© Borgis - New Medicine 3/2005, s. 37-39
Lidia Zawadzka-Głos, Mieczysław Chmielik, Anna Bielicka
Laryngeal papillomatosis in children
Department of Paediatric Otorhinolaryngology, Medical University of Warsaw, Poland
Head: Prof. Mieczysław Chmielik MD, PhD
Laryngeal papilloma in children is a frequent condition caused by the human papilloma virus (HPV). In spite of its benign histology, recurrent respiratory papillomatosis (RRP) has a tendency to recur frequently, spreading throughout the airways. RRP can affect any section of the respiratory tract; in 96% of cases the larynx is affected. In tracheotomized patients, papillomas have a tendency for descent into the lower respiratory tract. In the present paper, authors present four cases of papillomatosis of the larynx, trachea and bronchi.
Laryngeal papillomas in children are a frequent condition caused by the human papilloma virus (HPV). Owing to the molecular hybridisation technique, nearly 77 types of HPV have been isolated; type 6 and type 11 are responsible for benign changes in the larynx and respiratory tract. Types 16, 18, 31, 45 of HPV are rarely seen, being responsible for progressive transformation in the papilloma into malignant tumours (5, 7, 8).
Recurrent respiratory papillomatosis (RRP) is associated with exophytic lesions of the airway. Clinically, laryngeal papilloma may differentiate as juvenile-onset laryngeal papilloma and adult-onset laryngeal papilloma, but it is likely that the natural history of papilloma growth is one continuum of age distribution, usually with exacerbations and remissions. Despite of its benign histology, RRP presents potential morbidity due to severity of involvement of the airway and to the risk of malignant degeneration. It is often difficult to treat because of its tendency to recur and spread throughout the respiratory tract. Juvenile papilloma is characterised by massive growth, frequently multifocal, with a tendency to spread causing lesions and involving healthy mucous membranes. Papillomas also show multiple recurrences, but often a regression of the condition is observed at puberty. Frequent recurrence of this condition and various periods of remission are connected with the existence of the virus in a latent form, periodically reactivated.
HPV shows a predilection to infect sites where ciliated columnar and squamous epithelia are juxtaposed. This explains the frequent involvement of the false vocal folds, the upper and lower margins of the ventricle, and the lower surface of the true vocal folds. Less frequently, lesions are found on the nasopharyngeal surface of the soft palate, the mid-zone of the laryngeal surface of the epiglottis, and mucosa of the carina. In tracheotomized patients, papillomas are often encountered at the stoma. It is postulated that the junction of ciliary and squamous epithelia is a location particularly prone to infection with latent vital forms. An endotracheal tube may play the same role in the mechanical dissemination or implantation of papilloma virus as a tracheotomy in this setting, through the interruption of the continuous respiratory mucosal surface. Tracheotomy is a procedure which accelerates the dissemination of lesions within the respiratory tract (4). According to some authors, lower respiratory tract papillomatosis concerns 1-4% of patients with juvenile laryngeal papillomatosis. The prognosis in these cases is always serious.
At the Department of Paediatric Otorhinolaryngology of the Medical University in Warsaw, we have treated 98 children with laryngeal papillomatosis in the period between 1980 and 2005. In four children papilloma of the trachea, bronchi and lung was diagnosed. The period of follow-up was 8-16 years.
Papilloma of the larynx, trachea and bronchi was diagnosed during laryngotracheobronchoscopy. These lesions were removed in classical papillotomy using rigid bronchoscope and the Kleinsasser arrangement and using argon plasma coagulation in one child. All children had a chest X-ray. In two children combined surgical and pharmacological treatment with interferon alpha was applied; one of these children underwent chemotherapy in another medical centre.
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