THROAT - Juvenile laryngeal papilloma

History : MacKenzie firsl described this condition 100 years ago.
These papillomas affect not only the larynx, but other areas of the respiratory tract, Hence they are also called recurrent respiratory papillomatosis.

What is the Aetiology of juvenile laryngeal papilloma?

1.       Age: 3-15 years. Majority of children present before 4 years of age
2 .      More than 1500 new cases every year
3.       Found in all socioeconomic segments of society
4.       Viral infection of the epithelial cells by the human papilloma virus
5.       Hormonal imbalance

What is the pathology of juvenile laryngeal papilloma?

Papillomata have a tendency to grow on the anterior commissure of the vocal cords. They come in clusters and are sessile, spreading over a wide area of mucosa.

Recurrence is due to the activation of dormant virus from the normal mucosa adjacent to the lesion.

Common sites :
1. Anterior commissure of larynx.
2 . Vocal cords.
3. Rarely - gingiva, lips, soft palate, tonsillar pillar and pulmonary parenchyma. The lesion has a predilection for points of airway constriction causing drying, crusting and irritation.

Microscopy : Immunofluorescent techniques show evidence of  human papilloma virus having incorporated into cellular DNA.

What are symptoms  of  juvenile laryngeal papilloma?

1. Initially, hoarseness of voice or abnormal cry.
2. Gradually increasing stridor and respiratory distress as the disease progresses.

What is treatment of  juvenile laryngeal papilloma?

Medical treatment : Inferon injection, antivirals, tetracycline and systemic hormones have been tried. However, they are not very effective.

Surgical treatment:

1.       Surgical removal by microlaryngoscopy and CO2  laser,allows removal of          all disease causing minimal damage to the musculature.

2.       Excision by sharp cup forceps during microlaryngoscopy.

3.       Application of chemical cauterizing agents like silver nitrate (rarely
done).
4.       Tracheostomy should be done if the patient has severe respiratory distress.

Progress: Most papillomata disappear by puberty. The chances of recurrence are considerably reduced after use of laser surgery.
Chances of malignant changes are also very minimal.




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