Laryngeal papillomatosis removal

Laryngeal papillomatosis removal

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
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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

Preoperative management

Patient evaluation

System	Considerations
Airway
Neurologic
Cardiovascular
Pulmonary
Gastrointestinal
Hematologic
Renal
Endocrine
Other

Procedure variants

	Variant 1	Variant 2
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