OtoRhinoLaryngology Portal

The Leading Online Gallery of Otolaryngology and Head & Neck Surgery Specialty

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Recurrent Respiratory Papillomatosis (RRP)


 Anterior commissure papillomas which had cause hoarse voice in an adult male..


 Florid papillomas involving glottic and subglottic regions.


A close-up view of laryngeal papillomatosis.

Early tracheal seedling or papillomas (arrows).


Extensive papilloma lesions obstructing the laryngeal inlet (X) and involving laryngeal surface of epiglottis (+).  [E - epiglottis] 



Papillomas involving laryngeal surface of epiglottis (arrow),.  [E - epiglottis, ETT - endotracheal tube (flexometallic)] 


Papillomas with obstructive tracheal involvement. The left true vocal fold is spared. 

Papillomas involving tracheal wall which had caused progressive obstruction.


Watch video of recurrent laryngeal papillomatosis (RRP) @ YouTube



RRP: Tracheostomal Implantation

Papilloma lesion involving inferior quadrant of tracheostomy opening. 

Endotracheal Tube for CO2-Laser Microsurgery


     Laserflex endotracheal tube- safe          Poorly-wrapped and partly exposed

                                                                       normal endotracheal tube

 Laserflex endotracheal tube with double cuff near its distal end


Inadequately inserted ETT with the proximal cuff sitting just below the papillomas.  This can also be caused by excessive neck extension or manipulation

during laryngoscope insertion or suspension.


Ruptured proximal cuff of ETT with leakage of saline.  Distal cuff filled

with methylene blue is still intact; otherwise it will be flooded with blue fluid 

and obvious bubbling will be seen. 

If the latter happens, stop lasering immediately and re-insert new ETT!!!


A properly wrapped endotracheal tube with aluminium foil tape.

 A laser-shield II endotracheal tube by Medtronic.

Carbonization of Tissue during CO2-Laser Microsurgery

Carbonization or char (the black burnt area) is a potential media that can trigger micro-fire if struck by laser.  It needs to be suck-out or wipe away if cumulated significantly.  Good laser parameter settings minimize its formation.  Striking

on oozing blood gives similar effect.

Figure showed the appearance of papilloma lesion immediately after laser a strike by using a micromanipulator (without scanning).  When well-focused and correct wattage used, a clean vaporization with minimal char achieved.

Video Clip on The Use of Microdebrider for Laryngeal Papillomatosis Removal


CO2-Laser Microsurgery of Focal True Vocal Fold Squamous Papilloma 

Pre-laser surgery.



 During laser surgery with linear guide in view.  The papilloma being gently pulled medially.


Immediate post-laser surgery. 

Adult-Onset Laryngeal Papilloma with Dysplastic Change


 Recurrence of papillomatous lesion resulting in worsening hoarseness in a patient with previous histopathologically-confirmed papilloma with dysplastic change.  Repeat direct laryngoscopy was performed for biosy and ablation of the lesions.

[L - left, R - right]




The endoscopic laryngeal view after CO2 laser microsurgery.