What Are Laryngeal Papillomas?
Cancer Data Verified

Laryngeal Papillomas - Clinical Features, Diagnosis, and Treatment

Published on Aug 25, 2022 and last reviewed on Aug 09, 2023   -  4 min read


Laryngeal papilloma is a benign neoplasm of the larynx (voice box) in children. It is called juvenile laryngeal papillomatosis in infants below five years.

What Are Laryngeal Papillomas?

Neoplasms or cancers of the larynx, that is, the voice box in children, are complex, challenging, and have high recurrence rates. Amongst these neoplasms, the benign (non-malignant) tumors of the larynx called laryngeal papillomas are quite common. The peak incidence of laryngeal papilloma occurs in infants or children between two and five years. There is no sex predilection as both genders may be equally affected. However, the infant often presents with a hoarse tone cry that may be the first clinical symptom of laryngeal papilloma. Because they occur in children commonly and are not malignant, these authentic and benign neoplasms are also called juvenile laryngeal papillomatosis in medical terminology. Recurrent respiratory papillomatosis (RRP) is when these neoplasms recur in a lifetime and is characterized primarily by over-proliferation of benign squamous papillomas, especially within the aerodigestive tract. Recurrent respiratory papillomatosis is one of the most common yet benign mesenchymal origin neoplasms of the larynx in children. This condition may either have a childhood-onset type or would be again an adult-onset type.

What Are the Clinical Features of Laryngeal Papillomas?

The clinical features of laryngeal papillomas include:

  • Breathing difficulty would be the most common clinical feature in the child. Severe and advanced cases will have the child gasping for breath due to the mechanical blockage or obstruction at the larynx region.

  • Laryngeal papilloma in infants and children appears as pale white and translucent masses that are friable in consistency and involve either the true cords, the false cords, or the anterior commissure (a joint or junction between two anatomical parts) in the larynx region or even the epiglottis.

  • These papillomas can also extend into the subglottic region.

How Does Tracheostomy Impact Papillomas?

History needs to be elicited by the pediatrician or the health care professional about the previous record of the child regarding any tracheostomy procedure performed. Children with neuromuscular disorders and respiratory diseases who have difficulty breathing may require a surgical procedure known as tracheostomy to facilitate breathing. Tracheostomy opens up the airway into the trachea or windpipe. In tracheostomized children, these papillomas may occur within the bronchi or in the tracheal stroma or implant at the tracheostomy site. Research also suggests that genital warts in the mother during pregnancy may also be transmitted to the infant at the time of birth, causing laryngeal masses or papillomas.

What Are the Diagnostic Challenges and Differential Diagnosis in Laryngeal Papillomas?

Juvenile laryngeal papillomas also need to be differentiated from vocal nodules, polyps (small clumps of tissue growth), and laryngeal granulomas, which occur more often due to trauma or inflammatory causes in the child and are non-neoplastic. In contrast, laryngeal papillomas remain a benign form of cancer.

Laryngeal papillomas are also diagnostically challenging, considering the need to use mechanical devices such as laryngoscopes. The procedure can be performed better in older children as they tend to cooperate and withstand the procedure reasonably; however, it tends to be difficult in infants as they may not permit examination. Hence differential diagnosis plays a significant role in determining the accurate diagnosis based upon the child's age. These papillomas peak only in age groups between two to five years. Also, they should be differentiated from common viral infections, allergies, asthma, vocal nodules, or chest infections that are more common in the developing infant or child and are environmentally induced. In infants, certain conditions like laryngeal paralysis, laryngeal webs, subglottic haemangiomas, and laryngomalacia cause hoarseness of voice and stridor. Hence differential diagnosis is all-important for confirming the diagnosis as a laryngeal papilloma.

How Is Laryngeal Papillomas Managed?

The aim of treatment strategies for treating this condition is not just to establish the airway, to eliminate the hoarseness of voice and stridor, but also to preserve the voice of the infant or child and to prevent recurrent lesions of this tumor. Also, the surgeon should aim to cause minimal trauma during the surgery while operating on the laryngeal tissues. The laryngeal papillomas can be managed using the following surgical methods:

  • Microlaryngoscopy (MLS) - This technique coupled with CO2 (carbon dioxide) laser vaporization is the fundamental surgical treatment for removing and preventing the recurrence of laryngeal papillomas. The advantage of the laser during the technique enables the operator or surgeon to avoid injury to the laryngeal tissues like the ligament and muscle areas and also helps prevent local scarring of the region. Laser vaporization with KTP (photoselective potassium titanyl phosphate), argon, or flash dye lasers is commonly used by surgeons to avoid postoperative edema and to maintain good surgical hemostasis or bleeding control. When the operator does not use laser vaporization, MLS can be performed by laryngeal cup forceps to remove the tumor's bulk.

  • Microdebrider - These are used to shave the papilloma off using laryngeal blades.

  • Coblators - They are used to remove papillomas, provide hemostasis, and work at temperatures between 40 to 70 degrees Celsius.

  • Adjuvant Treatment Options - Surgical removal may not alone suffice to completely establish the airway, protect the voice, and prevent lesion recurrence. Hence other modalities like alpha interferon therapy are used alongside recombinant deoxyribonucleic acid (DNA) technology, intralesional systemic injections of Acyclovir and Ribavirin, or immunomodulatory antireflux therapy in the cases of respiratory papillomatosis are essential adjuvants for complete elimination and recurrence prevention of the benign tumor.


To conclude, laryngeal papillomas are benign yet challenging neoplasm to treat due to their high recurrence rates and spread to the adjacent respiratory tract as recurrent respiratory papillomas. However, specific surgical procedures and medications can help prevent the recurrence of laryngeal papillomas. In addition, early diagnosis and prompt treatment can help reduce this condition's risks.

Last reviewed at:
09 Aug 2023  -  4 min read




Comprehensive Medical Second Opinion.Submit your Case

Related Questions & Answers

The Anatomy of Tongue And Perception of Taste

Article Overview: The human tongue has essential functions ranging from bolus ingestion to chewing and swallowing. Read the article to learn about the tongue and its taste perception. Read Article

Sowmiya D
Sowmiya D

What Is the Function of Tongue? Apart from chewing and deglutition, the tongue as a sensory organ is responsible for possessing the peripheral apparatus of taste buds and papillae for perceiving taste, facial expressions, and speech. In addition, the tongue makes the food bolus, and its movements al...  Read Article

HPV and Oropharyngeal Cancer

Article Overview: This article focuses on the nature of human papillomavirus (HPV) and its role in developing oropharyngeal cancer. Read Article

Mohammed Osama Aboborda
Mohammed Osama Aboborda
Otolaryngology (E.N.T)

Introduction: Papillomaviruses is a group of more than 200 viruses, some of which can be transmitted by sexual contact. HPV was proved to be involved in the pathogenesis of throat cancer in men and women; also, they are responsible for cervical cancer in women. Some members of the HPV family can cau...  Read Article

I have sore throat with bumps. Please help.

Query: Hello doctor, I have had a sore throat for about two weeks now and the wall of my throat has some sort of bumps on it. My tongue as well has bumps on them but they are not painful.  Read Full »

Popular Articles Most Popular Articles

Do you have a question on Laryngeal Papilloma or ?

Ask a Doctor Online

* guaranteed answer within 4 hours.

Disclaimer: No content published on this website is intended to be a substitute for professional medical diagnosis, advice or treatment by a trained physician. Seek advice from your physician or other qualified healthcare providers with questions you may have regarding your symptoms and medical condition for a complete medical diagnosis. Do not delay or disregard seeking professional medical advice because of something you have read on this website. Read our Editorial Process to know how we create content for health articles and queries.