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Guedes Damaso 1, Inês Cunha1, Inês Moreira1, José Colaço1, Carla Moreira1, Bernardo Araújo1, Herédio Sousa1, Ezequiel Barros1

1. Serviço de Otorrinolaringologia, Hospital Dona Estefânia, Centro Hospitalar de Lisboa Central, EPE, Lisboa;

- 13th Congress of European Society of Pediatric Otorhinolaryngology, 18-21 de Junho de 2016, Lisboa (poster)

Objective: Describe a rare case of juvenile papillomatosis of the nasopharyngeal surface of the soft palate and posterior pillars of the pharynx, surgically approached with combined transnasal and transoral microdebrider resection.
Methods: A 9 year-old boy was referred from a foreign country, complaining of persistent and disturbing snoring with frequent apnea episodes. At inspection large papillomatous obstructive lesions were observed in the oropharynx, inserting in the posterior side of the soft palate and posterior pharyngeal pillars. Nasal fiberendoscopy showed several lesions obstructing the rhino-oropharyngeal transition, suggesting papillomatosis. The surgical and adjuvant treatment was proposed.
Results: Surgical intervention was done using oropharyngeal approach with microdebrider papilloma resection, with remaining lesions in the upper part of the soft palate and posterior aspect of the posterior pharyngeal pillars. A combined approach using nasal endoscopic visualisation allowed the complete resection of the identified lesions. Cidofovir was applied by submucous injection in the affected areas. Histology revealed benign squamous papilloma lesions. The patient has already been operated 5 times, in the last 3 years, due to the characteristic regrowth of the lesions, but the recurrence rate is decreasing. Three months after last surgery, fiberendoscopy didn´t show any papilloma regrowth, but synechia between the right posterior pillar and the posterior oro-pharyngeal wall was identified. The patient report important sleep quality improvement without significant respiratory complaints after surgery.
Conclusions: Isolated pharyngeal squamous papilloma lesions are uncommon and to our knowledge this is the first pediatric case ever reported. Also it is the first description in literature of combined transoral or transnasal surgical approach in a pediatric patient with papilloma lesions.

Palavras-chave: nasopharyngeal papillomatosis