A 4-month-old infant presents with progressively worsening biphasic stridor and recurrent croup-like episodes. There is a large cutaneous haemangioma over the beard area of the face and neck. Microlaryngoscopy shows a reddish-blue compressible submucosal mass in the subglottis. Next step in management is:

• A Oral propranolol therapy ✓
• B Tracheostomy as definitive treatment
• C Systemic corticosteroids alone with observation
• D CO2 laser excision of the entire lesion

Explanation

Subglottic haemangioma classically presents with biphasic stridor in infancy and is associated with cutaneous haemangiomas, particularly in the beard distribution. Beta-blocker therapy with propranolol has become the mainstay of treatment and has largely replaced systemic steroids and open surgical excision. Tracheostomy is reserved for severe airway compromise awaiting drug response, and CO2 laser resection carries risk of subglottic scarring and stenosis.

Reference: Cummings Otolaryngology: Head and Neck Surgery, 7th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.