Management of congenital subglottic hemangioma

Objective: This study was conducted to assess the safety and efficacy of in dividualized management of congenital subglottic hemangioma (CSH) at the Ch ildren's Memorial Hospital in Chicago; describe treatment modalities, inclu ding endoscopic excision with the carbon dioxide (CO2) laser, systemic cort icosteroids, and intralesional corticosteroid injection with short-term int ubation; and determine the success of these various strategies in avoiding tracheotomy. Methods: During the 10-year period between January 1, 1988 and December 31, 1997, 28 infants were diagnosed with CSH. A retrospective review of medica l records was undertaken to determine demographics, presenting symptoms, lo cation of the lesion, therapeutic modality, and complications. All patients were contacted at the time of writing. Results: Twenty-eight patients met the criteria for this study. Gender dist ribution was 1.8:1 female to male. Age at diagnosis ranged from 4 weeks to 8 months, with a mean of 78.8 days and a median of 60 days. The location of CSH was most often posterior and on the left. Associated hemangiomas were found in 14 (50%) cases. The most common symptoms were strider and cough. M anagement included I to 13 operative direct laryngoscopies and bronchoscopi es, endoscopic excision with the (CO2) laser, and the use of systemic and i ntralesional corticosteroids. No patient required tracheotomy. Conclusion: Morbidity and the need for tracheotomy in CSH patients can be m inimized using a combination of therapeutic modalities. Each infant's treat ment is individualized based on the severity of the patient's symptoms and the morphology of the lesion.