Endoscopic Nd:YAG laser therapy of infantile subglottic hemangioma

Abstract

Summary. Of the many therapeutic modalities that have been developed for infantile subglottic hemangioma (ISH), the most common technique is endoscopic excision with carbon dioxide laser, used alone or combined with other therapeutic techniques. A staged procedure has been proposed as the preferred choice for patients with severe airway obstruction. Nevertheless, ever since the neodymium: yttrium-aluminum-garnet (Nd:YAG) laser was developed, this modality has been considered feasible to treat vascular tumor in the airway due to good hemostasis power. We present two cases of ISH with severe airway obstruction that underwent endoscopic surgery using an one-stage Nd:YAG laser approach. Details of the laser characteristics and surgery techniques are described in this article.

Current perspectives on the optimal management of infantile hemangioma

“…49 , 50 Other ablative lasers have also been used, such as the potassium titanyl phosphate (KTP) laser 51 and the Nd:Yag laser. 52 However, it is important to note that an obstructing subglottic hemangioma is potentially life-threatening, and it is common to treat with multiple modalities, including medical therapy, and laser ablation.…”

Open excision of subglottic hemangioma with microscopic dissection

“…It is considered a coagulating laser with deep penetration. Although some authors have used it with success in the treatment of SGH [16], many consider the risk for transmural injury to be significant and are therefore wary of recurrent SGS [15]. PDL has dramatically changed the treatment of cutaneous hemangiomas since its introduction in the 1980s.…”

Treatment of Congenital Subglottic Hemangiomas

“…[13][14][15][16] The same technical precautions reported for other laser sources also apply to diode laser surgery. First, the diode laser's beam, in contrast to the carbon dioxide laser beam, is carried by flexible optic fibers that can be coupled with telescopes permitting access to sites such as the subglottic region that are difficult to explore with other techniques.…”

“…Diode laser also appears to be more precise and less invasive than other devices such as Neodymium:YAG and potassium-titanyl-phosphate lasers, which have been used to treat hemangiomas in a small number of cases. [13][14][15][16] The same technical precautions reported for other laser sources also apply to diode laser surgery. In particular, to prevent the evolution of scarring, damage to the perichondrium must be avoided.…”