PAPILLOMA

Recurrent respiratory papillomatosis (RRP) is a disease in which papilloma, or wart-like tissues, grow over previously normal throat structures including the vocal folds. Papillomas are caused by a strain of the Human Papilloma Virus (HPV) – other strains of the same virus are responsible for warts, cervical cancer in females, and some forms of head and neck cancer. Although many people are infected with the human papilloma virus, only some individuals have vocal fold (cord) papillomas. The reason for this is unknown. While papillomas mostly occur along the surfaces of the vocal folds they can spread to involve tissues of the mouth, throat, nose, trachea and lungs.

Papilloma on both vocal folds.

Papilloma on the upper, or anterior, portion of both vocal folds. Note the transition to normal epithelium posteriorly.

Papilloma occluding almost the entire trachea, causing this patient severe shortness of breath.

Symptoms of Papillomatosis:

• Hoarseness or voice changes
• Difficulty breathing
• Cough
• Coughing of blood
• Nasal obstruction

Diagnosis
Papillomatosis is diagnosed with laryngoscopy, in which a camera is either placed in the nose or the mouth to evaluate the vocal folds. Bronchoscopy and esophagoscopy can help determine if the disease has spread to other parts of the body.

If a lesion is seen, a biopsy is performed. Laryngoscopy with biopsy can be performed either in the office or in the operating room. This procedure provides tissue which is analyzed for analysis.

Vocal Fold Papilloma Treatment
Vocal cord papillomatosis are treated with surgery. Traditionally, surgery is performed in the operating room in which a patient is asleep. A laryngoscope is placed through the mouth while laser and other instruments may be used to remove the disease. The carbon dioxide laser is used by many doctors for management of disease. This laser is used both to cut papilloma off of the vocal folds and to vaporize papilloma as well. Fine instruments such as scissors and forceps are used to remove small amounts of tissue in a very controlled fashion.