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Laryngotracheal papillomatosis — Clinical Guidelines

Overview

Laryngotracheal papillomatosis is a rare, benign neoplasm characterized by recurrent growths in the larynx and trachea, often leading to airway obstruction. It primarily affects children but can occur in adults, requiring multidisciplinary management including endoscopic resection, stenting, and surgical reconstruction 6 7.

Diagnosis

Clinical Presentation: Hoarseness, stridor, respiratory distress, and recurrent respiratory infections 6.

Endoscopic Evaluation: Essential for visualizing papillomas and assessing airway patency 6.

Grading Systems: Utilization of the Myer-Cotton classification for severity and the European Laryngological Society (ELS) classification for comprehensive staging 3 6.

Management

Endoscopic Procedures: Initial treatment involving repeated endoscopic removal of papillomas 6.

Surgical Interventions: Single-stage laryngotracheal reconstruction (SS-LTR) for severe cases; cricotracheal resection and anastomosis (CTRA) for high-grade stenosis 3 7.

Sedation and Weaning: Standardized protocols for sedation withdrawal post-LTR to minimize complications 5.

Airway Stenting: Use of specialized prostheses like the LT-Mold for complex cases to maintain airway patency 7.

Special Populations

Pediatrics: Focus on minimizing perioperative complications and optimizing phonation and swallowing post-LTR 8.

Comorbidities: Consideration of systemic comorbidities in surgical planning and outcomes prediction 3.

Key Recommendations

Implement standardized sedation weaning protocols post-laryngotracheal reconstruction to reduce complications and length of stay (Evidence: Moderate 5).

Utilize the European Laryngological Society classification system for comprehensive staging and predicting surgical outcomes in benign laryngotracheal stenosis (Evidence: Moderate 3 6).

Employ endoscopic techniques initially for recurrent papillomas, reserving surgical interventions like SS-LTR or CTRA for severe, high-grade stenosis (Evidence: Expert opinion 3 6).

References

1 Tendron A, Atallah S, Wagner I, Baujat B, Dauzier E. Varying ENT practices in adult post-intubation laryngotracheal stenosis after the COVID epidemic in France: A CHERRIES analysis. European annals of otorhinolaryngology, head and neck diseases 2024. link 2 Li L, Strum D, Pestieau SR, Zalzal G, Preciado D. Sedation withdrawal following single stage laryngotracheal reconstruction: Does dexmedetomidine help?. International journal of pediatric otorhinolaryngology 2020. link 3 Fiz I, Monnier P, Koelmel JC, Di Dio D, Fiz F, Missale F et al.. Multicentric study applying the european laryngological society classification of benign laryngotracheal stenosis in adults treated by tracheal or cricotracheal resection and anastomosis. The Laryngoscope 2020. link 4 Gorostidi F, Vinckenbosch P, Lambercy K, Sandu K. Lamb larynx model for training in endoscopic and CO. European archives of oto-rhino-laryngology : official journal of the European Federation of Oto-Rhino-Laryngological Societies (EUFOS) : affiliated with the German Society for Oto-Rhino-Laryngology - Head and Neck Surgery 2018. link 5 Kozin ED, Cummings BM, Rogers DJ, Lin B, Sethi R, Noviski N et al.. Systemwide change of sedation wean protocol following pediatric laryngotracheal reconstruction. JAMA otolaryngology-- head & neck surgery 2015. link 6 Monnier P, Dikkers FG, Eckel H, Sittel C, Piazza C, Campos G et al.. Preoperative assessment and classification of benign laryngotracheal stenosis: a consensus paper of the European Laryngological Society. European archives of oto-rhino-laryngology : official journal of the European Federation of Oto-Rhino-Laryngological Societies (EUFOS) : affiliated with the German Society for Oto-Rhino-Laryngology - Head and Neck Surgery 2015. link 7 Monnier P. Airway stenting with the LT-Mold: experience in 30 pediatric cases. International journal of pediatric otorhinolaryngology 2007. link 8 Smith ME, Mortelliti AJ, Cotton RT, Myer CM. Phonation and swallowing considerations in pediatric laryngotracheal reconstruction. The Annals of otology, rhinology, and laryngology 1992. link

Laryngotracheal papillomatosis