How do infantile hemangiomas cause airway obstruction?

Updated: Nov 09, 2020
  • Author: Richard J Antaya, MD; Chief Editor: William D James, MD  more...
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Airway obstruction is a rare complication of hemangiomas; upper lip lesions very seldom obstruct both nasal passages. This can be a problem for young infants who are obligate nose breathers. Cervical parapharyngeal or palatal hemangiomas can cause acute or subacute obstruction.

Insidious signs and symptoms, such as sleep apnea, cor pulmonale, or even failure to thrive, can be associated with hemangiomas in the upper aerodigestive tract. Laryngeal (often referred to as subglottic) hemangiomas present early (6-8 wk) with symptoms of inspiratory or biphasic stridor, especially with feeding or crying. Cough, cyanosis, or hoarseness may be associated findings. The diagnosis is confirmed by direct laryngoscopy, MRI, soft tissue anteroposterior neck radiographs, or esophagography.

Prompt consultation with a pediatric otolaryngologist should be sought for all suspected cases. Treatment includes systemic beta-blockers like propranolol, corticosteroids, or interferon alfa, as well as excisional or laser surgery. Tracheostomy is sometimes necessary until the airway becomes patent.

Upper airway hemangiomas appear to be associated more commonly with superficial cutaneous hemangiomas involving the mandibular branch of the trigeminal nerve (beard area hemangiomas). [53] They can occur without cutaneous involvement.

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