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Open excision of subglottic hemangioma with microscopic dissection.

OBJECTIVE: To evaluate the efficacy of open excision of subglottic hemangioma utilizing microscopic dissection techniques.

DESIGN: Retrospective review of case series.

SETTING: Tertiary care teaching children's hospital.

PATIENTS: The study included 8 patients ages 7 weeks to 8 months. All patients underwent open microscopic excision of subglottic hemangioma between 2000 and 2006.

INTERVENTION: All patients underwent full pre-operative evaluation including micro-direct laryngoscopy and bronchoscopy. All resections were carried out with an anterior cricoid split and partial laryngofissure. Intra-laryngeal dissections were carried out under a cross-table binocular dissecting microscope. Mucosal preservation was practiced whenever possible. Thyroid ala cartilage graft was used to augment subglottic laryngeal framework. Patients were intubated for 3-7 days prior to reassessment and extubation.

RESULTS: Eight patients were treated with microscopic open excision of subglottic hemangioma. All patients were successfully extubated. During the follow-up period, 2/8 patients developed early subglottic stenosis that required endoscopic laser treatment. Median follow-up time was 37 months (range 3-84 months). No recurrences have been observed.

CONCLUSION: Microscopic dissection adds precision to open excision of subglottic hemangioma. Such precision enables complete excision while accomplishing maximal mucosal preservation, thus limiting the risk of recurrence and subglottic stenosis.

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