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Papilloma of the larynx and tracheobronchial tree in children. A retrospective study
Insights
Direct laryngoscopy effectively treats laryngeal papillomatosis. Avoiding tracheotomy and minimizing intubation reduces tracheobronchial papilloma complications, prioritizing airway establishment through repeated endoscopic procedures.
Area of Science:
- Pediatric Otolaryngology
- Respiratory Medicine
- Surgical Oncology
Background:
- Papilloma of the larynx and tracheobronchial tree presents a significant clinical challenge in pediatric patients.
- Previous treatment modalities have been associated with complications, necessitating safer alternatives.
Purpose of the Study:
- To evaluate the efficacy and safety of direct laryngoscopy with apneic technique for treating laryngeal papillomatosis.
- To assess the impact of anesthetic techniques on the incidence of tracheobronchial papilloma and associated complications.
Main Methods:
- Retrospective review of 90 pediatric patients with laryngeal and tracheobronchial papilloma.
- Analysis of treatment outcomes using direct laryngoscopy under general anesthesia with apneic technique and intubation.
- Correlation of anesthetic choices with the occurrence of tracheobronchial papilloma and lung seeding.
Main Results:
- Direct laryngoscopy with apneic technique proved adequate for treating laryngeal papillomata.
- Avoiding tracheotomy and limiting intubation anesthetics correlated with a lower incidence of tracheobronchial papilloma and absence of lung seeding.
- Early decannulation was achieved in patients requiring tracheotomy, emphasizing airway management through repeated endoscopic procedures.
Conclusions:
- Direct laryngoscopy with apneic technique is a safe and effective treatment for laryngeal papillomatosis.
- Minimizing tracheotomy and intubation reduces the risk of lower airway papilloma spread and complications.
- Prioritizing airway establishment via repeated endoscopic interventions is crucial for managing this condition.
Abstract:
One hundred and forty cases of papilloma of the larynx and tracheobronchial tree are documented in the records of the Childrens Hospital of Los Angeles. The records of 90 patients were available and were reviewed intensively. The method of direct laryngoscopy with general anesthesia using apneic technique in most patients and intubation in some was an adequate method of treating patients with laryngeal papillomata. A general anesthetic was never used where obstruction was severe and the airway could not be controlled. The low incidence of papilloma of the tracheobronchial tree and an absence of parenchymal lung seeding in this series is attributed to the avoidance of a tracheotomy and fewer intubation anesthetics thus avoiding trauma to the trachea and bronchi. The immediate removal of the tracheotomy tube seems as alternative if the surgical procedure had been performed. In the patients in this series decannulation was accomplished in a very short period of time. The establishment of an airway seem to be a priority in the treatment of this disease and this can be accomplished by repeated endoscopic procedures rather than tracheotomy. Statistics are given, and prognosis based on the type of lesion and histopathology is documented.