Objectives: We review and report the use of high-dose bevacizumab for the treatment of recurrent respiratory papillomatosis (RRP) in pediatric patients. Methods: We included all patients with pediatric-onset RRP who underwent bevacizumab (25 mg/mL) injections by a single practitioner. A series of 5 consecutive subepithelial injections were administered at 4- to 6-week intervals with concomitant 532 nm KTP laser ablation. The lesions were staged according to the Derkay staging system. The outcomes included pretreatment and posttreatment Derkay scores, the time interval between procedures, and voice outcomes. The demographic data extracted included sex, age at diagnosis, and current age. Results: Nine patients were included in this study, with 1 patient lost to follow-up; their median age was 8 years (range, 3 to 21 years). The mean bevacizumab dose was 14.25 mg (range, 5 to 45 mg). There was a median Derkay score of 11.5 (range, 4 to 23) at the time of diagnosis and a median 58% improvement following therapy. All patients demonstrated an increased time interval between injections, for a median improvement of 2.05× (range, 1.6× to 3.25×). Conclusions: Evidence exists in support of vascular endothelial growth factor as an important factor in the development of RRP. Although some variability in response is demonstrated by this study, high-dose bevacizumab appears to yield promising results for pediatric patients with RRP.

Augmentation with grafting and resection techniques have historically been the 2 primary operative approaches for the management of tracheal stenosis. Although these techniques have withstood the test of time and have resulted in high rates of surgical success, they do not adequately address the entire spectrum of laryngotracheal disorders. We therefore propose adding another option to the surgical armamentarium for selected patients: the cervical slide tracheoplasty (CST). This procedure is an adaptation of the standard slide tracheoplasty, which is currently our preferred management approach for children with tracheal stenosis caused by complete tracheal rings, absent tracheal rings, sleeve trachea, and stenosis of the distal third of the trachea; to date, we have successfully used this established procedure in more than 100 patients.¹

Research from JAMA Otolaryngology–Head & Neck Surgery — Comparison of the Pediatric Voice Handicap Index With Perceptual Voice Analysis in Pediatric Patients With Vocal Fold Lesions