title: Management of complex glottic stenosis in children with recurrent respiratory papillomatosis.
abstract: OBJECTIVE
  To describe our management of complex glottic stenosis in tracheotomy dependent children with severe recurrent respiratory papillomatosis.
  
  
  METHODS
  Retrospective chart review at a tertiary care children's hospital.
  
  
  RESULTS
  Three children with complex glottic stenosis secondary to severe recurrent respiratory papillomatosis were treated at our institution since 2011. Two patients had complete stenosis, and the third had near-complete stenosis. Two patients were managed using balloon dilation alone, and the third also underwent laryngotracheal reconstruction with posterior costal cartilage grafting. Two patients have been successfully decannulated and the third has been tolerating continuous tracheotomy capping for greater than twelve months. All three patients underwent aggressive debridement of papillomatosis and balloon dilation every 4-6 weeks until their burden of disease was controlled. In two patients, the glottic airway was patent, and the third continued to have complete restenosis between procedures and required laryngotracheoplasty with multiple post-operative dilation procedures to establish an adequate glottic airway.
  
  
  CONCLUSIONS
  Severe laryngeal stenosis is a well-described complication of recurrent respiratory papillomatosis, but its management is not well-defined. Aggressive management of papillomatosis with frequent debridement is critical in successfully managing laryngeal stenosis. Balloon dilation alone may be surprisingly effective in these patients, and laryngotracheoplasty can be used as an adjunct procedure in those patients who fail balloon dilation. Given the quality of life issues and concerns regarding distal spread of disease with tracheotomies in these patients, we feel that aggressive management and early decannulation is in the patient's best interest.
authors: Albert Einstein College of Medicine, Bronx, NY, United States. Electronic address: gruberb@gmail.com.
authors: Bianca
authors: B
authors: Siegel
authors: Lee P
authors: LP
authors: Smith
mesh_terms: D000293:Adolescent; D002675:Child, Preschool; D018450:Disease Progression; D005260:Female; D005500:Follow-Up Studies; D005931:Glottis / Q000473:pathology / Q000601:surgery; D006776:Hospitals, Pediatric; D006801:Humans; D007828:Laryngoscopy / Q000379:methods*; D007829:Laryngostenosis / Q000209:etiology* / Q000503:physiopathology / Q000601:surgery*; D008297:Male; D030361:Papillomavirus Infections / Q000150:complications* / Q000175:diagnosis / Q000601:surgery*; D019651:Plastic Surgery Procedures / Q000379:methods; D012141:Respiratory Tract Infections / Q000150:complications* / Q000175:diagnosis / Q000601:surgery*; D012189:Retrospective Studies; D018570:Risk Assessment; D012494:Sampling Studies; D012720:Severity of Illness Index; D014140:Tracheotomy / Q000379:methods; D016896:Treatment Outcome
keywords: Decannulation; Glottic; Laryngotracheal; RRP; Reconstruction; Recurrent respiratory papillomatosis; Stenosis; Tracheotomy