Juvenile papillomatoses is caused by -
Ans. is 'a' i.e., HPV o Juvenile laryngeal papilloma is associated with HPV.o HPV6 and HPV11 are most commonly associated with laryngeal disease.o HPV11 is associated with a more aggressive disease and makes the patient more prone to malignant change.Juvenile papilloma (Recurrent laryngeal papillomatosis)o Recurrent Respiratory' Laryngeal Papillomatosis is a disease of viral origin characterized by presence of multiple recurrent papillomas in the larynx. The disease is common in anterior part of glottis, especially anterior commissure.Etiology'o Associated with Human Papilloma Virus infection (HPV).o HPV6 and HPVII are most commonly associated with laryngeal disease.o HP VII is associated with a more aggressive disease and makes the patient more prone to malignant change.Epidemiologyo Most commonly occur in children < 5 years of age (2 -5 years).o Males are affected equally as females. (First bom vaginally delivered child of a teenage mother is most prone).Transmissiono The exact mode of transmission is not known.o There is a recognized association between maternal genital warts (condylomata acuminata) and recurrent laiyngeal papillomatosis both conditions being caused by HPV6 and HPV 11."Most children with Recurrent laryngeal papillomatosis are born to mothers with condylomata acuminatum during pregnancy and parturitiono Intrauterine transmission of HPV is implicated as the mode of transmission for the above reasons.Clinical Presentationo Hoarseness and abnormal cry are usual presenting features.o Dyspnea, stridor and eventually complete airway obstruction may occur on progression.Prognosiso Adult onset papillomatosis has a less severe course than Juvenile onset disease.o Disease in association with HP V6 has a less severe course than that in association with HPV 11."Remission of recurrent papillomatosis may take place at any time; the disease is more likely to undergo remission in the larynx (48%) than in the tracheobronchial treeo Malignant transformation is rare but may be seen (squamous cell CA).Treatmento Surgery is the primary modality of treatment.o Endoscopic surgical removal is the preferred treatment (CO, laser is the most commonly used modality ),o Recurrence is common and multiple procedures are often required.o Other treatments which are adjunctive to above treatment includesi) Systemic interferon (has not shown sustained benefit)ii) Photodynamic therapylift Intralesional injection of antiviral drug (cidofovir).Aduit onset papillomao Single, smaller in size, less aggressive and do not recur after surgery,o Most common age affected is 30-40 years and is more common in males,o It arises from anterior half of vocal cord or anterior commisure.o Treatment is same.
HPV
EBV
CMV
HSV
Benign Tumors