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

Abstract

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: CO2 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, CO2 laser vaporization is reported to be effective. In all 30% of the infants treated in Boston Children's Hospital with CO2 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. CO2 laser vaporization is seldom applied because of the risk of subglottic stenosis.

Diagnosis and Management of Infantile Hemangioma

“…317,[326][327][328][329][330] However, many clinicians have now reported success and low complication rates using propranolol in the management of airway IHs. 326,[331][332][333][334][335][336] Although the optimal dose and appropriate duration of therapy remain uncertain, most clinicians are dosing the drug as they would for cutaneous IH.…”

“…Successful management has been achieved in 77% to 87% of cases with the use of intralesional steroids. 317,327 Airway IHs causing focal obstruction may be addressed surgically by a subtotal endoscopic approach by using a microscope or telescope or by total excision through an open approach. Subtotal approaches generally use a laser 317 or rotarypowered instrument.…”

Open Excision of Subglottic Hemangiomas to Avoid Tracheostomy

“…Hoeve et al 16 reported an average intubation of 37 days in 14 successful cases (out of a total of 18 cases) and an average intubation of 54 days in the failed cases. One patient was intubated for 129 days.…”

Hemangioma subglótico tratado con propranolol: Una nueva alternativa terapéutica. Caso clínico

“…Sin embargo, aquellos pacientes que respondían debían permanecer con altas dosis de corticoides (3 mg/kg/día) por tiempos prolongados con los efectos colaterales propios de la corticoterapia prolongada. Existen reportes de infiltraciones intralesionales de corticoides con una tasa de éxito de 83%, pero esta técnica no ha sido adoptada globalmente, ya que los pacientes deben permanecer intubados por un tiempo promedio de cincuenta días y porque se requieren múltiples aplicaciones, lo cual eleva el costo del tratamiento 9 .…”