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David L. Walner, MD; Noah P. Parker, BA; Oliver S. Kim, MD; Ronald M. Angeles, MD; Duane D. Stich, MD

Arch Otolaryngol Head Neck Surg. 2008;134(3):272-277.

Objective  To describe a previously unreported condition of the neonatal larynx.

Design  Case series of 4 neonates with an uncommon laryngeal lesion.

Setting  Tertiary care children's hospital.

Patients  Four neonates in the first 10 days of life with stridor, hoarseness, and respiratory distress.

Intervention  The patients were examined using flexible fiberoptic laryngoscopy, and laryngeal lesions were identified and subsequently removed using microlaryngoscopy. Photodocumentation of the lesions was performed. Microscopic evaluation of biopsy specimens by a pathologist followed.

Main Outcome Measures  Each patient's medical record was carefully reviewed for prenatal history, birth history, neonatal history, pathologic findings, and office follow-up.

Results  All 4 neonates were delivered atraumatically and developed symptoms of upper airway obstruction within the first few minutes to days of life. Each neonate was found to have an obstructive laryngeal lesion requiring surgical intervention. No child had other congenital abnormalities or a history of obvious laryngeal trauma. Pathologic review of each laryngeal specimen revealed inflammatory lesions with characteristic features of a lobular capillary hemangioma (or a pyogenic granuloma).

Conclusions  The diagnosis of a lobular capillary hemangioma of the larynx should be considered in the differential diagnosis of a newborn with stridor, hoarseness, or respiratory distress. The cases seem to be of congenital origin, although acquired pathogenesis cannot be ruled out. Treatment of these lesions includes microscopic surgical excision.

Author Affiliations: Department of Otolaryngology and Bronchoesophagology, Rush University Medical Center (Dr Walner and Mr Parker), Departments of Pediatric Otolaryngology (Dr Walner) and Pathology (Dr Kim) and Division of Neonatology, Department of Pediatrics (Dr Stich), Advocate Lutheran General Hospital, and Department of Pathology, University of Illinois–Chicago Hospital (Dr Angeles), Chicago.