Technique modifications for septodermoplasty: an illustrative case

Abstract

Background: Hereditary hemorrhagic telangiectasia (HHT) is an autosomal dominant disease that results in telangiectasia of the sinonasal tract, gastro-intestinal tract as well as possible arteriovenous malformations of the lung, liver and brain. One of the most common disease manifestations of HHT is epistaxis. Severe recurrent epistaxis necessitating iron therapy and blood transfusion is often managed with septodermoplasty. Its initial description was as an open surgical technique requiring nasal packing.

Case presentation: We describe a modified approach to septodermoplasty done completely endoscopically and without nasal packing for a patient with severe epistaxis due to HHT.

Conclusion: The described technique modifications for the presented case allowed for same day discharge following surgery, complete take of the skin graft and resultant epistaxis control that ended thepatient's transfusion dependency. The merits of these modifications should be further evaluated in a clinical trial.

Fig. 1

Left septodermoplasty demonstrating application of Floseal for hemostasis

Fig. 2

Left septodermoplasty demonstrating the septal mucosal defect

Fig. 3

Left septodermoplasty demonstrating endoscopic STSG placement

Fig. 4

Endoscopic application of TISSEEL sealant over the STSG

Fig. 5

Endoscopic image at two weeks follow-up post left sided septodermoplasty