Introduction:
Infantile haemangiomas are the most common vascular tumours in children, with higher prevalence in females and low birth weight infants. Beard distribution haemangiomas, involving the lower face, chin, preauricular areas, and anterior neck, are often associated with airway involvement in the supraglottic or subglottic regions. Even isolated head and neck haemangiomas may carry a risk of airway complications. Diagnosis relies on clinical evaluation, with bronchoscopy reserved for complex cases.

Aim:
To emphasise early recognition and treatment of airway involvement in focal head and neck haemangiomas.

Case study:
A 4-month-old former 27-week preterm infant with birth weight of 1.07 kg, who required oxygen support since birth. He was referred for upper airway assessment due to stridor during crying. Examination revealed a stridor with subcostal and suprasternal recession and a 1.5x1.0 cm submental haemangioma. Direct laryngoscopy and bronchoscopy under anaesthesia identified an extensive airway haemangioma extending from the nasal cavity to the bronchi. The infant was treated with oral propranolol. At 11-month follow-up, the airway haemangioma had resolved, and the submental haemangioma had significantly reduced in size.

Results and discussion:
Recognizing the association between head and neck haemangiomas and airway involvement is essential for prompt and effective management.

Conclusions:
Head and neck haemangiomas, even if they appear isolated, may still pose a risk of airway involvement. Early recognition and a multidisciplinary approach are essential for managing these complex cases. Propranolol therapy plays a critical role in the treatment of these lesions, but close monitoring and ongoing follow-up are necessary to ensure successful outcomes and prevent airway complications.