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Tagline Voice Center : Massachusetts General Hospital
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Department of Surgery

 

RRP: RECURRENT RESPIRATORY PAPILLOMATOSIS OF THE LARYNX

General Information

The MGH Center for Laryngeal Surgery and Voice Rehabilitation is recognized nationally and internationally for their highly-successful pioneering surgical techniques to preserve voice and breathing function in those patients who develop RRP of the voice box.  We introduced the highly-effective green-light 532nm Pulsed-KTP angiolytic laser treatment, office-based angiolytic laser treatment, and most recently, the use of the anti-angiogenesis drug Avastin.  We have published our RRP work extensively in the peer-reviewed literature and textbooks and have taught these techniques in medical centers throughout the USA and abroad.  [1-24]  For this reason, doctors from the USA and overseas seek care at the MGH Voice Center. 

Patients with recurrent papillomatosis can be tremendously challenging.  When aggressive recurrent disease is encountered, the surgeon and patient must delicately balance airway safety, the effects of multiple general anesthetics, as well as quality of life and employment disturbance resulting from vocal dysfunction and procedural disability. Parsing these issues often requires extensive communication to ensure that the patient’s and surgeon’s goals are mutually aligned.


Treatement

Planning regular treatment intervals can be difficult given when managing RRP since irregular and unpredictable clinical behavior between patients and even within the same patient.  We introduced the green-light 532nm Pulsed-KTP laser as a reliable means of treating papilloma while minimizing vocal scarring, which greatly facilitates management.  Selective disruption of the micro-vessels in the papilloma lesions through photoangiolysis has been shown to be a highly effective means of treating the disease while preserving vocal function..  

Click on the video cases below to see examples of the procedures that are done routinely and the results of those treatments.

We do not use the CO2 laser or microdebriders due to the fact that these devices are more likely to cause injury to the delicate vocal membranes.  Over the past several years, our treatment paradigm for papilloma has shifted from the operating room under general anesthesia (exclusively) to a majority of the procedures being done as an office-based laryngeal surgery under local anesthesia.  This critical advancement that we created has yet to be provided to most patients in the USA and overseas.

Most recently, we pioneered the use of Avastin (Bevacizumab) to prevent recurrence of laryngeal papillomatosis.  Initial observations thus far suggest that a majority of patients can be injected with Avastin in the office with limited subsequent need for laser treatment.    We are in the process of more formally studying the Avastin as a treatment for RRP.  However, initial operative management of these patients with the pulsed-KTP laser under general anesthesia remains an integral part of our papilloma treatment paradigm to control the initial volume of disease.  The precision afforded by direct larynoscopy with high-powered magnification from a surgical microscope and the ability to treat the undersurface of glottic structures has proven to be valuable.