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Office-Based Subglottic Evaluation in Children With Risk of Subglottic Hemangioma
Robert H Chun1, Michael E McCormick2, Timothy Martin2
1Department of Otolaryngology, Medical College of Wisconsin, Milwaukee, Wisconsin, USA rchun@mcw.edu.
Insights
In-office lower airway evaluation (OLAE) is a safe and effective method for assessing airway hemangiomas in infants with infantile hemangiomas (IH) or PHACE syndrome. This awake procedure avoids general anesthesia, ensuring timely diagnosis and management for high-risk children.
Area of Science:
- Pediatric Otolaryngology
- Pediatric Pulmonology
- Medical Imaging
Background:
- Infantile hemangiomas (IH) and PHACE syndrome present a significant risk of airway involvement in children.
- V3 cutaneous IH and PHACE syndrome are associated with high incidences of airway hemangioma (29% and 52%, respectively).
- Clinical evaluation of the airway is crucial for early detection and management in these high-risk pediatric populations.
Purpose of the Study:
- To report the experience with in-office lower airway evaluation (OLAE) in high-risk children.
- To assess the feasibility and safety of awake OLAE for evaluating airway hemangiomas.
- To determine if OLAE can be performed without sedation in infants with IH and PHACE syndrome.
Main Methods:
- Retrospective review of 8 children (5 with IH, 3 with PHACE syndrome) who underwent OLAE since 2003.
- In-office lower airway evaluation performed without sedation.
- High-speed recording and playback utilized for detailed assessment.
- Serial OLAE used to monitor disease progression and treatment response in one case of subglottic hemangioma.
Main Results:
- Eight high-risk children underwent OLAE at an average age of 2.75 months.
- Two children presented with stridor; one was diagnosed with subglottic hemangioma.
- Ten upper tracheoscopies were performed without any respiratory complications.
- The procedure successfully evaluated the trachea in all patients.
Conclusions:
- Airway evaluation is essential for managing infants with IH and PHACE syndrome.
- Awake OLAE is a possible and safe technique for evaluating and monitoring tracheal conditions in high-risk infants.
- This method avoids the need for general anesthesia, preventing diagnostic delays and complications.
Purpose:
Children with V3 cutaneous infantile hemangiomas (IH) and PHACE syndrome have a high incidence for airway hemangioma, 29% and 52%, respectively. Therefore, a clinical evaluation for these high-risk children is essential. We report our experience with in-office lower airway evaluation (OLAE) in these high-risk children.
Results:
Since 2003, 5 children with IH of the V3 cutaneous distribution and 3 children with PHACE syndrome underwent OLAE. Average age of presentation was 2.75 months. Two children had stridor at initial evaluation, and 1 child had subglottic hemangioma. This child was evaluated serially with OLAE to monitor disease progression and treatment response. A total of 10 upper tracheoscopies were performed on the 8 patients without respiratory complications.
Conclusion:
An airway evaluation is essential to evaluate and manage this high-risk population. Typically, operative endoscopy requires general anesthesia. However, in these high-risk children, we have performed OLAE without sedation to evaluate the trachea. High-speed recording and playback is essential in this method. Our series demonstrates that awake OLAE is possible and may be a safe technique to evaluate and monitor disease progression in these high-risk patients. These patients avoided general anesthesia and delay in diagnosis and did not incur any complications during or after OLAE.
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