Microdebrider-assisted Microsurgery for Laryngeal Papillomatosis: A Case-Control Study in Comparison with Cold Instrument Surgery
- VernacularTitle:Төвөнхийн папилломатозын мэс заслын эмчилгээний харьцуулсан судалгаа
- Author:
Ariunaa E
1
;
Ganchimeg P
1
;
Nergui S
2
Author Information
1. Mongolian National University of Medical Sciences
2. First Central Hospital of Mongolia
- Publication Type:Journal Article
- Keywords:
Voice Disorders;
Voice Quality;
Vocal Cords;
Human Papillomavirus
- From:
Mongolian Journal of Health Sciences
2025;89(5):90-94
- CountryMongolia
- Language:Mongolian
-
Abstract:
Background:Laryngeal papillomatosis is a chronic recurrent benign tumor of the airway caused by infection with human
papillomavirus (HPV) types 6 and 11, developing in the epithelial lining of the laryngeal mucosa. According to R.
Y. Seedat et al., clinical manifestations of the disease include hoarseness (25.9%), dyspnea (51.9%), and stridor (70.1%).
Hyperplasia and keratinization of the mucosa lead to increased numbers of abnormal cells, which invade beyond the
basement membrane and induce atypical changes in normal cells, resulting in uncontrolled proliferation. This causes benign
tumor growth, and when mucosal integrity is disrupted, viral proteins may reactivate, leading to recurrence. Surgical
treatment is required for each recurrence, and impaired vocal fold vibration negatively affects voice quality. In the early
stages, the disease may be misdiagnosed as asthma or allergy, and in some cases, can present as acute respiratory distress,
posing a life-threatening risk. Patients with juvenile-onset recurrent respiratory papillomatosis (JORRP) require surgery
an average of 4.4 times annually and 19.7 times during their lifetime.
The goals of surgical treatment are to remove papillomatous lesions, reduce symptoms, secure the airway, preserve vocal
function, extend the interval between recurrences, and improve quality of life. However, surgery alone cannot completely
prevent recurrence. Currently, traditional cold instruments, microdebriders, and CO₂ lasers (10,600 nm) are widely used,
but no standardized guideline exists.
Aim:To compare the outcomes of traditional cold instrument surgery with microdebrider-assisted microsurgery in the
treatment of laryngeal papillomatosis.
Materials and Methods:A hospital-based case–control study was conducted at the Department of Otolaryngology, National
Center for Maternal and Child Health. A total of 76 patients diagnosed with laryngeal papillomatosis were included.
Clinical records of 52 patients treated with cold instruments between 2018 and 2022 were reviewed as the control group,
while 24 patients who underwent microdebrider-assisted microsurgery formed the case group. Disease severity was assessed
using the Derkay staging system, and voice outcomes were evaluated with the GRBAS scale and Voice Handicap
Index (VHI). Statistical analyses included group comparisons and correlation testing, with significance set at p<0.05.
Results:Of the 76 patients, 52 were in the control group and 24 in the case group. The control group included 36 males
(69.2%) and 16 females (30.8%) with a mean age of 42.2±15.7 years, while the case group included 15 males (62.5%)
and 9 females (37.5%) with a mean age of 44.6±15.9 years. No significant differences in age or Derkay scores were found
between groups (p>0.05). The case group had significantly shorter operative times (24.6±17.6 vs. 30.3±7.8 min, p=0.014)
and hospital stays (2.8±2.6 vs. 3.3±0.9 days, p<0.001). However, the recurrence interval was longer in the control group
(5.7±6.3 vs. 1.5±3.6 months, p=0.001), while the total number of surgeries per patient was higher in the case group
(22.8±36.9 vs. 8.7±11.8). Voice outcomes improved more significantly in the case group, with lower GRBAS (5.3±2.3
vs. 8.4±2.9, p<0.01) and VHI scores (36.8±11.7 vs. 66.4±12.4, p<0.001). Positive correlations were observed between
Derkay scores and total number of surgeries (ρ=0.35), as well as between GRBAS and VHI scores (ρ=0.37).
Conclusion:Microdebrider-assisted surgery for laryngeal papillomatosis significantly reduced operative time and hospital
stay while improving postoperative voice outcomes compared with cold instrument surgery. However, the shorter
recurrence interval and higher surgery frequency in some cases indicate the need for long-term monitoring and further
evaluation of this method.
- Full text:2025121010370414299Төвөнхийн папилломатозын мэс заслын эмчилгээний харьцуулсан судалгаа.pdf
