IATROGENIC AIRWAY STENOSIS WITH RECURRENT RESPIRATORY PAPILLOMATOSIS

Objective: To describe the presentation of, factors contributing to, a nd treatment of iatrogenic airway stenosis (IAS) associated with recur rent respiratory papillomatosis (RRP). Design: Retrospective case seri es. Setting: Pediatric tertiary care center. Patients: The charts of p atients treated for RRP in our institution from 1980 to 1995 (N=50) we re reviewed. Seven patients were identified as having IAS based on end oscopic findings. Main Outcome Measures: Prevalence and types of IAS w ithin our RRP patient population, methods used to treat IAS, and succe ssful treatment of IAS. Results: Of the 7 patients identified, 3 had i solated posterior glottic stenosis (PGS) and 1 had isolated subglottic stenosis. The other 3 had multiple areas of IAS as follows: PGS with bronchial stenosis, supraglottic stenosis with PGS, and tracheomalacia with tracheal stenosis from a supra-stomal granuloma. The factors ass ociated with IAS were extensive papilloma growth in the posterior glot tis, prolonged periods of frequent laryngoscopies, and the use of nons tandard therapies, which in our series included topical podophyllum re sin or photodynamic therapy. Six patients, all of whom had tracheal RR P at some point in their disease process, required tracheotomy. Five p atients required laryngotracheal reconstruction. Laryngotracheal recon struction permitted decannulation in all cases. Tracheal papillomas be came sessile and nonobstructive after decannulation. Laryngotracheal r econstruction with rib grafting was most frequently performed. Of our 50 patients, none who did not have IAS required a tracheotomy. Of the 44 patients who did not require a tracheotomy, only 1 had tracheal pap illomas. Conclusions: Occasionally, therapy for RRP is complicated by IAS. In our series, PGS was most common. Tracheotomy was associated wi th the presence of both IAS and distal RRP. In selected cases, laryngo tracheal reconstruction can be successfully accomplished when RRP is p resent, and subsequent regression of tracheal RRP is likely.