Recurrent respiratory papillomatosis treated with laser surgery and intra-lesion bevacizumab (Avastin®) injection. Characteristics of mucosal glottic wave analyzed with HSDP, kymography, regional FFT & red-color pattern

Chapter 19

  • Krzysztof Izdebski
  • Raul M. Cruz
Keywords: papilloma, bevacizumab, Avastin®, laser surgery, HSDP, LVS, professional voice user, kymography, P-FFT, RCA


Recurrent respiratory papillomatosis (RRP) is a devastating disorder, especially in a professional voice user. The mainstay of treatment is based on immaculate serial removal of regrowing papillomas, usually with a laser. Repetitive laser excisions can cause significant scarring and webbing. The risks of post-operative sequela are exponentially increased with anterior location of papilloma clusters. The resultant dysphonia is not amenable to physiological voice therapy protocols. Additional or adjunctive treatments are eagerly sought by patients to avoid complications. Many of these treatments remain unproven. Recently, bevacizumab (Avastin®) has been advocated as potentially useful. Consequently, we report a case treated with potassium titanyl phosphate (KTP) lasering of papillomas with adjunctive intra-lesional bevacizumab injections. Current outcome of the case is analyzed with both traditional laryngovideostroboscopy (LVS) and High Speed Digital Phonoscopy (HSDP).