Papillomatosis

Incidence of recurrent respiratory papillomatosis (RRP) in USA estimated at 4.3:100,000 among children and 1.8:100,000 among adults.

Vertical transmission during delivery is believed to be the major mode of transmission for juvenile-onset recurrent respiratory papillomatosis (JORRP).

Case reports show malignant transformation of RRP to squamous cell carcinoma.

Children diagnosed with JORRP at <3 y of age tend to have more aggressive disease.

Adult-onset recurrent respiratory papillomatosis (AORRP) typically presents in the fourth decade of life.

Mask ventilation or intubation difficult due to obstruction from papilloma.

Increased risk of complete obstruction during induction or with muscle paralysis.

Upper airway obstruction from laryngeal papillomatosis associated with pulm Htn.

Laryngeal papilloma prolapse causing complete airway obstruction; unable to ventilate or intubate, leading to hypoxia and cardiac arrest

Airway fire from CO ₂ laser therapy during surgical resection

The term papillomatosis describes multiple papillomas, or benign epithelial tumors found on the epidermis and mucous membranes.

RRP can be further classified into adult onset (>18 y of age) or juvenile onset (age <10 y).

Papillomas are caused by HPV.

The hope with HPV vaccine is to prevent transmission of the virus to neonates, reducing the incidence of RRP and oropharyngeal cancers associated with HPV.

Can have highly recurrent nature in children (HPV-11), requiring repeated exposure to anesthesia and surgical treatment

Laryngeal papillomas may be found on vocal cords, epiglottis, pharynx, or trachea.

Most commonly caused by human papillomaviruses 6 and 11, rarely HPV-16 or HPV-18