Image Based Question-66167

A 4 year old boy presented with dyspnea,stridor,hoarseness.On examination of Larynx,following structure is seen.Which among the following are true about this condition?

A. Tracheostomy may be needed in severe cases

B. May develop anywhere in the respiratory tract

C. The disease associated with HPV-11 is more severe than with HPV-6.

D. All.

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Correct Answer » D Explanation

Ans;D. All of the above.

The condition shown in the picture above represents Laryngeal papillomatosis.

RECURRENT LARYNGEAL PAPILLOMATOSIS

• RRP has a bimodal age distribution and manifests most commonly in children younger than 5 years (juvenile-onset RRP [JORRP]) or in persons in the fourth decade of life (adult-onset RRP [AORRP]).

• JORRP is more common and more severe than AORRP.

CAUSE :

• JORRP is caused by exposure to HPV during the peripartum period.

• The disease associated with HPV-11 is more severe than with HPV-6.

• The mode of infection in adults is still not known, but sexual transmission is likely.

CLINICAL FEATURES:

• Papillomas may develop anywhere in the respiratory tract, from the nose to the lung; however, >95% of cases involve the larynx.

• JORRP affects males and females in equal numbers, whereas AORRP is more common in males.

• Because the larynx is the most frequently affected site for both JORRP and AORRP, symptoms of upper airway obstruction predominate.

• Hoarseness is the most common presenting symptom(as these lesions particularly affect the “true” and “false” vocal cords.)

INVESTIGATIONS :

• Laryngoscopy:Reveals the characteristic multiple, friable, irregular warty,cauliflowerlike growths in the larynx.

TREATMENT :

• The primary treatment involves repeated surgical debulking, usually by means of microdebridement, angiolytic laser, cryotherapy, or carbon dioxide laser. This may be followed by an injection of cidofovir into the resection site in patients with moderate-to-severe disease.

• Interferon treatment appears to slow the rate of growth without curing the disease.

• Tracheostomy may be needed if significant airway obstruction occurs.

• A quadrivalent vaccine for prevention of genital HPV infection was approved in 2006. This vaccine protects against HPV types 6, 11, 16, and 18 and therefore has promise for decreasing the incidence of RRP.