Iatrogenic airway stenosis with recurrent respiratory papillomatosis

Objectives: To describe the presentation of, factors contributing to, and treatment of iatrogenic airway stenosis (IAS) associated with recurrent respiratory papillomatosis (RRP). Design: Retrospective case series. Setting: Pediatric tertiary care center. Patients: The charts of patients treated for RRP in our institution from 1980 to 1995 (N=50) were reviewed. Seven patients were identified as having IAS based on endoscopic findings. Main Outcome Measures: Prevalence and types of IAS within our RRP patient population, methods used to treat IAS, and successful treatment of IAS. Results: Of the 7 patients identified, 3 had isolated posterior glottic stenosis (PGS) and 1 had isolated subglottic stenosis. The 3 had multiple areas of IAS as follows: PGS with bronchial stenosis, supraglottic stenosis with PGS, and tracheomalacia with tracheal stenosis from a suprastomal granuloma. The factors associated with IAS were extensive papilloma growth in the posterior glottis, prolonged periods of frequent laryngoscopies, and the use of nonstandard therapies, which in our series included topical podophyllum resin or photodynamic therapy. Six patients, all of whom had tracheal RRP at some point in their disease process, required tracheotomy. Five patients required laryngotracheal reconstruction. Laryngotracheal reconstruction permitted decannulation in all cases. Tracheal papillomas became sessile and nonobstructive after decannulation. Laryngotracheal reconstruction 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 papillomas. Conclusions: Occasionally, therapy for RRP is complicated by IAS. In our series, PGS was most common. Tracheotomy was associated with the presence of both IAS and distal RRP. In selected cases, laryngotracheal reconstruction can be successfully accomplished when RRP is present, and subsequent regression of tracheal RRP is likely.