The biology and management of subglottic hemangioma: past, present, future.
OBJECTIVE
Objectives were 1) to review the presentation, natural history, and management of subglottic hemangioma; 2) to assess the affect of five variables (age, gender, degree of subglottic narrowing, location and extent of subglottic hemangioma, and lack or presence of other hemangioma) and the outcome of six different treatment modalities (conservative monitoring, corticosteroid, laser surgery, tracheotomy, laryngotracheoplasty, and interferon) in the management of subglottic hemangioma; and 3) to present specific guidelines to help determine the best possible treatment modality at the time of initial presentation.


METHODS
Retrospective review in the setting of three tertiary care pediatric medical centers.


METHODS
Methods included 1) extensive review of the literature; 2) a systematic review with respect to age, gender, presentation, associated medical problems, location and degree of subglottic narrowing, initial treatment, need for subsequent treatments, outcome, complications, and prognosis; and 3) statistical analysis to determine the effect of five variables (age, gender, degree of subglottic narrowing, location and extent of subglottic hemangioma, and lack or presence of other hemangioma) and the outcome of six different treatment modalities (conservative monitoring, corticosteroid, laser surgery, tracheotomy, laryngotracheoplasty, and interferon).


RESULTS
In all, 116 patients with a mean age of 4.7 months were treated. The most common location of subglottic hemangioma was the left side. The range of subglottic narrowing was 10% to 99% (mean percentage, 65%). Twenty-six patients (22%) were managed with a single treatment modality, which included conservative monitoring (n = 13), corticosteroid (n = 11), and tracheotomy (n = 2). Ninety patients (78%) required multimodality treatments. Overall, the treatments included conservative monitoring (n = 13), corticosteroid (n = 100), tracheotomy (n = 32), CO2 laser (n = 66), interferon (n = 5), and laryngotracheoplasty (n = 25). Complication rates included the following: conservative monitoring (none), corticosteroid (18%), tracheotomy (none), CO2 laser (12%), interferon (20%), and laryngotracheoplasty (20%). The following variables showed statistical significance in the outcome of different treatment modality: 1) degree of subglottic narrowing (P < .001), 2) location of subglottic hemangioma (P < .01), and 3) presence of hemangioma in other areas (P < .005). Gender (P > .05) and age at the time of presentation (P > .06) did not show any statistical significance on the outcome of the treatments.


CONCLUSIONS
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.
Rahbar
Reza
R
Department of Otolaryngology and Communication Disorders, Children's Hospital, Harvard Medical School, Boston, Massachusetts 02155, USA. reza.rahbar@childrens.harvard.edu
Nicollas
Richard
R
Roger
Gilles
G
Triglia
Jean-Michel
JM
Garabedian
Erea-Noel
EN
McGill
Trevor J
TJ
Healy
Gerald B
GB
D000305:Adrenal Cortex Hormones / Q000627:therapeutic use; D002675:Child, Preschool; D005260:Female; D005500:Follow-Up Studies; D005931:Glottis; D006391:Hemangioma / Q000175:diagnosis / Q000628:therapy*; D006801:Humans; D007223:Infant; D007822:Laryngeal Neoplasms / Q000175:diagnosis / Q000628:therapy*; D007830:Larynx / Q000601:surgery; D053685:Laser Therapy; D008297:Male; D012189:Retrospective Studies; D014132:Trachea / Q000601:surgery
D000305:Adrenal Cortex Hormones