Subglottic hemangioma
If you want to know about the causes and treatment of subglottic hemangioma, its causes and symptoms, if you or those around you have subglottic hemangioma and you are worried about this and you want to know about this disease of the larynx, we recommend that you read more.
What you will read next:
subglottic hemangioma, Introduction
The most common head and neck tumor in infants is subglottic hemangioma
Fifty percent of infants with subglottic hemangiomas also have skin hemangiomas.
Babies born with subglottic hemangioma have shortness of breath from birth. Symptoms usually appear between the ages of three and six months, and upper respiratory tract infections, symptoms such as infant shortness of breath and special breathing sounds called stridor, worsen.
What is hemangioma, what are its symptoms, why it occurs, how it is diagnosed and what the treatment will be is one of the topics that we will discuss in the following.
To learn more about this common disease in infants, we will first talk a little about the anatomy of the larynx.
anatomy of the larynx
The larynx is located in the middle line of the neck and is located around the third to sixth vertebrae of the neck and From about the third to sixth vertebrae of the neck, it leads from the top to the throat and from the bottom to the trachea.
The larynx has cartilages that are held together by membranes and ligaments that move together by a group of internal and external muscles and muscles.
The laryngeal cavity is made up of different parts
Laryngeal entrance or atrium
The laryngeal cavity is made up of different parts
- Laryngeal entrance or atrium
- Laryngeal Utricule and Saccule
- Laryngeal muscles
- Vocal cords
- And the space below the vocal cords which is called subglottic space
Cricoid cartilage is a cartilage located in a circular shape at the back and its arch is located at the front, and it is the only circular skeleton that is completely located in the larynx.
What does the larynx do?
The larynx is the airway from the upper respiratory tract to the lower respiratory tract.
That is, in the inhale, the vocal cords move away from each other and in the exhale, they come closer together. Another task and another action is that the larynx acts as a protective mechanism. That is, the sphincter action at the entrance to the larynx and the false and true vocal cords when swallowing protects the lower parts of the respiratory system, trachea, and lungs.
Another function of the larynx is coughing.
Coughing plays an important role in expelling fluids and objects that have entered the airways. Coughing occurs when the glottis closes and then suddenly opens on exhalation. It will not be possible to cough without glottis function.
Closing the glottis fixes the chest when lifting objects, Another important function is that sound is produced in the larynx by closing the glottis and moving the mucosal folds of the true vocal cords and allowing air to pass through the subglottis and then by repeatedly returning the vocal folds to their previous state.
It is said that the more and more powerful the contractions and the approach of the vocal cords, the more resistance they create in the passage of air, Therefore, the frequency of the sound produced will be lower.
The higher the air pressure under the glottis relative to the atmosphere, the louder the sound produced.
What is subglottic hemangioma?
Laryngeal hemangioma, or subglottic hemangioma, is a clot of blood vessels that is located just below the vocal cords, these masses usually grow rapidly. This rapid growth occurs within 6 to 12 months and then it will start to wrinkle and fade.
Epidemiology
Subglottic hemangioma, abbreviated sgh, is a benign mass and tumor that develops in infancy and can cause many obstructive airway problems.
In general, we must say that neonatal hemangiomas and congenital hemangiomas make up 4 to 5% of the population of children and infants and are in fact the most common form of head and neck tumors in children.
We must also say that these subglottic hemangiomas account for one and a half percent of all congenital laryngeal problems, and that girls are twice as likely as boys to have them.
Why do these subglottic hemangiomas occur?
These hemangiomas are the result of a vascular malformation.
In other words, the remaining tissues of the fetal mesangium located in the subglottis may grow and proliferate and form the subglottic hemangioma.
Some of the features of subglottic hemangiomas are:
- Very fast growth in the first year of life
- Decay in the next five years of life
If the laryngeal laser is performed, there is a 20% risk of developing stenosis of the throat following the complications of the laser.
If it causes acute obstructive problems, it will require interventions to open the airway, including the tracheostomy.
Respiratory stridor is sometimes called a noisy breathing. It is a persistent, loud pulmonary sound that is heard when inhaling and causes narrowing of the upper airways, such as narrowing of the larynx.
Risk factors
Low birth weight babies
And premature babies
More than normal babies are at risk for laryngeal hemangiomas, but it is interesting to note that studies show that when a woman has multiple Childbirth, Children that born in multiple births are at higher risk for this complication.
signs
- Clinical signs and manifestations of subglottic hemangiomas include persistent cough that sounds like a croup.
- noisy breathing or respiratory stridor
- Difficulty breathing
What causes subglottic hemangiomas?
in fact, subglottic hemangiomas are non-hereditary vascular masses, that is, they are not passed on through the genes from parents to children, and no food, no food, no activity, and no medication used during pregnancy can cause subglottic hemangiomas to occur.
The main source of hemangiomas is stem cells.
The finding that they originate in mesenchymal tissue and stem cells is important and can help us know what therapeutic and pharmacological interventions we can take to stop their growth and kill them.
One of the important points to note is that subglottic laryngeal hemangiomas can easily be misdiagnosed because They may have few signs or symptoms or symptoms that overlap with other illnesses in children.
Interestingly, 50% of children who have had laryngeal or subglottic hemangiomas also have hemangiomas on the surface of the skin.
we have to say that babies who have very severe and large subglottic hemangiomas when they are born, that is, with significant obstructions and airway obstruction, can develop respiratory distress, which can be dangerous.
Diagnosis
To diagnose neonatal hemangiomas or subglottic hemangiomas, a simple X-ray from the baby's neck is done, this scan, if done correctly, can show a lump in the baby's airway.
Flexible laryngoscopy, which is commonly performed in the office and clinic, can also be helpful enough for the doctor to see the hemangioma that is causing the breathing problem and symptoms.
Among the paraclinical procedures that help physicians to make a diagnosis are the following: plain X-ray imaging, as well as CT scans and MRI, in some cases angiograms and biopsies as well as blood tests of suspicious tissue is also performed.
Are subglottic hemangiomas of concern?
If you have a child with subglottic hemangioma at birth, pediatrician can perform routine checkups, depending on your child's condition, if he or she has not had a complete or significant airway obstruction.
Be sure to call the emergency room if the hemangioma bleeds or appears to be inflamed, swollen, or infected.
treatment
The treatment chosen by a doctor for laryngeal hemangiomas depends on the clinical condition, symptoms, and severity of the child's respiratory distress.
Among the items that are considered as treatment modalities, we mention the following:
Use of corticosteroids that can reduce its size and volume, tracheostomy if the child has respiratory problems due to airway obstruction, use of laser therapy, intralesional corticosteroid injections and microdebridement and open surgery.
The treatments mentioned above should be recommended by your doctor according to your condition and your child. Some treatments that are common for subglottic hemangiomas, such as surgical microdebridement or laser therapy, can themselves cause secondary stenosis or stenosis below the larynx.
Concluding remarks
Laryngeal hemangiomas, subglottic hemangiomas, are more common in infants, especially in the first six months of life, and 50% of cases are associated with cutaneous hemangiomas. In infants, these hemangiomas are capillary.
Because the clinical signs and manifestations of laryngeal hemangiomas are very similar to those of croup, they may be misdiagnosed, so it is important that people have a laryngoscopy so that the doctor can see the soft mass under the mucus under the vocal cords.
Treatment for severe shortness of breath includes injections of corticosteroids, and if shortness of breath persists tracheostomy or tracheotomy is necessary.
Subglottic or laryngeal hemangiomas, or hemangiomas of the vocal cords, are cavernous in adults.
Symptoms in adults include hoarseness or dysphonia and bleeding, and treatment in adults includes corticosteroids and radiation therapy.