In the case of sub-glottic hemangioma, with serious immediate or cortico-resistant dyspnea, it is not always possible to wait for the growth of the laryngo-tracheal skeleton and the spontaneous involution of the angioma. On the basis of a series of 25 cases, we propose in these serious forms the following therapeutic escalation: very high dose corticotherapy, with betamethasone at 0.12 to 0.48 mg/kg/day for 15 days, followed by a degressive treatment over 6 weeks to 3 months; intubation to overcome a difficult stage in the event of aggravation of the angioma with a rhinopharyngitis. Embolization and the use of the laser proved unsatisfactory in the extensive forms of angiomas. In the event of failure of the preceding treatment, we perform a tracheotomy, the duration of which can be reduced by the surgical exeresis of the angioma with a widening of the larynx.