King Fahd Specialist Hospital, Saudi Arabia
Title: Laryngeal Papilloma, what are we missing
Biography: Al-Driweesh Bshair Abdulrahman
Case presentation: 11 year old boy medically free presented with hx of voice hoarseness, not investigated before. No hx of Choking episodes No hx of Cough, dyspnea, DOB. No hx of Airway Traumanot in distress, vitally stable saturating well.
Bronchoscopy showed: Mobile vocal cords, Papillomatous mass, Normal subglottic area, Normal Arytenoids. What are we missing?
It is the most common pediatric benign laryngeal neoplasm and second most common cause of childhood hoarseness. It is characterized by (wart-like) growths of the airway predominantly affecting the larynx and trachea (and occasionally bronchi and lung parenchyma). DNA has been retrieved from normal laryngeal and tracheal mucosa in 4% of cases. The mode of transmission include vertical and sexual.
Risk factors of acquiring JoRRP are mothers with active condylomata (2/3), young mothers, vaginal delivery, first child, low S E. Treatment objectives include relieve airway obstruction, improve voice quality, and to facilitate remission
Are we missing anything?
Counseling, the impact of a diagnosis of HPV infection; cultural issues- HPV testing may be seen as an indicator of infidelity or premarital sex, Positive test result could lead to excommunication from the family, Chart documentation. psychologist, sex therapist or social worker, adolescent sexuality- Adolescents want to discuss issues of sexuality with their health care providers and are likely to discuss these issues in a nonthreatening environment. They prefer to be asked questions rather than being expected to volunteer information and need reassurance that their privacy will be respected and information will not be shared.
Future and Controversies: Use of medical therapy to eradicate latent papilloma virus found in 20% of normal-appearing mucosa, to determine the genetic predisposition via genetic studies, New human papillomavirus (HPV) vaccine recommended for preteen and teenage girls, Controversy still exists concerning the best mechanism of surgical removal, and addressing the socio-sexual environment in our conservative culture