Treatment Of Laryngeal Papillomatosis Research Articles

Laryngeal Papillomatosis: A Non-traditional Flexible Endoscopic Approach

To evaluate the efficacy of flexible endoscopic laryngeal surgery (FELS) using unconventional tools in the treatment of laryngeal papillomatosis (LP). We applied FELS using forceps, diathermy snare, and Nd:YAG laser for 47 patients with LP. In 38 cases (81%), surgeries were performed under topical anesthesia with spontaneous respiration and in seven cases we used general anesthesia with superimposed high-frequency jet ventilation. In two cases, both types of anesthesia were used in different sessions. In 22 cases (46.8%), the interventions were performed as outpatient procedures. The Nd:YAG laser was used in the majority (89.4%) of cases. The expected result (complete eradication of the visible lesion) was obtained in all treated patients without procedure complications. Disease recurrence was established in 16 cases (34%) that led to repeated surgeries. FELS, using Nd:YAG laser as a main tool, is a safe and effective approach that can be a feasible alternative to the conventional approach in the treatment of LP due to possibility to avoid repeated general anesthesia with its associated risks; applicability for the patients, who have contraindications for general anesthesia and transoral microsurgery; possibility to perform the intervention in an outpatient setting that leads to essential reduction of medical costs; economy of time. Nd:YAG laser ablation, preceded by diathermy snare resection, allows reducing the time of the intervention and thermal injury of the adjacent tissues, compared to using laser alone, and can be used in bulky and obstructive lesions that present a limitation for nonablative techniques.

A Patient with Juvenile Recurrent Respiratory Papillomatosis Complicated by Laryngeal Stenosis after Laryngeal Microsurgery: A Clinical Case

BACKGROUND: The relevance of the problem of juvenile respiratory papillomatosis lies in the recurrent course of the disease in young children. This can lead to the development of respiratory stenosis, requiring repeated, in some cases, monthly surgical treatments for endolaryngeal removal of papillomas, which sometimes leads to persistent scar stenosis of the larynx. We present clinical case of achieving remission of recurrent juvenile papillomatosis of the larynx. CLINICAL CASE: Patient, 5 years old, who applied in February 2016, was hospitalized in the ENT department with severe dyspnea, laryngoscopy revealed laryngeal papillomatosis with 3–4 grade stenosis. Over the past 10 months, the patient has undergone laryngeal surgery 6 times using cold instruments and a CO2 laser due to papillomatosis. Taking into account the recurrent nature of the course of the disease, the patient is administered to consult an allergist-immunologist. Based on the anamnesis and the results of the tests, the immunologist-allergist diagnosed: Primary immunodeficiency, unspecified (insufficiency in the production of specific antibodies), persistent allergic rhinitis, in the stage of incomplete remission and prescribed treatment. The patient was operated twice from 2017 to 2018 for a developed post-operative complication – cicatricial stenosis of the larynx. With these surgical repairs, no recurrence of laryngeal papillomatosis was detected. Furthermore, in 2021, according to endovideolaryngoscopy, remission was confirmed. R In this clinical case, we managed to achieve remission of laryngeal papillomatosis in a patient after surgery and treatment by an immunologist. Allergen elimination and immunocorrection helped us achieve deep remission. Surgical treatment eliminated laryngeal stenosis, recovering breathing and voice quality. Furthermore, this clinical case demonstrates the importance of studying the immune status in patients with laryngeal papillomatosis. CONCLUSION: The results obtained by us show the need for the use of immunomodulators in these patients. All children with prolonged hoarseness should undergo laryngoscopy, which will allow diagnosing laryngeal papillomatosis at earlier uncomplicated stages of the disease. Treatment of laryngeal papillomatosis should be comprehensive and in addition to surgical treatment should include differential immune correction. RESULTS AND DISCUSSION: In the above clinical case, we managed to achieve remission of laryngeal papillomatosis in a patient after surgery and treatment by an immunologist. Allergen elimination and immunocorrection helped us achieve deep remission. Surgical treatment eliminated laryngeal stenosis, recovering breathing and voice quality. Furthermore, this clinical case demonstrates the importance of studying the immune status in patients with laryngeal papillomatosis. The results obtained by us show the need for the use of immunomodulators in these patients. All children with prolonged hoarseness should undergo laryngoscopy, which will allow diagnosing laryngeal papillomatosis at earlier uncomplicated stages of the disease. Treatment of laryngeal papillomatosis should be comprehensive and in addition to surgical treatment should include differential immune correction.

Treatment strategy of papillomatosis of the larynx at children

In this review the authors consider the issues of contemporary methods of medical and surgical treatment of laryngeal papillomatosis in children with due regard for advantages and disadvantages of such methods. The author conducted the analysis of the efficacy of the latest techniques of combined therapy using of modern technologies. The optimal treatment regimen based on the etiological factors and antirecurrent effectiveness of this pathology is provided.

The Utility of Narrow Band Imaging in the Treatment of Laryngeal Papillomatosis in Awake Patients

To determine the value of narrow band imaging (NBI) in visualizing laryngeal papillomatosis (LP), specifically in the awake patient. Retrospective chart review followed by trial of intervention. Ten patients treated for LP in the awake setting were included in the study. Still shots of the same diseased region of the larynx were taken from each procedure, one under white light and one under NBI. The 10 pairs of pictures were then sent to multiple fellowship-trained laryngologists, along with a questionnaire designed to evaluate visualization with NBI versus white light. Raters concluded that NBI improved visualization of diseased tissue 90.0% of the time and showed areas of diseased tissue unappreciated by halogen light in 46.7% of the procedures. They believed that NBI better defined the borders of diseased tissue in 76.7% of the photo sets, and that in 70.0% of the sets, NBI was the better visualization technique in general. However, it was found that 16.7% of the time it was more difficult to visualize areas of diseased tissue with NBI. This study suggests that NBI may provide some benefit in the visualization and treatment of LP in the awake patient. Further work should be done to evaluate its utility in pathology of the larynx.

Effects of conjugated linoleic acid and high oleic acid safflower oil in the treatment of children with HPV-induced laryngeal papillomatosis: a randomized, double-blinded and crossover preliminary study.

BackgroundSurgery is the mainstay therapy for HPV-induced laryngeal papillomatosis (LP) and adjuvant therapies are palliative at best. Research revealed that conjugated-linoleic acid (CLA) may improve the outcome of virally-induced diseases. The effects of Clarinol™ G-80 (CLA) and high oleic safflower oil (HOSF) on children with LP (concomitant with surgery) were evaluated.DesignA randomized, double-blinded, crossover and reference-oil controlled trial was conducted at a South African medical university. Study components included clinical, HPV type/load and lymphocyte/cytokine analyses, according to routine laboratory methods.ParticipantsOverall: ten children enrolled; eight completed the trial; five remained randomized; seven received CLA first; all treatments remained double-blinded.InterventionChildren (4 to 12 years) received 2.5 ml p/d CLA (8 weeks) and 2.5 ml p/d HOSF (8 weeks) with a washout period (6 weeks) in-between. The one-year trial included a post-treatment period (30 weeks) and afterwards was a one-year follow-up period.Main outcome measuresChanges in numbers of surgical procedures for improved disease outcome, total/anatomical scores (staging system) for papillomatosis prevention/viral inhibition, and lymphocyte/cytokine counts for immune responses between baselines and each treatment/end of trial were measured.FindingsAfter each treatment all the children were in remission (no surgical procedures); after the trial two had recurrence (surgical procedures in post-treatment period); after the follow-up period three had recurrence (several surgical procedures) and five recovered (four had no surgical procedures). Effects of CLA (and HOSF to a lesser extent) were restricted to mildly/moderately aggressive papillomatosis. Children with low total scores (seven/less) and reduced infections (three/less laryngeal sub-sites) recovered after the trial. No harmful effects were observed. The number of surgical procedures during the trial (n6/available records) was significantly lower [(p 0.03) (95% CI 1.1; 0)]. Changes in scores between baselines and CLA treatments (n8) were significantly lower: total scores [(p 0.02) (95% CI −30.00; 0.00)]; anatomical scores [(p 0.008) (95% CI −33.00: -2.00)]. Immune enhancement could not be demonstrated.ConclusionsThese preliminary case and group findings pave the way for further research on the therapeutic potential of adjuvant CLA in the treatment of HPV-induced LP.

Papilomas y papilomatosis laríngea. Tratamiento con láser CO 2. Nuestra experiencia en 15 años

Objectives The study goal was to evaluate the efficacy of CO 2 laser surgery in the treatment of laryngeal papillomatosis. We analysed several parameters such as gender, average age, relapse rate and viral serotype. Material and methods A total of 26 diagnosed patients were included in this retrospective descriptive review. All of them were treated with CO 2 laser for laryngeal papillomas between 1995 and 2010. Results This pathology was more prevalent in males (65.5%), with a slight predominance of a single larynx localisation over multiple lesion locations. Human papillomavirus (HPV) DNA was detected in 75.8% of the cases; genotypes 6 and 11 prevailed. Of the patients in this review, 44.8% relapsed; the relapse average was 2–3 episodes per patient. A total of 20.7% of cases were in remission (no relapse in the last 2 months); 34.5%, clearing (no apparent relapse in the last 3 years); and 41.3% in the healing stage (without relapse in the last 5 years). There was only one case that showed malignancy. Conclusion Papillomatosis is characterised as a pathology with an unpredictable course and with a low probability of malignancy. CO 2 laser surgery has meant a revolution in symptomatic treatment, but there is presently no curative treatment.

Papillomas & laryngeal papillomatosis. Treatment with CO2 laser surgery. Our experience over 15 years

ObjectivesThe study goal was to evaluate the efficacy of CO2 laser surgery in the treatment of laryngeal papillomatosis. We analysed several parameters such as gender, average age, relapse rate and viral serotype. Material and methodsA total of 26 diagnosed patients were included in this retrospective descriptive review. All of them were treated with CO2 laser for laryngeal papillomas between 1995 and 2010. ResultsThis pathology was more prevalent in males (65.5%), with a slight predominance of a single larynx localisation over multiple lesion locations. Human papillomavirus (HPV) DNA was detected in 75.8% of the cases; genotypes 6 and 11 prevailed. Of the patients in this review, 44.8% relapsed; the relapse average was 2–3 episodes per patient. A total of 20.7% of cases were in remission (no relapse in the last 2 months); 34.5%, clearing (no apparent relapse in the last 3 years); and 41.3% in the healing stage (without relapse in the last 5 years). There was only one case that showed malignancy. ConclusionPapillomatosis is characterised as a pathology with an unpredictable course and with a low probability of malignancy. CO2 laser surgery has meant a revolution in symptomatic treatment, but there is presently no curative treatment.

Treatment of Laryngeal Papillomatosis with KTP Laser Photocoagulation in Office Surgery : A Case Report

再発性喉頭乳頭腫に対しKTPレーザーを用いた光凝固治療が奏効したので報告する。KTPレーザーはヘモグロビンに吸収されやすく，低出力で照射すると周囲の組織損傷を最小限に，血管性病変を光凝固することができ，また軟性内視鏡のチャンネルを使うことで表面麻酔下の外来日帰り手術が可能である。この原理を用い，乳頭腫の栄養血管を凝固することで腫瘍の制御を試みた。症例は60歳男性で，過去3回ラリンゴマイクロサージャリーを受けたが今回再発した。病変は右声帯膜様部，両側声帯後方，喉頭蓋に認め高度嗄声を呈していた。表面麻酔下，軟性内視鏡を用いてKTPレーザーによる腫瘍血管の光凝固をした。3カ月後，ほとんどの病変は消失し，音声も著明な改善をえた。本法は喉頭乳頭腫に対する低侵襲手術として有用であると思われた。

Treatment of recurrent respiratory papillomatosis with microsurgery in combination with intralesional cidofovir—a prospective study

Recurrent respiratory papillomatosis (RRP) is an uncommon disease that may cause symptoms ranging from hoarseness to severe obstruction of the airway. Several treatment modalities have been tried, all with varying success. The goal of this study is to assess the benefit of the intralesional injection of cidofovir as an adjunct to microsurgical excision in treatment of laryngeal papillomatosis. All patients with RRP who presented between 1999 and 2004 at the University Medical Center Groningen were prospectively analyzed, regardless of the patients' age at presentation or duration of the disease. Not all patients were treated with cidofovir. To be included, all patients required a history of repeated microsurgery because of severe recurrence of RRP or because of severe technical difficulties in excising or vaporizing the lesion. Local microsurgery was performed, and then cidofovir, 2.5 mg/ml, was injected intralesionally. Treatment was repeated after 6, 12, 18, 24 and 30 weeks. Six male and three female patients were treated with cidofovir. Localization was the glottis in seven and the technically inaccessible dorsum epiglottidis and subglottis in one case each. The seven patients with glottic localization were cured. The two other patients showed recurrences, but at a lower rate than previously. Several times, however, more than six procedures were necessary. Cumulative doses of cidofovir ranged from 10.5 to 128 mg per patient. Cidofovir is a promising and powerful therapeutic approach for the treatment of RRP. Currently, the combination of microsurgery with intralesional cidofovir seems to be the treatment of choice for RRP.

Human papillomavirus in larynx.

The core of the present clinical and basic research knowledge of laryngeal human papillomavirus (HPV) infection is described. Review. A computer-aided search of MEDLINE database supplemented by hand searches of key journals was conducted. One of the tumor-promoting factors in the larynx is the HPV found both in normal laryngeal epithelium and in laryngeal tumors. The most important manifestation of laryngeal HPV infection is laryngeal papillomatosis, a rare disease caused by HPV types 6 and 11. In laryngeal carcinogenesis, the role of HPV remains uncertain. The means of transmission of HPV are partly unknown, and the course of laryngeal HPV infection is unpredictable and variable. Treatment of laryngeal papillomatosis is based on surgery, especially on CO2 laser and shaver. Alpha-interferon is the drug of choice in patients whose response to surgery is poor. However, neither interferon nor other antiviral drugs are able to eradicate the virus from laryngeal mucosa. Little is known about immunological mechanisms involved in laryngeal HPV infection, but in defense against HPV cellular immunity is considered a more important mechanism than humoral immunity. A good experimental model of HPV infection is lacking in which the entire viral life cycle can take place. Organotypic cell cultures (collagen rafts) are useful, but the rate-limiting step in this method is the difficulties in culturing HPV-positive epithelial cells. Although laryngeal papillomatosis is clinically well defined, the mechanisms and treatment modalities of laryngeal HPV infection need further investigations.

Unusual adverse reaction in a patient sensitized with Photosan 3

Serious side effects of photodynamic therapy (PDT) are rare (A.L. Abramson, M.J. Shikowitz, M.J. Shikowitz, V.M. Mullooly, Clinical effects of photodynamic therapy on recurrent laryngeal papillomas, Arch. Otolaryngology Head Neck Surg., 118 (1992) 25–29; A.L. Abramson, M.J. Shikowitz, Clinical exacerbation of systemic lupus erythematosus after photodynamic therapy of laryngotracheal papillomatosis, Laser Surg. Med., 13 (1993) 677–679). The most frequent side effects of PDT are hypersensitive skin reactions, local edema, nausea, a metallic taste and liver-toxicity (J. Feyh, E. Kastenbauer, Treatment of laryngeal papillomatosis with photodynamic laser therapy, Laryngorhinootologie, 71 (1992) 190–192; J. Feyh, R. Gutmann, A. Leunig, Die Photodynamische Therapie im Bereich der Hals-, Nasen-, Ohrenheilkunde Laryngorhinootologie, 72(6) (1993) 273–278; M.S. Kavuru, A.C. Mekta, Treatment of recurrent respiratory papillomatosis, N. Engl. J. Med., 326 (1992) 204–205; B.L. Wenigg, D.M. Kurtzmann, Photodynamic therapy in the treatment of squamous cell carcinomas of the head and neck, Arch. Otolaryngol Head Neck Surg., 116 (1990) 1267–1270). In this case a patient (aged 57 years) suffering from a recurrent larynx papillomatosis was treated with PDT. He was sensitized with Photosan 3 (DHE) 2.5 mg kg −1 body weight, 24 h to photoradiation. As a light source, an argon dye lase, operating at a wavelength of 630 nm was used, coupled with a cylindrical light applicator. After treatment the patient was admitted to an intensive care unit for 24 h. 3 h after photoradiation, general urticarial wheals arose, as well as techycardia and a decrease in blood pressure followed by all the signs of serious anaphylaxis. 1.5 h after treatment with adrenaline and cortisone and stabilization of the cardiac and circulatory situation no more skin lesions were visible.

β‐ＩＦＮが有効であった喉頭乳頭腫の２例

We have treated one adult with multiple and one with isolated laryngeal pa-pillomatosis. The former, a 27-year-old male was not controlled with the combination of laser surgery and local injection and systemic administration of α-IFN, but he was cured by local injections of six million units of β-IFN combined with laser surgery. The latter, a 44-year-old male was cured by local injections of three million units of β-IFN and resection. The results indicate that local laryngeal injection of β-IFN is useful in the treatment of laryngeal papillomatosis.

Treatment of laryngeal papillomatosis with photodynamic laser therapy

Laryngeal papillomas represent a disease of the head and neck that can be treated only symptomatically by surgical means. Twelve Patients (six adults and six children) with recurrent laryngeal papillomas were admitted to a pilot study for photodynamic laser treatment (Fig. 2). Forty-eight hours after intravenous application of hematoporphyrin derivative, PDT was performed by means of a specially developed laser light applicator (Fig. 1) under general anaesthesia. The laser light was generated by an argon-pumped dye laser system operating at a wavelength of 630 nm. On endoscopic evaluation the papilloma showed a whitish livid colour 24 hours after PDT. During the following 3-5 days the papilloma tissue was sloughed and the true and false vocal cords were covered by fibrin. Some 3-4 weeks after PDT the endolaryngeal mucosa had reepithelized in all patients with no signs of residual disease (Fig. 3). Despite the initial multifocal nature of the papilloma, even beyond the anterior commissure, no synechia developed.

Acyclovir in the treatment of laryngeal papillomatosis

We report the results obtained in a study of 3 young patients with laryngeal papillomatosis, who were treated with acyclovir after tumor excision using forceps was performed under microlaryngoscopy. No recurrence of the papillomatosis occurred between 18 and 42 months post-therapy. Laryngeal papillomatosis is the most common proliferative laryngeal lesion in children. Different non-surgical therapies have been used to prevent its recurrence but with poor results. Acyclovir is a drug with proved efficacy in DNA viral diseases. Since papillomata of the larynx is most likely a viral disease which is imputed to have a DNA virus etiology, acyclovir may be effective to control it.

Treatment of laryngeal papillomatosis with bovine wart vaccine: Report of cases.

Treatment of laryngeal papillomatosis with bovine wart vaccine: Report of cases.