Open excision of subglottic hemangioma with microscopic dissection.

OBJECTIVE

To evaluate the efficacy of open excision of subglottic hemangioma utilizing microscopic dissection techniques.

DESIGN

Retrospective review of case series.

SETTING

Tertiary care teaching children's hospital.

PATIENTS

The study included 8 patients ages 7 weeks to 8 months. All patients underwent open microscopic excision of subglottic hemangioma between 2000 and 2006.

INTERVENTION

All patients underwent full pre-operative evaluation including micro-direct laryngoscopy and bronchoscopy. All resections were carried out with an anterior cricoid split and partial laryngofissure. Intra-laryngeal dissections were carried out under a cross-table binocular dissecting microscope. Mucosal preservation was practiced whenever possible. Thyroid ala cartilage graft was used to augment subglottic laryngeal framework. Patients were intubated for 3-7 days prior to reassessment and extubation.

RESULTS

Eight patients were treated with microscopic open excision of subglottic hemangioma. All patients were successfully extubated. During the follow-up period, 2/8 patients developed early subglottic stenosis that required endoscopic laser treatment. Median follow-up time was 37 months (range 3-84 months). No recurrences have been observed.

CONCLUSION

Microscopic dissection adds precision to open excision of subglottic hemangioma. Such precision enables complete excision while accomplishing maximal mucosal preservation, thus limiting the risk of recurrence and subglottic stenosis.