Orofacial hereditary haemorrhagic telangiectasia: high power diode laser in early and advanced lesion treatment

Hereditary Haemorrhagic Telangiectasia (HHT) is a muco-cutaneous inherited disease. Symptoms are epistaxis, visceral arterio-venous malformations, multiple muco-cutaneous telangiectasia with the risk of number increasing enlargement, bleeding, and super-infection. The aim of this work is to show the dual Diode Laser efficacy in preventive treatment of Early Lesions (EL < 2mm) and therapeutic treatment of Advanced Lesions (AL < 2mm). 21 patients affected by HHT with 822 muco-cutaneous telangiectatic nodules have been treated in several sessions with local anaesthesia and cooling of treated sites. EL preventive treatment consists of single Laser impulse (fibre 320) in ultrapulsed mode (2 mm single point spot). AL therapeutic treatment consists of repeated Laser impulses in pulsed mode (on 200ms / off 400ms). According to the results, Diode Laser used in pulsed and ultra-pulsed mode is very effective as noninvasive treatment both in early and advanced oral and perioral telangiectasia.

[1]  H. Plauchu,et al.  Age-related clinical profile of hereditary hemorrhagic telangiectasia in an epidemiologically recruited population. , 1989, American journal of medical genetics.

[2]  K. Harii,et al.  Experience of sclerotherapy and embolosclerotherapy using ethanolamine oleate for vascular malformations of the head and neck , 2009, Scandinavian journal of plastic and reconstructive surgery and hand surgery.

[3]  Robert I. White,et al.  The natural history of epistaxis in hereditary hemorrhagic telangiectasia , 1991, The Laryngoscope.

[4]  B. Jacobson.  Hereditary hemorrhagic telangiectasia: A model for blood vessel growth and enlargement. , 2000, The American journal of pathology.

[5]  B. Lange,et al.  Efficiency of laser treatment in patients with hereditary hemorrhagic telangiectasia , 2011, European Archives of Oto-Rhino-Laryngology.

[6]  H. Glueck,et al.  Hereditary hemorrhagic telangiectasia (Osler-Weber-Rendu disease). An electron microscopic study of the vascular lesions before and after therapy with hormones. , 1975, Archives of otolaryngology.

[7]  P. Bayrak-Toydemir,et al.  Genotype–phenotype correlation in hereditary hemorrhagic telangiectasia: Mutations and manifestations * , 2006, American journal of medical genetics. Part A.

[8]  A. Guttmacher,et al.  Hereditary hemorrhagic telangiectasia. , 1995, The New England journal of medicine.

[9]  C. Shovlin,et al.  Hereditary haemorrhagic telangiectasia (Osler-Weber-Rendu syndrome): a view from the 21st century , 2003, Postgraduate medical journal.

[10]  A. Guttmacher,et al.  Hereditary haemorrhagic telangiectasia: a questionnaire based study to delineate the different phenotypes caused by endoglin and ALK1 mutations , 2003, Journal of medical genetics.

[11]  P. Shakespeare,et al.  Treatment of hereditary haemorrhagic telangiectasia by the pulsed dye laser , 1997, The Journal of Laryngology & Otology.

[12]  A. Kjeldsen,et al.  Prevalence of pulmonary arteriovenous malformations (PAVMs) and occurrence of neurological symptoms in patients with hereditary haemorrhagic telangiectasia (HHT) , 2000, Journal of internal medicine.

[13]  P. Barnes,et al.  Intracranial hemorrhage in infants and children with hereditary hemorrhagic telangiectasia (Osler-Weber-Rendu syndrome). , 2002, Pediatrics.

[14]  J. Werner,et al.  Mucocutaneous telangiectases of the head and neck in individuals with hereditary hemorrhagic telangiectasia -- analysis of distribution and symptoms. , 2004, European journal of dermatology : EJD.

[15]  José Carlos Nardi,et al.  Síndrome de Rendu-Osler-Weber: relato de caso e revisão de literatura , 2008 .

[16]  E. Maiorano,et al.  Oral laser surgical pathology: a preliminary study on the clinical advantages of diode laser and on the histopathological features of specimens evaluated by conventional and confocal laser scanning microscopy. , 2008, Minerva stomatologica.

[17]  R. Pyeritz,et al.  Hereditary hemorrhagic telangiectasia: An overview of diagnosis, management, and pathogenesis , 2011, Genetics in Medicine.

[18]  J. Parkin,et al.  Laser Photocoagulation in Hereditary Hemorrhagic Telangiectasia , 1981, Otolaryngology--head and neck surgery : official journal of American Academy of Otolaryngology-Head and Neck Surgery.

[19]  S. Paradela,et al.  Treatment of cutaneous and mucosal telangiectases in hereditary hemorrhagic telangiectasia: Report of three cases , 2007, Journal of cosmetic and laser therapy : official publication of the European Society for Laser Dermatology.

[20]  A. Del Vecchio,et al.  Laser treatment of 13 benign oral vascular lesions by three different surgical techniques , 2013, Medicina oral, patologia oral y cirugia bucal.

[21]  J. Jorge,et al.  Oral vascular malformation in a patient with hereditary hemorrhagic telangiectasia: a case report. , 2012, Special care in dentistry : official publication of the American Association of Hospital Dentists, the Academy of Dentistry for the Handicapped, and the American Society for Geriatric Dentistry.

[22]  J. Lammers,et al.  Hereditary hemorrhagic telangiectasia (Osler-Weber-Rendu disease): new insights in pathogenesis, complications, and treatment. , 1996, Archives of internal medicine.

[23]  C. Sabbà,et al.  Hereditary hemorrhagic telangiectasia: clinical features in ENG and ALK1 mutation carriers , 2007, Journal of thrombosis and haemostasis : JTH.

[24]  A. Guttmacher,et al.  International guidelines for the diagnosis and management of hereditary haemorrhagic telangiectasia , 2009, Journal of Medical Genetics.

[25]  A. Greene.  Current concepts of vascular anomalies. , 2012, The Journal of craniofacial surgery.

[26]  D. Apfelberg,et al.  Expanded role of the argon laser in plastic surgery. , 1983, The Journal of dermatologic surgery and oncology.

[27]  A. Shapiro,et al.  Hereditary haemorrhagic telangiectasia , 2008, Haemophilia : the official journal of the World Federation of Hemophilia.

[28]  D. Jain,et al.  Liver disease in patients with hereditary hemorrhagic telangiectasia. , 2000, The New England journal of medicine.

[29]  H. Arendrup,et al.  Pulmonary arteriovenous fistulas in hereditary hemorrhagic telangiectasia. , 2009, Acta medica Scandinavica.

[30]  C. Shovlin,et al.  Hereditary haemorrhagic telangiectasia and pulmonary arteriovenous malformations: issues in clinical management and review of pathogenic mechanisms , 1999, Thorax.

[31]  J. T. Garner,et al.  Hereditary Hemorrhagic Telangiectasia , 1975, Clinical pediatrics.

[32]  A. Guttmacher,et al.  Diagnostic criteria for hereditary hemorrhagic telangiectasia (Rendu-Osler-Weber syndrome). , 2000, American journal of medical genetics.

[33]  Jeffrey L. Wrana,et al.  Signal Transduction by the TGF-β Superfamily , 2002, Science.

[34]  M. Landthaler,et al.  Hereditary haemorrhagic telangiectasia treated by pulsed neodymium:yttrium-aluminium-garnet (Nd:YAG) laser (1,064 nm) , 2008, Lasers in Medical Science.

[35]  D. Ribatti,et al.  Accelerated wound healing of oral soft tissues and angiogenic effect induced by a pool of aminoacids combined to sodium hyaluronate (AMINOGAM). , 2008, Journal of biological regulators and homeostatic agents.

[36]  A. Guttmacher,et al.  Report on the workshop on Hereditary Hemorrhagic Telangiectasia, July 10-11, 1997. , 1998, American journal of medical genetics.

[37]  M. Fiorella,et al.  Diode laser in the treatment of epistaxis in patients with hereditary haemorrhagic telangiectasia , 2012, Acta otorhinolaryngologica Italica : organo ufficiale della Societa italiana di otorinolaringologia e chirurgia cervico-facciale.

[38]  M. Porteous,et al.  Hereditary haemorrhagic telangiectasia: a clinical analysis. , 1992, Journal of medical genetics.