Premium
Subglottic hemangioma: A comparison of CO 2 laser, Neodym‐Yag laser, and tracheostomy
Author(s) -
Nicolai Thomas,
FischerTruestedt Cordula,
Reiter Karl,
Grantzow Rainer
Publication year - 2005
Publication title -
pediatric pulmonology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.866
H-Index - 106
eISSN - 1099-0496
pISSN - 8755-6863
DOI - 10.1002/ppul.20164
Subject(s) - medicine , subglottic stenosis , surgery , stenosis , tracheal stenosis , airway obstruction , airway , radiology
For airway obstruction caused by subglottic hemangiomas, tracheostomy is still regarded by some as the only established therapy, despite numerous other therapeutic options. Resection with lasers was also reported, but subglottic scar formation may occur, and different laser types may have advantages over others. The charts of 46 consecutive patients over 26 years were reviewed. Until 1986, therapy involved systemic steroids or tracheostomy. Thereafter, a Neodym‐Yag and after 1995 a CO 2 laser was used. Mean initial stenosis was 61.0% in the first (n = 15), 85.8% in the Neodym‐Yag (n = 14), and 86.7% in the CO 2 period (n = 17). Tracheostomy rates could be reduced from 76.9% to 46.9% with the Neodym‐Yag and to 30.8% with the CO 2 laser, and to 22.2% in children not intubated before referral. One tracheostomy obstruction resulted in severe neurological damage; granulomas required resection in 37.5%. Secondary subglottic stenosis was found in 15.4% with the Neodym‐Yag, but not with the CO 2 laser. With tracheostomy, 12.5% were symptom‐free at age 2–3 years, vs. 25.0% in the Neodym‐Yag and 41.6% in the CO 2 laser period. Speech development was delayed in 75.0% with tracheostomy, and parental anxiety lessened in only 18.8% before the second birthday (68.8% without tracheostomy). Since the end of the retrospective analysis, we treated a further 21 patients (mean stenosis, 83.3%) with the CO 2 laser, with only one tracheostomy (4.8%). Compared to steroids and tracheostomy, a significant reduction in morbidity and speech developmental delay, and an improved quality of life, were achieved with CO 2 laser resection, and this approach was superior to the Neodym‐Yag laser. Pediatr Pulmonol. 2005; 39:233–237. © 2005 Wiley‐Liss, Inc.