Office-Based Subglottic Evaluation in Children With Risk of Subglottic Hemangioma

Ann Otol Rhinol Laryngol. 2016 Apr;125(4):273-6. doi: 10.1177/0003489415608868. Epub 2015 Oct 14.

Abstract

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.

Keywords: PHACE; bronchoscopy; infantile hemangioma; office-based procedure; propranolol; subglottic hemangioma.

MeSH terms

  • Ambulatory Care*
  • Aortic Coarctation / epidemiology
  • Bronchoscopy*
  • Cohort Studies
  • Comorbidity
  • Eye Abnormalities / epidemiology
  • Facial Neoplasms / epidemiology
  • Female
  • Glottis
  • Hemangioma / diagnosis*
  • Hemangioma / epidemiology
  • Humans
  • Infant
  • Laryngeal Neoplasms / diagnosis*
  • Laryngeal Neoplasms / epidemiology
  • Laryngoscopy*
  • Male
  • Neurocutaneous Syndromes / epidemiology
  • Retrospective Studies
  • Risk Factors
  • Skin Neoplasms / epidemiology
  • Tracheal Neoplasms / diagnosis*
  • Tracheal Neoplasms / epidemiology

Supplementary concepts

  • PHACE association