Case report: Treatment failure using propanolol for treatment of focal subglottic hemangioma

Open airway surgery for subglottic hemangioma in the era of propranolol: Is it still indicated?

“…However, our findings suggest that subglottic hemangiomas may not be as responsive to propranolol as hemangiomas in other locations. There have been several other reports in the literature of subglottic hemangiomas with poor response or regrowth following initiation of propanolol therapy [10,11]. In our series, the rate of propranolol failure was 50% which is significantly higher than that reported in the literature; prior series of subglottic hemangiomas showed propranolol failure rates of 14-20% [9,11].…”

“…Other authors have described successful surgical extirpation of hemangioma, often in a single stage fashion with thyroid ala graft augmentation [10,14]. However, there are other options; Vijayasekaran [13] published a series of 21 patients who underwent open excision of subglottic hemangiomas, and only 10 of them were augmented with either costal or thyroid cartilage.…”

“…Several other recent reports have also highlighted the potential for regrowth despite initial response to propranolol [10][11][12]. These reports highlight the importance of close follow-up in these patients and suggest that propranolol may not be as effective for airway hemangiomas as originally described.…”

Propranolol for the treatment of subglottic hemangiomas

“…After 1 month of treatment with initial response, symptoms returned, and open surgical excision was required [13]. Similarly, Canadas et al documented an isolated left subglottic hemangioma that initially showed 90% obstruction with 3 months of response followed by resistance to propranolol with return of stridor and subsequent open excision [14].…”

“…Other documented studies include a case report from 2009 which showed a rapid clinical response to propranolol alone without the use of steroids in a 4-month old patient with a 95% obstructing lesion, [2] while Leboulanger et al showed efficacy of the drug in 13/14 patients in their retrospective review [13]. In contrast, two other case reports have shown disappointing results, both describing initial response followed by worsening of the lesion [13,14]. We present a review of subglottic hemangiomas evaluated and treated at Texas Children's Hospital over the past five years.…”