Background: Recurrent respiratory papillomatosis (RRP) is a common benign neoplasm affecting the larynx and upper respiratory tract. The patient has the potential to develop a fatal consequence and the disease itself is often difficult to treat because of its tendency to recur, spreading throughout the respiratory tract, and turn to malignancy.

Objective: To determine: (a) the incidence of extra-laryngeal involvement of respiratory papillomatosis, (b) treatment modalities and outcomes, (c) malignant change and (d) factors associated with the presence of extra-laryngeal involvement.

Material and Method: Medical records of extra-laryngeal papilloma patients between January 1998 and December 2007 at a tertiary hospital in Northeastern Thailand were retrospective reviewed. Demographic data, clinical findings, presenting symptoms, therapy, and outcomes were analyzed.

Results: Of the 53 patients diagnosed with RRP, eight had extra-laryngeal involvement (15.1%); four, three, and one of the trachea, trachea and lungs, and tracheostomy stoma, respectively. A common presenting symptom was hoarseness. Diffuse and lesions of the larynx were the most common characteristic in both extra-laryngeal (100%) and only-laryngeal (91%) groups. The respective extra-laryngeal spread develops within one year, 21 years, and 30 years in six cases (75%), one (12.5%), and one (12.5%), respectively. The respective improvement rate and curative rates of treatment were 25% and 37.5% for extra-laryngeal and 40.5% and 26.2% for only-laryngeal RRP. One patient died due to massive extra-laryngeal involvement of the lung and malignant change. Laser was used as treatment option in all cases. Increased use of KTP laser as additional treatment modality for extra-laryngeal RRP was observed. Tracheostomy had a significant association with the presence of extra-laryngeal involvement [(p-value = 0.038, odds ratio 8.40 (1.32 to 53.40)].

Conclusion: RRP has a significant rate of extra-laryngeal spread with increased need of more optional treatment modalities. Tracheostomy is an important factor associated with the presence of extra-laryngeal spread. Malignant change should be taken into consideration as it can result in fatality.

Keywords: Recurrent, Respiratory, Laryngeal, Papillomatosis, Spread