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Review
. 2018 Jan 14;3(1):22-34.
doi: 10.1002/lio2.132. eCollection 2018 Feb.

Current and future management of recurrent respiratory papillomatosis

Ryan Ivancic  1 , Hassan Iqbal  1 , Brad deSilva  2 , Quintin Pan  1   2 , Laura Matrka  2
Affiliations
Review

Current and future management of recurrent respiratory papillomatosis

Ryan Ivancic et al. Laryngoscope Investig Otolaryngol. .

Abstract

Objectives: Recurrent respiratory papillomatosis (RRP) is a chronic disease of the respiratory tract that occurs in both children and adults. It is caused by the human papillomavirus (HPV), in particular low-risk HPV6 and HPV11, and aggressiveness varies among patients. RRP remains a chronic disease that is difficult to manage. This review provides perspectives on current and future management of RRP.

Results: The current standard of care is surgical excision, with adjuvant therapies as needed. Surgical management of RRP has evolved with the introduction of microdebriders and photoangiolytic lasers; the latter can now be used in the office setting. Numerous adjuvant pharmacologic therapies have been utilized with some success. Also, exciting preliminary data show that HPV vaccines may prolong the time to recurrence in the RRP population. There is also optimism that wide-spread HPV vaccination could reduce RRP incidence indirectly by preventing vertical HPV transmission to newborns.

Conclusion: To date, the biology of RRP is not well understood, although it has been noted to become more aggressive in the setting of immune suppression. Additional research is needed to better understand immune system dysfunction in RRP such that immunomodulatory approaches may be developed for RRP management.

Level of evidence: 4.

Keywords: Recurrent respiratory papillomatosis (RRP); human papillomavirus (HPV); laryngeal papillomatosis; microdebrider; vaccine.

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Figures

Figure 1
Figure 1
Single patient with tracheal and right mainstem bronchial involvement. This indicates more severe RRP with distal spread. 1. Subglottic papilloma. 2. Distal tracheal papilloma. 3. Two sites of papilloma growth: at the anterior tracheal wall just proximal to carina and just distal to the carina at the right proximal mainstem bronchus. RRP = Recurrent respiratory papillomatosis.
Figure 2
Figure 2
Images 1–4 are from a single patient. 1. Appearance of papilloma with supraglottic and vocal fold involvement. 2. Appearance during debridement. 3. Appearance post‐KTP laser treatment. 4. Magnified view of vocal folds post‐KTP laser treatment. 5. Appearance after cidofovir injection into vocal folds (separate patient). KTP = potassium‐titanyl‐phosphate; RRP = Recurrent respiratory papillomatosis.
See this image and copyright information in PMC

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