A review of the current management of infantile subglottic haemangioma, including a comparison of CO(2) laser therapy versus tracheostomy.
OBJECTIVE
We reassessed the current practice and treatment options used in the management of subglottic haemangiomas (SGHs), including the place for open submucosal surgical excision, and have compared the results of different therapeutic modalities used for SGHs.


METHODS
The two studies were conducted as separate exercises; (1) a retrospective review of 36 patients collected over a recent 8-year period to assess the current practice and treatment options in use; (2) a retrospective comparative study of a previous cohort of 51 patients with SGHs treated in one of four groups: (a) tracheostomy alone, (b) tracheostomy and CO(2) laser, (c) systemic steroids and CO(2) laser (no tracheostomy) and (d) intralesional steroid injection, CO(2) laser therapy, or both, followed by intubation.


RESULTS
Systemic steroids were the most commonly used modality of treatment. Resolution of the SGH was achieved in 89% of cases at a mean follow up duration of 34 months. However, tracheostomy was required in 58% of cases, with a mean time from diagnosis to decannulation of 30 months. The time to resolution of SGHs does not appear to be reduced by laser therapy compared with treatment by tracheostomy alone. Intralesional steroid injection or laser therapy together with intubation was associated with avoidance of a tracheostomy in 66% of cases. Single-stage open surgical excision in two cases resulted in successful resolution of the SGH and discharge after a mean follow up period of 3 months.


CONCLUSIONS
Despite the more widespread use of steroids and other treatment modalities, the requirement for tracheostomy has remained unchanged over the last 20 years. The use of laser therapy does not appear to confer any additional therapeutic benefit over and above tracheostomy alone in bringing about resolution of SGHs. Systemic steroids may reduce the size of the haemangioma but are associated with multiple adverse effects. The decision to use the above techniques must, therefore, be made in the light of these observations. Our early experience of single-stage excision suggests that this technique represents an exciting and promising surgical alternative, and its more widespread adoption may be the only way of further improving the outcome of patients with SGHs.
Chatrath
Paul
P
Department of Paediatric Otolaryngology, Great Ormond Street Hospital for Children, London WC1N 3JH, UK. pchatrath@yahoo.com
Black
Myles
M
Jani
Piyush
P
Albert
David M
DM
Bailey
C Martin
CM
D002245:Carbon Dioxide; D015331:Cohort Studies; D003131:Combined Modality Therapy; D005260:Female; D005500:Follow-Up Studies; D006391:Hemangioma / Q000175:diagnosis / Q000628:therapy*; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D015552:Injections, Intralesional; D007822:Laryngeal Neoplasms / Q000175:diagnosis / Q000628:therapy*; D053685:Laser Therapy; D008297:Male; D011241:Prednisone / Q000008:administration & dosage*; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D014139:Tracheostomy / Q000379:methods*; D016896:Treatment Outcome
D002245:Carbon Dioxide; D011241:Prednisone