TREATMENT & PREVENTION
The goal of treatment is to clear the airway of papillomas and to prevent or reduce the occurrence of new papillomas. Surgical interventions include a debulking procedure to reduce papillomas and utilization of a potassium titanyl phosphate (KTP) laser, carbon dioxide (C02) laser, microdebrider, pulsed dye laser (PDL), or some combination of the above.
Your child's physician may also prescribe an antiviral medication, especially for children who require more than four surgical treatments a year.
There are two vaccines currently approved and available in the United States ("U.S.") to prevent Human Papilloma Virus ("HPV"), which is the underlying cause of JRRP. Gardasil is a quadrivalent vaccine providing protection against HPV Types 6, 11, 16 and 18. Types 6 and 11 are most associated with genital warts and 16 and 18 with cervical cancer. Cervarix is a bivalent vaccine containing only Types 16 and 18. Gardasil does contain Types 6 and 11, which are associated with JRRP. Gardasil is approved for people 9-26 years of age. The recommendation is for both boys and girls to get vaccinated with the three required doses at age 11 or 12. If mothers are vaccinated as young adults, hopefully we can prevent HPV and HPV-induced JRRP for future generations.
Pediatric tracheostomy and Airway Reconstruction Surgery
A tracheostomy is a surgically created opening through the neck and into the windpipe that provides a passage for air when the typical route is blocked. It may be used temporarily or for long-term management of airway obstruction. Tracheostomy are used to treat airway obstruction that can be caused by a variety of conditions, including:
Tumors (abnormal growths) in the larynx or trachea
Subglottic Stenosis (narrowing of airway below the vocal folds and above the trachea)
Tracheomalacia (softening of tissue of the trachea)
Laryngomalacia (softening of tissue of the larynx)
Vocal cord paralysis (inability of vocal fold movement)
Hemangioma (a vascular malformation in the larynx or trachea)
Choanal atresia (narrowing or blockage of nasal passage(s))
Complete tracheal ring (a defect in the cartilage rings that causes narrowing of the tracheal passage)
Pediatric Airway Reconstruction
Airway reconstruction is a surgical procedure designed to reconstruct the trachea and larynx of children who have narrowing of the airway. The narrowing occurs for a variety of reasons, such as prolonged intubation or trauma. Reconstruction of the airway often results in the ability to remove the tracheostomy tube and to breathe without it.
Pediatric airway reconstruction may also be useful for children born with narrow airways that don’t have a tracheostomy but suffer from recurrent croup episodes or exercise intolerance.
When the narrowing is just below the vocal cords, we call this narrowing Subglottic Stenosis. When the airway narrowing is lower down in the trachea (airpipe), we call this Tracheal Stenosis.
There are two different surgical approaches that may be used to treat Subglottic Stenosis:
Laryngotracheal Reconstruction: Aims to make the airway bigger.
Cricotracheal Resection: Designed to remove the scarred airway and bring the sections just above and below the scarred area together.
Surgery for Tracheal Stenosis is divided into Primary Resection and Reanastomosis (tracheal resection and re-anastomosis) or a procedure for longer sections of narrowing called a Slide Tracheoplasty.
Synagis is a vaccination to help prevent Respiratory Syncytial Virus ("RSV") in children with tracheostomies. RSV is a viral infection that is common among children who were born prematurely during the winter season (when children get sick most often). This vaccine is offered through your pediatrician’s office. Please contact them for details.