Young’s procedure

Nasal closure, also known as the Young’s procedure, was first described for atrophic rhinitis in 1967, and it was first used for HHT in 1994 [48]. This procedure involves closing the nasal vestibule, and can be done either unilaterally or bilaterally. A result of a bilateral Young’s procedure is anosmia. A 2012 study by Richer looked at 36 patients, all of whom were receiving regular iron or blood transfusions at the time of surgery. This study found that 30 of the 36 patients had complete cessation of epistaxis following the Young’s procedure, and none of them required transfusions for epistaxis in the follow-up period (mean follow-up was 34 months) [48]. While control of epistaxis is typically very good, this must be weighed with the anosmia and changes in taste that will be expected to occur following this surgery. A 2013 case report highlighted a patient who had a Young’s procedure and unfortunately developed epistaxis that was refractory to pressure. After having her airway secured, her oropharynx packed, and her internal maxillary arteries embolized (bilaterally), she eventually had her Young’s procedure reversed to enable placement of nasal packing. This report highlights a very rare, but life-threatening complication that can occur post Young’s procedure; mainly that when the nose is closed, the ability to pack the nose in a standard fashion is lost [49].

Summary: Young’s procedure is effective, but it must be weighed against the expected changes in smell and taste as well as long-term risks to the patient. This procedure may have a role in select cases when employed as unilateral treatment.

Level of Evidence: Level 4 (1 case series) [48]; level 5 (1 case report) [49]