42 Benign Laryngeal Tumours

42.1 Recurrent Respiratory Papillomas (Fig. 42.1)

42.1.1 Epidemiology

• Most common benign tumour of the larynx

• HPV types 6, 11

• Bimodal distribution: 2 to 3 years; 20 to 30 years; M:F

• Incidence 4.5 per 100,000 children and 2 per 100,000 adults

• Occurs anywhere from lips to lungs

• Extralaryngeal spread 30%

• VFs, anterior commissure, and false cords are the most common sites

• Aims of treatment include maintenance of a safe airway and laryngeal function, while waiting for resolution

• Mechanism of transmission unknown, possible link to cervical papillomas and vaginal delivery

• Remission rate is high necessitating multiple surgeries if presents at ages 6–10 years and confined to larynx

• Typically presents with dysphonia may have stridor and airway obstruction

• Risk of malignant change 2 to 3%

• Seeding risk if tracheostomy performed

42.1.2 Treatments

• Medical

α-Interferon

– Subcutaneous injection alternate days for 6 months

– Adverse effects common including neurological impairment, decreased renal function, and hepatocellular damage

– Cessation results in regeneration

Cidofovir

– Cytosine nucleotide analogue

– Mechanism of action: selective inhibition of viral DNA polymerase and therefore prevention of viral replication and transcription

– Independent of phosphorylation by viral enzymes, unlike acyclovir

– First licensed for use in cytomegalovirus-related retinitis in AIDS

< div class='tao-gold-member'>

Only gold members can continue reading. Log In or Register to continue

Stay updated, free articles. Join our Telegram channel

Join