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Pyriform sinus haemangioma: an unusual presentation of an unusual condition. The Journal of Laryngology & Otology 2011; 125:1196-8. [PMID: 21729438 DOI: 10.1017/s0022215111001307] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
OBJECTIVE We present a rare case of an unusual presentation of a pyriform sinus haemangioma in a normally healthy, Caucasian woman, including our management and a review of the literature. CASE REPORT A 44-year-old woman presented complaining of bringing up fresh blood whilst brushing her teeth, dysphonia, food sticking in her throat, and epigastric pain for the preceding 12 months, accompanied by a 17.5 kg weight loss. She underwent pre-operative computed tomography and subsequent complete excision of a pyriform sinus haemangioma using CO2 laser. DISCUSSION Haemangiomas are congenital vascular malformations and can affect any part of the body. They are not prevalent in adults and are rarely found in the pyriform sinus. Their common presenting symptoms and management have been previously documented; however, the presented case is unusual in both its presentation and management.
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DeMarcantonio MA, Darrow DH, Gyuricsko E, Derkay CS. Obstructive sleep disorders in Prader-Willi syndrome: The role of surgery and growth hormone. Int J Pediatr Otorhinolaryngol 2010; 74:1270-2. [PMID: 20880597 DOI: 10.1016/j.ijporl.2010.08.001] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2010] [Revised: 08/03/2010] [Accepted: 08/05/2010] [Indexed: 11/27/2022]
Abstract
OBJECTIVE To review the effectiveness and safety of surgical intervention for obstructive sleep apnea in Prader-Willi syndrome. BACKGROUND The muscle hypotonia and obesity associated with Prader-Willi syndrome (PWS) result in a high rate of obstructive sleep apnea (OSA). The use of growth hormone therapy in these patients has been associated with sudden death, raising concerns that such treatment may exacerbate obstructive sleep apnea. As a result, it has been suggested that children with PWS be evaluated for OSA and indications for adenotonsillectomy prior to instituting growth hormone therapy. The true effectiveness of surgical intervention in these cases, however, remains in doubt. METHODS Retrospective review of patients with a diagnosis of PWS who underwent adenoidectomy or adenotonsillectomy from January 2001 to July 2009 at a regional, tertiary care children's hospital. Patients underwent pre-operative and post-operative polysomnography. Differences between pre-operative and post-operative body-mass index (BMI), apnea-hypopnea index (AHI), and median oxygen saturation and oxygen saturation nadir were analyzed. RESULTS Five patients were identified during the study period. Three patients underwent adenotonsillectomy, 1 patient adenoidectomy alone, and another adenotonsillectomy with uvulopalatopharyngoplasty (UPPP). While median AHI was found to have decreased from 16.4 to 4.4, no statistically significant change could be demonstrated (p=0.274). Mean O(2) and nadir O(2) saturation also improved, but without reaching statistical significance. No intra-operative complications were noted. CONCLUSIONS Our series, and other small case series, have demonstrated that complete resolution of sleep apnea in PWS patients is difficult to obtain with upper airway surgery alone. It is suggested that children with PWS being considered for growth hormone therapy undergo assessment for OSA by polysomnography. Patients identified with OSA should be referred for management by tonsillectomy and/or continuous positive airway pressure (CPAP) and then reassessed for residual airway obstruction prior to instituting hormonal therapy.
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Perkins JA, Chen EY, Hoffer FA, Manning SC. Proposal for Staging Airway Hemangiomas. Otolaryngol Head Neck Surg 2009; 141:516-521. [DOI: 10.1016/j.otohns.2009.06.751] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2009] [Revised: 06/30/2009] [Accepted: 06/30/2009] [Indexed: 12/01/2022]
Abstract
OBJECTIVE: To describe a method of airway infantile hemangioma staging using standardized assessment of airway narrowing, and hemangioma location and volume, as determined with endoscopy and CT angiography. STUDY DESIGN: Case series with chart review. SETTING: Tertiary pediatric hospital, 2003-2008. SUBJECTS AND METHODS: Subjects included airway hemangioma patients evaluated at a tertiary pediatric hospital. Data collected were age at first symptoms, diagnostic evaluation, percent airway compromise, and estimated hemangioma volume. Data were analyzed with descriptive and Fisher exact statistics. RESULTS: Twelve patients were identified and seven had complete data sets. Mean age at first symptoms was 1.9 months (SD 1.09 months, range 0.5-4 months). Evaluation consisted of nasopharyngoscopy, microlaryngoscopy, CT angiography, and/or MRI. Mean laryngeal airway narrowing was estimated at 63.75 percent (SD 19.0%, range 40%-90%). Total hemangioma volume was less in patients with isolated (focal) endolaryngeal hemangiomas compared with airway hemangiomas associated with extralaryngeal (segmental) hemangiomas. Airway hemangioma stages were stage one (5 of 12; 41.6%), stage two (6 of 12; 50.0%), and stage three (1 of 12; 8.3%). CONCLUSION: This method of airway hemangioma staging may be applicable to treatment planning and used to measure treatment outcomes.
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Affiliation(s)
- Jonathan A. Perkins
- the Division of Pediatric Otolaryngology, Seattle Children's Hospital, Seattle, WA
- the Department of Otolaryngology-Head and Neck Surgery, University of Washington, Seattle, WA
| | - Eunice Y. Chen
- the Division of Pediatric Otolaryngology, Seattle Children's Hospital, Seattle, WA
- the Department of Otolaryngology-Head and Neck Surgery, University of Washington, Seattle, WA
| | - Fredric A. Hoffer
- the Department of Pediatric Radiology, Seattle Children's Hospital, Seattle, WA
| | - Scott C. Manning
- the Division of Pediatric Otolaryngology, Seattle Children's Hospital, Seattle, WA
- the Department of Otolaryngology-Head and Neck Surgery, University of Washington, Seattle, WA
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Perkins JA, Duke W, Chen E, Manning S. Emerging Concepts in Airway Infantile Hemangioma Assessment and Management. Otolaryngol Head Neck Surg 2009; 141:207-212. [DOI: 10.1016/j.otohns.2009.04.013] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2009] [Revised: 04/08/2009] [Accepted: 04/15/2009] [Indexed: 11/29/2022]
Abstract
OBJECTIVE: The purpose of this study was to evaluate changes in airway infantile hemangioma treatment. STUDY DESIGN: Retrospective. SUBJECTS: Airway hemangioma patients, tertiary pediatric hospital. METHODS: Data collected included age at diagnosis, evaluation methods, hospitalizations, airway size, and interventions. Patients were divided into group A (1981–1993) and group B (1994–2005) and were analyzed using descriptive statistics, the Fisher exact test, and the Student t test. RESULTS: Thirty-two subjects were identified. Nasopharyngoscopy was used more in group B (11/16 [69%]) than group A (4/16 [25%], P = 0.032). CT angiography (3/16 [19%]) and laryngeal distractors (11/16 [69%]) were only used in group B; these techniques showed airway hemangiomas to be “transglottic,” not just “subglottic.” Intralesional steroids alone (3/16 [19%]) and primary hemangioma excision (2/16 [13%]) were new treatments used in group B. Frequent direct laryngoscopies (>six) correlated with tracheotomy (5/32 [16%], P = 0.015). Presenting age (<2 months) impacted treatment more than airway hemangioma size. CONCLUSIONS: New methods of airway infantile hemangioma assessment changed our concept of airway hemangiomas and their primary treatment.
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Affiliation(s)
- Jonathan A. Perkins
- From the Division of Pediatric Otolaryngology, Seattle Children's Hospital, Seattle, WA
| | - William Duke
- Department of Otolaryngology–Head and Neck Surgery, Seattle Children's Hospital, Seattle, WA
- Division of Otolaryngology–Head and Neck Surgery, Madigan Army Medical Center, Tacoma, WA
| | - Eunice Chen
- From the Division of Pediatric Otolaryngology, Seattle Children's Hospital, Seattle, WA
| | - Scott Manning
- From the Division of Pediatric Otolaryngology, Seattle Children's Hospital, Seattle, WA
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Hazarika P, Pillai S, Jacob SM, Punnoose SE, Roy A. Application of potassium-titanyl-phosphate (KTP) laser in the excision of pyriform fossa hemangioma. Am J Otolaryngol 2006; 27:136-8. [PMID: 16500479 DOI: 10.1016/j.amjoto.2005.07.016] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2005] [Indexed: 11/18/2022]
Abstract
Pyriform fossa hemangioma, especially of the cavernous type, is a rare case and very few such lesions have been encountered in general otolaryngological practice. We report such a lesion in a 36-year-old, middle-aged woman presenting with complaint of foreign body sensation in the throat. Examination revealed a hemangioma in the right pyriform fossa that was successfully managed using KTP-532 laser and bipolar cautery.
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Affiliation(s)
- Produl Hazarika
- Department of E.N.T., Kasturba Medical College, Manipal, India.
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Abstract
Hemangiomas of infancy are common in the general pediatric population, are usually easily diagnosed, and generally do not require treatment. However, a small but significant percentage of hemangiomas of infancy may develop complications, including infection or ulceration. In addition, hemangiomas located in some anatomic regions may be associated with other anomalies and therefore require more careful monitoring and earlier intervention to prevent permanent sequelae. This review focuses on distinguishing hemangiomas from vascular malformations and delineates the natural history of hemangiomas of infancy, with an emphasis on identifying those hemangiomas that require additional evaluation and closer follow-up. Current treatment modalities, including the use of systemic steroids and the pulsed-dye laser, are discussed. In addition, several conditions that often present with cutaneous hemangiomas are described, including PHACES syndrome and neonatal hemangiomatosis. Finally, an assessment is made of the current understanding of the biology of hemangioma proliferation and involution, including the role of endothelial growth factors and GLUT1, a new marker for hemangiomas of infancy.
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Affiliation(s)
- Kara N Smolinski
- Section of Pediatric Dermatology, Children's Hospital of Philadelphia, PA 19104, USA
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Abstract
PURPOSE OF REVIEW Subglottic hemangioma is a challenging congenital anomaly involving the larynx in children. Management is not uniform, and no single treatment modality has been accepted as ideal. During the last several years only a few articles have dealt with this topic. The purpose of this review is to examine the published literature and discuss the alternative treatments of SGH. The authors also describe their approach and the use of microdebrider as a new surgical tool. RECENT FINDINGS Observation is an option for the rare case of SGH with minimal airway obstruction. However, most cases will require some additional intervention. Systemic steroids intralesional steroid injection, laser ablation with both the CO2 and KTP lasers, interferon (IFN) and open surgical excision have all been utilized. SUMMARY The authors found few technical innovations in this field in the last 5 years. All techniques utilized have some degree of success. However, all approaches have downsides and are associated with complications, some of which can be very serious. Ideally, more structured research comparing techniques would be helpful to best determine operative and postoperative management.
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Affiliation(s)
- Seth M Pransky
- Department Pediatric Otolaryngology and Head-Neck Surgery, San Diego Children's Hospital, San Diego, California 92123, USA.
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Rahbar R, Nicollas R, Roger G, Triglia JM, Garabedian EN, McGill TJ, Healy GB. The biology and management of subglottic hemangioma: past, present, future. Laryngoscope 2005; 114:1880-91. [PMID: 15510009 DOI: 10.1097/01.mlg.0000147915.58862.27] [Citation(s) in RCA: 71] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
OBJECTIVES/HYPOTHESIS 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. STUDY DESIGN 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. CONCLUSION 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.
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Affiliation(s)
- Reza Rahbar
- Department of Otolaryngology and Communication Disorders, Children's Hospital, Harvard Medical School, Boston, Massachusetts 02155, USA.
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Bent JP. Airway hemangiomas: contemporary management. Lymphat Res Biol 2004; 1:331-5. [PMID: 15624563 DOI: 10.1089/153968503322758157] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022] Open
Abstract
METHODS A review of the literature and the author's pediatric otolaryngology experience regarding the clinical presentation and contemporary management of airway hemangiomas, with an emphasis on subglottic hemangiomas. CONCLUSION A myriad of medical and surgical treatment options exist for children with airway hemangiomas. Careful application of these technologies allows for satisfying outcomes in most cases.
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Affiliation(s)
- John P Bent
- Albert Einstein School of Medicine, New York Otolaryngology Institute, New York, New York 10021, USA.
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10
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Abstract
A myriad of medical and surgical treatment options exist for children with airway hemangiomas. Careful application of these technologies allows for satisfying outcomes in most cases. A review of the literature is presented, plus the author's experience in pediatric otolaryngology regarding the clinical presentation and contemporary management of airway hemangiomas, with an emphasis on subglottic hemangiomas.
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Affiliation(s)
- John P Bent
- Albert Einstein School of Medicine, New York Otolaryngology Institute, New York, New York 10021, USA.
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Desuter GRR, El Makhloufi K, François GJ, Godding VM, Saint-Martin C, Buts JP, Hamoir MFA. Postcricoid hemangioma: an overlooked cause of dysphagia in infants?-a case report. Dysphagia 2004; 19:48-51. [PMID: 14745646 DOI: 10.1007/s00455-003-0028-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Feeding and swallowing disorders in children remain a major challenge owing to a wide differential diagnosis. Hemangioma of the upper aerodigestive tract represents one of the numerous non-neoplastic causes of dysphagia. We report two cases of postcricoid hemangioma causing inhalation and recurrent respiratory infections, treated successfully with systemic corticotherapy alone. To our knowledge, these are the second and third cases described in the literature. After a short review of the literature, the diagnostic procedures are discussed and a management strategy is proposed for this clinical entity, by far underestimated.
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Affiliation(s)
- Gauthier R R Desuter
- ENT-Head & Neck Surgery Department, Cliniques universitaires Saint-Luc, Université catholique de Louvain, Brussels, Belgium.
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Abstract
Recent research pertaining to laser applications for the treatment of capillary malformations (port wine stains) and cutaneous and subglottic hemangiomas is reviewed within the context of advances in laser technology and current therapeutic practices and controversies. Although laser advances have resulted in the concomitant growth of new clinical applications, research over the past year has focused on refining and improving existing applications, with the ultimate goal of being able to individualize treatment. Research initiatives aimed at improving the outcomes of pulse dye laser treatment for capillary malformations have illustrated the complexity of the interaction between laser characteristics, methods of laser application, variations in human skin and tissue, and morphologic parameters of involved blood vessels. Investigations of cutaneous hemangioma have addressed the issue of early pulse dye laser intervention, and results of a significant prospective study clearly demonstrate that this offers no benefit. Studies of subglottic hemangioma have compared the outcomes of treatment with carbon dioxide (CO(2)) and the potassium-titanyl-phosphate lasers, concluding that the latter results in superior outcomes, with less risk of posttreatment subglottic stenosis.
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Affiliation(s)
- Richard G Azizkhan
- Division of Pediatric Surgery, Cincinnati Children's Hospital Medical Center, OH 45229, USA.
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Chatrath P, Black M, Jani P, Albert DM, Bailey CM. A review of the current management of infantile subglottic haemangioma, including a comparison of CO(2) laser therapy versus tracheostomy. Int J Pediatr Otorhinolaryngol 2002; 64:143-57. [PMID: 12049827 DOI: 10.1016/s0165-5876(02)00072-1] [Citation(s) in RCA: 36] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
OBJECTIVES 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.
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Affiliation(s)
- Paul Chatrath
- Department of Paediatric Otolaryngology, Great Ormond Street Hospital for Children, London WC1N 3JH, UK.
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Abstract
A variety of congenital anomalies arise within the laryngeal or tracheal airway. Symptoms primarily include airway obstruction, hoarseness, and difficulty feeding. The diagnosis is typically made by a combination of clinical presentation, physical examination, and endoscopic evaluation. Definitive intervention may be necessary requiring endoscopic or open laryngeal surgery. Some of the more common congenital laryngeal and tracheal anomalies are discussed with respect to their diagnostic evaluation, clinical presentation, and management.
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Affiliation(s)
- B J Wiatrak
- Department of Pediatric Otolaryngology, The Children's Hospital of Alabama, Birmingham, AL 35233, USA
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Abstract
OBJECTIVE To discuss treatment modalities for subglottic haemangioma (SGH). METHODOLOGY Case report of two children definitively managed by different modalities. RESULTS Management by CO2 laser vaporization in one child, and laser followed by interferon 2-alpha in the second child were both successful in controlling the SGH without the need for tracheostomy. CONCLUSIONS The stepped-care approach at John Hunter Children's Hospital, Newcastle, New South Wales, is presented. Both laser surgery and interferon can help control SGH. Careful surveillance and interdisciplinary cooperation are essential to achieve a good outcome.
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Affiliation(s)
- P J Walker
- Department of Paediatrics, John Hunter Children's Hospital, Newcastle, and,Department of Paediatrics, Port Macquarie Base Hospital, Port Macquarie, New South Wales, Australia
| | - D Cooper
- Department of Paediatrics, John Hunter Children's Hospital, Newcastle, and,Department of Paediatrics, Port Macquarie Base Hospital, Port Macquarie, New South Wales, Australia
| | - D Macdonald
- Department of Paediatrics, John Hunter Children's Hospital, Newcastle, and,Department of Paediatrics, Port Macquarie Base Hospital, Port Macquarie, New South Wales, Australia
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Van Den Abbeele T, Triglia JM, Lescanne E, Roger G, Nicollas R, Ployet MJ, Garabédian EN, Narcy P. Surgical removal of subglottic hemangiomas in children. Laryngoscope 1999; 109:1281-6. [PMID: 10443834 DOI: 10.1097/00005537-199908000-00018] [Citation(s) in RCA: 41] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVE To examine the indications and the results of surgical excision of severe subglottic hemangiomas. DESIGN Retrospective study and case series. SETTING Four academic tertiary care centers of pediatric otolaryngology. PATIENTS Twenty children were included from 1991 to 1997. All presented with severe subglottic hemangiomas resistant to classical treatments such as corticosteroids and/or CO2 laser. INTERVENTION Six children were operated on using laryngotracheal reconstruction and prolonged stenting by a reinforced Silastic roll and 14 children were operated on by a single-stage laryngotracheoplasty and postoperative intubation in a pediatric intensive care unit. RESULTS All patients were successfully decannulated or extubated and have been free from recurrent hemangiomas. CONCLUSION The surgery of severe subglottic hemangiomas is a reliable technique in selected patients and should be considered in corticoresistant or corticodependent, circular, or bilateral hemangiomas.
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Affiliation(s)
- T Van Den Abbeele
- Department of Pediatric Otorhinolaryngology, Robert Debré Hospital, Paris, France.
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