The disease almost invariably involves the larynx, especially true and false vocal cords, subglottic areas and ventricles {10,126}. Papillomas may spread to other laryngeal sites; the most frequent sites of extralaryngeal spread are the oral cavity, followed by trachea and bronchi. Extralaryngeal extension of RRP has been identified in 30% of children and in 16% of adult patients {240}. Endobronchial and pulmonary dissemination occurs in 5% of patients with RPP {585}. Rare cases of isolated tracheal lesions without laryngeal involvement have been reported {2662}. The distribution of RRP follows a predictable pattern,

Fig. 3.43 Laryngeal papillomatosis. A Recurrent respiratory papillomatosis fills the endolaryngeal space. B Multilobulated grape like clusters of papillomas are located on the right side and anterior commissure of the larynx. (Endoscopic view)

occurring mainly at anatomic sites in which ciliated and squamous epithelia are juxtaposed. An injury of ciliated mucosa after surgical procedures may result in squamous metaplasia creating an iatrogenic squamous-ciliary junction, thereby inducing a new background for additional tumours {1280}.

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