The juvenile form is believed to be acquired during birth from maternal vaginal warts. The condition does not manifest, however, until months or years later when significant papillomata develop. In general, those who present early usually present with airway obstruction, while older children usually present with progressive hoarseness. Treatment is extremely difficult and frequent recurrence is a rule rather than exception. At laryngoscopy, there is usually extensive involvement of the whole larynx; simultaneous tracheal and pharyngeal involvement by the papillomata is not uncommon. Repeated CO2 laser therapy offers the best control of the disease. In severe cases, antiviral therapy including interferon therapy may be tried. Although the effectiveness of treatment is unpredictable, spontaneous regression of the papilloma may occur at any age.
The adult form typically presents with progressive hoarseness and laryngoscopy, and reveals either a solitary papilloma or multiple but discrete papillomata. These usually affect the true cord. Histologically, they are squamous papilloma and should be considered a premalignant lesion. The papilloma should be removed for histological evaluation and the base of the lesion treated with a CO2 laser. The patient should refrain from smoking and be closely followed up for recurrence.
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