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recurrent respiratory papillomatosis

recurrent respiratory papillomatosis
24 Aug, 2017

Laryngeal papilloma

Juvenile recurrent laryngeal papillomatosis is the most common benign laryngeal tumour of the paediatric population and the second most common cause of hoarseness in paediatric age group.

Cause

RRP is a disease caused by human papilloma virus type 6 and 11. It is characterized by proliferation of squamous papilloma which is mostly benign in nature in upper aero digestive tract.

Age of onset  

RRP can occur both in the paediatric population and in adults.

Two distinct forms of recurrent respiratory papillomatosis are identified the juvenile form which is the more aggressive form and the lesser aggressive form which is seen in adults.

Transmission

There is a strong association between the maternal infection and the incidence of RRP. Though the exact mechanism is not clearly understood but vertical transmission that occurs during delivery is thought to be a major mode for transmission of disease.

 

Prevention

Immunization of all children 11 to 12 years of age i.e. before their sexual debut should be vaccinated. Vaccination has also been recommended for boys and girls till the age of 20. There are two types of vaccines available in the market. The quadrivalent vaccine which is active against HPV 6, 11, 16 and 18 and bivalent vaccine provides protection against. HPV 16, 18 but not 6 and 11.

Clinical features

Hoarseness is the primary symptom of RRP secondarily; stridor may be seen in patients.

There may be varied presentation but usually change in voice is the primary presentation feature, wherein the parents may complain of weak cry in case of neonates or hoarseness in case of older children. The earlier the age of presentation, the more aggressive is the disease. There is a higher incidence of tracheostomy for airway maintenance in children presenting early in their life.

Diagnosis

Usually it’s a clinical diagnosis wherein the papilloma can be identified on routine indirect Laryngoscopy or rigid/ fibreoptic laryngoscopy with the advent of flexible scopes with chip on tip technology as small as 1.8mm it is now feasible to make the diagnosis even in neonates. The use of videostroboscopy and I-scan imaging can quite useful in diagnosing the condition.

Treatment

The primary treatment for RRP is micro-laryngeal surgery. There are various modalities which can be used for the treatment. The mostly widely used modality for the management of viral papilloma is co2 laser. The laser with a wavelength of 10,600mm can be used for extensive laryngeal papillomatosis as well as isolated lesions with the use of acupulse co2 laser. The lesions can be managed effectively with minimal damage to underlying lamina. However, the ablations of lesions with co2 laser are associated with plume containing viral which can cause infection to the surgical staff, so adequate precautions are mandatory.

There is a shifting trend towards use of micro debrider assisted debulking of the lesions with presentation of underlying lamina propria.

Recently the use of KTP laser for ablation of RRP in office settings has become popular. This does not require any admission and desired result can be obtained without damaging the cords.

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