Papilloma Larynx

By

Dr. T. Balasubramanian M.S. D.L.O.

Papilloma larynx are glistening whitish irregular mass seen in the larynx. It involves the vocal cords, false cords, and epiglottis. These masses are friable and bleed on touch.

It occurs in two forms : 1. Juvenile papilloma and 2. Adult papilloma.

Juvenile papilloma : Occurs in infants and young children. It is multiple, and show aggressive behaviour. These lesions are known to recur even after successful surgery. It is caused by Human papilloma virus type 6 or type 1. The affected children are known to get their infection from infected mother's genitals during delivery.

These lesions appear as multiple white glistening irregular, friable masses over the true / false vocal cords. It can also involve epiglottis. These lesions have a prediliction to involve the squaocolumnar junction. They show a very aggressive behaviour. Reccurrence even after successful surgical removal is common.

The affected patients have hoarseness of voice. The child may have difficulty especially while crying. If the mass reaches a size large enough to obstruct the laryngeal inlet, patients develop stridor.

Adult papilloma: Is solitary in nature, known to involve the true vocal cord at the junction of the anterior 1/3 and posterior 2/3. This is the mobile portion of the vocal cord. Males are affected twice as common as females. These lesions are not aggressive and hence surgical management is always successful.

Management:

Tracheostomy: to secure the airway if the patient manifests with stridor.

Microlaryngeal excision of the masses - Bleeding and airway complications are common during this procedure.

Cryosurgery - Bleeding is minimised during this procedure

Laser surgery - Is best suited for juvenile papillomas. In this procedure the bleeding is minimal, and scarring is also minimal.

Recurrence - In juvenile papilloma can be reduced by postoperative treatment with interferon. Herbal drung (TUJA) has been tried with varying degrees of success.