Hostname: page-component-78c5997874-94fs2 Total loading time: 0 Render date: 2024-11-02T22:36:04.222Z Has data issue: false hasContentIssue false
  • English
  • Français

Failure of propranolol in the treatment of childhood haemangiomas of the head and neck

Published online by Cambridge University Press:  16 August 2011

J Goswamy ,
M P Rothera  and
I A Bruce
J Goswamy*
Affiliation:
Department of Paediatric Otorhinolaryngology, Royal Manchester Children's Hospital, UK
M P Rothera
Affiliation:
Department of Paediatric Otorhinolaryngology, Royal Manchester Children's Hospital, UK
I A Bruce
Affiliation:
Department of Paediatric Otorhinolaryngology, Royal Manchester Children's Hospital, UK Honorary Senior Lecturer, The University of Manchester, UK
*
Address for correspondence: Mr J Goswamy, Department of Paediatric Otorhinolaryngology, Royal Manchester Children's Hospital, Oxford Road, Manchester M13 9WL, UK E-mail: [email protected]
Get access Rights & Permissions [Opens in a new window]

Abstract

Background:

Infantile haemangiomas enter a rapid proliferative phase within months of birth, before slowly involuting. Those with the potential for disfigurement or morbidity require intervention. Propranolol has emerged as an effective new treatment modality, with the potential to become the first-line treatment of choice.

Methods:

Four children with haemangiomas of the head and neck were treated with propranolol at a tertiary referral centre. The size of the haemangioma and the symptoms resulting from airway compromise were monitored.

Results:

Three of the four children showed a dramatic response to treatment with propranolol. However, one child responded initially but was readmitted with stridor secondary to new haemangioma proliferation.

Conclusions:

We report a cautionary case in which a subglottic haemangioma developed contemporaneously with propranolol treatment, requiring surgical intervention. This finding highlights the need for regular follow up of treatment response, and the need for monitoring for treatment side effects.

Keywords

InfanthemangiomasCongenitalLarynxNoseFacePropranolol
Type
Main Articles
Information
The Journal of Laryngology & Otology , Volume 125 , Issue 11 , November 2011 , pp. 1164 - 1172
Copyright
Copyright © JLO (1984) Limited 2011

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

Footnotes

Presented at the 138th Semon Club Meeting, 20 November 2009, London, UK

References

1Mulliken, JB, Glowacki, J. Mast cell hemangiomas and vascular malformations. Pediatrics 1982;70:48–51Google Scholar
2Chang, LC, Haggstrom, AN, Drolet, BA, Baselga, E, Chamlin, SL, Garzon, MC et al. Growth characteristics of infantile haemangiomas: implications for management. Pediatrics 2008;122:360–7CrossRefGoogle ScholarPubMed
3Leaute-Labreze, C, de la Roque, ED, Hubiche, T, Boralevi, F, Thambo, JB, Taieb, A. Propranolol for severe hemangiomas of infancy. N Engl J Med 2008;358:2649–51CrossRefGoogle ScholarPubMed
4Sanchez Perez, R, Cortes Mora, P, Gonzalez Rodriguez, JD, Rodriguez Sanchez, F, De la Pena de Torres, J. Treatment of infantile haemangiomas with propranolol [in Spanish]. An Pediatr (Barc) 2008;68:152–4Google Scholar
5Denoyelle, F, Leboulanger, N, Enjolras, O, Harris, R, Roger, G, Garabedian, EN. Role of propranolol in the therapeutic strategy of infantile laryngotracheal hemangioma. Int J Pediatr Otorhinolaryngol 2009;73:1168–72Google Scholar
6Jephson, CG, Manunza, F, Syed, S, Mills, NA, Harper, J, Hartley, BEJ. Successful treatment of isolated subglottic haemangioma with propranolol alone. Int J Pediatr Otorhinolaryngol 2009;73:1821–3Google Scholar
7Lawley, LP, Siegfried, E, Todd, JL. Propranolol treatment for hemangioma of infancy: risks and recommendations. Pediatr Dermatol 2009;26:610–14CrossRefGoogle ScholarPubMed
8Qin, ZP, Liu, XJ, Li, KL, Zhou, Q, Yang, XJ, Zheng, JW. Treatment of infantile hemangiomas with low-dose propranolol: evaluation of short-term efficacy and safety [in Spanish]. Zhonghua Yi Xue Za Zhi 2009;89:3130–4Google ScholarPubMed
9Maturo, S, Hartnick, C. Initial experience using propranolol as the sole treatment for infantile airway haemangiomas. Int J Pediatr Otorhinolaryngol 2010;74:323–5CrossRefGoogle Scholar
10Truong, MT, Chang, KW, Berk, DR, Heerema-McKenney, A, Bruckner, AL. Propranolol for the treatment of a life-threatening subglottic and mediastinal infantile hemangioma. J Pediatr 2010;156:335–8CrossRefGoogle ScholarPubMed
11Sans, V, Dumas de la Roque, E, Berge, J, Grenier, N, Boralevi, F, Mazereeuw-Hautier, J et al. Propranolol for severe infantile hemangiomas: follow-up report. Peds 2009;124:e423–31CrossRefGoogle ScholarPubMed
12Buckmiller, L, Dyamenahalli, U, Richter, GT. Propranolol for airway hemangiomas: case report of novel treatment. Laryngoscope 2009;119:2051–4Google Scholar
13Theletsane, T, Redfern, A, Raynham, O, Harris, T, Prose, NS, Khumalo, NP. Life-threatening haemangioma: a dramatic response to propranolol. J Eur Acad Dermatol Venereol 2009;23:1465–6Google Scholar
14Zimmermann, AP, Wiegand, S, Werner, JA, Eivazi, B. Propranolol therapy for infantile haemangiomas: review of the literature. Int J Pediatr Otorhinolaryngol 2010;74:338–42CrossRefGoogle ScholarPubMed
15Leon-Villapalos, J, Wolfe, K, Kangesu, L. GLUT-1: an extra diagnostic tool to differentiate between haemangiomas and vascular malformations. Br J Plast Surg 2005;58:348–52CrossRefGoogle ScholarPubMed
16North, PE, Waner, M, Mizeracki, A, Mihm, MC. GLUT1: a newly discovered immunohistochemical marker for juvenile hemangiomas. Human Pathol 2000;31:11–22CrossRefGoogle ScholarPubMed
17D'Angelo, G, Lee, H, Weiner, RI. cAMP-dependent protein kinase inhibits the mitogenic action of vascular endothelial growth factor and fibroblast growth factor in capillary endothelial cells by blocking Raf activation. J Cell Biochem 1997;67:353–663.0.CO;2-V>CrossRefGoogle ScholarPubMed
18Sommers Smith, SK, Smith, DM. Beta blockade induces apoptosis in cultured capillary endothelial cells. In Vitro Cell Dev Biol Anim 2002;38:298–304Google Scholar
19Hoffmann, BB. Adrenoreceptor antagonist drugs. In: Katzung, BG. Basic and Clinical Pharmacology, 10th edn.New York: McGraw Hill, 2007;147–58Google Scholar
20Inder, T. How long can I go? The impact of hypoglycaemia on the immature brain. Pediatrics 2008;122:440–1Google Scholar
21Burns, CM, Rutherford, MA, Boardman, JP, Cowan, FM. Patterns of cerebral injury and neurodevelopmental outcomes after symptomatic neonatal hypoglycaemia. Pediatrics 2008;122:65–74CrossRefGoogle Scholar
22Bitar, MA, Moukarbel, RV, Zalzal, GH. Management of congenital subglottic haemangioma: trends and success over the past 17 years. Otolaryngol Head Neck Surg 2005;132:226–31Google Scholar