1. Background

• hemangiomas represent a hemartoma of blood vessel development and can be found within any organ of the body
• laryngeal hemangiomas:
  • usually subglottic
  • asymmetrically located usually posteriorly
  • usually asymptomatic at birth but may become problematic during the early months of life due to enlargement

1. Respiratory Manifestations

• inspiratory and expiratory stridor
  • worse with crying & upper respiratory tract infections
• hoarseness, harsh cry
• chronic cough
• dyspnea +/- respiratory distress
• upper airway obstruction

2. Others

• feeding difficulties +/- failure to thrive

3. Associated Findings

• 50% of patients also have cutaneous hemangiomas

1. Direct Laryngoscopy

• diagnostic
• hemangioma
  • compressible, consistency of a firm sponge, covered with normal mucosa
• biopsy may cause significant bleeding although tends to be fibrotic

2. Imaging Studies

1. Supportive

• respiratory support with severe or life-threatening upper airway obstruction, i.e., intubation, tracheostomy

2. Medical

• high dose systemic steroids
  • high response rate but coupled with side effects
  • tend to recur with cessation of therapy

3. Surgery

• indications
  • significant upper airway obstruction
  • failure to regress spontaneously or after steroid therapy
• excision
  • CO2 laser, cryotherapy, open excision, endoscopic excision
  • side effects include hemorrhage and postoperative scarring and stenosis

4. Prognosis

• natural history is one of growth over 6-18 months followed by spontaneous regression