1
|
Gupta DK, Mayandi P, Mathews S, Bhatnagar V. An Idiopathic Acquired Supraglottic Web. Indian J Otolaryngol Head Neck Surg 2024; 76:2885-2889. [PMID: 38883523 PMCID: PMC11169291 DOI: 10.1007/s12070-024-04549-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2023] [Accepted: 02/04/2024] [Indexed: 06/18/2024] Open
Abstract
Laryngeal webs are abnormal formation of an epithelium-covered fibrous tissue between two structures within the larynx (Pegg et al. in Ear Nose Throat J 90(10):486-488, 2011). Most of the laryngeal webs occurs at the level of glottic region which may extend till anterior 1/3rd of vocal cords, but it can also extend in to posterior glottis and inferiorly till subglottic region (Singh in J Indian Assoc Pediatr Surg 14(3):108-109, 2009). Acquired laryngeal webs are more common than congenital laryngeal web. Idiopathic supraglottic web is a rare entity and only one case have been reported worldwide (Table 1). We report a case of an idiopathic acquired supraglottic web in a 27-year-old man. The web was managed with CO2 laser excision under micro laryngoscopy guidance.
Collapse
|
2
|
Soloperto D, Gazzini S, Cerullo R. Molecular Mechanisms of Carcinogenesis in Pediatric Airways Tumors. Int J Mol Sci 2023; 24:ijms24032195. [PMID: 36768522 PMCID: PMC9916405 DOI: 10.3390/ijms24032195] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2022] [Revised: 01/15/2023] [Accepted: 01/18/2023] [Indexed: 01/24/2023] Open
Abstract
Primary tumors of the airways in the pediatric population are very rare entities. For this reason, little is known about the pathogenesis of these neoplasms. Understanding the biology has different practical implications: for example, it could help in the differential diagnosis, have a prognostic significance, or may lead to the development of a targeted therapy. The aim of this article is to present the current knowledge about pediatric airways tumors, focusing on the molecular mechanisms that cause the onset and progression of these neoplasms. After a brief introduction of epidemiology and clinical presentation, the tumorigenesis of the most frequent pediatric airways tumors will be described: Juvenile-onset recurrent respiratory papillomatosis (JORRP), Subglottic Hemangiona (SH), Rhabdomyosarcoma (RMS), and Mucoepidermoid carcinoma (MEC).
Collapse
|
3
|
Gluvajić D, Šereg-Bahar M, Jerin A, Janša R, Hočevar-Boltežar I. The Impact of Laryngopharyngeal Reflux on Occurrence and Clinical Course of Recurrent Respiratory Papillomatosis. Laryngoscope 2021; 132:619-625. [PMID: 34338331 DOI: 10.1002/lary.29793] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2021] [Revised: 07/13/2021] [Accepted: 07/21/2021] [Indexed: 12/28/2022]
Abstract
OBJECTIVES/HYPOTHESIS Laryngopharyngeal reflux (LPR) has been proposed both as a trigger for recurrent respiratory papillomatosis (RRP) onset and as a factor favoring an aggressive clinical course. STUDY DESIGN In this prospective study, 106 participants were recruited within a period of 24 months at the Department of Otorhinolaryngology and Cervicofacial Surgery, University Medical Centre Ljubljana. METHODS This study compared a group of RRP patients (N = 36) with a group of LPR patients (N = 28) and a group of healthy participants (N = 42) based on Reflux Symptom Index (RSI), Reflux Finding Scores (RFS), and saliva analyses (pH, pepsin concentration, bile acid concentration, and pepsin enzymatic activity). RESULTS The RRP group compared to the LPR group showed a statistically significant difference only in RSI and RFS scores, while the RRP group compared to healthy controls showed significantly higher values in all tested parameters (RSI score, RFS, saliva pH, pepsin concentration, bile acids concentration, pepsin enzymatic activity). CONCLUSIONS LPR is common in RRP patients and significantly more prevalent compared to healthy controls. Our results show that saliva analyses are a better office-based tool than RSI questionnaires and RFS scores for diagnosing LPR in RRP patients. LEVEL OF EVIDENCE Level 3 Laryngoscope, 2021.
Collapse
Affiliation(s)
- Daša Gluvajić
- Department of Otorhinolaryngology and Cervicofacial Surgery, University Medical Centre, Ljubljana, Slovenia
| | - Maja Šereg-Bahar
- Department of Otorhinolaryngology and Cervicofacial Surgery, University Medical Centre, Ljubljana, Slovenia.,Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
| | - Aleš Jerin
- Institute of Chemistry and Biochemistry, University Medical Centre, Ljubljana, Slovenia
| | - Rado Janša
- Clinical Department of Gastroenterology, University Medical Centre, Ljubljana, Slovenia
| | - Irena Hočevar-Boltežar
- Department of Otorhinolaryngology and Cervicofacial Surgery, University Medical Centre, Ljubljana, Slovenia.,Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
| |
Collapse
|
4
|
Lawlor C, Balakrishnan K, Bottero S, Boudewyns A, Campisi P, Carter J, Cheng A, Cocciaglia A, DeAlarcon A, Derkay C, Fayoux P, Hart C, Hartnick C, LeBoulanger N, Moreddu E, Muntz H, Nicollas R, Peer S, Pransky S, Rahbar R, Russell J, Rutter M, Seedat R, Sidell D, Smith R, Soma M, Strychowsky J, Thompson D, Triglia JM, Trozzi M, Wyatt M, Zalzal G, Zur KB, Nuss R. International Pediatric Otolaryngology Group (IPOG): Juvenile-onset recurrent respiratory papillomatosis consensus recommendations. Int J Pediatr Otorhinolaryngol 2020; 128:109697. [PMID: 31698245 DOI: 10.1016/j.ijporl.2019.109697] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2019] [Revised: 09/26/2019] [Accepted: 09/26/2019] [Indexed: 12/16/2022]
Abstract
OBJECTIVES To develop consensus recommendations for the evaluation and management of juvenile-onset recurrent respiratory papillomatosis (JORRP) in pediatric patients. METHODS Expert opinion by the members of the International Pediatric Otolaryngology Group (IPOG). The mission of the IPOG is to develop expertise-based consensus recommendations for the management of pediatric otolaryngologic disorders with the goal of improving patient care. The consensus recommendations herein represent the first publication by the group. RESULTS Consensus recommendations including diagnostic considerations, surgical management, systemic adjuvant therapies, postoperative management, surveillance, and voice evaluation. These recommendations are based on the collective opinion of the IPOG members and are targeted for otolaryngologists, primary care providers, pulmonologists, infectious disease specialists, and any other health care providers that manage patients with JORRP. CONCLUSIONS Pediatric JORRP consensus recommendations are aimed at improving care and outcomes in this patient population.
Collapse
Affiliation(s)
- Claire Lawlor
- Department of Otolaryngology, Children's National Health System, Washington, DC, United States.
| | | | - Sergio Bottero
- Department Pediatric Surgery, Bambino Gesù Pediatric Hospital, Rome, Italy
| | - An Boudewyns
- Department of Otorhinolaryngology, Head and Neck Surgery, Antwerp University Hospital, Edegem, Belgium
| | - Paolo Campisi
- Department of Otolaryngology-Head and Neck Surgery, Hospital for Sick Children, University of Toronto, Toronto, ON, Canada
| | - John Carter
- Department of Otolaryngology, Ochsner Health System, New Orleans, LA, United States
| | - Alan Cheng
- Department of Pediatric Otolaryngology, The Sydney Children's Hospital Network-Westmead Campus, The University of Sydney, Sydney, NSW, Australia
| | - Alejandro Cocciaglia
- Servicio de Endoscopía Respiratoria, Hospital de Pediatría Juan P. Garrahan, Ciudad Autónoma de Buenos Aires, Argentina
| | - Alessandro DeAlarcon
- Division of Pediatric Otolaryngology-Head & Neck Surgery, Cincinnati Children's Hospital Medical Center, University of Cincinnati, Cincinnati, OH, United States
| | - Craig Derkay
- Department of Otolaryngology - Head and Neck Surgery, Eastern Virginia Medical School, Sentara Norfolk General Hospital, Norfolk, VA, United States
| | - Pierre Fayoux
- Department of Pediatric Otolaryngology-Head Neck Surgery, Jeanne de Flandre Hospital-CHU Lille, Lille, France
| | - Catherine Hart
- Division of Pediatric Otolaryngology-Head & Neck Surgery, Cincinnati Children's Hospital Medical Center, University of Cincinnati, Cincinnati, OH, United States
| | - Christopher Hartnick
- Department of Otolaryngology-Head and Neck Surgery, Massachusetts Eye and Ear Infirmary, Boston, MA, United States
| | - Nicolas LeBoulanger
- Department of Otorhinolaryngology, Hôpital Universitaire Necker-Enfants Malades, Paris, France
| | - Eric Moreddu
- Department of Pediatric Otolaryngology Head and Neck Surgery, La Timone Children's Hospital (Aix-Marseille University), Marseille, France
| | - Harlan Muntz
- Division of Otolaryngology - Head and Neck Surgery, University of Utah School of Medicine, Salt Lake City, UT, United States
| | - Richard Nicollas
- Department of Pediatric Otolaryngology Head and Neck Surgery, La Timone Children's Hospital (Aix-Marseille University), Marseille, France
| | - Shazia Peer
- Department of Otorhinolaryngology, Red Cross War Memorial Children's Hospital, University of Cape Town, Cape Town, South Africa
| | - Seth Pransky
- Pediatric Specialty Partners, San Diego, CA, United States
| | - Reza Rahbar
- Department of Otolaryngology & Communication Enhancement, Boston Children's Hospital, Boston, MA, United States
| | - John Russell
- Department of Otorhinolaryngology, Our Lady's Children's Hospital Crumlin, Dublin, Ireland
| | - Michael Rutter
- Division of Pediatric Otolaryngology-Head & Neck Surgery, Cincinnati Children's Hospital Medical Center, University of Cincinnati, Cincinnati, OH, United States
| | - Riaz Seedat
- Department of Otorhinolaryngology, Universitas Academic Hospital, Bloemfontein, South Africa
| | - Douglas Sidell
- Department of Otolaryngology-Head and Neck Surgery, Stanford University, Palo Alto, CA, United States
| | - Richard Smith
- Department of Otolaryngology -Head and Neck Surgery, Carver College of Medicine, University of Iowa Health Care, Iowa City, IA, United States
| | - Marlene Soma
- Department of Paediatric Otolaryngology, Sydney Children's Hospital, Randwick, NSW, Australia
| | - Julie Strychowsky
- Department of Otolaryngology-Head and Neck Surgery, Children's Hospital at London Health Sciences Centre, Western University, London, ON, Canada
| | - Dana Thompson
- Division of Otolaryngology-Head and Neck Surgery, Ann & Robert H. Lurie Children's Hospital of Chicago, And Northwestern Feinberg School of Medicine, Chicago, IL, United States
| | - Jean-Michel Triglia
- Department of Pediatric Otolaryngology Head and Neck Surgery, La Timone Children's Hospital (Aix-Marseille University), Marseille, France
| | - Marilena Trozzi
- Department Pediatric Surgery, Bambino Gesù Pediatric Hospital, Rome, Italy
| | - Michelle Wyatt
- Great Ormond Street Hospital for Children, London, United Kingdom
| | - George Zalzal
- Department of Otolaryngology, Children's National Health System, Washington, DC, United States
| | - Karen B Zur
- Division of Otolaryngology, Children's Hospital of Philadelphia, Philadelphia, PA, United States
| | - Roger Nuss
- Department of Otolaryngology & Communication Enhancement, Boston Children's Hospital, Boston, MA, United States
| |
Collapse
|
5
|
Lawlor CM, Dombrowski ND, Nuss RC, Rahbar R, Choi SS. Laryngeal Web in the Pediatric Population: Evaluation and Management. Otolaryngol Head Neck Surg 2019; 162:234-240. [PMID: 31842676 DOI: 10.1177/0194599819893985] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE To discuss the presentation, evaluation, and management of pediatric laryngeal web. STUDY DESIGN Retrospective case series. SETTING Single tertiary care center. SUBJECTS All patients with laryngeal web at Boston Children's Hospital in the past 22 years. METHODS No exclusion criteria. Charts mined for age at presentation, presenting symptoms, degree/location of web, associated syndromes, number/type of surgical procedures, and postoperative outcomes. RESULTS Thirty-seven patients were included (13 male, 24 female). Average age at diagnosis was 3.7 years (0-19.5 years). Mean follow-up was 4.4 years (range, 0-16.4 years). There were 26 congenital webs (70.2%) and 11 acquired webs (29.8%). Presenting symptoms were vocal (29 patients, 78.4%) and respiratory (22 patients, 60%). Underlying syndromes or synchronous airway lesions included the following: premature (n = 5), congenital heart disease (n = 18), subglottic stenosis (n = 5), 22q11.2 deletion syndrome (n = 10), and recurrent respiratory papillomatosis (n = 4). There were 20 type 1 webs, 6 type 2 webs, 8 type 3 webs, and 3 type 4 webs; 10 had subglottic extension of the laryngeal web. Twelve patients were managed conservatively with observation. Eighty-four interventions were performed: 18 open and 66 endoscopic (sharp division, 32; dilation, 33; mitomycin C, 14; laser, 5; keel, 6; triamcinolone injection, 8; stent, 15; removal of granulation tissue, 5). Tracheotomy was required in 11 patients, and 5 patients were decannulated. Voice improved in 12 patients, with respiratory symptoms in 12 patients. Web recurred in 17 patients. One patient died due to airway complications. CONCLUSIONS Pediatric laryngeal web is an uncommon but challenging lesion. Patients need to be evaluated for comorbid syndromes and synchronous airway lesions. Management includes open and endoscopic procedures. Procedures should be tailored to the child's presentation.
Collapse
Affiliation(s)
- Claire M Lawlor
- Department of Otolaryngology, Children's National Medical Center, Washington, DC, USA.,Department of Otolaryngology & Communication Enhancement, Boston Children's Hospital, Boston, Massachusetts, USA
| | - Natasha D Dombrowski
- Department of Otolaryngology, Children's National Medical Center, Washington, DC, USA.,Department of Otolaryngology & Communication Enhancement, Boston Children's Hospital, Boston, Massachusetts, USA
| | - Roger C Nuss
- Department of Otolaryngology, Children's National Medical Center, Washington, DC, USA.,Department of Otolaryngology & Communication Enhancement, Boston Children's Hospital, Boston, Massachusetts, USA
| | - Reza Rahbar
- Department of Otolaryngology, Children's National Medical Center, Washington, DC, USA.,Department of Otolaryngology & Communication Enhancement, Boston Children's Hospital, Boston, Massachusetts, USA
| | - Sukgi S Choi
- Department of Otolaryngology, Children's National Medical Center, Washington, DC, USA.,Department of Otolaryngology & Communication Enhancement, Boston Children's Hospital, Boston, Massachusetts, USA
| |
Collapse
|
6
|
Ivancic R, Iqbal H, deSilva B, Pan Q, Matrka L. Immunological tolerance of low-risk HPV in recurrent respiratory papillomatosis. Clin Exp Immunol 2019; 199:131-142. [PMID: 31628850 DOI: 10.1111/cei.13387] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/15/2019] [Indexed: 12/12/2022] Open
Abstract
Recurrent respiratory papillomatosis (RRP) is characterized by benign exophytic lesions of the respiratory tract caused by the human papillomavirus (HPV), in particular low-risk HPV6 and HPV11. Aggressiveness varies greatly among patients. Surgical excision is the current standard of care for RRP, with adjuvant therapy used when surgery cannot control disease recurrence. Numerous adjuvant therapies have been used to control RRP with some success, but none are curative. Current literature supports a polarization of the adaptive immune response to a T helper type 2 (Th2)-like or T regulatory phenotype, driven by a complex interplay between innate immunity, adaptive immunity and HPV6/11 proteins. Additionally, certain immunogenetic polymorphisms can predispose individuals to an HPV6/11-tolerant microenvironment. As a result, immunomodulatory efforts are being made to restore the host immune system to a more balanced T cell phenotype and clear viral infection. Literature has shown exciting evidence for the role of HPV vaccination with Gardasil or Gardasil-9 as both primary prevention, by decreasing incidence through childhood vaccinations, and secondary prevention, by treating active RRP disease. Multi-institution randomized clinical trials are needed to better assess their efficacy as treatment for active disease. Interestingly, a DNA vaccine has recently shown in-vitro success in generating a more robust CD8+ T cell response. Furthermore, clinical trials for programmed death 1 (PD-1) inhibitors are under investigation for RRP management. Molecular insights into RRP, in particular the interplay between RRP and the immune system, are needed to advance our understanding of this disease and may lead to the identification of immunomodulatory agents to better manage RRP.
Collapse
Affiliation(s)
- R Ivancic
- College of Medicine, The Ohio State University, OH, USA
| | - H Iqbal
- Department of Otolaryngology-Head and Neck Surgery, The Ohio State University Wexner Medical Center, Columbus, OH
| | - B deSilva
- Department of Otolaryngology-Head and Neck Surgery, The Ohio State University Wexner Medical Center, Columbus, OH
| | - Q Pan
- Case Comprehensive Cancer Center, Cleveland, OH
| | - L Matrka
- Department of Otolaryngology-Head and Neck Surgery, The Ohio State University Wexner Medical Center, Columbus, OH
| |
Collapse
|
7
|
Kumar N, Preciado D. Airway Papillomatosis: New Treatments for an Old Challenge. Front Pediatr 2019; 7:383. [PMID: 31620412 PMCID: PMC6759931 DOI: 10.3389/fped.2019.00383] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2019] [Accepted: 09/05/2019] [Indexed: 12/14/2022] Open
Abstract
Recurrent respiratory papillomatosis (RRP) is the recurrent growth of small, benign tumors, or papillomas, in the respiratory tract, caused by human papillomavirus (HPV). Currently, there is no cure. Palliative treatments seek to prevent airway obstruction, keep underlying tissues healthy, and maintain voice quality. The most common intervention, the local surgical removal of papillomas, may be inadequate as a standalone treatment for pediatric populations that experience rapid papilloma regrowth, as repeated surgeries cause increased damage to the surrounding tissues and impose significant emotional and economic burden on families. Interferon α and Cidofovir have been shown to lengthen the time between surgical interventions and/or decrease the total number of procedures needed, although the evidence of their efficacy and safety is controversial. Novel therapies, including photodynamic therapy, indole-3-carbinol, anti-reflux medication, heat shock protein, and Mumps and HPV vaccination, may provide potential avenues for treatment, but require further research. Among all the novel therapies investigated, systemic bevacizumab seems to offer the most promising alternative to surgery. Randomized control trials to investigate its impact, especially in a pediatric population, should be conducted before implementing it as a standard form of care. This review will summarize the latest literature on medical care for aggressive RRP disease.
Collapse
Affiliation(s)
- Nankee Kumar
- Sheikh Zayed Center for Pediatric Surgical Innovation, Children's National Health System, Washington, DC, United States
| | - Diego Preciado
- Sheikh Zayed Center for Pediatric Surgical Innovation, Children's National Health System, Washington, DC, United States.,Division of Pediatric Otolaryngology, Children's National Health System, Washington, DC, United States
| |
Collapse
|
8
|
Bovo R, Trevisi P, Zanoletti E, Cazzador D, Volo T, Emanuelli E, Martini A. New trends in rehabilitation of children with ENT disorders. ACTA OTORHINOLARYNGOLOGICA ITALICA 2018; 37:355-367. [PMID: 28530252 PMCID: PMC5720863 DOI: 10.14639/0392-100x-1426] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/07/2016] [Accepted: 12/05/2016] [Indexed: 11/23/2022]
Abstract
In the last 20 years, neonatal survival has progressively increased due to the constant amelioration of neonatal medical treatment and surgical techniques. Thus, the number of children with congenital malformations and severe chronic pathologies who need rehabilitative care has progressively increased. Rehabilitation programs for paediatric patients with disorders of voice, speech and language, communication and hearing, deglutition and breathing are not widely available in hospital settings or in long-term care facilities. In most countries, the number of physicians and technicians is still inadequate; moreover, multidisciplinary teams dedicated to paediatric patients are quite rare. The aim of the present study is to present some new trends in ENT paediatric rehabilitation.
Collapse
Affiliation(s)
- R Bovo
- Department of Neuroscience, Institute of Otorhinolaryngology, University Hospital of Padua, Italy
| | - P Trevisi
- Department of Neuroscience, Institute of Otorhinolaryngology, University Hospital of Padua, Italy
| | - E Zanoletti
- Department of Neuroscience, Institute of Otorhinolaryngology, University Hospital of Padua, Italy
| | - D Cazzador
- Department of Neuroscience, Institute of Otorhinolaryngology, University Hospital of Padua, Italy
| | - T Volo
- Department of Neuroscience, Institute of Otorhinolaryngology, University Hospital of Padua, Italy
| | - E Emanuelli
- Department of Neuroscience, Institute of Otorhinolaryngology, University Hospital of Padua, Italy
| | - A Martini
- Department of Neuroscience, Institute of Otorhinolaryngology, University Hospital of Padua, Italy
| |
Collapse
|
9
|
Chen J, Shu Y, Naunheim MR, Chen M, Cheng L, Wu H. Prevention of laryngeal webs through endoscopic keel placement for bilateral vocal cord lesions. Front Med 2017; 12:301-306. [PMID: 28948508 DOI: 10.1007/s11684-017-0549-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2016] [Accepted: 04/26/2017] [Indexed: 11/30/2022]
Abstract
Transoral microresection for treatment of vocal cord lesions involving the anterior commissure may result in anterior glottic webs. In this study, we retrospectively reviewed 54 patients who underwent microsurgery for bilateral lesions involving the anterior commissure and categorized them into two groups. The keel placement and control groups received endoscopic keel placement and mitomycin C, respectively. During the follow-up of at least 1 year, the laryngeal web formation rate significantly decreased in the keel placement group compared with that in the control group (18.6% versus 54.5%, P < 0.05). Furthermore, the voice handicap index-10 scores for patients without web formation decreased in both the keel placement and control groups (P < 0.0001 and P < 0.001, respectively). A pseudomembrane covering the vocal cords was detected in 16.3% (7 of 43) cases after keel removal. A total of 100% (7 of 7) of these cases and 2.8% (1 of 36) of the other cases formed laryngeal webs (P < 0.0001). Endoscopic keel placement could be an effective method for preventing anterior glottic webs after surgery for bilateral vocal cord diseases involving the anterior commissure. The pseudomembrane observed at the time of keel removal may imply a high risk of web formation.
Collapse
Affiliation(s)
- Jian Chen
- Department of Otolaryngology-Head and Neck Surgery, Eye, Ear, Nose, and Throat Hospital, Fudan University, Shanghai Key Clinical Disciplines of Otorhinolaryngology, Shanghai, 200031, China
| | - Yilai Shu
- Department of Otolaryngology-Head and Neck Surgery, Eye, Ear, Nose, and Throat Hospital, Fudan University, Shanghai Key Clinical Disciplines of Otorhinolaryngology, Shanghai, 200031, China
| | - Matthew R Naunheim
- Department of Otology and Laryngology, Harvard Medical School, Boston, MA, 02138, USA.,Department of Otolaryngology, Massachusetts Eye and Ear Infirmary, Boston, MA, 02138, USA
| | - Min Chen
- Department of Otolaryngology-Head and Neck Surgery, Eye, Ear, Nose, and Throat Hospital, Fudan University, Shanghai Key Clinical Disciplines of Otorhinolaryngology, Shanghai, 200031, China
| | - Lei Cheng
- Department of Otolaryngology-Head and Neck Surgery, Eye, Ear, Nose, and Throat Hospital, Fudan University, Shanghai Key Clinical Disciplines of Otorhinolaryngology, Shanghai, 200031, China.
| | - Haitao Wu
- Department of Otolaryngology-Head and Neck Surgery, Eye, Ear, Nose, and Throat Hospital, Fudan University, Shanghai Key Clinical Disciplines of Otorhinolaryngology, Shanghai, 200031, China.
| |
Collapse
|
10
|
Su CY, Alswiahb JN, Hwang CF, Hsu CM, Wu PY, Huang HH. Endoscopic Laser Anterior Commissurotomy for Anterior Glottic Web: One-Stage Procedure. Ann Otol Rhinol Laryngol 2017; 119:297-303. [DOI: 10.1177/000348941011900505] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Objectives The conventional method for preventing web formation after anterior glottic web surgery is keel insertion. However, this presents risks of airway compromise and granulation tissue formation, which could necessitate tracheotomy in addition to a secondary procedure for keel removal. We introduce a novel, 1-stage endoscopic laser anterior commissurotomy for preventing anterior glottic web re-formation. Methods Twenty patients with glottic webs involving the anterior commissure were studied. The lesions were removed by transoral carbon dioxide laser microsurgery. In all patients, the anterior glottic web was vaporized along with the inner perichondrium of the thyroid cartilage over the anterior commissure area, creating a raw vertical break “alley” between the anterior vocal folds that measured between 0.3 and 0.5 cm in width and between 0.8 and 2 cm in length. The preoperative and postoperative vocal folds and voice quality were evaluated by videostrobolaryngoscopy and voice recordings. Results All 20 patients had anterior glottic webs ranging from 11 % to 64% of the length from the anterior commissure to the vocal process. None of the patients developed restenosis at the anterior commissure of a severity similar to that of the initial lesion during follow-up (mean, 13 months; range, 3 to 44 months). All patients except 1 reported satisfaction with their voice improvement. Outcome analysis revealed that partial re-formation of the web was noted in 4 patients. Conclusions One-stage, endoscopic laser anterior commissurotomy was effective and relatively safe for removing glottic webs, for preventing anterior glottic web re-formation, and for improving vocal fold performance among our patients.
Collapse
Affiliation(s)
- Chih-Ying Su
- Memorial Hospital-Kaohsiung Medical Center, Department of Otolaryngology, Chang Gung University College of Medicine (Su), Kaohsiung, and the Dr Su Voice Beauty Clinic (Su), Taipei City, Taiwan
| | - Jamil N. Alswiahb
- Memorial Hospital-Kaohsiung Medical Center, Department of Otolaryngology, Chang Gung University College of Medicine (Su), Kaohsiung, and the Dr Su Voice Beauty Clinic (Su), Taipei City, Taiwan
| | - Chung-Feng Hwang
- Memorial Hospital-Kaohsiung Medical Center, Department of Otolaryngology, Chang Gung University College of Medicine (Su), Kaohsiung, and the Dr Su Voice Beauty Clinic (Su), Taipei City, Taiwan
| | - Cheng-Ming Hsu
- Memorial Hospital-Kaohsiung Medical Center, Department of Otolaryngology, Chang Gung University College of Medicine (Su), Kaohsiung, and the Dr Su Voice Beauty Clinic (Su), Taipei City, Taiwan
| | - Pei-Yin Wu
- Memorial Hospital-Kaohsiung Medical Center, Department of Otolaryngology, Chang Gung University College of Medicine (Su), Kaohsiung, and the Dr Su Voice Beauty Clinic (Su), Taipei City, Taiwan
| | - Hsun-Hsien Huang
- Memorial Hospital-Kaohsiung Medical Center, Department of Otolaryngology, Chang Gung University College of Medicine (Su), Kaohsiung, and the Dr Su Voice Beauty Clinic (Su), Taipei City, Taiwan
| |
Collapse
|
11
|
Parelkar KA, Thorawade VP, Shah KA, Walli AK, Pareek AH. A Misdiagnosed Laryngeal Web: Treated with an Innovative Self-Made Keel. J Clin Diagn Res 2017; 11:MD04-MD06. [PMID: 28658820 DOI: 10.7860/jcdr/2017/27221.9908] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2017] [Accepted: 04/17/2017] [Indexed: 11/24/2022]
Abstract
Laryngeal web is a rare congenital anomaly. Late presentation at the age of 10 years as in our case, with misleading diagnosis of asthma in a Cohen's type III glottic web is even rarer. In cases of congenital laryngeal web the aim is to provide a patent airway and to achieve a good voice quality. Regardless of the technique used; the primary concern is recurrence. Traditionally, the treatment of choice for laryngeal web was laryngofissure with placement of a keel however; endoscopic laser excision of the web with keel placement is now the preferred technique for thin anterior glottic webs. This endoscopic technique not only requires a Lichtenberger needle carrier but also the ready-made keel, which many of the government set-ups in our country cannot provide. For an alternative to this problem, we have described an innovative, minimally invasive technique for placement of a self-made silicone keel without any sophisticated instruments.
Collapse
Affiliation(s)
- Kartik Anil Parelkar
- Senior Resident, Department of Ear, Nose and Throat, JJ Hospital, Mumbai, Maharashtra, India
| | - Vandana P Thorawade
- Associate Professor, Department of Ear, Nose and Throat, Solapur Government Medical College and Hospital, Mumbai, Maharashtra, India
| | - Keya A Shah
- Senior Resident, Department of Ear, Nose and Throat, K.E.M Hospital, Mumbai, Maharashtra, India
| | - Ankur K Walli
- Resident, Department of Ear, Nose and Throat, JJ Hospital, Mumbai, Maharashtra, India
| | - Ankur H Pareek
- Senior Resident, Department of Ear, Nose and Throat, K.E.M Hospital, Mumbai, Maharashtra, India
| |
Collapse
|
12
|
Dominguez LM, Johns MM, Simpson CB. Mid-membranous Vocal Fold Webs: Case Series. J Voice 2016; 31:381.e1-381.e3. [PMID: 27427165 DOI: 10.1016/j.jvoice.2016.06.013] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2016] [Revised: 06/21/2016] [Accepted: 06/23/2016] [Indexed: 10/21/2022]
Abstract
INTRODUCTION Laryngeal webs are a rare clinical entity, with those in the mid-membranous region occurring even less commonly. This is the first case series describing this condition. CASE REPORT We describe the clinical course of four patients with mid-glottic webs and propose the possible pathophysiology. DISCUSSION Trauma to the vocal folds followed by an inflammatory reaction is the likely event leading to the development of this lesion. Endoscopic division of this type of web has shown good postoperative voice outcomes without any recurrences. CONCLUSION The mid-glottic web is a rare clinical entity for which there is no defined etiology. It is likely that trauma results in an inflammatory reaction and, ultimately, web formation. Further studies are needed to identify risk factors for this condition.
Collapse
Affiliation(s)
- Laura M Dominguez
- Department of Otolaryngology, UT Health Science Center San Antonio, San Antonio, Texas.
| | - Michael M Johns
- Department of Otolaryngology, University of Southern California, Los Angeles, California
| | - C Blake Simpson
- Department of Otolaryngology, UT Health Science Center San Antonio, San Antonio, Texas
| |
Collapse
|
13
|
Edwards J, Tanna N, Bielamowicz SA. Endoscopic Lysis of Anterior Glottic Webs and Silicone Keel Placement. Ann Otol Rhinol Laryngol 2016; 116:211-6. [PMID: 17419526 DOI: 10.1177/000348940711600309] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Objectives: Acquired anterior glottic webs occur most commonly after endoscopic resection of laryngeal papilloma involving the anterior vocal folds. Treatment of anterior glottic webs has included a tracheotomy with laryngofissure and placement of a laryngeal stent or keel. We have used an endoscopic technique of web lysis and placement of a laryngeal keel without tracheotomy over the past 7 years. Methods: A retrospective chart review was conducted of all cases of endoscopic web lysis and keel placement performed by the senior author (S.A.B.). Results: Over the past 7 years, 10 patients underwent the procedure, with a mean follow-up of 18 months. The length of the anterior web was up to two thirds of the membranous vocal fold. Outcomes analysis revealed a recurrence in 1 patient and 2 minor complications necessitating treatment. Conclusions: Endoscopic web lysis and keel placement offers superior results with less morbidity compared to open techniques.
Collapse
Affiliation(s)
- John Edwards
- Division of Otolaryngology, The George Washington University, 2150 Pennsylvania Ave NW, Suite 6-301, Washington, DC 20036, USA
| | | | | |
Collapse
|
14
|
Mouadeb DA, Belafsky PC. In-Office Laryngeal Surgery with the 585nm Pulsed Dye Laser (PDL). Otolaryngol Head Neck Surg 2016; 137:477-81. [PMID: 17765779 DOI: 10.1016/j.otohns.2007.02.003] [Citation(s) in RCA: 42] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2006] [Revised: 01/08/2007] [Accepted: 02/05/2007] [Indexed: 11/19/2022]
Abstract
OBJECTIVES: The 585nm pulsed dye laser (PDL) is a promising tool for in-office laryngeal surgery. Data with respect to the safety and efficacy of the PDL for office laryngeal use is sparse. The purpose of this study is to review our experience with unsedated office PDL surgery. METHODS: Records of individuals undergoing in-office PDL between September 1, 2004, and September 1, 2006 were abstracted from a clinical database. RESULTS: Forty-seven patients underwent 117 treatments. The most common indications were recurrent respiratory papillomatosis (RRP), Reinke's edema, and vocal fold polyps. One hundred and four of 117 procedures were felt to be a success ablating all disease. Thirteen treatments requred early termination. The most common factor responsible for termination was an inability to achieve a comfortable level of anesthesia. One patient with Reinke's edema developed postprocedure stridor that required a 3-day hospital admission for observation and corticosteroids. There was no incidence of any vocal fold scarring, web formation, or other complications. CONCLUSIONS: The 585nm PDL is a promising tool for in-office treatment of various laryngeal disorders. Complications are rare.
Collapse
Affiliation(s)
- Debbie Aviva Mouadeb
- The Center for Voice and Swallowing, University of California at Davis Medical Center, Department of Otolaryngology-Head and Neck Surgery, Sacramento, CA, USA.
| | | |
Collapse
|
15
|
San Giorgi MRM, Helder HM, Lindeman RJS, de Bock GH, Dikkers FG. The association between gastroesophageal reflux disease and recurrent respiratory papillomatosis: A systematic review. Laryngoscope 2016; 126:2330-9. [DOI: 10.1002/lary.25898] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Revised: 12/08/2015] [Accepted: 01/04/2016] [Indexed: 01/26/2023]
Affiliation(s)
- Michel R. M. San Giorgi
- Department of Otorhinolaryngology-Head & Neck Surgery; University Medical Center Groningen; Groningen The Netherlands
- Graduate School of Medical Sciences (Cancer Research Center Groningen); University of Groningen; Groningen The Netherlands
| | - Herman M. Helder
- Department of Otorhinolaryngology-Head & Neck Surgery; University Medical Center Groningen; Groningen The Netherlands
| | - Robbert-Jan S. Lindeman
- Department of Otorhinolaryngology-Head & Neck Surgery; University Medical Center Groningen; Groningen The Netherlands
| | - Geertruida H. de Bock
- Department of Epidemiology; University of Groningen, University Medical Center Groningen; Groningen The Netherlands
- Graduate School of Medical Sciences (Cancer Research Center Groningen); University of Groningen; Groningen The Netherlands
| | - Frederik G. Dikkers
- Department of Otorhinolaryngology-Head & Neck Surgery; University Medical Center Groningen; Groningen The Netherlands
- Graduate School of Medical Sciences (Cancer Research Center Groningen); University of Groningen; Groningen The Netherlands
| |
Collapse
|
16
|
Izadi F, Ahmadi A, Zobairy H, Bakhti S, Hirbod H, Safdarian M. Fraser syndrome with laryngeal webs: Report of two cases and a review of the literature. Int J Pediatr Otorhinolaryngol 2015; 79:1959-62. [PMID: 26384833 DOI: 10.1016/j.ijporl.2015.08.043] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2015] [Revised: 08/28/2015] [Accepted: 08/29/2015] [Indexed: 11/30/2022]
Abstract
Fraser syndrome is a rare genetic disorder characterized by cryptophthalmos, syndactyly and laryngeal atresia. Although laryngeal webs occur uncommonly, they are the main cause of death in the first week of life in these patients. In this paper, we report two cases of Fraser syndrome with laryngeal webs. One of them was a twelve-year-old girl, primarily diagnosed with a supraglottic laryngeal web. In the course of treatment, a second web was also identified at the level of vocal cords, which is to our knowledge the first case of Fraser syndrome with two laryngeal webs in different levels.
Collapse
Affiliation(s)
- Farzad Izadi
- Department of Otolaryngology, Head and Neck Surgery, Iran University of Medical Sciences, Tehran, Iran.
| | - Aslan Ahmadi
- Department of Otolaryngology, Head and Neck Surgery, Iran University of Medical Sciences, Tehran, Iran.
| | - Hosna Zobairy
- Department of Otolaryngology, Head and Neck Surgery, Iran University of Medical Sciences, Tehran, Iran
| | - Sepideh Bakhti
- Department of Otolaryngology, Head and Neck Surgery, Iran University of Medical Sciences, Tehran, Iran
| | - Hengameh Hirbod
- Department of Otolaryngology, Head and Neck Surgery, Iran University of Medical Sciences, Tehran, Iran
| | - Mahdi Safdarian
- Department of Otolaryngology, Head and Neck Surgery, Iran University of Medical Sciences, Tehran, Iran.
| |
Collapse
|
17
|
Galluzzi F, Schindler A, Gaini RM, Garavello W. The assessment of children with suspected laryngopharyngeal reflux: An Otorhinolaringological perspective. Int J Pediatr Otorhinolaryngol 2015; 79:1613-9. [PMID: 26279249 DOI: 10.1016/j.ijporl.2015.07.037] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2015] [Revised: 07/26/2015] [Accepted: 07/27/2015] [Indexed: 12/24/2022]
Abstract
The assessment of pediatric laryngopharyngeal reflux (LPR) is controversial. Otorhinolaryngologists may play a role in the evaluation of children with suspected LPR detecting typical airway endoscopic findings and/or associated diseases and may help in the selection of children to be subjected to further instrumental tests. In this perspective the present review aims at examining the available evidence in the literature regarding the assessment of LPR in children. After careful literature search there are no current validated symptoms assessment questionnaires for LPR evaluation in children; flexible fiberoptic nasopharyngolaryngoscopy remains controversial as a diagnostic tool in suspect LPR cases; even though the multichannel intraluminal impedance with pH monitoring has been proposed as the instrumental gold standard, further evidence need to be found for validation in children with typical features of LPR.
Collapse
Affiliation(s)
| | - Antonio Schindler
- Phoniatric Unit, Department of Biomedical and Clinical Sciences "L. Sacco," University of Milan, Milan, Italy
| | - Renato Maria Gaini
- Department of Otorhinolaryngology, San Gerardo Hospital, Monza, Italy; Department of Surgery and Translational Medicine, University of Milano-Bicocca, Milan, Italy
| | - Werner Garavello
- Department of Otorhinolaryngology, San Gerardo Hospital, Monza, Italy; Department of Surgery and Translational Medicine, University of Milano-Bicocca, Milan, Italy
| |
Collapse
|
18
|
Carifi M, Napolitano D, Morandi M, Dall'Olio D. Recurrent respiratory papillomatosis: current and future perspectives. Ther Clin Risk Manag 2015; 11:731-8. [PMID: 25999724 PMCID: PMC4427257 DOI: 10.2147/tcrm.s81825] [Citation(s) in RCA: 107] [Impact Index Per Article: 11.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Although recurrent respiratory papillomatosis is a benign disease of the upper aerodigestive tract caused by infection with human papillomavirus, the disease process is unpredictable, ranging from mild disease and spontaneous remission to an aggressive disease with pulmonary spread and requirement for frequent surgical debulking procedures. It can present a protracted clinical course and cause potentially life-threatening compromise of the airways. Over recent decades, a number of alternative medical therapies to standard surgical treatment have been investigated, with modest outcomes overall. Currently, some additional therapies are being explored, together with novel surgical instrumentation that can help to avoid inevitable long-term stenotic complications, ultimately affecting quality of life. Hopefully, clinicians might soon be able to significantly improve the quality of treatment and outcomes for patients affected with recurrent respiratory papillomatosis, with human papillomavirus vaccination having a potentially important role.
Collapse
Affiliation(s)
- Marco Carifi
- Department of Otolaryngology, Azienda Ospedaliera di Rilievo Nazionale A Cardarelli, Naples, Italy
| | - Domenico Napolitano
- Department of Otolaryngology, Azienda Ospedaliera di Rilievo Nazionale A Cardarelli, Naples, Italy
| | - Morando Morandi
- Department of Otolaryngology, Azienda Ospedaliera di Rilievo Nazionale A Cardarelli, Naples, Italy
| | - Danilo Dall'Olio
- Department of Otolaryngology, Ospedale Maggiore CA Pizzardi, Bologna, Italy
| |
Collapse
|
19
|
Emmett SD, Akst LM, Skinner ML. Acquired Glottic Web Formation in a 3-Year-Old Girl: Case Report and Literature Review. INTERNATIONAL JOURNAL OF PEDIATRIC OTORHINOLARYNGOLOGY EXTRA 2014; 9:139-140. [PMID: 36213696 PMCID: PMC9541600 DOI: 10.1016/j.pedex.2014.07.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
Pediatric glottic webs are most commonly congenital in origin. Acquired webs in children are typically traumatic in nature, primarily from external trauma or intubation. We report a unique variation of this post-traumatic etiology: a web centered at the junction of the anterior one-third and posterior two-thirds of the vocal folds, possibly formed after phonotraumatic stress from severe coughing. Our case suggests that careful attention should be paid to persistent voice changes after acute illness, as this may be a sign of laryngeal web in the setting of phonotraumatic stress.
Collapse
Affiliation(s)
- Susan D. Emmett
- Corresponding author Susan D. Emmett, MD, Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University School of Medicine, Johns Hopkins Outpatient Center, 6 floor, 601 North Caroline Street, Baltimore, MD 21287, , 410-955-1932 (phone), 410-955-6526 (fax)
| | | | | |
Collapse
|
20
|
Paniello RC, Desai SC, Allen CT, Khosla SM. Endoscopic Keel Placement to Treat and Prevent Anterior Glottic Webs. Ann Otol Rhinol Laryngol 2013; 122:672-8. [DOI: 10.1177/000348941312201102] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
We performed a retrospective chart review to examine and describe our clinical experience of use of the Lichtenberger technique to place silicone elastomer keels after lysis of existing webs or for prevention of webs following anterior commissure surgery in adults. Twenty-two patients were identified for inclusion, ranging in age from 24 to 80 years. For 18 patients with existing glottic webs, the surgical procedure involved laryngoscopy with complete lysis of the anterior glottic web by laser or sharp technique, followed by placement of a square of silicone elastomer that is sutured in place with the Lichtenberger needle holder and left in place for 3 to 5 weeks. The procedure was well tolerated, and successfully corrected the web in all but 2 cases. For 4 patients, the procedure was performed prophylactically at the time of anterior commissure surgery considered high-risk for web formation. The procedure does not require a tracheotomy, and patients can maintain a normal diet and have functional phonation while the keel is in place. This approach to treating anterior glottic webs offers several advantages over traditional open thyrotomy with keel placement and should be considered to treat or prevent anterior glottic webs.
Collapse
|
21
|
Abstract
Extraesophageal reflux disease, commonly called laryngopharyngeal reflux disease (LPRD), continues to be an entity with more questions than answers. Although the role of LPRD has been implicated in various pediatric diseases, it has been inadequately studied in others. LPRD is believed to contribute to failure to thrive, laryngomalacia, recurrent respiratory papillomatosis, chronic cough, hoarseness, esophagitis, and aspiration among other pathologies. Thus, LPRD should be considered as a chronic disease with a variety of presentations. High clinical suspicion along with consultation with an otolaryngologist, who can evaluate for laryngeal findings, is necessary to accurately diagnose LPRD.
Collapse
|
22
|
Abstract
Recurrent respiratory papillomatosis (RRP) is a rare, benign disease with no known cure. RRP is caused by infection of the upper aerodigestive tract with the human papillomavirus (HPV). Passage through the birth canal is thought to be the initial transmission event, but infection may occur in utero. HPV vaccines have helped to provide protection from cervical cancer; however, their role in the prevention of RRP is undetermined. Clinical presentation of initial symptoms of RRP may be subtle. RRP course varies, and current management focuses on surgical debulking of papillomatous lesions with or without concurrent adjuvant therapy.
Collapse
|
23
|
Pegg D, Kanatas A, Makura Z. Idiopathic acquired supraglottic web: a case report. EAR, NOSE & THROAT JOURNAL 2012; 90:486-8. [PMID: 22033961 DOI: 10.1177/014556131109001009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
We report a case of an idiopathic acquired supraglottic web in an 83-year-old man. The web was managed with a combination of dilation and unilateral CO(2) laser excision. Subsequent to removal, the web recurred three times; it was removed in the same fashion twice and left alone once. To the best of our knowledge, this is the first reported case of a truly idiopathic acquired laryngeal web.
Collapse
Affiliation(s)
- David Pegg
- Department of Anaesthesia, Leeds General Infirmary, Leeds, U.K
| | | | | |
Collapse
|
24
|
Affiliation(s)
- Dary J. Costa
- Department of Otolaryngology-Head and Neck Surgery, Saint Louis University School of Medicine, St. Louis, Mo
| | - John A. Stith
- Department of Otolaryngology-Head and Neck Surgery, Saint Louis University School of Medicine, St. Louis, Mo
| |
Collapse
|
25
|
Gallagher TQ, Derkay CS. Pharmacotherapy of recurrent respiratory papillomatosis: an expert opinion. Expert Opin Pharmacother 2009; 10:645-55. [PMID: 19284366 DOI: 10.1517/14656560902793530] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND Recurrent respiratory papillomatosis is caused by the human papillomavirus types (HPV) 6 and 11. It affects both children and adults. In a small number of cases, the disease can be very aggressive causing significant morbidity and possibly death. Surgical therapy is the primary treatment but in patients with aggressive disease, adjunctive therapy is initiated. The majority of these adjuncts center on immunomodulation, disruption of molecular signaling cascades or interruption of viral replication to help decrease the severity of the disease. Recently, a preventative vaccine has become available but data on its effectiveness will be at least a decade away. In the mean time, researchers are examining other vaccination strategies in the fight against HPV disease. OBJECTIVE We will review the following pharmacotherapies used in the adjunct treatment of RRP: interferon, acyclovir, ribivirin, cidofovir, COX-2 inhibitors, retinoids, anti-reflux medications, zinc, indole-3-carbinol, therapeutic/preventative vaccines. METHODS This is a review paper. Utilizing Medline and Pubmed from 1966 to present, the key words as well as the above listed adjunct treatments were searched for relevant papers. CONCLUSION The evidence supporting each of these adjuncts varies with a majority having only case reports or cases-series to support their use. However, there is hope on the horizon with regard to the HPV vaccine and its potential to prevent future transmission of this disease.
Collapse
|
26
|
Abstract
Papillomas are rare tumors that originate from the mucosa. They may appear in the nose, paranasal sinuses, oral cavity, larynx, trachea, or the skin. Papillomas are mainly asymptomatic and are therefore mostly diagnosed coincidentally. In contrast, laryngeal papillomatosis may cause stridor, dyspnoea, and hoarseness. A viral cause of the disease seems likely, especially human papilloma virus. Mechanical irritation is also a possible reason when the nose, oral cavity, or oropharynx is affected. All papillomas, independent of their origin, may recur, and have the possibility of malignant degeneration in common. The therapy of choice is complete surgical excision. Regarding laryngeal papillomatosis, laser vaporisation or excision using the CO(2)laser is recommended. Because retreatments using conventional modalities are frequently necessary, especially in the case of laryngeal papillomatosis, adjuvant therapies are applied with the aim of reducing the recurrence rate and prolonging the interval between treatments.
Collapse
|
27
|
Wiatrak BJ, Wiatrak DW, Broker TR, Lewis L. Recurrent Respiratory Papillomatosis: A Longitudinal Study Comparing Severity Associated With Human Papilloma Viral Types 6 and 11 and Other Risk Factors in a Large Pediatric Population. Laryngoscope 2009; 114:1-23. [PMID: 15514560 DOI: 10.1097/01.mlg.000148224.83491.0f] [Citation(s) in RCA: 200] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
OBJECTIVES/HYPOTHESIS A database was developed for prospective, longitudinal study of recurrent respiratory papillomatosis (RRP) in a large population of pediatric patients. Data recorded for each patient included epidemiological factors, human papilloma virus (HPV) type, clinical course, staged severity of disease at each surgical intervention, and frequency of surgical intervention. The study hypothesizes that patients with HPV type 11 (HPV-11) and patients younger than 3 years of age at diagnosis are at risk for more aggressive and extensive disease. STUDY DESIGN The 10-year prospective epidemiological study used disease staging for each patient with an original scoring system. Severity scores were updated at each surgical procedure. METHODS Parents of children with RRP referred to the authors' hospital completed a detailed epidemiological questionnaire at the initial visit or at the first return visit after the study began. At the first endoscopic debridement after study enrollment, tissue was obtained and submitted for HPV typing using polymerase chain reaction techniques and in situ hybridization. Staging of disease severity was performed in real time at each endoscopic procedure using an RRP scoring system developed by one of the authors (B.J.W.). The frequency of endoscopic operative debridement was recorded for each patient. Information in the database was analyzed to identify statistically significant relationships between extent of disease and/or HPV type, patient age at diagnosis, and selected epidemiological factors. RESULTS The study may represent the first longitudinal prospective analysis of a large pediatric RRP population. Fifty-eight of the 73 patients in the study underwent HPV typing. Patients infected with HPV-11 were significantly more likely to have higher severity scores, require more frequent surgical intervention, and require adjuvant therapy to control disease progression. In addition, patients with HPV-11 RRP were significantly more likely to develop tracheal disease, to require tracheotomy, and to develop pulmonary disease. Patients receiving a diagnosis of RRP before 3 years of age had significantly higher severity scores, higher frequencies of surgical intervention, and greater likelihood of requiring adjuvant medical therapy. Patients with Medicaid insurance had significantly higher severity scores and required more frequent surgical debridement. Birth by cesarean section appeared to be a significant risk factor for more severe disease and necessity of more frequent surgical intervention. CONCLUSION Statistical analysis of the relationships among epidemiological factors, HPV type, and clinical course revealed that patients with HPV-11 and patients younger than 3 years of age at RRP diagnosis are prone to develop more aggressive disease as represented by higher severity scores at endoscopic debridement, more frequent operative debridement procedures per year, a greater requirement for adjuvant therapy, and greater likelihood of tracheal disease with tracheotomy.
Collapse
Affiliation(s)
- Brian J Wiatrak
- Department of Pediatric Otolaryngology, Children's Hospital of Alabama, Birmingham, Alabama, USA
| | | | | | | |
Collapse
|
28
|
Abstract
Anterior laryngeal webs can be congenital or acquired and occur secondary to a surgical procedure, intubation, or infection. Clinical presentation can include vocal and respiratory symptoms. The first step in managing a laryngeal web is performing flexible laryngoscopy, followed by a direct laryngoscopy under general anesthesia. Treatment remains a challenge. Endoscopically, the web can be incised with cold instruments or by laser, mitomycin-C can be applied, and a silastic keel can be inserted in the anterior commissure. Externally, an anterior cricothyrotomy is necessary and a silastic keel can be placed; anterior cartilage graft can be inserted in case of a thick web. Regardless of the technique used, the primary concern is recurrence.
Collapse
|
29
|
Stamataki S, Nikolopoulos TP, Korres S, Felekis D, Tzangaroulakis A, Ferekidis E. Juvenile recurrent respiratory papillomatosis: still a mystery disease with difficult management. Head Neck 2007; 29:155-62. [PMID: 17022088 DOI: 10.1002/hed.20491] [Citation(s) in RCA: 49] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023] Open
Abstract
Juvenile recurrent respiratory papillomatosis (RRP) is the most common benign neoplastic disease of the larynx in children and adolescents and has a significant impact on patients and the health care system with a cost ranging from $60,000 to $470,000 per patient. The aim of this paper is to review the current literature on RRP and summarize the recent advances. RRP is caused by human papillomavirus (HPV; mainly by types 6 and 11). Patients suffer from wart-like growths in the aerodigestive tract. The course of the disease is unpredictable. Although spontaneous remission is possible, pulmonary spread and malignant transformation have been reported. Surgical excision, including new methods like the microdebrider, aims to secure an adequate airway and improve and maintain an acceptable voice. Repeated recurrences are common and thus overenthusiastic attempts to eradicate the disease may cause serious complications. When papillomas recur, old and new adjuvant methods may be tried. In addition, recent advances in immune system research may allow us to improve our treatment modalities and prevention strategies. A new vaccine is under trial to prevent HPV infection in women; the strongest risk factor for juvenile RRP is a maternal history of genital warts (transmitted from mother to child during delivery). Better understanding of the etiology of the disease and the knowledge of all available therapies is crucial for the best management of the affected patients.
Collapse
Affiliation(s)
- Sofia Stamataki
- ENT Department, Johns Hopkins Hospital, Baltimore, Maryland, USA
| | | | | | | | | | | |
Collapse
|
30
|
Pignatari SSN, Liriano RYG, Avelino MA, Testa JRG, Fujita R, De Marco EK. Refluxo gastroesofágico em pacientes portadores de papilomatose recorrente de laringe. ACTA ACUST UNITED AC 2007. [DOI: 10.1590/s0034-72992007000200011] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
A cada ano aumentam as evidências de que o refluxo gastroesofágico seja um fator que contribui para as desordens de vias aéreas, principalmente na população pediátrica, podendo gerar sintomas respiratórios como estridor, tosse crônica, pneumonias de repetição e bronquite crônica. Estudos recentes têm sugerido que a associação entre papilomatose laríngea recorrente e refluxo gastroesofágico possa ser um fator determinante na recorrência e crescimento dos papilomas. OBJETIVO: O objetivo deste estudo foi verificar a freqüência e a intensidade do refluxo gastroesofágico em crianças portadoras de Papilomatose Laríngea Recorrente (PLR). MATERIAL E MÉTODOS: Foram selecionadas 10 crianças portadoras de papilomatose laríngea recorrente, de ambos os sexos, com idade entre 3 e 12 anos. Todas foram submetidas a pH-metria de 24 horas com duplo canal para avaliação da presença e intensidade de refluxo gastroesofágico. RESULTADOS: Cinqüenta por cento dos pacientes apresentaram evidências de refluxo gastroesofágico patológico em nível do esfíncter distal, e 90% apresentou refluxo proximal patológico. CONCLUSÃO: A freqüência da associação entre refluxo gastroesofágico proximal em pacientes portadores de papilomatose recorrente de laringe é extremamente alta.
Collapse
|
31
|
Pignatari SSN, Liriano RYG, Avelino MAG, Testa JRG, Fujita R, De Marco EK. Gastroesophageal Reflux in patients with Recurrent Laryngeal Papillomatosis. Braz J Otorhinolaryngol 2007; 73:210-4. [PMID: 17589729 PMCID: PMC9450676 DOI: 10.1016/s1808-8694(15)31068-5] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2006] [Accepted: 05/29/2006] [Indexed: 12/03/2022] Open
Abstract
UNLABELLED Evidence of a relation between gastroesophaeal reflux and pediatric respiratory disorders increases every year. Many respiratory symptoms and clinical conditions such as stridor, chronic cough, and recurrent pneumonia and bronchitis appear to be related to gastroesophageal reflux. Some studies have also suggested that gastroesophageal reflux may be associated with recurrent laryngeal papillomatosis, contributing to its recurrence and severity. AIM the aim of this study was to verify the frequency and intensity of gastroesophageal reflux in children with recurrent laryngeal papillomatosis. MATERIAL AND METHODS ten children of both genders, aged between 3 and 12 years, presenting laryngeal papillomatosis, were included in this study. The children underwent 24-hour double-probe pH-metry. RESULTS fifty percent of the patients had evidence of gastroesophageal reflux at the distal sphincter; 90% presented reflux at the proximal sphincter. CONCLUSION the frequency of proximal gastroesophageal reflux is significantly increased in patients with recurrent laryngeal papillomatosis.
Collapse
|
32
|
Zacharisen MC, Conley SF. Recurrent respiratory papillomatosis in children: masquerader of common respiratory diseases. Pediatrics 2006; 118:1925-31. [PMID: 17079563 DOI: 10.1542/peds.2006-1555] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Recurrent respiratory papillomatosis in children is an uncommon but potentially life-threatening benign tumor of the respiratory tract with laryngeal predilection. The diagnosis of recurrent respiratory papillomatosis may be challenging unless there is a high index of suspicion and awareness of the variable presentations. METHODS We reviewed the medical charts of children with recurrent respiratory papillomatosis treated at a tertiary children's hospital. The presentation of recurrent respiratory papillomatosis is illustrated by a series of case reports. We provide a paradigm to assist in the early diagnosis of children with recurrent respiratory papillomatosis. RESULTS Five patients, aged 2 to 6 years, were erroneously diagnosed with recurrent croup, asthma, laryngeal hemangioma, and tracheomalacia after presenting with variable degrees of chronic dyspnea, cough, stridor, dysphonia, weak cry, and syncope. Once the diagnosis of recurrent respiratory papillomatosis was made, recurring surgical ablation of papillomata was initiated. CONCLUSIONS Any child presenting with a voice disturbance with or without stridor is recommended to have diagnostic flexible fiber-optic laryngoscopy. Recurrent respiratory papillomatosis should be considered in children when other common pediatric airway diseases either do not follow the natural history or do not respond to treatment of the common disorder.
Collapse
Affiliation(s)
- Michael C Zacharisen
- Department of Pediatrics, Section of Allergy and Immunology, Medical College of Wisconsin, Milwaukee, Wisconsin, USA.
| | | |
Collapse
|
33
|
Abstract
Recurrent respiratory papillomatosis is a frustrating and challenging disease for surgeons, patients, and patients' families. Although the voice and airway manifestations are managed surgically, a "cure" for this disease remains elusive. In this edition of the "Seminar Series," we endeavor to review the current literature regarding the epidemiology, etiology, clinical manifestations, and surgical and medical treatments of this disorder. The key to future management of recurrent respiratory papillomatosis may lie in its prevention, if current efforts to develop an effective vaccine come to fruition.
Collapse
Affiliation(s)
- Craig S Derkay
- Department of Otolaryngology, Eastern Virginia Medical School, 825 Fairfax Ave, Suite 510, Norfolk, VA 23507, USA
| | | |
Collapse
|
34
|
Abstract
The purpose of this review is to describe and to critically discuss recent advances in the management of recurrent respiratory papillomatosis (RRP). The goal of surgery in RRP remains the control of symptoms. A curative therapy cannot be expected. The microdebrider and the CO(2)-laser are currently the most widely used surgical options. Literature reports an increase in adjuvant medical therapies of 10-22%. The most common drugs in adjuvant therapy are interferon, cidofovir and indole-3-carbinole/diindolylmethane. The lack of controlled studies limits our ability to accurately assess the antiviral action of the adjuvant therapies. At the moment, therapeutic interventions remain focused on the surgical removal of papillomas when possible, and additional adjuvant therapy is available for the minority of patients for whom surgical management fails to adequately control their disease. Recent advances in immunologic research offer the hope of immune system modulation as potential future treatment modalities to better control this disease process.
Collapse
Affiliation(s)
- K Huber
- Universitäts-HNO-Klinik Mannheim
| | | | | |
Collapse
|
35
|
Palomar Asenjo V, Palomar García V, Soteras Ollé J, Ruiz Giner A. [Cidofovir activity in infantile recurrent respiratory papillomatosis]. ACTA OTORRINOLARINGOLOGICA ESPANOLA 2005; 56:22-4. [PMID: 15747720 DOI: 10.1016/s0001-6519(05)78565-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
We report the case of a 4 year old boy that arrived to our department refering a 4 months history of dysphony complicated in the last week with inspiratory estridor. He was diagnosed of respiratory papillomatosis. In the next 10 months he underwent 6 operations to remove papillomas with CO2 laser. In the last operation we decided to add adjuvant therapy with intralesional injections of cidofovir once all papillomas had been removed. After more than a year of monitoring he remains disease free.
Collapse
Affiliation(s)
- V Palomar Asenjo
- Servicio de Otorrinolaringología y Patología Cérvico-Facial, Hospital Universitari Arnau de Vilanova de Lleida, Facultad de Medicina Universitat de Lleida.
| | | | | | | |
Collapse
|
36
|
McKenna M, Brodsky L. Extraesophageal acid reflux and recurrent respiratory papilloma in children. Int J Pediatr Otorhinolaryngol 2005; 69:597-605. [PMID: 15850681 DOI: 10.1016/j.ijporl.2004.11.021] [Citation(s) in RCA: 55] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2004] [Revised: 11/08/2004] [Accepted: 11/23/2004] [Indexed: 10/25/2022]
Abstract
OBJECTIVE Recurrent respiratory papillomatosis (RRP) is a benign infectious disease which is caused by the human papilloma virus (HPV). When it infects the larynx, hoarseness and airway obstruction are often the presenting symptoms. Latent virus is found in the laryngeal mucosa of many more patients than exhibit the disease. The factors which lead to virus activation have not been identified, however, extra-esophageal acid reflux disease (EERD) has been suggested as one of these factors. METHODS This is a case series of four patients with RRP who had increase in severity of their disease with the recognition of concurrent extra-esophageal acid reflux. The clinical course of the papillomatosis and the diagnosis and treatment of reflux are compared over time. RESULTS In all four cases, with identification and treatment of the EERD, control of the RRP improved, and in at least two patients, was complete with resolution of the EERD. Lapses in compliance with medications or behavioral and dietary recommendations in three out of four patients led to a rebound in symptoms and signs of RRP, including worsening of vocal quality and the endoscopic appearance of the larynx. CONCLUSION The clinical course of these patients suggests a link between the presence of EERD and RRP. The inflammation induced by chronic acid exposure may result in the expression of HPV in susceptible tissues. Prompt diagnosis and effective treatment of EERD should be considered in all patients with difficult to control RRP or with clinical presentation or endoscopic signs of EERD.
Collapse
Affiliation(s)
- Margo McKenna
- Department of Otolaryngology, Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, MA, USA.
| | | |
Collapse
|
37
|
Abstract
PURPOSE OF REVIEW The purpose of this article is to review recent literature regarding pediatric recurrent respiratory papillomatosis (RRP) published within the last year. By reviewing and assessing these articles, a more clear understanding regarding the etiology and management of pediatric RRP can be obtained, allowing physicians to better care for their pediatric RRP patients. RECENT FINDINGS Pediatric RRP continues to be an extremely difficult management problem for otolaryngologists. This disease process continues to be a significant burden on the health care system and is a significant cause of morbidity in affected patients and their families. The incidence of RRP continues to be approximately 3.96 per 100,000 in the pediatric population. It has been noted recently that approximately 7 of every 1000 children born to mothers with vaginal condyloma develop pediatric RRP. Although the mainstay of surgical management has traditionally been the CO2 laser, newer surgical techniques have demonstrated efficacy in the management of pediatric RRP patients, including powered instrumentation and the pulse-dye laser. The traditional adjuvant medical therapies used for pediatric RRP continue to be commonly used, including interferon-alpha2a, retinoic acid, and indol-3-carbinol/diindolylmethane (I3C/DIM). Recently cidofovir has demonstrated efficacy in selected patients. In addition, current research regarding vaccine therapy for pediatric RRP has shown promise. Basic science research in the field of immunology has demonstrated multiple defects in cell-mediated immunity, which has shed further light on the etiology of pediatric RRP. SUMMARY Pediatric RRP continues to be a highly morbid disease process. New surgical and medical therapies offer hope for better control of this disease in affected patients. Recent advances in immunologic research offer the hope of immune system modulation and augmentation as potential future treatment modalities to better control this disease process.
Collapse
Affiliation(s)
- Brian J Wiatrak
- Department of Pediatrics and Surgery, University of Alabama at Birmingham, USA.
| |
Collapse
|