Multiple Laryngeal Papilloma in Children Symptoms and Treatment

What Is Papilloma?

A Papilloma is a benign tumor. It grows in an outward direction. It can develop anywhere on the body. Papilloma in larynx is benign tumour of the Larynx that is epithelial in origin. Laryngeal papilloma is most common in children upto 5 years. These tumors are not malignant. They are usually not considered dangerous unless it causes discomfort or pain. Surgery is done to remove a papilloma. According to Wikipedia Papilloma refers to a benign epithelial tumor growing exophytically (outwardly projecting) in finger-like fronds.  Papillomatosis is a condition of having multiple papillomas in one area, such as the larynx.

Types:-

1. Single papilloma
2. Multiple papilloma

Before proceed lets see the

Anatomy of Larynx:

The larynx is situated in the midline of the neck at the meeting of the aero digestive passages. It lies in front of the laryngopharynx from the level of the 3rd to 6th cervical vertebrae.It consist of a frame work of cartilages connected by ligaments and membranes lined by a mucous membrane and moved by muscle in vertical & antero-posteriorly during swallowing and phonation.

Multiple Laryngeal papilloma of Children:

Human papilloma virus types 6 and 11 are the cause of Multiple Laryngeal Papilloma. It is the commonest laryngeal Papilloma tumor in children. It occurs at any age from birth to 5 years. Children’s usually gets infection from mother infected with genital warts during child birth. But caesarean section operation does not exclude the incidence of transmission. Boys are more affected than girls.

Pathology:

It may grow anywhere in the respiratory tract from the lips to the lungs but the vocal cords, anterior commissure and vestibular folds are the common site of involvement. Spontaneous regression at puberty may occur. The growth may present as scattered single lesion or clusters or as a huge exuberant mass. They can be sessile or Pedunculated mass.

Clinical features:

Initially child presents with Hoarseness of voice and abnormal cry. Later stridor and Dyspnea occurs.

Diagnosis:

Diagnosis can be done by taking careful History from mother and Fibro optic Laryngoscopy (FOL). Definitive diagnosis is done by Direct laryngoscopy and biopsy.

Treatment:

The principle of treatment is to remove the papilloma’s as they appear without damaging the larynx.

1. Microlaryngeal Excision or Laser Excision (CO2 or KTP). If disease involves anterior commissure two operations at 4 weeks interval are required to prevent web formation.

A biopsy is generally taken, especially if an area looks suspicious. A combination of lasers, micro-instruments and injections are used to treat the involved areas. In advanced centers, the ideal laser to treat papillomas is the KTP LASER.

2. Other methods of treatment are Alfa Interferon which reduces the growth of papilloma, Isotretinoin, Antiviral drug Ribavirin, podophyllin, cryo etc. These methods are not successful as Microlaryngeal Excision.

3. Tracheostomy should be avoided if possible as the papilloma’s can become implanted into the trachea bronchi.

4. Symptomatic treatment.

For better understanding see here in ehow How to Treat Laryngeal Papillomatosis.

Recurrence is common. Repeated surgery can lead to permanent scaring and Web formation. Recurrence of disease does not indicate failure of treatment or expertise of the treating physician.

Single Papilloma:-

It is common in adult. It is pedunculated and usually arises from ant. Third of vocal cord or occurs near the anterior commissure. Some times it may changes to malignancy.

Histopathology:-

There is papillomatous projection with central core of connective tissue covered by deep layer of stratified squamous epithelium and well defined basement membrane.

Presentation and Treatment:

Patient usually presents with Hoarseness of voice and Occasional cough.

Indirect laryngoscopy shows polypoidal mass. Fiber optic laryngoscopy (F.O.L) can also be done.

Endoscopic removal is treatment of choice and Biopsy under G.A. or L.A is done for confirmation.

Prevention:

Human papilloma viruses 6 and 11 causes it. These also cause genital warts. Children get the disease through contact at birth with a mother who has these viruses in her body. By practicing safe sex, you can save yourself and your children a lot of suffering. Check if you have genital warts or not.

This post is helpful for the undergraduate students of MBBS and postgraduate students in ENT. General people can also get a Idea about the disease. If your children shows these symptoms bring him/her to your Physician urgently.

Thanks