What is the treatment for papilloma (papillomatosis) of the throat?

Treatment of Throat Papilloma (Papillomatosis)

Repeated surgical debulking is the primary treatment for recurrent respiratory papillomatosis (RRP), with the goal of maintaining airway patency while preserving laryngeal function. 1

Primary Surgical Approaches

The mainstay of treatment involves surgical removal of papillomas through several techniques:

• CO₂ laser vaporization or excision is the recommended surgical method for laryngeal papillomatosis, allowing precise removal while minimizing damage to surrounding tissue 2
• Electrocautery can physically destroy visible lesions in a single visit under local anesthesia 1
• Cryotherapy destroys lesions through thermal-induced cytolysis and is effective for smaller lesions 1
• Conventional surgical excision ensures complete removal of infected epithelium at the base and allows histopathological examination to rule out dysplasia or malignant transformation 3, 1

Disease Characteristics and Prognosis

Understanding the natural history helps guide treatment intensity:

• Juvenile-onset RRP (JORRP) typically requires a median of 13 lifetime surgeries to maintain an open airway, with younger age at diagnosis associated with more aggressive disease requiring more frequent procedures 1
• Adult-onset disease generally follows a less aggressive course but still requires vigilant monitoring 4, 5
• The disease course is unpredictable, ranging from spontaneous remission to aggressive persistent or recurrent disease 4
• Malignant transformation to squamous cell carcinoma is possible, particularly in papillomas harboring high-risk HPV genotypes (16 and 18), especially in immunosuppressed individuals 3, 4, 6

Infection Control During Procedures

Critical safety measures during surgical treatment include:

• Use tight-fitting masks with small pore sizes, dedicated smoke evacuators, and full barrier clothing (gowns, gloves, masks, eye shields) to minimize transmission risk of intact HPV DNA during laser or electrosurgery procedures 1

Prevention Considerations

• The quadrivalent HPV vaccine (covering types 6,11,16, and 18) has potential to reduce the incidence of RRP, as approximately 90% of anogenital warts and RRP cases are associated with HPV types 6 and 11 1
• Routine HPV vaccination is recommended for all individuals aged 11-12 years, which may prevent future cases of respiratory papillomatosis 7

Critical Pitfalls to Avoid

• Incomplete removal of infected epithelium at the lesion base leads to recurrence; ensure complete excision during surgery 3
• Failure to obtain histopathological diagnosis may miss dysplasia or early malignant transformation, particularly important given the potential for squamous cell carcinoma development 3, 4, 6
• Inadequate long-term surveillance can miss recurrences or malignant transformation; bronchoscopy remains the most reliable method for ongoing monitoring and enables direct visualization of lesions in the central airways 4
• Underestimating airway compromise risk, particularly in children with JORRP who may require emergency intervention for life-threatening obstruction 4, 5