October 20, 2010

Oral Human Papillomavirus (HPV) Removal

The following note is placed in the patient’s chart when a wart is found in their mouth.  They are then counseled on the risks and benefits of getting it removed.

Genital human papillomavirus (also called HPV) is the most common sexually transmitted infection (STI). There are more than 40 HPV types that can infect the genital areas of males and females. These HPV types can also infect the mouth and throat. Most people who become infected with HPV do not even know they have it.
HPV is not the same as herpes or HIV (the virus that causes AIDS). These are all viruses that can be passed on during sex, but they cause different symptoms and health problems.
Most people with HPV do not develop symptoms or health problems from it. In 90% of cases, the body’s immune system clears HPV naturally within two years.
But sometimes, certain types of HPV can cause genital warts in males and females. Rarely, these types can also cause warts in the throat — a condition called recurrent respiratory papillomatosis or RRP. Other HPV types can cause cervical cancer. These types can also cause other, less common but serious cancers, including cancers of the vulva, vagina, penis, anus, and head and neck (tongue, tonsils and throat). The types of HPV that can cause genital warts are not the same as the types that can cause cancer. There is no way to know which people who get HPV will go on to develop cancer or other health problems. Visible genital warts can be removed by the patient him or herself with medications. They can also be treated by a health care provider.  Some people choose not to treat warts, but to see if they disappear on their own.  No one treatment is better than another.  2,300 women and 9,000 men get head and neck cancers per year in the USA. [Note: although HPV is associated with some of head and neck cancers, most of these cancers are related to smoking and heavy drinking.]
The patient was made aware that they have a wart inside their mouth and therefor could be elsewhere.  NV: the patient will decide to either have the wort removed with a Nd:YAG or not.

43 y/o/w/m



Removed HPV of the facial surface of #3 on attached tissue, before/after photos, with Nd:YAG (100?s, 80Hz, 4.0W, 300? fiber), Topical anesthetic 20% lido/4% Tetra/2% phenylephrine with Articaine 4% 100,000 epi just a drop of infiltration,  Pt informed not to eat food, bite or chew on lips or tongue while anesthetic is still working.   Next Visit: Re-eval, Recall

47 y/o/w/m.  This is a wart on the tip of the uvula.

The little bleeding happened when I let go of the uvula with the hemostat.

Removed HPV on the end of the uvula, before/after photos, with Nd:YAG (180us pulses, 80 Hz, 4.0W, 300 u fiber), Topical anesthetic 20% lido/4% Tetra/2% phenylephrine,  Tolerated well without discomfort, Next Visit: Re-eval