Recurrent respiratory papillomatosis (RRP) is a challenging disease that damages the quality of life of patients due to its repetitive nature and its disturbance of the patient’s airway and voice. Recent reports have revealed that its incidence has decreased with the increasing utilization of the quadrivalent and 9-valent HPV vaccine in several countries. Thus, prevention, leading to the elimination of RRP by increasing the vaccination rate is expected worldwide. The first step for the precise management of RRP is careful endoscopic evaluation of lesions in the squamociliary junctions of the upper airway, which are common sites of this disease. Image-enhanced endoscopy can clearly visualize the disease, with pathological examinations showing a central vascular core in each finger-like structure of the tumor. Office-based endoscopic laser surgery is often utilized in the surgical management of RRP. Recently, the advantages of the 445-nm blue laser, which possesses both cutting and photoangiolytic capabilities, in the office-based management of RRP have been reported. Medical treatment options, including anti-viral drugs, anti-angiogenic drugs, and the induction of anti-HPV immunity have been evaluated and have shown promising results. In particular, the systemic application of the anti-angiogenic agent Bevacizumab has shown a strong therapeutic effect, and could be a first-choice option for the treatment of advanced RRP. Furthermore, evaluations of DNA vaccines and PD pathway blockade as adjuvant therapeutic options are ongoing.

This review highlights the updated epidemiology, diagnosis, and therapy of RRP in the current era in which the eradication of this disease is underway with the expansion of HPV vaccination.

The conventional treatment of laryngeal papillomas has been surgical resection using a CO₂ laser, KTP laser, cold instrument, or microdebrider under general anesthesia in an operating room. The recent advent of flexible fiber systems has made office-based laser treatment possible, and its widespread use is expected in the future. In addition, there are several reports describing the effectiveness of surgery with coblation as a novel method. Despite advances in the treatment of laryngeal papillomas, there is currently no curative treatment. Though surgery plays a major role in this field, the otolaryngologist should have a clear understanding of the concept of surgery, no matter what device is used to perform the procedure. The goal of surgery is to maintain an adequate voice function and secure the airway.

This review introduces the surgical treatment of laryngeal papillomas performed in the operating room under general anesthesia.

Recurrent respiratory papillomatosis is a chronic disease characterized by papillomatous growths of the airway predominantly affecting the larynx and trachea. The condition is generally caused by the low-risk types of human papillomavirus (HPV), HPV6 and HPV11. Although there is no evidence-based treatment modality, surgery is considered the standard treatment. However, additional adjuvant pharmacological treatment is being used increasingly frequently due to the high tendency for disease recurrence, although most published clinical research studies are the results of small-scale retrospective studies. Among various available pharmacotherapies, this review focuses on the intralesional injection of cidofovir, HPV vaccination, and intralesional or systemic injection of bevacizumab.

The pathogenesis of laryngeal papilloma (LP) is unclear. The Nanosuit-CLEM (correlative light and electron microscopy) method allows for easy scanning electron microscopy. We observed the process of HPV particle formation by the Nanosuit-CLEM method to visualize the life cycle of HPV in LP and to examine its clinical significance. Sixty-nine LP samples (30 patients) obtained from September 2005 to October 2021 were included in the present study. HPV was detected using PCR and the type was determined. Immunohistochemistry (IHC) was performed for p16, HPV-L1, and HPV-E4. We used NanoSuit-CLEM and transmission electron microscopy (TEM) to examine the samples. LP patients were mainly male (n = 25/30, 83.3%). The total number of surgeries in HPV-positive and HPV-negative cases were 3.60 (range: 1–16) and 1.30 (range: 1–3), respectively (p = 0.07). IHC showed that HPV-L1 and HPV-E4 were correlated and expressed on the tumor surface. NanoSuit-CLEM and TEM revealed the presence of HPV particles in HPV-L1 positive nuclei. A small number of HPV particle-like structures were also observed in negative cells adjacent to HPV-L1 positive cells. There was no evidence of HPV particles being released from the nuclei of the topmost cells of the tumor. HPV-L1 IHC-positive cases had a shorter surgical interval (p < 0.01) and more frequent surgeries (p = 0.04). P16 IHC was not associated with disease severity. We visualized the production of HPV particles in LP. Persistent HPV particle infection is associated with the severity of LP.

The present study investigated the associations among etiological risk factors, the presence of laryngeal mucosal inflammation by site, laryngeal hyperfunction, and the severity of hoarseness in chronic laryngitis. Of 45 dysphonic cases who were referred to the voice clinic at JCHO Osaka Hospital and diagnosed with chronic laryngitis, 55%, 27%, 11%, and 7% showed hoarseness of G0, G1R1, G2R2, and G3R3, respectively, at the initial consultation. As etiological risk factors, 24% and 18% had experienced vocal abuse in their profession and inhaled corticosteroid therapy, respectively, but none had any smoking habit. With regard to gastroesophageal reflux disease, 11% and 9% had typical reflux symptoms and esophageal mucositis under upper gastrointestinal endoscopy, respectively, and 62%, 78%, and 24% showed mucosal inflammation of the vocal folds, posterior laryngeal structures, and subglottic region under laryngoscopy, respectively. In addition, vocal hyperfunction was observed in 24%. After addressing each of the identified etiological factors, of the 18 cases showing objective hoarseness more severe than G1R1, 16 achieved vocal improvement to G0. In conclusion, the present results suggest that a substantial proportion of chronic laryngitis cases are associated with gastroesophageal reflux and have vocal impairment caused by organic changes in the vocal fold membrane rather than vocal hyperfunction.

Isolated cricoid cartilage fractures are extremely rare. Usually, the thyroid cartilage and other larynx tissues are also damaged in blunt trauma, causing narrowing of the upper airway. We describe a case of isolated cricoid cartilage fracture with only hoarseness and no respiratory symptoms in which we performed laryngeal framework surgery.

The patient was a 33-year-old woman with no significant medical history. She was bruised her neck and fractured her cricoid cartilage. Although there was mild dyspnea after the injury, it improved quickly, and only hoarseness remained. At three months after the injury, the patient was referred to our hospital for the treatment of hoarseness. CT showed isolated cricoid cartilage fracture and displacement of the cricoarytenoid joint, which was thought to be the cause of the hoarseness.

In the first surgery, we aimed to improve the hoarseness by moving the arytenoid cartilage without correcting the misalignment of the laryngeal framework. However, the hoarseness did not improve. Therefore, in the second surgery, the cricoid cartilage was divided to fundamentally correct the misalignment. This resulted in a dramatic improvement in the patient’s voice.

In the case of laryngeal trauma with scarring, radical surgery is necessary to improve the patient’s voice.

Various types of aspiration prevention surgeries have been developed, and this surgery is considered to be indicated in children with recurrent aspiration pneumonia. We herein report a pediatric case of Rett syndrome in which subglottic laryngeal closure was performed to prevent aspiration. A 15-year-old girl had been diagnosed with Rett syndrome at 4 years old and had undergone multiple previous surgeries for scoliosis. She had been suffering from recurrent aspiration pneumonia since 12 years old and undergone ventilator management 3 times. The patient was re-hospitalized for aspiration pneumonia, and tracheostomy was considered due to long-term intubation management. Since her family desired her to have safe oral intake even at the expense of her speech function, surgical treatment to prevent aspiration was decided. After the induction of general anesthesia, we checked the glottis and found bilateral vocal cord inflammation and granulation of the posterior glottis due to prolonged intubation, suggesting that glottis closure was not indicated. In addition, because of thoracic deformity, a high permanent tracheostomy hole was recommended in order to reduce the risk of brachiocephalic artery fistula due to cannula retention. Therefore, subglottic laryngeal closure was performed at the level of the cricoid cartilage. A postoperative videofluorographic swallowing study showed no anastomotic leakage, and she regained her oral intake ability. At six months after the surgery, the patient has continued oral intake and shown no deterioration in her respiratory condition.