Long Term Outcome of Juvenile Onset Recurrent Respiratory Papillomatosis in University Kebangsaan Medical Centre

Year 2020, Volume: 10 Issue: 1, 244 - 250, 25.04.2020

Bee See Goh Nadhirah Mohd Shakrı Jenny Loh Chen Nee

https://doi.org/10.32448/entupdates.673674

Abstract

Objective: To review the long term outcome of juvenile onset recurrent respiratory papillomatosis (JORRP) in University Kebangsaan Medical Centre (UKMMC).
Methods: A sixteen-year retrospective study – from January 2002 to June 2019 – of patients who presented with JORRP at our hospital was carried out.
Results: Nineteen cases were identified with the youngest age of presentation being eight months old. The mean follow-up time was 4.8 years. All patients had glottic papilloma, ten had multi-site involvement, namely at the subglottic, trachea, oropharynx and one case of distal spread to the lungs. The majority (71.4%) of patients with tracheostomy had extralaryngeal spread and shorter surgical intervals (a mean of 3.2 procedures per year). All our patients were treated surgically. Two patients with aggressive disease received a trial of the adjuvant therapies Gardasil and Cidofovir. However, no improvement was observed.
Conclusion: The worst prognosis is seen in younger-onset JORRP. Surgery is the mainstay of treatment and patients with aggressive disease may need adjuvant therapy. Unfortunately, there is a lack of a standard protocol for adjuvant therapies. Tracheostomy increases the risk of extralaryngeal spread and aggressive disease, and thus should be reserved for patients with severe airway compromise.

Keywords

Human papillomavirus infection, respiratory tract, pediatrics, tracheostomy

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