Vocal Cord Papilloma
What is Vocal Cord Papilloma?
Vocal cord papilloma is a benign lesion of the larynx (throat) and vocal cords. Because of its tendency to recur frequently, papilloma is very difficult to treat. It usually requires endoscopic airway examination and may require surgical treatment if necessary. Today, vocal cord papilloma can be treated with lasers specifically designed for papilloma, which do not damage the underlying healthy tissues.
How does Papilloma Occur?
Papillomas form as thin elongated protrusions from a rich vascular connective tissue covered by hyperplastic flat epithelium. It is thought that human papillomavirus (HPV) plays a role in its formation. HPV is a DNA virus that causes benign proliferation in epithelial tissue when it infects the laryngeal mucosa. There are more than twenty types of HPV. Among these, HPV-6 and HPV-11 are most frequently involved in the formation of papillomas. These two subtypes are also responsible for a significant proportion of the warts seen in the genital area. It is known that pathologies caused by HPV-11 progress more severely than those caused by HPV-6.
It has been proven that there is a relationship between the maternal genital wart (condyloma acuminatum) and the laryngeal papilloma vocal cord papilloma in children. 20-60% of children with laryngeal papilloma have been found to have condyloma acuminatum in their mothers. It is believed that transmission occurs during passage through the motherâs birth canal. Indeed, papilloma is seen much less frequently in children born by cesarean section.
At What Ages is Vocal Cord Papilloma Seen?
Vocal cord papilloma can be seen at any age. The ages it is most commonly seen are children aged 5 and under as well as adults aged 30 and over.
Does Vocal Cord Papilloma Grow Faster in Children?
Papillomas seen in childhood are more common than those seen in adulthood, and their clinical findings are much more pronounced and recurrent.
Clinical Appearance
Papillomas typically appear as numerous wart-like lesions. They can be seen anywhere in the upper airway, but 95% of cases are seen in the larynx. Pathologies in the larynx usually affect the true vocal cords and false vocal cords (ventricular bands). The first complaint that brings patients to the doctor is usually hoarseness. Wheezing during breathing, coughing, difficulty breathing, and pain while eating or swallowing can also be causes of complaint. You can watch the examination videos of two separate patients with vocal cord papilloma below.
Treatment
Since the virus that causes papilloma can also reside within normal-looking tissues, complete cure of the disease is not possible. The primary goals of treatment are to keep the airway open and to ensure adequate levels of quality voice. For this purpose, surgery should aim to cause minimal scarring and least damage to healthy tissues.
Recurrences are common. There is also a small risk of becoming malignant.
Some Points to Consider About Recurrent Respiratory Papillomatosis (RRP)
- In the presence of RRP, tracheotomy should be avoided as much as possible to prevent stomal involvement.
- Papilloma virus is found in the superficial epithelial layer.
- Since the viral capsid antigen is found in the outer layers of the diseased epithelium, removal of all exophytic lesions is essential.
- The appearance of the lesions can rarely be mistaken for carcinoma (voice box cancer), so pathologic sampling is necessary.
- The nasopharyngeal aspect of the soft palate and the undersurface of the vocal cords should be examined, as occult RRP may be present.
- Jet ventilation should not be preferred as there may be contamination of the lower respiratory tract.
- Lasers, which can be applied specifically for vocal cord papillomas, may help to preserve as much vocal function as possible.