Return to index

Recurrent Papilloma
case presentation


    69 year old lady with 8 year history of sudden onset recurrent respiratory papillomatosis in the larynx and a total 13 laser excisions. Between surgical management of papillomas, her voice returns to reasonably functional level for approximately 8 months before recurrence of the problem. After her last surgery, approximately 7 months ago, she was very pleased with the outcome. Two months ago she reports having had flu, and she then lost her voice suddenly. She reports being aphonic for several weeks, and having a cough. She notes that recently her voice returned, but she is hoarse.

Initial examination

    The patient presented with a moderately dysphonic voice, characterized by moderate roughness, mild breathiness, mild aesthenia and a moderately strained quality. The general pitch of her voice is judged to be abnormally low, although her pitch range is within normal limits at 25 semitones. Maximum phonation time is a low 14 seconds. the audio sample below illustrates the quality of her voice.

    Preoperative reading of the "Three Bears passage". Note the strained, dry quality, and repeated breaths during a relatively short passage.

    Videoendoscopy reveals that the patient has recurrence of laryngeal papilloma, giving the vocal folds a rough edge, and interfering with phonation.

    Preoperative laryngoscope images. Left: maximally closed glottis. Right: open glottis on inhalation. Note the irregular edge to both vocal folds, with papilloma on both left and right folds, but with the left vocal fold being more affected (right in image). Click here to compare to postop results.

    Stroboscopy shows that the mucosal wave on both vocal folds is very restricted. Scarring from previous operations together with new papillomae can explain this.

    Preoperative Strobed Video recording. Note the limited vocal fold mucosal wave.


    The patient was placed under general anaesthesia with a 6.0 laser safe endotracheal tube. Under direct microlaryngoscopy, biopsies were taken using microlaryngeal instruments. Recurrent respiritory papillomatosis was found to diffusely involve both vocal folds. The subglottis and supraglottis were free of disease. Using a defocused carbon dioxide laser on 5 watts, continuous superpulse mode, th papillomata were ablated from both vocal folds , with only the left anterior commissure lased to prevent webbing scars. Result was photodocumented as seen below.

    Intraoperative images. Left: after biopsy removal of papillomas.

Postoperative Examination

    Two months after the operation, the patient returns for a followup examination. She reports an improved voice, and is judged to be mildly dysphonic with mild roughness, no breathiness, no asthenia, and no strained quality. This represents a very good result for this patient. Click here to compare the audio sample below with the preop sample.


    Postoperative audio recording. Compare to preop sample.

    Videostroboscopy reveals slightly rough irregular vocal fold edges, to be expected after so many surgeries. Mucosal action is much more pronounced, although far from being normal. The patient is satisfied with the result of the surgery, and her voice is adequate for her purposes, claiming that it does not impact negatively on her quality of life.

    Two month postoperative laryngoscope images. Left: Glottis open.

    It seems as though your Browser does not support embedding of video and audio objects. Click <a href="">here</a> to get a listing of the objects included in this page.

    It seems as though your Browser does not support embedding of video and audio objects. Click <a href="">here</a> to get a listing of the objects included in this page.

    Postoperative Strobed Video recording.

Return to index