Treat larynx papillomatosis gently with the (blue) laser

Recurrent respiratory Papillomatosis (RRP)

Recurrent respiratory papilloma (RRP) are benign lesions that – in the head-and-neck region – predominantly grow inside of the larynx (laryngeal papillomatosis). When they involve the vocal folds, they mostly induce hoarseness. RRP tend to be a chronic problem because proper treatment is not based on radical excision, but mass reduction. However, there are good therapeutic options that we can offer our patients to try to eradicate all papilloma.

Papillomas are benign growths caused by the HPV virus (Human Papilloma Virus), comparable to warts. If the larynx with the vocal folds is affected, one speaks of a larynx papillomatosis (larynx papillomatosis) or laryngeal papillomatosis. This acute voice disorder is one of the rare voice disorders (around 3 out of 100,000 people). Since the papillomas disturb the vibrations of the vocal folds, hoarseness usually occurs at an early stage.

Our voice clinic is highly specialized is diagnosing all reasons and effects of RRP problems and offers state-of-art therapeutical options to regain a mostly normal voice function. Patients come from all over the world for phonosurgical treatment, e.g. photoangiolytic laser surgery with KTP or blue laser, injections, and therapeutic vaccination. We perform surgery in the office or in general anesthesia, both in an ambulatory setting.

As an alternative to removing the papillomas under general anesthesia, an outpatient laser operation with a photoangiolytic laser (KTP laser or blue laser) with superficial spray anesthesia and painlessly can be carried out. The laser is used to cauterize only the blood vessels within the vocal cord and to protect the mucous membrane above it – similar to the dermatological treatment of spider veins in the skin. The sclerosing of the superficial vessels within the vocal fold leads to the papillomas „drying out“ after a few days. This procedure can save the patient multiple general anesthesia.
Papillomas – like warts – can come back even after a complete surgical removal. Many patients require multiple operations. We have developed a treatment concept in which the surgical removal under general anesthesia and / or local anesthesia is combined with the injection of a virostat and other measures and with which we have had very good experiences.

In this interesting new article, Markus Hess and Susanne Fleischer describe their technique for managing recurrent laryngeal papillomatosis in an outpatient setting using channelled endoscopes.

With the surface, which appears dotted with a special vascular pattern, the suspected diagnosis can be included or excluded with a high degree of certainty if the endoscope optics are of the appropriate quality. However, the final confirmation of the diagnosis must be made by a histological examination of the tissue. The HPV type can also be determined and the benign nature of the change can be demonstrated.

Papillome an den Stimmlippen
Papillomas with a typical, dotted surface. Image taken during outpatient examination with flexible endoscopy with high-resolution optics (white light).
Papillome an den Stimmlippen
Kehlkopfpapillomatose MEDICAL VOICE CENTER
The same finding in flexible endoscopy, now with NBI illumination.
The same finding during KTP lasering, which is performed on an outpatient basis under local anesthesia. One recognizes the laser fiber, which was introduced by the working channel of the flexible optics. The green light is created by reflections in the KTP laser.