Update on Recurrent Respiratory Papillomatosis

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Key points

  • Recurrent respiratory papillomatosis (RRP) is a devastating, albeit rare, disease in which papillomas of the airway cause hoarseness and airway obstruction.

  • Surgical therapy for RRP requires a team approach with otolaryngologists, anesthesia providers, and operating room personnel working together in a facility properly equipped to manage difficult airways.

  • The recent introduction of a 9-valent human papillomavirus vaccine offers hope for prevention of transmission of the virus to neonates and

Natural history and risk factors

RRP is a heterogeneous disease, caused by 2 primary strains of HPV (HPV 6 and HPV 11), and presenting in 2 predominant age groups (juvenile onset, occurring before the age of 12 years; and adult onset, occurring from 20–40 years of age). It has previously been shown that HPV 11 is the more aggressive viral strain of the two, and that younger age of presentation is associated with a more detrimental course.3

Recent work has brought an understanding of the natural history of adult-onset RRP

Frontiers in medical treatment

Until HPV vaccination rates reach levels high enough to promote herd immunity, RRP will still demand further advances in treatment. Although surgical treatment continues to be vital in both the diagnosis as well as control of the disease, major strides are being made in the basic sciences that may pave the way to further medical therapies. These advances range from novel DNA vaccine development to the investigational use of therapies previously used to treat viral hepatitis or ocular neoplastic

Summary

RRP is a frustrating, capricious disease with the potential for morbid consequences because of its involvement of the airway and the risk of malignant degeneration. The goals of surgical therapy are to maintain a safe airway with a serviceable voice while avoiding excessive scarring. When children require surgical therapy more frequently than 4 times in 12 months or have evidence of distal spread of RRP outside of the larynx, adjuvant medical therapy should be considered.

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    Disclosure: The authors have nothing to disclose.

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