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Purpose
Recurrent respiratory papillomatosis is a disease caused by the human papilloma virus (HPV). HPV is frequently localised in the larynx. The disease tends to recur and frequent intervention is usually required. Management modules include surgical intervention using microdebriders or laser ablation as well as adjuvant treatments which aim mai...
Similar publications
This study aims to investigate the efficacy of office-based potassium-titanyl-phosphate (KTP) 532-nm laser in the management of recurrent laryngeal papillomatosis (RLP) following other treatments. A retrospective assessment was performed on 55 patients in 259 cases of RLP between 2012 and 2019. Derkay scores were obtained for all patients who under...
Citations
... Concretamente, investigaciones que han utilizado diversos métodos de evaluación y análisis de voz. Del total de los artículos revisados, cuatro de ellos investigaron pacientes con PRR (Chung et al., 2022;Kono et al., 2016;Lindman et al., 2004;Parker et al., 2020), tres con pacientes con PLR (Awad et al., 2019;Lehto et al., 2007;Romero et al., 2016) y dos trabajos en pacientes con VIH (Mathew y Bhat, 2007. Es decir, que el VPH supone la ETS que con mayor frecuencia altera las características de la voz. ...
... A pesar de que los autores no utilizaron medidas objetivas para evaluar y analizar las características de la voz, sí utilizaron el cuestionario VHI-30 para emitir un juicio sobre la percepción subjetiva del paciente. Los resultados de este estudio convergen con los resultados de Awad et al. (2019), poniendo de manifiesto que el tratamiento quirúrgico acompañado de la terapia logopédica mejoran notablemente las características de la voz en pacientes con PLR. ...
... En cuanto a la primera pregunta de investigación: ''¿Qué métodos son los más utilizados para evaluar la voz de los pacientes en las diferentes ETS?'', destacan en medidas objetivas el análisis acústico de la voz; para las medidas subjetivas se emplea el cuestionario Voice Handicap Index VHI y la escala GRBAS (Hirano, 1981). Atendiendo a las medidas objetivas, el análisis de parámetros acústicos se llevó a cabo en siete artículos (Awad et al., 2019;Kono et al., 2016;Lehto et al., 2007;Lindman et al., 2004;Mathew y Bhat, 2007Parker et al., 2020). Este conjunto de trabajos presenta metodologías heterogéneas. ...
Las Enfermedades de Transmisión Sexual (ETS) son un conjunto de afecciones clínicas altamente infectocontagiosas siendo la cavidad bucal el lugar donde aparecen las primeras manifestaciones clínicas. Además, en el 90% de los casos, la laringe se encuentra involucrada, lo que provoca también cambios en la voz. Es por ello que el presente artículo tiene como objetivo realizar una revisión sistemática con el fin de arrojar luz acerca de las alteraciones de la voz que manifiestan los pacientes con ETS respondiendo a las siguientes preguntas: ¿Qué métodos son los más utilizados para evaluar la voz de los pacientes en las diferentes ETS? ¿Cuál es la ETS que con mayor frecuencia afecta a la voz? ¿Qué tipo de tratamiento médico reciben los pacientes con ETS? ¿Qué tipo de intervención logopédica reciben los pacientes con ETS? Se seleccionaron 9 artículos de las bases de datos Pubmed, WoS y Scopus. En general, los resultados muestran que el Virus del Papiloma Humano (VPH) es la ETS que con mayor frecuencia provoca alteraciones en la voz. A pesar de que la mayoría de los estudios utiliza únicamente exploraciones instrumentales, entre los métodos más empleados para evaluar la voz destacan los análisis acústicos y las escalas de voz (VHI-30 y GRBAS). Resulta llamativo que todos los pacientes reciban tratamiento médico, mientras la terapia logopédica presenta un bajo porcentaje en comparación.
... Một trường hợp u nhú thanh quản phải phẫu thuật lại lấy bỏ tổn thương. Tỷ lệ tái phát trong nhóm u nhú là 10%, trong khi NC của Rehab Awad sử dụng Coblator trong phẫu thuật tỷ lệ tái phát là 21,4% [9], nghiên cứu của Lương Thị Minh Hương phẫu thuật bằng dụng cụ vi phẫu thông thường là 30,4% [1]. Không có tổn thương nang thanh thiệt tái phát sau mổ, khác với NC của Lee DH sử dụng dao diện có tỷ lệ tái phát 22,2% [6] và NC của Singhal sử dụng laser có tỷ lệ tái phát là 8,3% [7]. ...
Mục tiêu: Mô tả đặc điểm lâm sàng và đánh giá kết quả phẫu thuật nội soi điều trị các khối u, nang lành tính vùng hạ họng thanh quản bằng Coblator II. Đối tượng và phương pháp: 83 bệnh nhân có u, nang hạ họng thanh quản được phẫu thuật nội soi lấy tổn thương bằng Coblator II tại Bệnh viện TƯQĐ 108 từ tháng 01/2019 đến tháng 12/2022. Phương pháp nghiên cứu tiến cứu mô tả từng trường hợp có can thiệp. Kết quả: Nam/nữ ≈ 2,0, tuổi trung bình 49,06 ± 11,39, yếu tố nguy cơ hay gặp là viêm họng mạn (86,8%) và hội chứng trào ngược dạ dày họng (75,9%), nuốt vướng là triệu chứng thường gặp nhất với 86,7%, tổn thương hay gặp nhất là nang thanh thiệt chiếm 60,2%, thời gian phẫu thuật dưới 30 phút chiếm 86,7%, lượng máu mất dưới 5ml chiếm 78,3%, chủ yếu đau mức độ nhẹ hoặc không đau (78,3% ở ngày thứ nhất và 98,8% ở ngày thứ 7), thời gian nằm viện trung bình 5,95 ngày, biến chứng sau mổ: 3 trường hợp chảy máu mức độ nhẹ, 3 trường hợp nhiễm trùng hốc mổ, 6 trường hợp tái phát sau 3-6 tháng. Kết luận: Coblator là phương pháp an toàn giúp kiểm soát chảy máu, giảm mức độ đau, hồi phục nhanh, ít biến chứng, bệnh nhân ra viện sớm.
... The study showed that 78.6% of patients had no relapses during the entire follow-up period (2 years), and coblation can preserve the surrounding tissues, reducing thermal damage to the mucous membrane of the vocal folds, which in turn can improve vocal results, and good hemostasis is also provided. [41]. ...
Objective
Review literature data on the coblation method in otorhinolaryngology.Materials and methodsAll materials from our study are published in peer-reviewed journals. The review is PubMed generated. In our clinic, 20 patients with bilateral paralytic laryngeal stenosis underwent cold-plasma posterior arytenoidcordotomy with Coblator II.ResultsThe analysis of the high-energy techniques currently applied in otorhinolaryngology shows the benefits of coblation due to the effect of lower temperatures on tissues. Patients subjectively reported improved breathing on day 10 with a closed coblation tracheostoma; after 3–6 months everyone underwent successful decannulation with plastic surgery of the cutaneous-tracheal fistula. Lately, the operated vocal fold was in the abduction position and the lumen of the glottis in the posterior third was 7–8 mm. Compensation of vocal function in the long-term postoperative period was achieved by patients due to long-term orthophonic training and the development of a vestibuloscapular phonation mechanism.Conclusion
The advantages of coblation are mainly minimal trauma to the surrounding tissues, convenient resection, the ability to perform complete hemostasis at one time, and easier postoperative period for the patient.
... Coblation wands may offer advantages in laryngeal surgery by minimizing thermal damage to surrounding tissue (which aids postoperative voice outcomes), achieving better intraoperative hemostasis to facilitate a bloodless surgical field when operating on vascular tumors, reducing operating times, and providing easier access to difficult to reach areas including working around corners. 8,9 In addition, we present a case series of four patients with LP, providing a comprehensive review of current diagnostic paradigms and management strategies. LP with multicentric lesions are rare, and we present two such cases, including the first synchronous lesion outside the head and neck region and one case with metastatic paraganglioma affecting the bilateral skull base, paravertebral region, liver, and adrenal gland. ...
Background
Laryngeal paragangliomas (LP) comprise a rare subset of head and neck neoplasms and are an important differential in the patient with a submucosal laryngeal mass.
Methods
We discuss an operative technique using coblation assisted excision via laryngofissure in the cases of four confirmed LPs and discuss the current literature with respect to diagnosis and management of these patients.
Results
Our case series of four patients demonstrate the laryngofissure approach for LP is safe, provides oncological cure and preserves laryngeal function. This technique with coblation has not been previously discussed in the surgical management of LPs. Patient‐reported postoperative voice and swallowing outcomes were excellent in all patients. Whole body imaging techniques were utilized in all patients, with octreotide scintigraphy demonstrating synchronous lesions in two of the four patients—one had a retroperitoneal lesion, whilst another patient had multiple lesions in the skull base, paravertebral region, liver, and adrenal gland.
Conclusions
Our cases also highlight the changing clinical paradigms in the diagnostic approach of LPs and an emerging role for octreotide scintigraphy in the workup of these patients. Coblation assisted excision via laryngofissure is efficient and effective in the surgical resection of LP. In patients with multicentric forms of LP, the size, side, and anatomic location of synchronous lesions should be considered in surgical planning to determine feasibility and safety of operative management.
Level of Evidence
IV
... The most common early symptom is hoarseness, which might be challenging to notice at a young age [40]. Another initial symptom is progressive dysphonia, which is also more frequent in adults [22,41]. Due to upper airway involvement, dyspnea, chronic cough, recurrent upper respiratory infections, pneumonia, acute respiratory distress, dysphagia, and/or failure to thrive may be present [41,42]. ...
... Another initial symptom is progressive dysphonia, which is also more frequent in adults [22,41]. Due to upper airway involvement, dyspnea, chronic cough, recurrent upper respiratory infections, pneumonia, acute respiratory distress, dysphagia, and/or failure to thrive may be present [41,42]. In addition, presence of HPV genomic sequences has been reported in the nasal cavity [43]. ...
... In addition, the measles-mumps-rubella (MMR) vaccine, when injected into RRP lesions, demonstrated moderate therapeutic benefit. However, further studies are needed to investigate the role of the MMR vaccine as a therapeutic agent for RRP (41,48). On the other hand, antireflux therapy is gaining importance as it has been implicated in reducing the recurrence rate of RRP [122][123][124]. ...
Recurrent Respiratory Papillomatosis (RRP) is a rare but severe manifestation of human papillomavirus (HPV). As our knowledge about HPV infections has expanded, it has become possible to understand the course of RRP disease and unravel plausible efficient methods to manage the disease. However, the surge in reports on HPV has not been accompanied by a similar increase in research about RRP specifically. In this paper, we review the clinical manifestation and typical presentation of the illness. In addition, the pathogenesis and progression of the disease are described. On the other hand, we discuss the types of treatments currently available and future treatment strategies. The role of vaccination in both the prevention and treatment of RRP will also be reviewed. We believe this review is essential to update the general knowledge on RRP with the latest information available to date to enhance our understanding of RRP and its management.
... It most commonly presents with hoarseness, mild respiratory distress, loss of voice, mouth breathing, foreign body sensation, stridor, and snoring. 7,[13][14][15] Interestingly, dysphonia is more commonly seen in adults than children. 14 The most common site for lesions are the true vocal cords followed by infrahyoid supraglottis, anterior commissure, subglottis, suprahyoid supraglottis, trachea, piriform sinus, and oropharynx. ...
Objectives
To identify studies evaluating the epidemiology of recurrent respiratory papillomatosis (RRP), including patient demographics, human papillomavirus (HPV) immunology, clinical course, surgical and medical treatments, and psychosocial factors.
Methods
A systematic literature search through PubMed was performed to identify studies evaluating the epidemiological factors associated with RRP. All studies were screened through a priori selection criteria using the titles and abstracts.
Results
A total of 208 studies were identified, of which 54 met eligibility criteria and were included in the review.
Conclusions
RRP is a rare disease most commonly caused by HPV 6 and 11. It is characterized by recurring benign papillomatous lesions in the respiratory tract, particularly the larynx. Existing evidence about disease risk factors is limited but includes both maternal HPV infection and patient smoking and sexual behaviors. Disease management involves a combination of routine surgical and medical treatment. Surgical techniques include CO2‐laser, sharp dissection, coblation, microdebridement, and photoangiolytic laser. Medical treatments which have been found to facilitate disease control off‐label include interferon‐alpha (IFN‐α), indole‐3‐carbinol, acyclovir, bevacizumab, retinoids, and the Gardasil and mumps vaccines. Many patients suffer from additional psychosocial challenges related to their diagnosis. Current disease knowledge remains limited, and more robust controlled trials about risk factors, medical therapies, and surgical options are needed.
Level of Evidence
5.
... Although LTP-RFA has been widely used in otolaryngological and oncological surgery with effective results over the past decade, it is a novel minimally invasive procedure to treat chronic pain disorders [31,32]. Unlike RFT, plasma coblation produces discharge plasma by using radiofrequency energy to break molecular bonds and causing tissue dissolution at a low temperature (40-70 C) [14,15]. ...
Objective
We aimed to evaluate masticatory dysfunction after two different types of ablation on the Gasserian ganglion for the treatment of idiopathic trigeminal neuralgia. We hypothesized that low-temperature plasma radiofrequency ablation (LTP-RFA) was noninferior to radiofrequency thermocoagulation (RFT) with respect to initial efficacy.
Methods
In the randomized, single-blind, parallel-group, noninferiority trial, 204 participants with idiopathic trigeminal neuralgia were randomly allocated to receive plasma ablation in the LTP-RFA group and radiofrequency ablation in the RFT group in a 1:1 ratio, with random block sizes of four or six. Participants were examined at baseline (T0), on the day of discharge (T1), and at the 6-month follow-up (T2). The primary end point was the clinincal effective rate in the LTP-RFA group compared with that in the RFT group after intervention on the day of discharge. Noninferiority was prespecified at -10%.
Results
The intention-to-treat analysis revealed that the initial efficacy rates were 91.2% in LTP-RFA group and 93.1% in RFT group (rate ratio [RR] = 0.979, 95% confidence interval [CI]: 0.904–1.061, P = 0.795). The difference between the two groups was 1.9% (95% CI: -5.6% to 9.4%), which showed that LTP-RFA demonstrated noninferiority compared with RFT in initial efficacy. Compared with the RFT group, the LTP-RFA group exhibited a significantly greater improvement in the maximum voltage of the masseter muscles with mean differences of 11.40 (95% CI: 10.52 to 12.27, P < 0.001) at T1 and 17.41 (95% CI: 14.68 to 20.13, P < 0.001) at T2, respectively. Similar results were observed for the asymmetry index of occlusion, the maximum voltage of the anterior temporalis, and the activity index of anterior temporalis / masseter muscles. No serious adverse events were observed in either group.
Conclusions
Compared with the RFT group, noninferior efficacy for pain relief and improvement of masticatory function was revealed in the LTP-RFA group.
... The remaining 16 studies analyzed one or more of the outcome measures in either the office or the OR setting only. Five studies [19][20][21][22][23] were in-office only, while eleven studies [24][25][26][27][28][29][30][31][32][33][34] were OR-based only. A total of 163 patients with RRP were treated in the office, while a total of 299 were treated in the OR. ...
... Eight studies, 24,26,28,[30][31][32][33][34] all of which assessed OR-based treatment only, reported the recurrence rate of RRP posttreatment (Appendix, Figure 1a). The recurrence rate ranged from 21.4% for coblation to 100% for CO 2 laser. ...
... However, for five of these (two office-based 21,23 and three ORbased 29,30,33 ), no standard deviation was available or able to be calculated, so the number of procedures from only 8 studies was used ( Figure 2). Six 24,25,27,28,31,34 of the 8 studies were OR-based, one 22 was office-based, and one 17 was both office-and OR-based. The weighted mean number of OR procedures was 1.47 (95% CI 1.22-1.72, ...
Objectives
Recurrent respiratory papillomatosis can be treated in the office or operating room (OR). The choice of treatment is based on several factors, including patient and surgeon preference. However, there is little data to guide the decision-making. This study examines the available literature comparing operative treatment in-office versus OR.
Methods
A systematic review was performed following Preferred Reporting Items for Systematic Reviews guidelines. Of 2,864 articles identified, 78 were reviewed full-length and 18 were included. Outcomes of interest were recurrence and complication rates, number of procedures, time interval between procedures, and cost.
Results
Only one study compared outcomes of operative in-office to OR treatments. The weighted average complication rate for OR procedures was 0.02 (95% confidence interval [CI] 0.00-0.32), n = 8, and for office procedures, 0.17 (95% CI 0.08-0.33), n = 6. The weighted average time interval between OR procedures was 10.59 months (5.83, 15.35) and for office procedures 5.40 months (3.26-7.54), n = 1. The weighted average cost of OR procedures was $10,105.22 ($5,622.51-14,587.83), n = 2 versus $2,081.00 ($1,987.64-$2,174.36), n = 1 for office procedures.
Conclusion
Only one study compares office to OR treatment. The overall data indicate no differences aside from cost and imply that office procedures may be more cost-effective than OR procedures. However, the heterogeneous data limits any strong comparison of outcomes between office and OR-based treatment of laryngeal papillomas. More studies to compare the two treatment settings are warranted.
... These lesions seen most often in transitional zone between the squamous epithelium and the ciliated columnar epithelium. [12] Papillomatosis growth in larynx may appear as exophytic, sessile, or pedunculated lesions and often limited to the larynx but often involving vocal folds, ventricles, subglottis, and laryngeal surface of the epiglottis. [13] However, it can be seen in any part of the aerodigestive tract. ...
... Surgery cannot prevent recurrence of the disease, so different adjuvant therapies are often provided to the patients. [18,19] The complete removal of the lesions may lead to recurrences in many patients due to the presence of latent viruses. In pediatric patients, approximately five surgical procedures per year are needed to prevent recurrences. ...
