Management Challenges And Outcome Of Juvenile Onset Respiratory Papillomatosis In A Tertiary Hospital In North Central Nigeria: A Preliminary Study

Abstract

Background/Aim: Juvenile Onset Recurrent Respiratory Papillomatosis (JoRRP) is a benign tumour attributed to human papillomavirus  infection with a high propensity to recur despite appropriate treatment. It is relatively rare but the commonest benign tumour of the  larynx in children. This study is aimed at evaluating its management challenges.

Materials and methods: This was a retrospective review  of patients with JoRRP at Ear, Nose and Throat (ENT) Department, University of Ilorin Teaching Hospital over a 7-year period. The patients' biodata, mode of presentations, surgical care, histopathological findings and management outcome were reviewed.

Results: A  total number of ten patients were diagnosed with JoRRP during the study period. Male to female ratio was 1:1. All the children were  delivered per vaginal and sixty percent were first children of their mothers. Hoarseness, breathy voice and worsening difficulty in  breathing were the presentation in 7 (70%) of cases, while 3 (30%) presented with only hoarseness and breathy voice. They all presented  first to General Practitioners and Paediatricians before ENT Specialist assessment and six (60%) patients presented to ENT department 6  months or more after the onset of symptoms. They all had direct laryngoscopy and excisional biopsy of laryngeal papillomatous lesions.  Thirty percent had tracheostomy done. There is a statistical significant relationship between tracheostomy rate and recurrence rate of  JoRRP.

Conclusion: JoRRP is a rare but potentially life-threatening benign tumor of the respiratory tract. Most of our patients presented  late and were misdiagnosed at presentation. The key to good management outcome remains early diagnosis, adequate management  and regular follow-up.