Recurrent respiratory papillomatosis (RRP) is the most prevalent benign tumor of the larynx in infants and children. The most common site is the larynx, with the vocal cord, ventricular cord, and epiglottis being the most common, but it can also occur in other parts of the respiratory tract, such as the nose, pharynx, trachea, and bronchi, which share common histologic features, namely the site of squamous epithelial and ciliated columnar epithelial migration. Human papillomavirus (HPV) types 6 and 11 are currently considered to be the main predisposing factors for this disease. Respiratory papilloma suffers from repeated surgeries due to its high recurrence and the specificity of the site of invasion. Currently, surgery remains the mainstay of treatment, with the main goals being to ensure airway patency, reduce the volume of tumors, reduce the spread of disease, improve the child’s voice quality, and prolong the interval between surgeries. The following are some of the new developments in the treatment of recurrent respiratory papilloma in recent years. 1. Emergency management of respiratory obstruction due to RRP For pediatric recurrent respiratory papilloma, intubation anesthesia is preferred in case of respiratory obstruction, and CO2 laser surgery is performed under supported laryngoscopy to relieve respiratory distress after complete removal of the tumor, and tracheotomy is not chosen as much as possible when conditions allow. At this time, the requirement for anesthesia intubation technique is higher. The type of anesthesia tube can be 2.5 or 3.0 while preserving the child’s voluntary breathing, and the action should be decisive and rapid, and intubation under direct vision of direct laryngoscope can also be chosen. Applying CO2 laser to remove tumor can avoid postoperative laryngeal edema and reduce tracheotomy rate. Combined application of laryngeal microdebrider and endotracheal endoscope for laryngeal and endotracheal papilloma According to a survey report on the treatment of recurrent respiratory papilloma in young children in the United States in 2004, 53% of children were treated with laryngeal microdebrider, more than those treated with CO2 laser. The principle of laryngeal microdebrider is a cutting drill that is connected to a suction device and fits into the larynx at a certain angle and length, so that the tumor tissue is cut and abraded by the fluidizer layer by layer and aspirated at the same time, so the surgical field is clear and less likely to damage normal tissue. The former was found to have less bleeding than the latter and reduced the formation of laryngeal scarring. The laryngeal microdissection drill allows for a clean field, clear resection, no pulling or tearing of surrounding tissues during the cutting and suctioning process, less side effects, and easier airway management. In China, due to economic reasons, children usually consult the doctor only after they have obvious respiratory distress, so the tracheotomy rate is significantly higher than that of foreign cases, because tracheotomy causes damage to the ciliated columnar epithelium in the trachea, forming medical squamous epithelium and ciliated columnar epithelial migration at the surgical incision; at the same time, the endotracheal tube is placed, and the continuous abrasion of the tracheal mucosa by the tube causes the area to turn into squamous epithelium and ciliated columnar epithelial migration. This increases the likelihood of viral infection. The spread of tumor in the trachea increases the difficulty and risk of surgery. In the past, tracheoscopy and microscope were used to remove endotracheal papilloma, but the field of view was unclear, the operation was difficult, bleeding was easy, the operation took longer, and the tumor was often not completely removed, and the child usually had respiratory distress within 1-2 months due to tumor recurrence. Applying laryngeal microdissection drill under the direct view of tracheal endoscope, the field of view is clear, and the tiny tumor on the mucosa of tracheal wall can be completely removed while attracting the tumor, avoiding the damage to the normal mucosa of tracheal wall and the formation of postoperative scar, less intraoperative bleeding, significantly shortening the operation time, and making the cycle of recurrence significantly longer due to the complete removal of tumor. 3. Discussion on the timing of extubation after tracheotomy There has been controversy on the issue of tracheotomy for respiratory papilloma. Some scholars believe that tracheotomy has positive significance to save the life of children and advocate early tracheotomy, however, tracheotomy is the main factor causing the tumor to spread into the trachea has been confirmed by many scholars’ studies. In addition, long-term tracheal tube has many negative effects on the child and his family, such as affecting the speech function of the child, the possibility of asphyxiation due to detachment, and the difficulty in caring for the child’s family, and the possibility of asphyxiation due to sputum crusts blocking the tube. Therefore, tracheotomy should be avoided as much as possible when conditions allow. For children who already have tracheotomy, in order to prevent the tumor from spreading in the trachea, the appropriate time should be chosen to remove the tracheal tube in time. By analyzing the clinical characteristics of 31 children with tracheotomy for juvenile recurrent respiratory papilloma, we obtained the following experience: (1) for those who have had tracheotomy for less than 3 months, a small or more clustered growth of papilloma in the larynx and no or only a small amount of tumor in the trachea around the tracheostomy opening or at the end of the tracheal cannula, the tracheal cannula can be removed at or after surgery; (2) for those who have had tracheotomy for more than 3 months (ii) for those who have had tracheotomy for more than 3 months, there are often more papillary tumors around the tracheostomy, the end of the tracheal tube and the surrounding tracheal wall, so we can observe them for a period of time after surgery and shorten the interval between the next surgery, and then remove the tracheal tube at the time of surgery or after surgery when the papillary tumors in the trachea are more limited; (iii) for children with diffuse tumor growth in the trachea, especially when the tumor is trailing, we apply the laryngeal microdissection drill to completely remove the For children with diffuse tumor growth in the trachea, especially when the tumor is trailing, we use microscopic laryngeal drill to completely remove the tumor and shorten the interval between each operation, and apply immune enhancer treatment systemically to slow down the growth of tumor, so that it tends to be limited, and then choose the time to remove the cannula. To avoid postoperative laryngeal edema leading to dyspnea.