Recurrent laryngeal papillomatosis. Retrospective analysis of 95 patients and review of the literature.

Background: Laryngeal papillomatosis is a benign neoplastic disease which is associated with and probably by the Human Papilloma Virus. It can be of significant importance for affected patients because of its recurrent clinical course. A great variety of therapeutic measures have been described including surgical removal either with conventional instruments or by using the laser. The aim of this study was to compare these two methods.

Patients: The clinical courses of all patients (53 male, 42 female) treated at the Dept. of Otolaryngology, Head and Neck Surgery, University of Kiel since 1960 were analysed retrospectively. The two most common forms of treatment, surgical removal either conventionally or with the use of the laser, were compared.

Results: Laryngeal papillomatosis is a disease of all ages, but often initially diagnosed in the first and fourth decade. In 25 cases the onset was before the age of 16. Puberty had no effect on the clinical course. A malignant degeneration was observed in four cases. Although the different forms of treatment did not affect the rate of recurrence, the rate of complications such as tracheostomy and glottic webs was significantly reduced after laser surgery. Since the introduction of this new form of therapy no further tracheostomies had to be performed on these patients.

Conclusion: The term juvenile laryngeal papillomatosis should be replaced by recurrent respiratory papillomatosis. One could then make a distinction according to the age of onset, i.e. in children below the age of 16 years and in adolescents and adults older than 15 years. The occurrence of squamous cell carcinomas in patients previously treated for papillomas underlines the need for repeated histological studies. Our studies have shown that surgical treatment remains the mainstay in the management of laryngeal papillomatosis, with laser surgical technique being superior to conventional removal.