Laryngeal papillomatosis removal - Revision history

Zining2023 at 19:52, 26 February 2026

2026-02-26T19:52:51Z

← Older revision		Revision as of 12:52, 26 February 2026
Line 158:		Line 158:
	#* More challenging in adults		#* More challenging in adults
	# TIVA with spontaneous ventilation		# TIVA with spontaneous ventilation
	#* Propofol + low dose remifentanil		#* Propofol + low dose remifentanil, consider ketamine
	#* Avoid neuromuscular blockade until secured		#* Avoid neuromuscular blockade until secured
	# Awake vocal cord intubation (adults)		# Awake vocal cord intubation (adults)

Zining2023: Finished procedure variants and references section

2026-02-26T19:12:07Z

Finished procedure variants and references section

← Older revision		Revision as of 12:12, 26 February 2026
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	Laser precautions (airway fire precautions)		Laser precautions (airway fire precautions)

	* N95 mask with laser safe eyewear		* N95 mask with laser safe eyewear<ref>{{Cite web\|title=Hygiene measures for HP viruses in the operating room\|url=https://www.hartmann-science-center.com/en/hygiene-knowledge/hygiene-measures/pathogen-specific-hygiene-measures/hygiene-measures-for-hpv-in-the-operating-room\|access-date=2026-02-26\|website=www.hartmann-science-center.com\|language=en}}</ref>
	* Smoke evacuator with ULPA filter		* Smoke evacuator with ULPA filter
	* Laser-safe ETT		* Laser-safe ETT
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	* Saline immediately available on field		* Saline immediately available on field

	Airway fire emergency protocol		Airway fire emergency protocol<ref>{{Cite journal\|date=2008-05-01\|title=Practice Advisory for the Prevention and Management of Operating Room Fires\|url=https://doi.org/10.1097/01.anes.0000299343.87119.a9\|journal=Anesthesiology\|volume=108\|issue=5\|pages=786–801\|doi=10.1097/01.anes.0000299343.87119.a9\|issn=0003-3022}}</ref>

	* Stop oxygen and laser		* Stop oxygen and laser
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	* Subglottic stenosis (from repeated procedures)		* Subglottic stenosis (from repeated procedures)
	* Distal airway spread		* Distal airway spread
			<ref>{{Citation\|title=Copyright\|date=2010\|url=https://doi.org/10.1016/b978-0-443-06959-8.00105-9\|work=Miller's Anesthesia\|pages=iv\|publisher=Elsevier\|isbn=978-0-443-06959-8\|access-date=2026-02-26}}</ref><ref>{{Cite book\|title=Anesthesiologist's manual of surgical procedures\|date=2020\|publisher=Wolters Kluwer\|isbn=978-1-4963-7125-6\|editor-last=Jaffe\|editor-first=Richard A.\|edition=6th ed\|location=Philadelphia\|editor-last2=Schmiesing\|editor-first2=Clifford A.\|editor-last3=Golianu\|editor-first3=Brenda\|editor-last4=Ovid Technologies, Inc}}</ref>

	==Procedure variants<!-- This section should only be used for cases with multiple approaches (e.g. Laparoscopic vs. open appendectomy). Otherwise, remove this section. Use this table to very briefly compare and contrast various aspects between approaches. Add or remove rows as needed to maximize relevance. Consider using symbols rather than words when possible (e.g. +, –, additional symbols such as ↑ and ↓ are available using the "Ω" tool in the editor). -->==		==Procedure variants<!-- This section should only be used for cases with multiple approaches (e.g. Laparoscopic vs. open appendectomy). Otherwise, remove this section. Use this table to very briefly compare and contrast various aspects between approaches. Add or remove rows as needed to maximize relevance. Consider using symbols rather than words when possible (e.g. +, –, additional symbols such as ↑ and ↓ are available using the "Ω" tool in the editor). -->==
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	\|+		\|+
	!		!
	!~~Variant 1~~		!Microdebrider
	!~~Variant 2~~		!Cold instruments
			!Laser excision
			!Office-based laser
	\|-		\|-
	\|Unique considerations		\|Unique considerations
	\|		\|Less fire risk
	\|		Tolerate higher FiO2
			\|Spontaneous ventilation
			or intermittent apnea preferred
			\|Laser precautions
			\|Often local/topical anesthesia
			Minimal sedation
	\|-		\|-
	\|~~Indications~~		\|Advantages
	\|		\|Shorter operating time
	\|		\|No thermal injury
	\|-		\|Precision
	~~\|Position~~		Hemostasis
	\|		\|Avoids GA
	\|
	\|-
	~~\|Surgical~~ time
	\|
	\|
	\|-
	~~\|EBL~~
	\|
	\|
	\|-
	~~\|Postoperative disposition~~
	\|
	\|
	\|-
	~~\|Pain management~~
	\|
	\|
	\|-		\|-
	\|Potential complications		\|Potential complications
	\|		\|Bleeding
	\|		Mucosal trauma
			\|Bleeding
			Airway edema
			\|Airway fire
			Thermal injury
			\|Laryngospasm
	\|}		\|}

Zining2023: Finished maintenance and emergence sections

2026-02-26T18:45:32Z

Finished maintenance and emergence sections

@@ Line 180: / Line 180: @@
 ===Maintenance and surgical considerations<!-- Describe the important considerations and general approach to the maintenance of anesthesia, including potential complications. Be sure to include any steps to the surgical procedure that have anesthetic implications. -->===
 ===Emergence<!-- List and/or describe any important considerations related to the emergence from anesthesia for this case. -->===
 ==Postoperative management==

Zining2023: Finished induction and airway management

2026-02-26T18:03:36Z

Finished induction and airway management

@@ Line 39: / Line 39: @@
 * Avoid overly aggressive resection to reduce webbing and dysphonia
-Suspension microlaryngoscopy - surgeon visualizes the larynx with laryngoscope and removes papillomas using:
+Suspension microlaryngoscopy (SML) - surgeon visualizes the larynx with laryngoscope and removes papillomas using:
 * Microdebrider
@@ Line 142: / Line 142: @@
 ==Intraoperative management==
 ===Monitoring and access<!-- List and/or describe monitors and access typically needed for this case. Please describe rationale for any special monitors or access. -->===
 ===Induction and airway management<!-- Describe the important considerations and general approach to the induction of anesthesia and how the airway is typically managed for this case. -->===
 ===Positioning<!-- Describe any unique positioning considerations, including potential intraoperative position changes. If none, this section may be removed. -->===
 ===Maintenance and surgical considerations<!-- Describe the important considerations and general approach to the maintenance of anesthesia, including potential complications. Be sure to include any steps to the surgical procedure that have anesthetic implications. -->===

Zining2023: Finished postop management section

2026-02-26T15:22:44Z

Finished postop management section

@@ Line 153: / Line 153: @@
 ==Postoperative management==
 ===Disposition<!-- List and/or describe the postoperative disposition and any special considerations for transport of patients for this case. -->===
 ===Pain management<!-- Describe the expected level of postoperative pain and approaches to pain management for this case. -->===
 ===Potential complications<!-- List and/or describe any potential postoperative complications for this case. -->===
 ==Procedure variants<!-- This section should only be used for cases with multiple approaches (e.g. Laparoscopic vs. open appendectomy). Otherwise, remove this section. Use this table to very briefly compare and contrast various aspects between approaches. Add or remove rows as needed to maximize relevance. Consider using symbols rather than words when possible (e.g. +, –, additional symbols such as ↑ and ↓ are available using the "Ω" tool in the editor). -->==

Zining2023: Finished preop section

2026-02-26T15:17:22Z

Finished preop section

← Older revision		Revision as of 08:17, 26 February 2026
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	\|-		\|-
	\|Airway		\|Airway
	\|		\| -Stridor at rest (inspiratory vs biphasic)
			-Retractions, work of breathing

			-Voice quality (hoarseness suggests glottic involvement)

			-Prior tracheostomy

			-Prior anesthesia records
	\|-		\|-
	\|Neurologic		\|Neurologic
	\|		\| -N/a
	\|-		\|-
	\|Cardiovascular		\|Cardiovascular
	\|		\| -Tachycardia from distress
			-Exercise intolerance
	\|-		\|-
	\|Pulmonary		\|Pulmonary
	\|		\| -Baseline oxygenation
			-Reactive airway disease history

			-Lower airway involvement
	\|-		\|-
	\|Gastrointestinal		\|Gastrointestinal
	\|		\| -NPO guidelines
			-Feeding difficulties
	\|-		\|-
	\|Hematologic		\|Hematologic
	\|		\| -Low bleeding risk
	\|-		\|-
	\|Renal		\|Renal
	\|		\| -N/a
	\|-		\|-
	\|Endocrine		\|Endocrine
	\|		\| -N/a
	\|-		\|-
	\|Other		\|Other
	\|		\| -OR precautions to possible viral aerosolization and laser plum (N95, smoke evacuator)
			-No isolation precautions outside OR
	\|}		\|}
	===Labs and studies<!-- Describe any important labs or studies. Include reasoning to justify the study and/or interpretation of results in the context of this procedure. If none, this section may be removed. -->===		===Labs and studies<!-- Describe any important labs or studies. Include reasoning to justify the study and/or interpretation of results in the context of this procedure. If none, this section may be removed. -->===
			Usually none. Consider imaging if distal airway involvement suspected

	===Operating room setup<!-- Describe any unique aspects of operating room preparation. Avoid excessively granular information. Use drug classes instead of specific drugs when appropriate. If none, this section may be removed. -->===		===Operating room setup<!-- Describe any unique aspects of operating room preparation. Avoid excessively granular information. Use drug classes instead of specific drugs when appropriate. If none, this section may be removed. -->===
			Airway equipment

			* Multiple small ETTs available (consider microcuff for pediatric patients)
			* LMA as rescue
			* Suction immediately available
			* Laser-safe ETT if laser planned
			* Backup rigid bronchoscope
			* Jet ventilation equipment if used
			* Difficult airway cart immediately available
			* Tracheostomy equipment if used

			Laser precautions (airway fire precautions)

			* N95 mask with laser safe eyewear
			* Smoke evacuator with ULPA filter
			* Laser-safe ETT
			* ETT cuff inflated with saline +/- methylene blue
			* Saline available on field
			* FiO2 < 30%, avoid nitrous

	===Patient preparation and premedication<!-- Describe any unique considerations for patient preparation and premedication. If none, this section may be removed. -->===		===Patient preparation and premedication<!-- Describe any unique considerations for patient preparation and premedication. If none, this section may be removed. -->===

			* Standard premedication acceptable if minimal obstruction
			* Avoid heavy sedation if airway obstruction presents
			* Glycopyrrolate may improve visualization
			* Dexamethasone to reduce airway edema

	===Regional and neuraxial techniques<!-- Describe any potential regional and/or neuraxial techniques which may be used for this case. If none, this section may be removed. -->===		===Regional and neuraxial techniques<!-- Describe any potential regional and/or neuraxial techniques which may be used for this case. If none, this section may be removed. -->===
			Not routinely used

			* Superior laryngeal nerve block or transtracheal block may be used in rare awake adults cases
			* Office-based laser procedures in adults may use topical anesthesia with minimal sedation

	==Intraoperative management==		==Intraoperative management==

Zining2023: Finished infobox

2026-02-26T14:56:17Z

Finished infobox

← Older revision		Revision as of 07:56, 26 February 2026
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	{{Infobox surgical procedure		{{Infobox surgical procedure
	\| anesthesia_type =		\| anesthesia_type = General
	\| airway =		(Topical/Local in select patients)
	\| lines_access =		\| airway = Shared airway
	\| monitors =		ETT (microcuff) or jet ventilation or intermittent apnea
	\| considerations_preoperative =		\| lines_access = PIV
	\| considerations_intraoperative =		\| monitors = Standard ASA
	\| considerations_postoperative =		\| considerations_preoperative = -Severity of airway obstruction (stridor, retractions)
			-Voice changes or feeding difficulties
			-Location and bulk of papillomas
			-Recent URI
			-Prior airway history
			\| considerations_intraoperative = -Shared airway with surgeon
			-Airway bleeding/edema
			-Airway fire prevention (laser precautions)
			-Smoke protection (N95, smoke evacuator)
			\| considerations_postoperative = -Laryngospasm risk
			-Airway edema
	}}Laryngeal papillomatosis or recurrent respiratory papillomatosis (RRP) is a benign but chronic, recurrent disease caused by human papillomavirus (HPV) types 6 and 11. Lesions most commonly occur on vocal cords but can involve any part of the larynx and occasionally subglottic or tracheal region. Papillomas grow exophytically and interfere with phonation and airway patency.		}}Laryngeal papillomatosis or recurrent respiratory papillomatosis (RRP) is a benign but chronic, recurrent disease caused by human papillomavirus (HPV) types 6 and 11. Lesions most commonly occur on vocal cords but can involve any part of the larynx and occasionally subglottic or tracheal region. Papillomas grow exophytically and interfere with phonation and airway patency.

Zining2023: Overview citation

2026-02-26T14:15:47Z

Overview citation

← Older revision		Revision as of 07:15, 26 February 2026
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	Office-based flexible endoscopic laser under topical sedation is possible in cooperative adults with limited disease		Office-based flexible endoscopic laser under topical sedation is possible in cooperative adults with limited disease

	Tracheotomy possible in severe, airway-compromising disease unresponsive to repeated microlaryngoscopy, but carries risk of distal viral spread along tracheobronchial tree		Tracheotomy possible in severe, airway-compromising disease unresponsive to repeated microlaryngoscopy, but carries risk of distal viral spread along tracheobronchial tree<ref>{{Cite journal\|last=Primov-Fever\|first=Adi\|last2=Madgar\|first2=Ory\|date=2019-12\|title=Surgery for adult laryngeal papillomatosis\|url=https://linkinghub.elsevier.com/retrieve/pii/S1043181019300661\|journal=Operative Techniques in Otolaryngology-Head and Neck Surgery\|volume=30\|issue=4\|pages=264–268\|doi=10.1016/j.otot.2019.09.008\|issn=1043-1810}}</ref>

	==Preoperative management==		==Preoperative management==

Zining2023: Finish overview with indications and surgical procedure

2026-02-26T14:10:55Z

Finish overview with indications and surgical procedure

@@ Line 13: / Line 13: @@
 ==Overview==
 ===Indications<!-- List and/or describe the indications for this surgical procedure. -->===
 ===Surgical procedure<!-- Briefly describe the major steps of this surgical procedure. -->===
 ==Preoperative management==

Zining2023: Page creation and brief overview

2026-02-26T13:52:36Z

Page creation and brief overview

New page

{{Infobox surgical procedure
| anesthesia_type =
| airway =
| lines_access =
| monitors =
| considerations_preoperative =
| considerations_intraoperative =
| considerations_postoperative =
}}Laryngeal papillomatosis or recurrent respiratory papillomatosis (RRP) is a benign but chronic, recurrent disease caused by human papillomavirus (HPV) types 6 and 11. Lesions most commonly occur on vocal cords but can involve any part of the larynx and occasionally subglottic or tracheal region. Papillomas grow exophytically and interfere with phonation and airway patency.

It affects both children (juvenile-onset) and adults (adult-onset), with more aggressive disease and higher recurrence rates typically see in children. There is no cure and recurrence is common, so patient often require multiple procedures over their lifetime. The goal of surgery is to relieve airway obstruction and improve voice quality.

==Overview==
===Indications===
===Surgical procedure===

==Preoperative management==
===Patient evaluation===
{| class="wikitable"
|+
!System
!Considerations
|-
|Airway
|
|-
|Neurologic
|
|-
|Cardiovascular
|
|-
|Pulmonary
|
|-
|Gastrointestinal
|
|-
|Hematologic
|
|-
|Renal
|
|-
|Endocrine
|
|-
|Other
|
|}
===Labs and studies===
===Operating room setup===
===Patient preparation and premedication===
===Regional and neuraxial techniques===

==Intraoperative management==
===Monitoring and access===

===Induction and airway management===

===Positioning===

===Maintenance and surgical considerations===

===Emergence===

==Postoperative management==
===Disposition===

===Pain management===

===Potential complications===

==Procedure variants==

{| class="wikitable wikitable-horizontal-scroll"
|+
!
!Variant 1
!Variant 2
|-
|Unique considerations
|
|
|-
|Indications
|
|
|-
|Position
|
|
|-
|Surgical time
|
|
|-
|EBL
|
|
|-
|Postoperative disposition
|
|
|-
|Pain management
|
|
|-
|Potential complications
|
|
|}

==References==

[[Category:Surgical procedures]]