2003