Management Of Subglottic Hemangioma Research Articles

Recent advances in pathophysiology and management of subglottic Hemangioma

Recent advances in pathophysiology and management of subglottic Hemangioma

Management of subglottic hemangiomas with carbon dioxide laser: Our 25-year experience and comparison with the literature

IntroductionSubglottic hemangiomas (SGH) are rare tumors of infancy arising between the perichondrium and the mucosa of the subglottic space. It is a potential life-threatening condition. Many therapeutic options exist for this disease, including lasers. ObjectiveTo report our 25-year experience of laser treatment of SGH. Material and methodsRetrospective review of charts. SettingClarós’ Otolaryngology and Head and Neck Surgery Clinic in Barcelona, Spain. ResultsWe recruited a total of 97 patients of whom 89 were treated with CO2 laser. Mean age at first contact was 2.1 months (range: 1.5–6.5). Sex ratio was 10 girls for 1 boy. Eighty percent of patients presented with stridor and 30.3% with recurrent acute laryngitis. Forty percent had associated cutaneous hemangiomas. They received an average of 1.85 laser session (range: 1–4) and 78.5% were healed after a maximum of 2. We had a 100% success rate and 1.1% complication rate (subglottic stenosis). ConclusionCO2 laser is a very effective and recommendable tool against subglottic hemangiomas. To achieve good results traditional laser safety measures should be respected besides some useful surgical tips.

Management of subglottic hemangioma with propranolol

Subglottic hemangioma is a rare but life- threatening condition which requires intervention. It generally starts proliferating in the first and second months of lifespan and whether there is a respiration problem or not, it causes biphasic stridor. Its diagnosis generally requires direct laryngoscopy or direct screening through bronchoscopy. This case report presents a 45-day-old girl who had subglottic hemangioma presenting with wheezing and stridor. Our case took propranolol with a dose of 2mg/kg/day and within 48h after the start of the treatment, obstructive symptoms started to alleviate considerably.

Emergency management of subglottic hemangioma in 3 infants, with high-dose corticosteroids and propranolol

Emergency management of subglottic hemangioma in 3 infants, with high-dose corticosteroids and propranolol

P148: Management of Subglottic Hemangioma with Microdebrider

P148: Management of Subglottic Hemangioma with Microdebrider

The Biology and Management of Subglottic Hemangioma: Past, Present, Future

Objectives were 1) to review the presentation, natural history, and management of subglottic hemangioma; 2) to assess the affect of five variables (age, gender, degree of subglottic narrowing, location and extent of subglottic hemangioma, and lack or presence of other hemangioma) and the outcome of six different treatment modalities (conservative monitoring, corticosteroid, laser surgery, tracheotomy, laryngotracheoplasty, and interferon) in the management of subglottic hemangioma; and 3) to present specific guidelines to help determine the best possible treatment modality at the time of initial presentation. Retrospective review in the setting of three tertiary care pediatric medical centers. Methods included 1) extensive review of the literature; 2) a systematic review with respect to age, gender, presentation, associated medical problems, location and degree of subglottic narrowing, initial treatment, need for subsequent treatments, outcome, complications, and prognosis; and 3) statistical analysis to determine the effect of five variables (age, gender, degree of subglottic narrowing, location and extent of subglottic hemangioma, and lack or presence of other hemangioma) and the outcome of six different treatment modalities (conservative monitoring, corticosteroid, laser surgery, tracheotomy, laryngotracheoplasty, and interferon). In all, 116 patients with a mean age of 4.7 months were treated. The most common location of subglottic hemangioma was the left side. The range of subglottic narrowing was 10% to 99% (mean percentage, 65%). Twenty-six patients (22%) were managed with a single treatment modality, which included conservative monitoring (n = 13), corticosteroid (n = 11), and tracheotomy (n = 2). Ninety patients (78%) required multimodality treatments. Overall, the treatments included conservative monitoring (n = 13), corticosteroid (n = 100), tracheotomy (n = 32), CO2 laser (n = 66), interferon (n = 5), and laryngotracheoplasty (n = 25). Complication rates included the following: conservative monitoring (none), corticosteroid (18%), tracheotomy (none), CO2 laser (12%), interferon (20%), and laryngotracheoplasty (20%). The following variables showed statistical significance in the outcome of different treatment modality: 1) degree of subglottic narrowing (P < .001), 2) location of subglottic hemangioma (P < .01), and 3) presence of hemangioma in other areas (P < .005). Gender (P > .05) and age at the time of presentation (P > .06) did not show any statistical significance on the outcome of the treatments. Each patient should be assessed comprehensively, and treatment should be individualized based on symptoms, clinical findings, and experience of the surgeon. The authors presented treatment guidelines in an attempt to rationalize the management of subglottic hemangioma and to help determine the best possible treatment modality at the time of initial presentation.

Use of potassium titanyl phosphate (KTP) laser in management of subglottic hemangiomas

Objective: to study the role of KTP laser in management of subglottic hemangioma. Design: retrospective analysis of patients with subglottic hemangioma treated by the senior authors. Setting: tertiary care teaching hospital. Patients: twelve patients with subglottic hemangiomas. Intervention: patients were treated with KTP laser (eight cases), CO 2 laser (two cases) or observation (two cases). Main outcome measure: resolution of symptoms, decrease in size of subglottic hemangioma or tracheotomy decannulation. Results: All patients treated with KTP laser or CO 2 laser had resolution of symptoms and five tracheotomy-dependent children were decannulated. Conclusion: subglottic hemangioma is a potentially life-threatening disease seen in young children. Most authors recommend use of either CO 2 or open surgical excision. There is very little data available on the use of KTP lasers in the management of subglottic hemangiomas. The KTP laser beam is preferentially absorbed by hemoglobin making this laser system more applicable to the treatment of vascular tumors such as the hemangioma. KTP laser is a good tool for management of subglottic hemangioma with a low incidence of complications.

The application of the potassium-titanyl-phosphate (KTP) laser in the management of subglottic hemangioma.

Subglottic hemangioma is the most common neoplasm of the infant airway. Most lesions involute spontaneously; however, some may grow to cause life-threatening respiratory tract distress. The standards of treatment have been tracheotomy, corticosteroids, and laser vaporization. However, use of the carbon dioxide laser has been associated with increased risk of damage to adjacent mucosa and an increased risk for the development of subglottic stenosis postoperatively. To review our experience with the use of the potassium-titanyl-phosphate laser in the treatment of subglottic hemangioma. A retrospective review of 6 patients with subglottic hemangioma treated with the potassium-titanyl-phosphate laser was carried out at a tertiary care children's hospital. Patients' medical charts were evaluated for factors such as age, sex, degree of airway obstruction, location of hemangioma, number of laser procedures performed, and postoperative results, including short- and long-term complications. All 6 patients had significant relief of airway obstruction after use of the potassium-titanyl-phosphate laser. Five of the patients had localized disease, and one had circumferential subglottic involvement. The average number of procedures was 1.7. There were no intraoperative complications. One patient had prolonged intubation following surgery, and only one developed grade 1 subglottic stenosis requiring dilation. Long-term results have been promising in that all patients are asymptomatic and follow-up laryngoscopy and bronchoscopy have shown complete resolution of the hemangioma. The potassium-titanyl-phosphate laser can be used to provide significant clinical relief of airway obstruction due to grade 1 and 2 subglottic hemangioma, with minimal complications.

Management of infantile subglottic hemangioma: laser vaporization, submucous resection, intubation, or intralesional steroids?

The infantile subglottic hemangioma can be treated in various ways. The results of the treatment used in the Sophia Children’s Hospital, intralesional steroids and intubation (IS+I), are discussed and compared with the results of other current treatment methods: CO 2 laser vaporization, submucous resection and intubation alone. A total of 18 infants were treated for subglottic hemangioma in our hospital: ten with IS+I alone, five were first treated with systemic therapy and later with IS+I alone and three with various therapies. IS+I was effective in 14 of the 15 patients, one patient was lost from follow up. The remaining three infants were treated with (combinations of) various therapies, because IS+I failed or was not tried. Two patients were finally cured, one still has a tracheotomy. Of other current therapies, CO 2 laser vaporization is reported to be effective. In all 30% of the infants treated in Boston Children’s Hospital with CO 2 laser needed a tracheotomy. Moreover subglottic stenosis is a serious complication. Submucous resection is often successful. It may be complicated by subglottic stenosis and in some cases, depending on the localization of the hemangioma, it may be contraindicated. Intubation alone is less effective than intubation combined with intralesional steroids. Management of subglottic hemangioma in Sophia Children’s Hospital is primarily intralesional steroids and intubation and secondarily submucous resection or tracheotomy. CO 2 laser vaporization is seldom applied because of the risk of subglottic stenosis.

The open surgical approach to subglottic hemangioma

The management of subglottic hemangioma in infants remains controversial. We report two patients in whom an open surgical approach was utilized to completely excise the subglottic hemangioma. Both children have been successfully extubated and have remained symptom-free since that time.