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Laryngeal Papillomas
Recurrent Respiratory Papillomatosis

General Considerations

  • Most common benign tumor of the trachea in children (60% of all benign tumors)
  • 2nd most common benign tumor of trachea in adults
    • Majority of primary tracheal tumors are malignant
  • In over 80% of cases, multiple papillomas occur in the trachea
  • Tracheal papilloma is associated with a laryngeal papilloma in 36%
  • Because of its high recurrence rate, it is also called Recurrent Respiratory Papillomatosis (RRP)
  • Caused by the human papilloma virus (HPV)
    • Most often types 6 and 11
    • Also the cause of skin warts and genital warts
    • Transmission of recurrent respiratory papillomatosis is believed to occur, at least in part, from mother’s infected cervix during childbirth
    • HPV is responsible for most cervical cancers and about 25% of head and neck cancers
  • Most common in children and then again 20-40 years of age
  • Significant recurrence rate may lead to numerous operative removals
  • Not the same as vocal cord polyps or nodules  

Clinical Findings

  • Children usually present around age 2-3 with
    • Male:female ratio 1:1
    • Cough, hacking in nature
    • Audible wheezing
    • Hemoptysis
    • Stridor
    • Dysphagia
    • Pneumonia
    • Aphonia
  • Adult-onset disease
    • Less severe than juvenile form
    • Male:female ratio in adults is 4:1
    • Painless hoarseness 

Imaging Findings


  • Diagnosis is made using flexible fiberoptic laryngoscopy
  • Chest radiographs are usually normal
    • Papillomas can present as multiple nodules in the chest, some of which may cavitate
  • CT scans of the neck and chest will demonstrate the extent of the lesions 


  • Surgical excision is the current standard of care in the treatment of RRP
    • Surgery is emergent if there is airway obstruction
  • Numerous surgeries may be needed because of the recurrence of these tumors (>100)
    • Adult form requires fewer surgical procedures
  • Tracheostomies are relatively contraindicated because they are believed to induce spread of the papilloma down the trachea into the bronchi and lungs
  • Medical therapies that are being tried include
    • Interferon
    • Photodynamic therapy
    • Indol-3-carbinol
    • Ribavirin
    • Acyclovir
    • Methotrexate
    • Mumps vaccine
    • Cidofovir
  • It is hoped that widespread use of anti-HPV vaccines (Gardisil) will eventually lead to eradication of the disease 


  • Progression to squamous cell carcinoma is reported but rare
  • The disease frequently becomes quiescent in adolescence

Laryngeal Papilloma. Soft tissue lateral view of the neck demonstrates a smooth, rounded soft tissue
mass arising from the posterior wall of the trachea at the level of the larynx (white arrows).
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EMedicine Recurrent Respiratory Papillomatosis  John E McClay, MD