Controlled risk of stenosis after surgical excision of laryngeal hemangioma.

OBJECTIVE

To evaluate the risk of subglottic stenosis after surgical excision of congenital subglottic hemangioma.

DESIGN

Retrospective analysis and case series.

SETTING

Tertiary care teaching hospital.

PATIENTS

A total of 13 pediatric patients diagnosed with subglottic hemangioma with unilateral, bilateral, or circular lesions and more than 50% airway obstruction between 1992 and 2001.

INTERVENTION

Open surgical excision was performed as a single-stage procedure either as primary or secondary intention. The cricoid cartilage was left open at the end of the procedure. Postoperative intubation was carried out in a pediatric intensive care unit.

MAIN OUTCOME MEASURE

An adequate airway after surgical excision.

RESULTS

All patients were successfully extubated. No recurrence was noted. Three patients developed subglottic stenosis, two grade 1 and one grade 2. All 3 showed a favorable outcome and did not require reintubation. One needed endoscopic management of the stenosis. Of these 3 cases, 2 occurred after carbon dioxide laser treatment (out of 3) and 1 after circumferential dissection (out of 3).

CONCLUSIONS

Extubation after surgery was successful in all cases of subglottic hemangioma. Risk of subglottic stenosis was limited and occurred only after circumferential dissection, especially if associated with prior traumatic laser damage of the hemangioma.