[Management of infantile subglottic hemangioma].
BACKGROUND
Subglottic hemangioma is an unusual lesion which can be treated in various ways. Multiple therapeutic attitudes with variable clinical results have been described. We present our experience in the management of these patients.


METHODS
During last the three years we have treated four patients with subglottic hemangioma. The mean age was of 4.5 +/- 2.8 months and the mean weight of 6.9 +/- 2.04 kg. We present its presenting symptoms, location and size of the lesion, grade of obstruction (according to the classification of subglottic stenosis of Cotton), the treatment applied, complications and results in the long term.


RESULTS
The lesions produced a mean obstruction of 83.75% of the airway (range 75-90%), being located in the right posterolateral region (2), left posterolateral region (1) and the last was completely to circulate. All the patients have been treated initially with steroids, but recurrence of symptoms when steroid dosage was decreased. All angiomas were removed surgically by submucous resection. No tracheotomy was performed. One patients developed a grade III subglottic stenosis that required an open surgery (laryngotracheoplasty with anterior a posterior graft). One patien suffered an overwhelming sepsis probably secondary to medical treatment. All patients had not had further respiratory difficulties. Postoperative follow-up is 18 months (range from 6 months to 3 years).


CONCLUSIONS
Treatment of subglottic hemangioma is difficult to standarize. Treatment with steroids have many adverse effects in children. The surgical treatment offer a good option in the treatment of the angiomas of great size. Traqueostomy as must be avoided in the management of these patients.
García-Casillas
M A
MA
Servicio de Cirugía Pediátrica, Hospital Infantil Gregorio Marañón, Madrid.
Matute
J A
JA
Cedrá
J
J
Vázquez
J
J
D000305:Adrenal Cortex Hormones / Q000008:administration & dosage / Q000627:therapeutic use; D000367:Age Factors; D001999:Bronchoscopy; D005260:Female; D005500:Follow-Up Studies; D005931:Glottis; D006391:Hemangioma / Q000150:complications / Q000175:diagnosis / Q000188:drug therapy / Q000601:surgery*; D006801:Humans; D007223:Infant; D007822:Laryngeal Neoplasms / Q000150:complications / Q000175:diagnosis / Q000188:drug therapy / Q000601:surgery*; D007829:Laryngostenosis / Q000209:etiology / Q000601:surgery; D008297:Male; D012008:Recurrence; D012737:Sex Factors; D013997:Time Factors; D016896:Treatment Outcome
D000305:Adrenal Cortex Hormones