Outcome Comparison of KTP laser and CO2 laser excision for Laryngeal papillomatosis -- A Systematic Review

Background: CO2 laser and the 532-nm potassium titanyl phosphate laser (KTP) were developed to treat Laryngeal papillomatosis (LP); however, the difference in their outcomes remains unclear. Methods: A systematic review was conducted through a comprehensive search of three databases. Results: Overall, the cure rates were 87.25% in the KTP group and 75.98% in the CO2 group (p＜0.05). The complications rates were significantly different between the two groups (p<0.0001). In addition, there was no significant difference between the recurrence rates of the CO2 group and the KTP group (10% vs 9.8%). The risks of bias were 13.1±1.45 and 13.6±1.52 for CO2 group and KTP group respectively, which indicated the fair quality of evidence. Conclusions: The available fair-quality evidence suggested that KTP laser excision may be a better choice for LP. Following evaluations on the benefits of the two surgical techniques with more high-quality randomized controlled studies are needed.

Expression Profiling of Tumorigenesis Genes in Patients of Laryngeal Papillomatosis

Recurrent Laryngeal papillomatosis (RLP) is a disease of the aero-digestive junction superimposed at the upper respiratory tract. Low risk human papillomavirus type 6 and 11 are infectious agents in RLP. Mainstay of treatment for RLP is CO2 laser vaporization for debulking of papilloma. Understanding of the gene changes at expression level might prove helpful for RLP management. The study was designed to evaluate the changes in tumorigenesis genes in RLP cases to mark the severity and aggression at gene expression level for disease management. Tissue samples and peripheral blood samples were acquired from clinically diagnosed RLP patients of age < 12 years undergoing CO2 laser vaporization. Control samples were taken from the normal thyroid tissue of individuals undergoing thyroidectomy. Relative quantitation of gene expression was done by real time polymerase reaction using cDNA samples. Up regulation of CXCL12/ CXCR4 signaling axis, parallel increase in GLUT-1 and over expression of IGF-I, EGFR and ER-α gene product was observed in RLP. On the other hand HIF-1a levels not discerned elevated along with VEGF, PIK3 and AKT gene expression profile. The expression analysis has provoked the possible strategies which can be planned to treat RLP by adjuvant and tailored medication to reduce multiple surgeries.

Complete atrio-ventricular block with coronary artery spasm due to direct laryngoscopy in a pediatric patient with laryngeal papillomatosis: a case report

Background Coronary artery spasm has rarely been reported in pediatric patients. Previous studies have reported comorbidities and risk factors for coronary artery spasms. We present the case of a complete atrio-ventricular (AV) block that occurred in the absence of other risk factors immediately after direct laryngoscopy. Case presentation A 2-year-old girl developed severe coronary artery spasm after direct laryngoscopy for elective laryngeal papillomatosis resection. Immediately after the initiation of laryngoscopy, complete AV block and ST elevation on lead II of the electrocardiogram were observed. These findings indicated that the complete AV block was caused by a right coronary artery spasm. Conclusion Coronary artery spasm resulting in lethal arrhythmia rarely occurs in healthy pediatric patients. To the best of our knowledge, this is the first pediatric case of a severe coronary artery spasm resulting in a complete AV block due to direct laryngoscopy in a healthy patient.

Systemic and local changes in the immunological status of patients with laryngeal papillomatosis

Human papillomaviruses (HPV) include a large family of viruses that are considered to be part of the normal flora of the human epithelium. However, the activation of these pathogenic agents leads to the formation of warts of the skin or papillomas of the mucous membranes. However, in most immunocompetent people, the virus remains latent. Patients with papillomatosis of the larynx (LP) and respiratory tract often have multiple relapses of the disease, which indicates the inability of their immune systems to inhibit the multiplication of the virus and is likely to be the result of complex and local immunosuppression. Indeed, a large list of works in which immune cells are studied at the sites of lesion describes defects in Langerhans cells (LC), an increase in the number of regulatory T-lymphocytes (Treg), the predominance of differentiation of T-helper cells into the Th2 type, and natural killer cell dysfunction (NK) and B-lymphocytes. But to date, there is no complete overview of the mechanism of immunosuppression in papillomas caused by HPV 6 and 11.

SPIES optical biopsies in laryngeal papillomatosis. The 4 waves sign

Laryngeal papillomatosis represents a challenging disease for the ENT surgeon. It has a recurrent pattern, with lesions that tend to be more and more extensive and affect the quality of life of the patient. Due to it’s viral etiology, multiple medical therapies have been attempted for these patients. Their results are still somewhat controversial, taking into account the local and systemic side effects. Diabetes mellitus (DM) patients are considered to be relatively immunocompromised and the laryngeal papillomatosis is more severe. The lesions occur at an epithelial level. The earlier the diagnosis, the better the outcome of the patient. The advancements made in the field of medical technologies made possible ample surgical interventions that maintain the natural airway. Out of these, the most used today is the CO2 LASER, with good results when correctly managed. The purpose of this paper is to present the use of an endoscopic method of examination, that uses SPIES filters, for a more accurate diagnosis of the epithelial lesions, which allows a better evaluation and more thorough follow-up of our patients. We believe attention should be paid to this topic due to the surgical, epidemiological and biological reasons.

Tracheostomy: Five-Year Review in a West African Hospital

Introduction: The aim of this study was to determine the frequency of tracheotomies in our department over the last five (5) years, list the indications and explain the technique and postoperative follow-up. Material and Methods: This is a 5-year (January 2013-December 2017) retrospective and analytical study of the records of patients who have had tracheotomies in the ENT and Neck and Facial Surgery department of the Ignace Deen National Hospital in Conakry. Results: During this period, 48 tracheotomies were performed in the department, with a frequency of 5.42%. The mean age of our patients was 35 years with extremes of 9 years and 67 years. The age group from 10 to 19 was the most affected. The sex ratio was 1.67. All socio-professional categories were affected. The aetiologies of the air obstacle were dominated by cancerous lesions: laryngeal cancer, laryngeal papillomatosis and hypopharyngeal cancer, representing 22.92%, 20.83% and 14.58% of cases respectively. The tracheotomy was most often carried out under local anaesthesia with a supra isthmic tracheal opening in an inverted H or I shape in 77.08% of cases. Complications observed in our series were cervical emphysema and obstructive mucus plug in 6.25% of cases and 1 case of death, i.e. 2.08%. Early decanulation was performed in 41.67% of cases. Conclusion: Tracheostomy is a lifesaving procedure and commonly performed in our practice. A proper technique with carefully selected indications enables minimises the risk of complications.

Role of thuja in the management of laryngeal papilloma

Juvenile respiratory laryngeal papillomatosis is a subset of a larger clinical entity of recurrent respiratory papillomatosis. It is characterised by the development of recurrent papillomata in the vocal folds. Human papillomavirus types 6 and 11 has been implicated to be the most common strain of virus associated with the formation of laryngeal papilloma. Clinical diagnosis is based on typical appearance of warty lesion on endoscopy. Surgery is the primary line of management along with adjuvant therapy like antiviral drugs and immunomodulators. Thuja occidentalis is a tree native to North America whose leaves and leaf oil have antiviral, antibacterial and antifungal properties. It has been widely used for the treatment of condylomatous skin lesions and warts. Here we discuss the outcome of thuja as an adjuvant therapy in the treatment of laryngeal papillomatosis in an 8-year-old child.