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Recurrent Respiratory Papillomatosis

(Laryngeal Papillomas)

By Udayan K. Shah, MD, Professor;Chief, Division of Otolaryngology, Sidney Kimmel Medical College at Thomas Jefferson University;Nemours/A.I. duPont Hospital for Children

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Recurrent respiratory papillomatosis is a rare, benign, viral airway tumor that is caused by the human papillomavirus. The most common way for patients to present is with laryngeal papillomas.

Recurrent respiratory papillomatosis most often occurs in the larynx as laryngeal papillomas. Laryngeal papillomas can occur at any age but are most common at ages 1 to 4 yr. They may reappear after treatment, undergo malignant transformation, and/or occasionally spread to the trachea or lungs.

Symptoms and Signs

Symptoms of recurrent respiratory papillomatosis can include weak cry, hoarseness, and, in severe cases, airway obstruction.

Diagnosis

  • Biopsy

The tumor is identified by laryngoscopy. The diagnosis of recurrent respiratory papillomatosis is confirmed by biopsy.

Treatment

  • Excision

Treatment of recurrent respiratory papillomatosis is excision. Because tumors may recur in weeks or months, multiple procedures may be required and surveillance by laryngoscopy and bronchoscopy is necessary. Surgery may involve pulsed-dye laser therapy or photodynamic therapy.

Antiviral drugs (eg, cidofovir) have been tried in severe cases. Lesions may regress at puberty in some patients. The quadrivalent human papillomavirus vaccine offers hope of prevention, but efficacy has not yet been proved.

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