PEDBASE.org - The Pediatric Database - Detailed information of JUVENILE LARYNGEAL PAPILLOMATOSIS

JUVENILE LARYNGEAL PAPILLOMATOSIS

DEFINITION:

A neoplasm of the larynx caused by the human papillomavirus characterized by hoarseness, dyspnea, and respiratory distress.

EPIDEMIOLOGY:

incidence: most common tumor of the larynx in childhood
age of onset:
- childhood (hoarseness)
risk factors:
- human papillomavirus infection during pregnancy

PATHOGENESIS:

1. Background

human papillomavirus infection of mother -> maternal vaginal condyloma -> aspiration of infected fluid during delivery -> laryngeal papillomatosis in a small percentage of infants exposed - may spontaneously regress after puberty

CLINICAL FEATURES:

1. Respiratory Manifestations

hoarseness
dyspnea (in persistent cases)
chronic cough
respiratory distress (can lead to obstruction)

2. Complications

recurrence
- common and may recur years to decades after therapy
laryngobronchial papillomatosis
malignancy
- rare
- malignant degeneration into squamous cell carcinoma
- more likely after radiation treatment

INVESTIGATIONS:

1. Direct Laryngoscopy

diagnostic - pink, warty tumor usually on the vocal cords

MANAGEMENT:

1. Surgical

indicated for relief of upper airway obstruction
direct laryngoscopy - removal with forceps
cryosurgery or laser surgery
radical excision and radiation are contraindicated

2. Medical

indications for: failure of surgical treatment or recurrent severe disease
systemic bleomycin
human leukocyte interferon

3. Prognosis

less aggressive types tend to undergo spontaneous remission especially near puberty

Pediatric Database - JUVENILE LARYNGEAL PAPILLOMATOSIS

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