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

Abstract

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.

Endoscopic Nd:YAG laser therapy of infantile subglottic hemangioma

“…12,22 The deep penetration (4-7 mm) 19 and concentrated focus of Nd:YAG laser can very precisely vaporize a lesion with minimal disruption of overlying normal mucosa, thereby preventing potential postoperative subglottic stenosis. 5 However, extensive thermal injury during Nd:YAG laser operation should not be overlooked. The danger of transmural injury to underlying structures was also mentioned if the duration of application is excessive.…”

“…20 A single-pulse or repeated-pulse mode at 0.5 sec, or decrease in laser power was suggested while approaching the tumor bed, avoiding ''popcorn effect'' of deep tissue that may lead to perforation or intractable cicatrix of airway structure. 5,21 We used, however, a continuous mode for better coagulation effect, with a smaller power (8 watt), rather than the 20-30 or 10-15 watt laser used in a previous studies, 5,6 for these two cases to minimize tissue damage. It is noteworthy that exposure of cricoid cartilage should be avoided completely and that power (watts) should be kept to the minimum setting required to excise tissue.…”

“…Carbon dioxide (CO 2 ) laser surgery, first proposed by Healy et al, 3 has been widely applied to treat ISH; however, subsequent reports identified numerous complications and a mixed result. 4,5 Neodymium: yttrium-aluminum-garnet (Nd:YAG) laser, which has been employed during bronchoscopic surgery for subglottic hemangioma has good hemostatic ability and little mucosa damage. 6 A staged operation was also recommended for giant airway lesion for preventing postoperative subglottic stenosis.…”

Clinical features and treatment results in children with hemangioma

“…Oral propranolol or steroids are the first choice in glottic hemangiomas and laser ablation methods are used in unresponsive cases 39,40 . In cases with unexplained upper respiratory obstruction findings, hemangiomas should be considered in the differential diagnosis.…”

Šiuolaikinis Galvos Ir Kaklo Srities Hemangiomų Gydymas

“…Galvos ir kaklo hemangiomos, sukeliančios pavojų kvėpavimo takų praeinamumui, dažniausiai yra paviršinės ir vienpusės. Siekiant užtikrinti kvėpavimo takų praeinamumą, gali tekti atlikti tracheostomiją ar greitą darinio pašalinimą lazeriu [34]. Tačiau dauguma autorių pateikia sėkmingus HA, esančių kvėpavimo takuose, gydymo propranololiu rezultatus [35].…”