This method should be avoided if at all possible, since the breathing tube may serve as a conduit for spread of the disease as far down as the tracheobronchial tree.A microdebrider is a tool that can suction tissue into a blade, which then cuts the tissue. Microdebriders are gradually replacing laser technology as the treatment of choice for laryngeal papillomatosis, due to their ability to selectively suction papillomas while relatively sparing unaffected tissue. In addition to the lower risk of complications, microdebrider surgery also is reportedly less expensive, less time-consuming, and more likely to give the person a better voice quality than the traditional laser surgery approaches. Nonsurgical adjuvant treatment
For about 20% of people, surgery is not sufficient to control their laryngeal papillomatosis, and additional nonsurgical and/or medical treatments are necessary. As of 2015, these treatments alone are not sufficient to cure laryngeal papillomatosis, and can only be considered supplemental to surgery. Some varieties of nonsurgical treatments include interferon, antiviral drugs (especially cidofovir, but also ribavirin and acyclovir), and photodynamic therapy. The monoclonal antibody against Vascular Endothelial Growth Factor (VEGF), Bevacizumab has shown promising result as an adjuvant therapy in the management of recurrent respiratory papillomatosis.Although vaccines are normally used to prevent infections from happening, HPV vaccines can be used therapeutically (after the infection has occurred). For most patients, the HPV vaccine significantly increases the length of time needed between surgeries. Prognosis
The evolution of laryngeal papillomatosis is highly unpredictable and is characterized by modulation of its severity and variable rate of progression across individuals.
Hot perforation melts a hole in the material, causing a reinforced ring around the hole. Hot needle perforation also assists when high density pin patterns are utilized, as the heat aids the perforation of the material. Die and punch
Die and punch sets can be used for thicker materials or materials that require large holes; this process is the most common for metalworking. The workpiece is sheared by pressing (either by machine or hand tool) the punch through the workpiece and into the die. The middle section of the workpiece is scrap; commonly known as the chad in paper and similar materials. The punch and die are shaped to produce the desired shaped hole. The clearance (the distance between the outside circumference of the punch and the inner circumference of the die) must be properly maintained to ensure a clean cut. Burrs are produced on the side of the workpiece that is against the die.Common applications are fruit and vegetable bags, hole punching and ticket punching. Laser perforation
Laser cutting can place many precise holes in a web. Laser perforations look similar in many respects to hot needle perforations. However, laser systems are expensive. The big advantage of laser perforation is the consistency of the hole size, compared to mechanical perforation. This is very important in modified atmosphere packaging for fresh produce. The laser perforation is often carried out on roll slitting machines (slitter rewinder) as the printed material is slit down to the finished roll size.