Treatment of Recurrent Respiratory Papillomatosis in Children with the Microdebrider

Abstract

The mainstay of treatment of children with recurrent respiratory papillomatosis has been CO2 laser laryngoscopy. Powered microdebriders allow precise removal of laryngeal lesions without thermal damage. The microdebrider may reduce costs by reducing operative time and limiting the need for expensive laser-related equipment. To compare the use of the microdebrider with that of the CO2 laser in children undergoing surgery for recurrent respiratory papillomatosis, we retrospectively reviewed the charts of 18 patients from 2 institutions covering a treatment period between December 1998 and October 2001. These patients were initially treated with the CO2 laser, but were switched to microdebrider resection during the review period. We recorded the number of procedures, the technique(s) of resection used, and the operative time for each procedure. We identified 18 patients, 11 male and 7 female, ages 18 months to 14 years. A total of 127 procedures were performed with the CO2 laser, and a total of 50 procedures were performed with the microdebrider. The mean number of procedures per patient was 10 (range, 2 to 17 procedures). The mean surgical time per procedure using the CO2 laser was 59.2 minutes (range, 8 to 130 minutes). The mean time per procedure with the microdebrider was 32.4 minutes (range, 12 to 47 minutes). This reduction in operative time was clinically and statistically significant (p = .0001, unpaired Student's t-test). We concluded that microdebrider resection of laryngeal papilloma in children allowed more rapid surgery with potentially reduced treatment costs. Other advantages of this technique include precise excision without thermal injury. Our report details useful refinements of technique with the microdebrider.

Papilomatose laríngea recorrente: experiência de 10 anos

“…Quanto ao tratamento, vários métodos têm sido descritos incluindo utilização de antibióticos, hormônios, eletrocoagulação, crioterapia, radiação, ultra-som, exérese cirúrgica, vacina autógena 2 , aplicação intralesional de cidofovir 22,23 e utilização de microdebridador para remoção das lesões 24 . Entretanto, nenhuma medida foi suficientemente eficaz no controle de múltiplos papilomas e recorrências.…”

Microdebrider resection of bilateral subglottic cysts in a pre-term infant: A novel approach

“…Recurrent respiratory papillomatosis [8], laryngomalacia [9], glottic [10] and subglottic and tracheal stenosis [11] have all been treated using the microdebrider. Lunn et al [11] highlight the advantages and disadvantages of use of the microdebrider within the airway well.…”

Recurrent Respiratory Papillomatosis

“…However long term results of these studies are still awaited. 3,4,5 Cold Steel Surgery microsurgical excision was the earliest transoral management option for RRP and is still a preferred treatment in Adult onset RRP with limited involvement. Standard microlaryngeal instruments and techniques may be utilized to completely excise laryngeal papillomata with good voice results, and in one recent series complete remission was observed in two year follow-up of six primary AORRP patients, although this treatment is not as effective in recurrent or extensive disease.…”