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Hereditary Hemorrhagic Telangiectasia: Nasal Septal Perforation Repair

About Dr. Jason Hamilton

Jason S. Hamilton, M.D. is the Director of Plastic and Reconstructive Surgery for the Osborne Head and Neck Institute based at Cedar-Sinai Medical Towers. Dr. Hamilton has advanced training in plastic and reconstructive surgical techniques involving the face, head, and neck, and limits his practice to the treatment of these areas exclusively.

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Nasal Septal Perforation Repair

Jason S. Hamilton, MD, FACS
Director of the Division of Plastic and Reconstructive Surgery
Osborne Head and Neck Institute, Los Angeles, CA
Ryan Osborne, MD, FACS
Director of the Division of Head and Neck Surgery
Osborne Head and Neck Institute, Los Angeles, CA

 

Figure 1: Schematic representation of the nasal cavity including the septum.
Figure 1: Schematic representation of the nasal cavity including the septum.

CLINICAL CHALLENGE

HHT is a hereditary disorder characterized by the proliferation of aberrant vascular tissue. HHT can manifest itself most notably through proliferation of telangiectasias or arteriovascular malformations (AVMs). In most cases formation of poorly formed blood vessels, telangiectasias, in the nasal septum lead to repeated bouts of nosebleeds (epistaxis). Typically treatment of these vessels with cauterization damages the nasal septum, leading to septal perforation.

PROCEDURE OVERVIEW

Figure 2: Schematic demonstrating a common location for septal defects.
Figure 2: Schematic demonstrating a common location for septal defects.

During an evaluation by a septal repair specialist, imaging of the nasal cavity is usually obtained to determine the presence, size, and location of any septal perforations as well as any other underlying damage that is not readily evident. Typically, HHT patients have undergone one or more cauterization procedures to address recurrent episodes of epistaxis. While effective at alleviating symptoms of bleeding, cauterization typically results in the destruction of septal tissue. Once it has been determined that a patient is an appropriate candidate for septal repair, preparations are made for surgical treatment. Perioperatively, cutting edge techniques are employed to repair the compromised septum and restore proper nasal anatomy.

Figure 3: Nasolaryngoscopy image of HHT patient demonstrating scaling and dried blood.
Figure 3: Nasolaryngoscopy image of HHT patient demonstrating scaling and dried blood.

SURGICAL CONSIDERATIONS

Depending on the severity of the septal perforation and associated structural compromise of the nose, a septal repair specialist may recommend concomitant reconstruction of the nose using rhinoplasty procedures to restore or improve proper breathing and avoid any undesirable symptoms or complications.

 
 
 

CLINICAL RESULTS

SURGEON COMMENTS

Dr. Jason Hamilton, Director of Plastic and Reconstructive Surgery at the Osborne Head and Neck Institute, is double board certified by the American Board of Facial Plastic and Reconstructive Surgery and the American Board of Otolaryngology/Head and Neck Surgery. His extensive training and expertise provide him with a unique perspective to address both functional and aesthetic concerns of the nose.

For more information on HHT or septal perforation repair, please contact the Osborne Head and Neck Institute or visit www.perforatedseptum.com

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