We present a case of obstructive sleep apnoea in a child that is caused by papillomatosis of the post-nasal space.

The incidence of p53 antigen and human papillomavirus (HPV) expression in archival formalin-fixed, paraffin-embedded tissue sections from verrucous carcinoma of the larynx was determined using immunohistochemistry.

The p53 oncoprotein was detected in four of 10 tissue samples (40 per cent). The same number of tumours had HPV antigen, and three cases had both p53 oncoprotein and HPV antigen. All positive cases were from heavy smokers and drinkers.

After surgical treatment, no tumour recurrence was present in our series. Four patients developed a second head and neck neoplasm and death occurred in three. Three of the patients with second tumour had p53 positive immunoreactivity and two had p13 and HPV expression.

Verrucous carcinoma of the larynx presented with overexpression of p53 antigen in a similar percentage to other head and neck cancers. The p53 immunohistochemical determination is well correlated with HPV detection and could have prognostic value in these tumours, but no statistical evidence was present.

Concern has been expressed regarding the seeding of viral DNA, in laryngeal papillomatosis, to other sites in the respiratory tract during treatment. Controversy exists regarding the concept of seeding by the laser plume. However, instrumentation and anaesthetic intubation are also strongly implicated in seeding DNA to the proximal respiratory tract. No cases of recurrent laryngeal papillomatosis and subsequent papilloma in the paranasal sinuses have been reported.