Juvenile papillomatosis

juvenile papillomatosis

1. Juvenile Papillomatosis Presented by:- Pranshay Sharma (90)

2. Juvenile papillomatosis is the most common benign neoplasm of the larynx in children. It is viral in origin and is caused by human papilloma DNA virus type 6 and 11. It is presumed that affected children got the disease at birth from their mothers who had vaginal human papilloma virus disease.

3. Papillomas mostly affect supraglottic and glottic regions of larynx but can also involve subglottis , trachea and bronchi . Children who had tracheostomy for respiratory distress due to laryngeal papillomas have higher incidence of tracheal and stomal involvement due to seeding. DNA virus particles have been found in the cells of basement membrane of respiratory mucosa and may account for widespread involvement and recurrence.

4. SIGN AND SYMPTOPMS Patient, often a child, between the age of 3 and 5 years presents with hoarseness or aphonia with respiratory difficulty or even stridor. Diagnosis is made by flexible fibreoptic laryngoscopy and later confirmed by direct laryngoscopy and biopsy. Papillomas are known for recurrence but rarely undergo malignant change.

5. TREATMENT Treatment consists of microlaryngoscopy and CO2 laser excision avoiding injury to vocal ligament. Recurrence is common and procedure needs to be repeated several times . In the absence of facilities of CO2 laser, tumour can be removed under microscope with cup forceps or a debrider similar to the one used in endoscopic nasal surgery. Aim of therapy is to maintain a good airway, preserve voice and avoid recurrence.

6. Besides surgery, various medical therapies are being used an adjuvants. Alpha-2a has shown promising results but has several side effects including fever, chills, myalgia, arthralgia, headache, loss of weight and suppression of bone marrow. Similarly 13-cis-retinoic acid has been used. This too has several side effects.