All patients with hoarseness and stridor must undergo laryngoscopy and fibrofolaryngotracheoscopy.
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Diagnosis of papillomatosis of the larynx
Laryngoscopic picture can be very varied.
In more rare cases, isolated small formations in size from millet grain to pea, located on one of the vocal folds or in the anterior commissure, are reddish in color. In other cases, papillomas have the appearance of cockscombs located on the upper and lower surfaces of the vocal folds; such forms are more common in adults. In young children, in which laryngeal papillomatosis occurs most often, diffuse forms of this formation are observed, in which papillomas have the appearance of conical formations that dot not only the walls of the respiratory slit, but also the adjacent surfaces of the larynx, even beyond the limits of the trachea and pharynx. These forms of papillomatosis are well vascularized and are characterized by rapid development and recurrence. With significant sizes, parts of papillomas can come off and cough off with sputum, slightly tinged with blood during coughing shocks.
The evolution of the disease is characterized by the progression of the proliferative process with penetration into all free cavities of the larynx and, in untreated cases, ends with attacks of acute suffocation requiring emergency tracheotomy.
Diagnosis in children does not cause difficulties, the diagnosis is made using direct laryngoscopy according to the characteristic external signs of the tumor. For differential diagnosis produce a mandatory biopsy. In children, papillomatosis of the larynx is differentiated from diphtheria, false croup, foreign body, congenital malignant tumors. In laryngeal papillomas in persons of mature age, oncological vigilance should be observed, since such papillomas, especially the so-called hard whitish-gray papillomas, have a tendency to malignancy.
When collecting the history should pay attention to the frequency of recurrence of the disease.
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General clinical studies are carried out in accordance with the plan of preparing the patient for surgical intervention, assessing the immune status.
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All patients should undergo endofibrolaryngotracheobronchoscopy in order to identify trachea and / or bronchial papillomatosis, as well as x-ray and tomographic examination of the lungs.
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With microlaryngoscopy, the picture of papillomatosis is very characteristic - the formation has the appearance of limited, often multiple papillary growths with a fine-grained surface and resembles a mulberry berry in appearance. Its color depends on the presence of blood vessels, layer thickness and keratinization of the epithelium, so the papilloma can change color at different periods of its development from red, pale pink to white. Differential diagnosis is carried out with tuberculosis and laryngeal cancer. Signs of malignancy - ulceration of papillomas, changes in vascular pattern, a sharp restriction of the mobility of the vocal fold in the absence of cicatricial process, immersion growth, keratosis. Difficulties of differential diagnosis are papillomas in elderly patients and patients with a large number of surgical interventions in history. The final diagnosis is established by histological examination.
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Indications for consulting other specialists
An immunologist consultation is indicated.
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