Objective To assess the advantages of powered instrumentation vs the carbon dioxide
laser in treating patients with juvenile-onset recurrent respiratory papillomatosis.
Design A retrospective study.
Setting Tertiary care children's hospital.
Patients Patients operated on for juvenile-onset recurrent respiratory papillomatosis
between January 1, 1999, and December 31, 2000. Papillomas were excised using
the microdebrider in one group and the carbon dioxide laser in the second
group.
Interventions Direct laryngoscopy and bronchoscopy, suspension microlaryngoscopy,
and excision of papillomas by the carbon dioxide laser or the microdebrider.
Main Outcome Measures Operative time and postoperative complications.
Results Seventy-three operations were performed (23 with the laser and 50 with
the microdebrider). Sixteen patients were included, 10 with active disease
and 5 with disease in remission; 1 was lost to follow-up. They had a mean
age of 3.75 years, and the male-female ratio was 7:9. The patients presented
mostly with hoarseness (13 [81%]). Four (25%) had soft tissue complications
with the laser. The microdebrider was less time-consuming than the laser,
although those treated with the microdebrider had more active disease. No
factor could be used to measure treatment outcome due to disease variability.
Those who were older, female, and African American tended to have less severe
manifestations of disease.
Conclusions The microdebrider proved to be less time-consuming than the carbon dioxide
laser when used in patients with juvenile-onset recurrent respiratory papillomatosis.
Soft tissue complications were nonexistent. In addition to safety, the microdebrider
is more appealing to the surgeon, anesthesiologist, and parents, especially
because these children often need subsequent surgical procedures.
