Hemangiomas are benign blood vessel tumors of infancy. Hemangiomas can present on the surface of the skin or deep to skin. They usually appear days to weeks after birth. They then go through a growth phase where they enlarge until approximately eight to 12 months of age.
Hemangiomas can occur anywhere in the body. They are typically on the skin or are deep to the skin. In the head and neck hemangiomas can be located on or around the face, eyes, ears, saliva glands, mouth, and tongue. Sometimes hemangiomas occur in the breathing passage just below the vocal cords. These hemangiomas are called “subglottic hemangiomas.” Babies with subglottic hemangiomas may have breathing difficulty.
A pediatric ENT should be consulted to decide on the best approach to diagnosis and treatment. Usually evaluation of hemangiomas involves a multidisciplinary team approach in which radiologists, dermatologists, and surgeons all evaluate the child and create a multi-step approach to treatment.
Vascular malformations are similar to hemangiomas in that they involve blood or lymph vessels. However vascular malformations do not rapidly grow during infancy and are typically present at the time of birth. Common types of vascular malformations include venous (vein) malformations and lymphatic malformations. Although benign, these masses in children can sometimes interfere with breathing, eating or a child’s appearance.
Symptoms of subglottic hemangiomas and vascular malformations
As these types of malformations can occur on the inside of the mouth, throat, or airway, it is often difficult for the parents to understand why their children have certain symptoms, including:
- Difficulty breathing or swallowing
- Increased congestion
- Stridor (noisy breathing)
Our team of pediatric ENTs at Johns Hopkins and evaluate children with hemangiomas and vascular malformations, particularly those malformations that involve the mouth, throat, saliva glands, or airway. Advanced diagnostic imaging may be important in evaluation of the malformation and deciding on the best approach to treatment.
We only treat children, so we have the necessary techniques and child-friendly atmosphere to thoroughly evaluate and diagnose our patients. Your child’s evaluation will include: A complete medical history and a thorough physical examination, using special lighted scopes if needed.
Different diagnostic studies may be ordered, including imaging studies, lab tests and detailed physical examinations. These may include:
- CT scan
- MRI scan
- Swallow study
- Neck X-ray
Treatment for subglottic hemangiomas and vascular malformations usually involves the combined efforts of a multidisciplinary team of pediatric ENTs, vascular specialists, facial plastic surgeons, dermatologists and interventional radiologists.
Subglottic hemangiomas may respond well to treatments involving:
- Propranolol (a beta-blocker)
- Oral steroid therapy
- Injections with steroid medication
- Laser treatments to shrink the subglottic hemangioma
- Surgical resection
- Occasionally tracheostomy
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