Management of Upper Airway Infantile Hemangiomas: Experience of One Italian Multidisciplinary Center

Abstract

Airway infantile hemangiomas (IHs) can represent a life-threatening condition since the first months of life. They may be isolated or associated to cutaneous IHs, and/or part of PHACES syndrome. Diagnosis, staging, and indication to treatment are not standardized yet despite the presence in the literature of previous case series and reviews. The diagnosis might be misleading, especially in the absence of cutaneous lesions. Airway endoscopy is the gold standard both for diagnosis and follow-up since it allows evaluation of precise localization and entity of obstruction and/or stricture. Proliferation of IH in the infant airways manifests frequently with stridor and treatment is required as soon as possible to prevent further complications. The first line of therapy is oral propranolol, but duration of treatment is not yet well-defined. All considered, we report the experience of our multidisciplinary center from 2009 to date, on 36 patients affected by airway IHs, and successfully treated with oral propranolol. Thus, the authors propose their experience for the management of airway IHs, specifically early diagnosis, when to perform endoscopy, how to interpret its findings, and when to stop the treatment.

Infantile Subglottic Hemangioma: A Case ReportInfantile Subglottic Hemangioma: A Case Report

“…For a very long time, the management of infantile hemangiomas did not have adequate guidelines and consensus and the treatment was not standardized despite the presence of multiple case series and reviews. 9 However, in 2019 the first clinical guideline for management for infantile hemangiomas 1 was released which provided risk stratification and recognition of potentially problematic hemangiomas, early and frequent monitoring during the first few months of life to identify infantile hemangiomas that require intervention, role of imaging and evidence based guidance for management of infantile hemangiomas with both pharmacologic options and surgical modalities along with indications for consultation, referral and monitoring including parent education. Subglottic hemangioma has been categorized as life threatening hemangioma because it could obstruct the airway.…”

“…Oral propranolol is the treatment of choice for infantile hemangioma including subglottic hemangioma. 1 , 9 It is continued for at least six months and often maintained until 1 year of age or longer. 1 Other intervention for subglottic hemangiomas include steroids, laser treatment, surgical excisions, tracheostomy or a combination of these therapies.…”

Infant in extremis: respiratory failure secondary to lower airway infantile hemangioma

“…Airway hemangiomas, specifically those causing airway obstruction account for about 1.4% of IHs [3]. Airway IH most often affect the larynx or upper airway in the subglottic region [6,7]. Upper airway IH often present with respiratory distress and biphasic stridor, and are often confused for croup or bronchiolitis [6].…”

“…Airway IH most often affect the larynx or upper airway in the subglottic region [6,7]. Upper airway IH often present with respiratory distress and biphasic stridor, and are often confused for croup or bronchiolitis [6]. Conversely, the incidence of lung and lower airway IHs is low and have mainly been described in limited case reports [8][9][10][11].…”

Airway management of a child with haemangioma tongue for dynamic airway assessment

“…Airway endoscopy is the gold standard for diagnosis and follow-up as it allows identification of precise location and cause of obstruction. [ 2 ] Airway obstruction is common after induction of general anaesthesia. [ 3 ] In the presence of macroglossia, maintaining spontaneous breathing during induction is vital.…”