1. Definition
2. Etiology
3. Histopatology
4. Clinical manifestations
5. Diagnose
6. Therapy and treatment (management)
7. Complications
definition
Laryngeal papilloma is a benign proliferative squamous epithelial cell larynx which most often found. Papillomavirus is the type of tumor that develops rapidly, although not malignant. These tumors can migrate to the oral cavity, nose, trachea and lungs, but the most common location is larynx.
There are two types of laryngeal papillomas: one is the laryngeal papilloma juvenilis usually multiple and tend to be aggressive. The other is a solitary senile larynx papilloma and less aggressive but can develop into malignant.
etiology
The cause of laryngeal papilloma is a " human papilloma virus ' ( HPV ) types 6.11 which infect epithelial cells. It is estimated that the spread of the disease is present at birth from mothers exposed by " genital warts ".
In the normal mucosa cells adjacent to the papilloma, also contain viral DNA that can be activated recurrent lesions. Papilloma in children is more often multiple and recur than adults. While the papilloma in adults is usually single but it tends to become malignant with a specific subtype found that HPV 16.
histopathology
Macroscopic : eksofitik lesions, such as cauliflower, gray or red and bleed easily. This type of lesion is aggressive and easily relapse, but may disappear spontaneously.
Microscopic: showing a group of connective tissue stroma and blood vessels such as the fingers are coated with a layer of squamous epithelial cells or parakeratotik keratotic surface. Sometimes a picture appeared that bermitosis cells.
clinical manifestations
Initial symptoms are the form of hoarse voice phonation disorders, disfoni even afoni. If the papilloma is large enough can cause respiratory problems such as cough, shortness, and stridor inspiration. In children, the bias occurs misdiagnosis, because often show symptoms of hoarseness, stridor, and respiratory distress after failed treatment of severe asthma or bronchitis.
diagnosis
anamnesis:
Found symptoms of hoarseness until afoni arise even respiratory distress. At the sound of crying children can appear abnormal. Found also a history of progressive hoarseness changes slowly, especially in patients who have a history of the parents had suffered Condyloma akuminata.
physical examination
Usually there is stridor on inspiration and direct laryngoscopy examination of the tumor that resembles the picture looks cauliflower, red, brittle, and bleed easily
Differential Diagnoses
1. Vocal cord polyp.
2. Vocal cord cyst.
3. Vocal cord nodules
4. bronchial asthma
5. bronchitis
6. laryngomalaise
Management
Laryngeal papilloma therapeutic goal is to maintain the airway, maintaining voice quality and eliminates the mass of papilloma and prevent recurrence.
a. Surgery
Some techniques used include: tracheostomy, laryngofissure, microlaryngoscope and extirpation by forceps, microcauter, microlaryngoscope with diathermy or ultrasound, cryosurgery, CO2 surgical laser.
b. medical
Drugs used: antivirus, hormone ( diethylstilbestrol ), steroids, and topical podophyllin
c. immunologically
using interferon
d. photodynamic therapy
This therapy uses dihematoporfirin ether which are activated with the appropriate wavelength (630 nm ).
Post-operative care including total voice rest during the first week, spoke softly during the second week, and gradually to normal in the third week. To speed healing and prevent mucosal dryness is important given the cold mist inhalation (cool mist ) during the first week.
complication
In general, laryngeal papillomas in children may heal spontaneously when puberty, but can be extended to the trachea, bronchus, and lung, believed to tracheostomy or extirpation due to action is not perfect.
prognosis
Prognosis is generally good, early diagnosis and appropriate treatment is a factor thought to affect recurrence. The cause of death is usually due to spread to the lungs.
