Recurrent respiratory papillomatosis (RRP) is a relatively rare disease caused by members of the human papilloma virus (HPV) family.<sup>32 Gissman L., Wolnik L., Ikenberg H. , e al. Human papillomavirus types 6 and 11 DNA sequences in genital and laryngeal papillomas and in some cervical cancers Proc Natl Acad Sci 1983 ;  80 : 560

Cliccare qui per andare alla sezione Riferimenti, 67 Mounts P., Shah K.V., Kashima H.K. Viral etiology of juvenile and adult onset squamous papilloma of the larynx Proc Natl Acad Sci USA 1982 ;  79 : 5425  [cross-ref]

Cliccare qui per andare alla sezione Riferimenti, 76 Quick C.A., Watts S.L., Krzyzek R.A. , e al. Relationship between condylomata and laryngeal papillomata Ann Otol 1980 ;  89 : 467

Cliccare qui per andare alla sezione Riferimenti</sup> Characterized by the growth of wart-like excrescences in the aerodigestive tract, RRP shows a tremendous predilection for the larynx and is the most common neoplasm to affect this organ in the pediatric population.<sup>20 Cohen S.R., Seltzer S., Gellor K.A. , e al. Papilloma of the larynx and tracheobronchial tree in children Ann Otol 1980 ;  89 : 497

Cliccare qui per andare alla sezione Riferimenti</sup> Hoarseness is the heralding symptom of RRP, although some children do not present until they are completely aphonic or develop life-threatening airway obstruction. Despite a benign histologic appearance, the clinical course of RRP is typified by relentless recurrences even after seemingly complete surgical excision.

The impact of RRP on patients, their families, and the health care system is immense. RRP affects an estimated 6000 children in the United States, and its management produces an annual cost of nearly $110 million.<sup>24 Derkay C. Task force on recurrent respiratory papillomas Arch Otolaryngol Head Neck Surg 1995 ;  121 : 1386

Cliccare qui per andare alla sezione Riferimenti</sup> Despite extensive investigational studies, no cure is available. Surgical excision is the mainstay of therapy but is generally only a temporizing measure. Laser vaporization of papillomata is performed every few months to preserve phonation and prevent asphyxiation, although disease exacerbations may necessitate more common procedures. Ultimately, most children enter spontaneous remission, but the age and severity of disease prior to this reprieve are variable and unpredictable. Disheartening recurrences may emerge even years after disease remission.

This article presents the unique characteristics of RRP, including its cause, mode of transmission, pathogenesis, clinical features, histologic appearance, treatment strategies, and outcome.