Difference between revisions of "Laryngeal papillomatosis removal"
Zining Chen (talk | contribs) (Overview citation) |
Zining Chen (talk | contribs) (Finished infobox) |
||
| Line 1: | Line 1: | ||
{{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. | ||
Revision as of 06:56, 26 February 2026
| Anesthesia type |
General (Topical/Local in select patients) |
|---|---|
| Airway |
Shared airway ETT (microcuff) or jet ventilation or intermittent apnea |
| Lines and access |
PIV |
| Monitors |
Standard ASA |
| Primary anesthetic considerations | |
| Preoperative |
-Severity of airway obstruction (stridor, retractions) -Voice changes or feeding difficulties -Location and bulk of papillomas -Recent URI -Prior airway history |
| Intraoperative |
-Shared airway with surgeon -Airway bleeding/edema -Airway fire prevention (laser precautions) -Smoke protection (N95, smoke evacuator) |
| Postoperative |
-Laryngospasm risk -Airway edema |
| Article quality | |
| Editor rating | |
| User likes | 0 |
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
- Airway obstruction (symptomatic)
- Voice dysfunction (interfering with communication or quality)
- Recurrent disease debulking
- Distal airway spread into subglottic or lower
Urgency ranges from elective to emergent depending on obstruction severity
Surgery is palliative, not curative, and does not remove HPV from the tissue
Surgical procedure
Principles:
- Preserve healthy mucosa to minimize scarring and voice disruption
- Avoid overly aggressive resection to reduce webbing and dysphonia
Suspension microlaryngoscopy - surgeon visualizes the larynx with laryngoscope and removes papillomas using:
- Microdebrider
- Rotating blade with suction to remove papillomas with minimal manipulation of surrounding tissue
- Rapidly debulk lesions with shorter operative time and less injury to surrounding tissue than lasers
- Cold instruments
- Traditional excision via forceps or scissors
- Useful for small or focal lesions and biopsy
- Laser resection
- CO2 historically used with precision and hemostasis
- Photoangiolytic lasers (KTP, pulsed dye) more favored with potentially lower scar formation
- Requires airway fire precautions
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[1]
Preoperative management
Patient evaluation
| 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
| Variant 1 | Variant 2 | |
|---|---|---|
| Unique considerations | ||
| Indications | ||
| Position | ||
| Surgical time | ||
| EBL | ||
| Postoperative disposition | ||
| Pain management | ||
| Potential complications |
References
- ↑ Primov-Fever, Adi; Madgar, Ory (2019-12). "Surgery for adult laryngeal papillomatosis". Operative Techniques in Otolaryngology-Head and Neck Surgery. 30 (4): 264–268. doi:10.1016/j.otot.2019.09.008. ISSN 1043-1810. Check date values in:
|date=(help)
Top contributors: Zining Chen