Factors Associated with Iatrogenic Laryngeal Injury in Recurrent Respiratory Papillomatosis

Abstract

ObjectiveTo describe iatrogenic laryngeal injury and identify its risk factors in recurrent respiratory papillomatosis (RRP) patients receiving surgical care.Study DesignCase‐control.SettingTertiary care academic hospital in a metropolitan area.MethodsCharts of patients with RRP seen at our institution from January 2002 to December 2022 were reviewed. Patients were separated into 2 cohorts based upon whether they experienced any form of iatrogenic laryngeal injury—including anterior commissure synechiae, vocal cord scar, reduced vocal fold pliability, vocal fold motion impairment, and glottic and/or subglottic stenosis. Adjusted logistic regressions were performed to identify factors associated with iatrogenic laryngeal injury.ResultsOf 199 RRP patients, 133 (66.8%) had identifiable iatrogenic laryngeal injury. The most common injuries were anterior commissure synechiae (n = 67; 50.4%) and reduced vocal fold pliability (n = 54; 40.6%). On a multivariate logistic regression, patients with diabetes mellitus (adjusted odds ratio [aOR] [95% confidence interval [CI]]: 2.99 [1.02, 8.79]; P = .04) and who received at least 10 surgeries lifetime (aOR [95% CI]: 14.47 [1.70, 123.19]; P = .01) were at increased risk for iatrogenic laryngeal injury, whereas receiving less than 5 surgeries (aOR [95% CI]: 0.21 [0.09, 0.51]; P < .001) was found to be protective. When treating the lifetime number of surgeries as a continuous variable, a greater number of surgeries was a significant risk factor for iatrogenic laryngeal injury (aOR [95% CI]: 1.32 [1.14, 1.53]; P < .001).ConclusionThese results suggest the importance of strict glucose control for diabetic patients receiving RRP surgical care, and emphasize the clinical need to identify medical therapies to decrease RRP surgical frequency for patients.

Systemic Bevacizumab for Recurrent Respiratory Papillomatosis: A Single Institution's Experience

“…Presently, management of RRP primarily involves repeat surgical operations-including cold steel/microdebrider, radiofrequency coblation, and lasers-to decrease papilloma burden, [1][2][3]12 which exposes patients to cumulative medical costs, increased treatment burden, and greater risk for iatrogenic complications. 13 Indeed, scar formation in the upper airway is not an uncommon complication following laryngology procedures, potentially leading to significant dyspnea and dysphonia that, in turn, may require additional operative management. [14][15][16] Until a cure for RRP is discovered, the development of medical therapies to limit papilloma recurrence and thereby reduce the frequency of surgical interventions will continue to be of utmost clinical importance.…”