This Article  • Full text  • PDF  • Reply to article  • Send to a friend  • Save in My Folder  • Save to citation manager  • Permissions  Citing Articles  • Contact me when this article is cited  Related Content  • Similar articles in this journal  Topic Collections  • Critical Care/ Intensive Care Medicine  • Oncology  • Adult Critical Care  • Head & Neck Cancer  • Dermatology  • Airway Obstruction  • Congenital Anomalies of Head & Neck  • Endoscopy of Upper Aerodigestive Tract  • Neoplasms of Head & Neck  • Pediatric Otolaryngology  • Pediatrics  • Congenital Malformations  • Hemangiomas  • Surgery  • Laser Surgery  • Prognosis/ Outcomes  • Drug Therapy  • Drug Therapy, Other  • Alert me on articles by topic  Social Bookmarking   What's this?

Our Experience Compared With Reports in the Literature

Roberto Saetti, MD; Marina Silvestrini, MD; Cesare Cutrone, MD; Surendra Narne, MD

Arch Otolaryngol Head Neck Surg. 2008;134(8):848-851.

Objective  To evaluate the outcome of our experience in the treatment of congenital subglottic hemangiomas.

Design  Retrospective review of records.

Setting  Airway tertiary care service.

Patients  From 1986 to 2006 we treated 39 pediatric patients affected by congenital subglottic hemangiomas.

Intervention  Therapeutic choice depended on presentation symptoms and grade of respiratory obstruction: 6 patients were primarily treated with only systemic steroids; 11 patients underwent intralesional corticosteroid injections followed by tracheal intubation and systemic steroid support; and 22 patients underwent primary diode laser treatment.

Main Outcome Measure  The outcomes were evaluated according to 1 or more of the following criteria: resolution of symptoms, reduction of airway obstruction, the need and duration of intubation, tracheotomy decannulation, need of further treatments, and occurrence of complications.

Results  Patients treated with only systemic steroids showed a success rate of 50% (3 of 6); patients who underwent intralesional corticosteroid injections followed by tracheal intubation and systemic steroid support reached a positive result in 73% of cases (8 of 11). On the whole, 18% of patients treated with full-dose systemic steroids developed significant adverse effects (3 of 17). The success rate was 95% among patients treated with diode laser as primary treatment (21 of 22), with a complication rate of 9% (2 of 22).

Conclusions  Endoscopic laser surgery is the therapeutic option that most approaches the objectives of securing the airway while using the least invasive method possible and reducing to a minimum the necessity and duration of intubation. On the basis of our experience, we believe that diode laser, owing to its physical and structural features, is the safest and most effective device for the treatment of congenital subglottic hemangiomas. Treatment with intralesional or systemic corticosteroids could have an adjuvant role.

Author Affiliations: Division of Airway Endoscopic Surgery, Azienda Ospedaliera, Università di Padova (Drs Saetti, Silvestrini, and Cutrone), and Venetian Oncologic Institute, Istituto Di Ricovero e Cura a Carattere Scientifico (Dr Narne), Padua, Italy.

CiteULike    Connotea    Del.icio.us    Digg    Reddit    Technorati    Twitter     What's this?