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Upper airway bronchoscopic interpretation
Published in Don Hayes, Kara D. Meister, Pediatric Bronchoscopy for Clinicians, 2023
Anita Deshpande, Cherie A. Torres-Silva, Catherine K. Hart
The endoscope is then brought closer in order to examine the vocal cords in greater detail. Vocal nodules are the most common cause of dysphonia in children18 and typically appear as firm, bilateral lesions located medially along the membranous vocal fold.19 Polyps are generally unilateral and can be sessile or pedunculated. Cysts can be categorized as mucoid or epidermoid and can be found along the medial edge of the membranous vocal fold or infracordal. Granulomas are often associated with mucosal trauma, such as intubation, surgical defect, or chronic cough, and are usually located in the vocal process.20 Recurrent respiratory papillomatosis is a challenging disease to control, can cause significant morbidity, and, in rare cases, can undergo malignant transformation.21 These lesions appear as recurrent, exophytic papillomas within the respiratory tract (Figure 4.7).
Drooling, Aspiration, and Oesophageal Problems
Published in R James A England, Eamon Shamil, Rajeev Mathew, Manohar Bance, Pavol Surda, Jemy Jose, Omar Hilmi, Adam J Donne, Scott-Brown's Essential Otorhinolaryngology, 2022
Laryngomalacia is typically associated with coexisting reflux. It is unclear if it is causative, although the increased work of breathing can make it self-perpetuating. Reflux has also been linked with: Subglottic stenosis—gastric acid in the presence of mucosal trauma (i.e. endotracheal intubation) may lead to stenosis. This is important when considering laryngotracheal reconstruction, because reflux exposure may affect wound healing.Apparent life-threatening events (ALTEs).Recurrent croup.Recurrent respiratory papillomatosis (reflux is thought to affect the rate of recurrence).Anterior commissure web formation.
Treatment
Published in William Bonnez, Guide to Genital HPV Diseases and Prevention, 2019
The management goal of recurrent respiratory papillomatosis is maintaining a free airway. This is achieved using laser surgery, which is delicate because of the risk of scarring. Cold blade surgery is also used, in particular using a microdebrider. An early disease onset is associated with a higher number of surgical interventions. Adjuvant therapies are commonly used, most commonly with I3C or DIM, interferon, photodynamic therapy, and cidofovir. Other adjuvant modalities with no more than anecdotal evidence of efficacy are also employed such as acyclovir, retinoids, and mumps vaccine injection.
Hyaluronan in vocal folds and false vocal folds in patients with recurrent respiratory papillomatosis
Published in Acta Oto-Laryngologica, 2018
Anna Holm, Urban Hellman, Claude Laurent, Göran Laurell, Karin Nylander, Katarina Olofsson
Vocal fold are usually infected by common cold viruses. In rare cases, specific human papilloma virus (HPV) genotypes persistently infect the VF, which is a prerequisite for the development of recurrent respiratory papillomatosis (RRP). This condition is characterized by benign wart-like lesions in the upper airway affecting voice- and respiratory function, commonly throughout life [1]. Currently, there are no curative treatment options for RRP. For symptom control, patients are treated with non-curative surgery. Two HPV subtypes are associated with RRP: HPV 6 and 11. These HPV subtypes exhibit a tropism for the VF, implying pronounced morbidity due to voice impairment and airway obstruction [1]. Despite RRPs tropism for the VF, Forslund et al. [2] were able to show the presence of HPV mRNA in adjacent, macroscopically healthy false vocal folds (FVF) in 50% of their patients. However, overall viral load was higher in the RRP lesions than in macroscopically healthy adjacent FVF.
Reported rationales for HPV vaccination vs. Non-vaccination among undergraduate and medical students in South Carolina
Published in Journal of American College Health, 2021
J. Barrera, S. Greene, E. Petyak, S. Kenneson, E. McGill, H. Howell, D. Billing, S. Taylor, A. Ewing, J. Cull
Significant morbidity and mortality can arise from HPV infection, both in males and females. HPV-related cervical cancer and oropharyngeal cancers (OPCs) are becoming increasingly more common, as well as penile, vaginal, anal, and vulvar cancers.3 Additionally, non-oncogenic strains of HPV (serotypes 6 and 11) are associated with recurrent respiratory papillomatosis or condyloma of the nasopharynx.4 HPV is the causal insult in nearly all cervical cancers with serotypes 16 and 18 noted in approximately 70% of cervical cancers.4 Cervical cancer is the second most prevalent cancer in women with an estimated 500 000 new diagnoses each year and OPC is the most common HPV-associated cancers.3
Systemic bevacizumab for recurrent respiratory papillomatosis. A case series
Published in Acta Oto-Laryngologica Case Reports, 2023
Kristine Grubbe Gregersen, Jeppe Friborg, Claus Andrup Kristensen, Kristian Hveysel Bork
Recurrent respiratory papillomatosis (RRP) is a human papilloma virus (HPV) 6/11 related, predominantly histologically benign neoplasm of the upper and lower airway affecting both younger (juvenile onset - JORRP) and older patients (adult onset - AORRP). Incidence of 1,8–4/100.000 [1], highest in AORRP; though potentially declining due to HPV vaccination [2], patients often require multiple surgeries to maintain airway patency and voice quality either in local or general anesthesia. Even so, a percentage of patients show an even more aggressive course of the disease defined as more than four surgeries per year and/or tracheobronchopulmonal spreading and they pose a challenge to surgical management [3].