[Teratomas of the nasopharynx. A report of three cases]. / Teratomas de nasofaringe. A propósito de tres casos.

Teratomas are the most common congenital tumors, but neoplasms of the nasopharynx are rare in neonates. The exact origin of teratomas is unknown and debated. Several theories of embryogenesis are possible. These neoplasms include elements from all three germinal layers (endoderm, mesoderm, and ectoderm). Four histological types of nasopharyngeal teratoma occur. We report three cases of dermoid teratoma. All the patients were siblings and two were twins. A review of several large series of pediatric teratomas confirmed the rarity of this site. The classification, clinical features, differential diagnosis and treatment are reviewed.

Preexpansion galeal scoring.

Preexpansion scoring releases the inflexible galea, permitting more rapid expansion of the scalp. In addition, when comparing this procedure with conventional scalp expansion, patients reported less pain when the galea was incised prior to insertion of the tissue expanders.

Clinical experience with the tunable pulsed-dye laser (585 nm) in the treatment of capillary vascular malformations.

A retrospective review of 134 patients who received laser therapy with the pulsed-dye laser at the 585-nm wavelength for capillary vascular malformations was conducted. These patients were treated over a 5-year period with a minimum follow-up of 2 years. Ninety-five patients were available for evaluation of results. Thirty-nine were lost to follow-up. Each birthmark was described before and after treatment under a classification system developed by the authors. Results were reported by classification, age, anatomic location, and race. Excellent or good results were obtained in the majority of patients in all age groups and regardless of the color of the birthmark. All anatomic areas and all ethnic groups responded to treatment with varying degrees of success. A range of up to eight treatments was required to achieve resolution. Scarring was an infrequent complication (1.1 percent) of treatment. Hypopigmentation was seen in 3.2 percent of treated patients. The pulsed-dye laser (585 nm) offers promise to patients of all ages and hope to those who previously were not candidates for laser therapy.

Tubed, folded radial forearm free flap for pharyngeal reconstruction and voice rehabilitation.

Reconstruction after total laryngectomy ideally includes restoration of voice with protected swallowing. Local flaps and tracheo-esophageal puncture with a prosthesis are widely used to accomplish this. Persistent problems, perhaps inherent to this solution, have led to the recent use of a tubed, folded radial forearm free flap for postlaryngectomy reconstruction. This flap has produced a good voice with low phonation pressures and minimal aspiration in 7 patients. A new configuration for this flap is described and 3 patients reported. Our flap's advantages include a simplified pedicle path, ease of construction, remote microanastomosis, and safer revision. Both patients with surviving flaps rapidly developed a good voice after reconstruction. Mild aspiration in 1 delayed oral intake and forced a successful revision. Our reconfigured flap may have some technical advantages, survives to length, and restores a good voice without significant aspiration. This and its simple care make it popular with patients. Development of this flap holds promise of more complete reconstruction after total laryngectomy.

"Off-the-shelf" techniques for continuous tissue expansion.

Since modern tissue expansion was introduced in 1976, it has proved to be a safe and effective technique for obtaining extra tissue where traditionally distant flaps and grafts had been used. However, the lengthy expansion times and prolonged gross deformity of conventional expansion protocols have often deterred both physician and patient from choosing this reconstructive option. Over the past decade, attempts to shorten the total expansion time have centered around decreasing the time intervals between injections. Recently, researchers at Washington University have developed the technique of continuous tissue expansion (CTE), using a custom-designed, computerized pump. With CTE, expansion times have been shortened from 2 weeks to 3 days. At our institution, we have demonstrated that CTE can be safely and economically performed with the use of equipment already existent in most medical centers. We describe the equipment and technique and present two cases of successful clinical application of CTE.

Decreasing the density of dark radiographs--a lost art.

The purpose of this paper is to describe a procedure that appears to have been lost with time and that reduces excess density [immaterial of the cause] on radiographs. This results in radiographs of greatly improved diagnostic quality. This procedure results in avoiding retakes resulting in a lower radiation dose to the patient and a saving of time. This procedure should not be considered as a substitute for poor radiological or processing techniques.