MANAGEMENT OF INFANTILE SUBGLOTTIC HEMANGIOMA - LASER VAPORIZATION, SUBMUCOUS RESECTION, INTUBATION, OR INTRALESIONAL STEROIDS

The infantile subglottic hemangioma can be treated in various ways. Th e results of the treatment used in the Sophia Children's Hospital, int ralesional steroids and intubation (IS + I), are discussed and compare d with the results of other current treatment methods: CO2 laser vapor ization, submucous resection and intubation alone. A total of 18 infan ts were treated for subglottic hemangioma in our hospital: ten with IS + I alone, five were first treated with systemic therapy and later wi th 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 re maining three infants were treated with (combinations of) various ther apies, because IS + I failed Or was not tried. Two patients were final ly cured, one still has a tracheotomy. Of other current therapies, CO2 laser vaporization is reported to be effective. In all 30% of the inf ants treated in Boston Children's Hospital with CO2 laser needed a tra cheotomy. Moreover subglottic stenosis is a serious complication. Subm ucous resection is often successful. It may be complicated by subglott ic stenosis and in some cases, depending on the localization of the he mangioma, it may be contraindicated. Intubation alone is less effectiv e than intubation combined with intralesional steroids. Management of subglottic hemangioma in Sophia Children's Hospital is primarily intra lesional steroids and intubation and secondarily submucous resection o r tracheotomy. CO2 laser vaporization is seldom applied because of the risk of subglottic stenosis. (C) 1997 Published by Elsevier Science I reland Ltd.