Clinical features

Squamous papillomas have been traditionally divided into juvenile and adult groups {586,1282,1519,2579} and additionally into multiple or solitary groups {1519,1524}. Although caused by the same viruses, they follow distinctly diverse and variable clinical courses. For children, extensive growth with rapid recurrences is characteristic. In some patients, RRP becomes indolent as the patient reaches adulthood. Disease progression is more frequent in the juvenile form, usually associated with subglottic papillomas and prior tracheotomy {2743}. Tracheobronchial extension of RRP is associated with morbidities such as pneumatocoeles, lung abscesses, tracheal stenosis and rarely malignant transformation {219}. The relatively small airway in children predisposes to airway obstruction. The clinical course in adults is usually not so dramatic, the development of respiratory distress and other complications are rare, although RRP can be aggressive with multiple recurrences {240,2074}.

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