Tracheal, bronchial, and pulmonary papillomatosis in children.

OBJECTIVES: To compare the clinical course of tracheal, bronchial, and pulmonary papillomatosis with clinical course of laryngeal papillomatosis in children.

STUDY DESIGN: The records of the 448 children with recurrent respiratory papillomatosis treated in St. Vladimir Moscow Children's Hospital between 1988 and 2003 were reviewed. In all cases, the diagnosis was confirmed histologically. Age at onset of symptoms, age at first surgery, number of surgical procedures, mean duration of surgical interval, possible causes, and age at a point of papillomatosis spread in the lower airways and course of the disease were analyzed.

SETTING: Academic children's hospital.

RESULTS: Papillomas extension down to lower airways was observed in 40 children (8.9%). Among 40 patients with lower airway recurrent respiratory papillomatosis, 8 (20%) demonstrated pulmonary involvement. The basic cause of papilloma extension to lower airways appeared to be tracheotomy performed in children with laryngeal papillomatosis (92.5% of cases). Incidence of satellite pharyngeal and esophageal papillomatosis is significantly higher in patients with lower airways papillomatosis, presenting evidence of lager process extension. The clinical course of lower airways papillomatosis is more aggressive as compared with laryngeal papillomatosis, and treatment efficacy in such children is lower.

CONCLUSIONS: All the patients with laryngeal papillomatosis having a history of tracheotomy require a regular endoscopic control and chest radiographs or computed tomography scanning because tracheal or pulmonary papillomatosis may occur in such patients even several years after decannulation. The prognosis for the disease after development of pulmonary papillomatosis is always serious.