Subglottic Hemangioma: Doctor Reconstructs Dina's Airway
| Pioneering Cincinnati Doctor Works Miracles for Children Nationwide |
|---|
Because of a pioneering doctor at Cincinnati Children's Hospital Medical Center, children around the world not only suffering from pneumonia but other stridor conditions are now tracheostomy free and sporting the same scar. To the parents of these children, Robin Cotton, MD, director of Otolaryngology (ENT), is a blessing. (Stridor is a term used to describe a high-pitch respiration noise. This noise is often a sign of an airway obstruction, which can result in a child needing a tracheostomy.) Dr. Cotton is able to reconstruct children's airways to get them off of a tracheostomy even in the most severe cases. Since 1974, he has reconstructed more than 2,000 airways of children ranging from a few months old to teenagers. Families come to him from all over the world. Throughout his career, he's had a 92 percent success rate in tracheal reconstruction. The airway reconstruction, developed by Dr. Cotton, involves taking cartilage from a child's ribs, placing a stent-like tube in the airway, and allowing the airway widened by the rib cartilage to heal around the tube in order to keep the airway open during the healing process. The outcome is a breathable airway for those who may not have had that chance in the past. |
Dr. Robin Cotton |
Dina was born with a rare condition called subglottic hemangioma, which caused her airway to become seriously obstructed. She went into respiratory distress. At only 10 weeks old, Dina required a tracheostomy. But thanks to a pioneering doctor, Dina's airway was reconstructed, allowing her to have the tracheostomy taken out.
Dina lives in Pasadena, California, with her family. She is a great example of the magic performed daily by the Head and Neck Surgery team in the Division of Pediatric Otolaryngology.
Dina was born in 2001, with a rare condition called subglottic hemangioma. When she was just 10 weeks old her airway became seriously obstructed and she went into respiratory distress. Most children like Dina require a tracheostomy because of severe obstruction of the airway which can produce significant respiratory distress. (A tracheostomy is a surgical procedure where a hole is cut into a child's airway, which is used to help the child breathe.)
About Subglottic Hemangioma
Subglottic hemangioma is a type of mass that consists mostly of blood vessels. It affects more females than males. The natural history of subglottic hemangioma is characterized by rapid growth (the proliferative phase) during the child's first few months of life, followed by a cessation of growth (stationary phase), then a period of involution where the swelling goes down.
Children usually show signs of subglottic hemangioma around the age of two to three months of life. The infant is often mistakenly treated for croup. Lateral radiographs can entertain the diagnosis of posterior subglottic masses but endoscopy is required to make a definitive diagnosis. An endoscopy is an examination under anesthesia with a thin, lighted tube that is placed in the airway and transmits images so the lining of the organs can be examined. The lesion is a red or blue submucosal mass (a mass that is in a layer of tissue that lies below a mucus membrane) seen at the level of the subglottis (the lower part of the larynx just below the vocal cords down to the top of the trachea, which takes air to the lungs).
Severe, recurrent and possible lethal obstruction to the airway is a usual and most striking symptom of the subglottic hemangiomas of infants. Because these hemangiomas are sessile (permanently attached), their intrusion upon the airway causes difficulty breathing. Some children may outgrow the problem, as the hemangioma will begin to get smaller after the first year of life.
Dina Receives a Tracheostomy
In December 2001, Dina received her tracheostomy. "This was the most challenging thing I've been through in my life. This topped any life stress," says Tina, Dina's mom and licensed entertainment attorney. "Dina required care virtually around the clock. She had to be suctioned every couple hours, was hooked up to an apnea monitor. Infections developed. She required a tube feeding moisture to her tracheostomy in order to prevent blockage which was hooked up to a noisy compressor. Her tracheostomy tube had to be changed regularly as well as the connecting ties. It was as if we were running an intensive care unit from her bedroom. She rarely left her crib and it was a nightmare to feed her.
As children with tracheostomies get older, they can't talk, don't develop normal speech patterns, go to special schools. Adds Tina, "You're at the mercy of nurses and other medical equipment companies. Not only does the parent have to take care of the child, you become the business manager for billing and insurance issues. Your life revolves around monitoring your child to keep them alive."
Dina's Family Travels to Cincinnati
Through extensive research, Dina's parents were able to find Robin Cotton, MD, at Cincinnati Children's. "To parents of tracheostomy kids, Cincinnati is like the trach capital of the world," says Tina. "Everywhere I turned, people would ask me what Dr. Cotton would say. When we traveled to Cincinnati, I felt like I was going to Oz to see this wizard of trachs."
The family traveled with Tina by plane to Cincinnati from Pasadena to see if Dr. Cotton might be able to reconstruct Dina's airway and have the tracheostomy taken out. Dr. Cotton gave Dina a 60 percent chance of fully recovering after airway reconstruction surgery. So, in December 2002, at the age of 16 months, Dina had surgery so that her tracheostomy could finally be removed.
Tina and her family were so thrilled about Dina's results that soon after their return to California, Tina sent Dr. Cotton a silver key chain with a note that read, "You are the key to my daughter's happiness. Thank you for opening up so many doors in her life."
