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[Treatment of infantile subglottic hemangioma by microdebrider]
Qi Huang1, Jingrong Lyu1, Zhihua Zhang1
1Department of Otorhinolaryngology Head and Neck Surgery, Xinhua Hospital, Shanghai Jiaotong University School of Medicine, Ear Institute, Shanghai Jiaotong University School of Medicine, Shanghai 200092, China.
Insights
Minimally invasive microdebrider removal is a safe and effective treatment for infantile subglottic hemangioma, especially for severe cases. This approach offers good outcomes with minimal complications and no recurrence in infants.
Area of Science:
- Pediatric Otolaryngology
- Pediatric Surgery
- Neonatal Medicine
Context:
- Infantile subglottic hemangioma (ISH) is a rare congenital vascular tumor.
- ISH can cause significant airway obstruction and respiratory distress in infants.
- Current treatment strategies for ISH vary, with a need for minimally invasive options.
Purpose:
- To evaluate the clinical features, minimally invasive treatment, and outcomes of infantile subglottic hemangioma.
- To assess the efficacy and safety of microdebrider-assisted removal for ISH.
- To determine the long-term results and recurrence rates following surgical intervention.
Summary:
- A retrospective analysis of 15 infants with ISH treated between 2009-2012.
- Five cases were treated with microdebrider-assisted removal under suspension laryngoscopy, with no intraoperative complications and rapid symptom resolution.
- Pathological confirmation revealed capillary hemangioma in nine cases; no recurrence or major complications were observed during 12-18 months follow-up.
Impact:
- Microdebrider removal is a safe, simple, and effective minimally invasive technique for ISH.
- This approach is particularly beneficial for infants with significant tracheal stenosis, recurrent infections, or acute laryngeal obstruction.
- Successful outcomes highlight the importance of individualized treatment and effective anesthesiologist-otolaryngologist collaboration.
Objective:
To investigate the clinical features, minimally invasive treatment, and outcomes of subglottic hemangioma in infants.
Methods:
Fifteen cases of infantile subglottic hemangioma treated from January 2009 to December 2012 were retrospective analysed. Average time of onset was within 43 days-5 months of age. Seven cases had symptoms of laryngeal obstruction one week after birth, and 8 cases had symptoms within three weeks to six weeks after birth. Fourteen cases were unilateral and 1 case bilateral. No case had tracheotomy. Seven cases were hospitalised after intubation. Of which 5 cases with subglottic hemangiomas who failed to respond to pharmacologic treatment were treated by microdebrider under suspension laryngoscope. Ten cases accepted suction cutter suction.
Results:
After surgery, nine cases were confirmed pathologically as capillary hemangioma. Average bleeding was 1-3 ml during operation, surgery usually lasted 10-15 minutes. No complications were found. Five cases required orotracheal intubation for 24 or 48 h after surgery, and no reintubation or tracheotomy was required in this series. Symptoms such as stridor and inspiratory retraction resolved approximately 12-72 h after surgery. Follow-up was 12-18 months after surgery, no systemic or local complications were observed, and no recurrence.
Conclusions:
The treatment of subglottic hemangioma is individualised. If the tracheal stenoses ≥ 50%, with recurrent infection and acute laryngeal obstruction, removal of tumor with microdebrider is the minimally invasive, safe, simple and effective method with less complications. It is important that the anaesthetist should work well with otolaryngologist during operation.
