A new technique using cultured epithelial sheets for the management of epistaxis associated with hereditary haemorrhagic telangiectasia

Abstract

A new technique for the treatment of severe epistaxis associated with hereditary haemorrhagic telangiectasia is described. The nasal septum and inferior turbinates, surgically denuded of respiratory epithelium, were grafted using autografts of cultured epithelial sheets derived from buccal epithelium. All patients upon whom this technique has been used have shown considerable lessening in the frequency and severity of their epistaxes although two patients received grafts on two occasions, in each case approximately three months apart. It is postulated that a nasal lining of stratified squamous epithelium is likely to be more resistant to trauma than the normal respiratory type, and this is supported by the observation that bleeds very seldom occur from the oral cavity in this syndrome.

Treatment of Recurrent Epistaxis in HHT

“…The original method [10,45] has been modified by several authors; Whicker and Lake [46] improved the access for septal perforations and posterior telangiectases by lateral rhinotomy. Instead of using a skin transplant, other authors have proposed amnion [47], buccal mucosa [14], cultivated epithelial sheets from buccal mucosal cells [48], thick full skin grafts [49] or myocutaneous flaps [50].…”

Hereditary haemorrhagic telangiectasia (Osler-Weber-Rendu syndrome): otorhinolaryngological manifestations

“…The amniotic membrane graft provides a bacteriostatic, immunostatic and protective epithelial lining with no crust formation 55 . It has been suggested that buccal mucosa can be an alternative graft for septodermoplasty 56 …”

Embolisationsbehandlung der akuten Blutung bei Morbus Osler

“…Pohar et al [15] erzielten mit der intranasalen Brachytherapie in einer Studie mit 43 Patienten ermutigende Resultate, beobachteten jedoch bei einigen Patienten Septumperforationen. Von Milton et al [16] wurde die erfolgreiche Behandlung der Epistaxis mittels Autotransplantation von in Kultur gezüchteten Plattenepithelien berichtet. Die Plattenepithelien stammten von Wangenschleimhaut ab.…”

“…Die Plattenepithelien stammten von Wangenschleimhaut ab. Als Vorteil gegenüber respiratorischem Epithel wurde die grössere mechanische Resistenz angesehen [16]. Rebeiz et al [17] behandelten 3 Patienten mit Epistaxis, die weder auf Lasertherapie noch auf septale Dermoplastiken ansprachen, mit Spalthauttransplantaten auf Nasenboden und seitlicher Nasenwand.…”