Double-barreled (diversionary) tracheostomy in the management of juvenile laryngeal papillomatosis.

A two-year-old female presented to the author with a 11/2 year history of multiple recurrences of juvenile laryngeal papillomatosis which when first seen had progressed to and below the tracheotomy site. The entire supraglottic larynx, glottis, and subglottic area were completely filled with exuberant papillomata. There was active growth of papilloma at and below the tracheotomy site and the tube had to be inserted through papilloma in order to reach a clear area in the trachea. In hopes of preventing further spread of papilloma below the area already involved and in order to control the airway and provide access to the subglottic area for laser removal, a double-barreled tracheostomy was performed. Laser treatment and/or spontaneous resolution ultimately resulted in complete clearing of all papillomata from the upper and lower tracheal segments. Four years and nine months after the initial procedure it was felt safe to attempt reconstruction. Her postoperative course was uneventful and she was successfully extubated three months later. Both vocal cords are normally mobile and her voice is quite clear although slightly hoarse as a result probably of slight changes in the edges of the cords because of the repeated surgical interventions. There has been no recurrence of papilloma now, over one year since reconstruction of the trachea. This somewhat radical approach to a life-threatening growth of endotracheal papilloma was successful in preventing further spread below the level of tracheostomy and ultimately permitted total reconstruction of an intact tracheal bronchial tree in the case reported.