Papillomas are common lesions of the larynx and other sites where ciliated and squamous epithelia meet
Unlike oral papillomas, recurrent respiratory papillomatosis typically becomes symptomatic, with hoarseness that occasion- ally progresses over weeks to months
These papillomas are almost always due to HPV types 6 and 11
Repeated laser vaporizations or cold knife resections via operative laryngoscopy are the mainstay of treatment
Severe cases can cause airway compromise in adults and may require treatment as often as every 6 weeks to maintain airway patency
Extension can occur into the trachea and lungs
Tracheotomy should be avoided, if possible, since it introduces an additional squamociliary junction for which papillomas appear to have an affinity
Interferon treatment has been under investigation for many years but is only indicated in severe cases with pulmonary involvement
Rarely, cases of malignant transformation have been reported (often in smokers), but recurrent respiratory papillomatosis should generally be thought of as a benign condition
Cidofovir (a cytosine nucleotide analog in use to treat cytomegalovirus retinitis) has been used with success as intralesional therapy for recurrent respiratory papillomatosis
Because cidofovir causes adenocarcinomas in laboratory animals, its potential for carcinogenesis is being monitored
The quadrivalent and new 9 serotype recombinant human HPV vaccines (Gardasil and Gardasil 9) offer hope for the eventual prevention of this benign, but terribly morbid, disease