Juvenile Laryngeal Papillomatosis

Epidemiology

The most common laryngeal tumor in children is squamous papilloma. Multiple papillomas are often referred to as juvenile laryngeal papillomatosis (JLP). JLP may be seen in both children and adults but is more common in children. It usually presents before the age of 3 and may become symptomatic during the first year of life. The exact age of presentation is thought to be based on the extent of disease and location. Other factors that may also be associated with age of presentation include hormonal influence, and incubation time. No sexual predilection has been described for JLP.

Clinical Findings

Patients with JLP most commonly present with signs of airway obstruction. The most common symptoms are hoarseness, stridor, recurrent croup, or change in voice quality. Although histologically benign, JLP may be a potentially life-threatening disease due to obstruction of the airway. However, acute respiratory distress is unusual because JLP characteristically results in gradual airway narrowing.

JLP most commonly involves the true vocal cords, although supraglottic or subglottic extension is common. The tracheobronchial tree is often involved with tracheal involvement is reported to be as high as 26%. The cause of such involvement is felt by some to be the result of “seeding” of viral particles during airway manipulation. Many authors believe tracheotomy increases the likelihood of distal spread and recommend not performing this procedure if at all possible. Distal spread may result in the formation of multiple lung nodules that may cavitate. Esophageal papillomas that are believed to result from JLP have also been reported.