Assessing Performance in Simulated Cleft Palate Repair Using a Novel Video Recording Setup.

OBJECTIVE: To test the feasibility of implementing a high-fidelity cleft palate simulator during a workshop in Santiago, Chile, using a novel video endoscope to assess technical performance. DESIGN: Sixteen cleft surgeons from South America participated in a 2-day cleft training workshop. All 16 participants performed a simulated repair, and 13 of them performed a second simulated repair. The repairs were recorded using a low-cost video camera and a newly designed camera mouth retractor attachment. Twenty-nine videos were assessed by 3 cleft surgeons using a previously developed cleft palate objective structured assessment of technical skill (CLOSATS with embedded overall score assessment) and global rating scale. The reliability of the ratings and technical performance in relation to minimum acceptable scores and previous experience was assessed. RESULTS: The video setup provided acceptable recording quality for the purpose of assessment. Average intraclass correlation coefficient for the CLOSATS, global, and overall performance score was 0.69, 0.75, and 0.82, respectively. None of the novice surgeons passed the CLOSATS and global score for both sessions. One participant in the intermediate group, and 2 participants in the advanced group passed the CLOSATS and global score for both sessions. There were highly experienced participants who failed to pass the CLOSATS and global score for both sessions. CONCLUSIONS: The cleft palate simulator can be practically implemented with video-recording capability to assess performance in cleft palate repair. This technology may be of assistance in assessing surgical competence in cleft palate repair.

Ganglioneuroma no interior de um névus melanocítico gigante: um mero achado acidental? / Cutaneous ganglioneuroma within giant congenital nevus: mere coincidence?

Ganglioneuromas cutâneos são lesões raramente descritas na literatura médica e, deforma ainda mais especial, em associação com outras lesões. Relatamos o achado de umamassa cervical detectada por exame de ultra-som pré-natal, que regrediu no decorrer dagravidez. Após o nascimento, extensa área pigmentada foi observada na mesma localizaçãoda massa, além de um tumor sólido palpável no seu interior. O diagnóstico diferencialcom outros tumores derivados de células da crista neural é importante, assim como acorrelação entre o névus piloso e o ganglioneuroma cutâneo.

Cutaneous ganglioneuroma have been occasionally reported in the literature. We describea case in which a cervical mass firstly detected by routine prenatal ultrasound examinationregressed throughout the months until delivery. After birth, an extensive area ofpigmentation was found at the same location, with a solid mass was perceptible within.The differential diagnosis between other neural crest tumors should be established, aswell the correlation between congenital nevus and cutaneous ganglioneuroma.

Qual é a profundidade da pigmentação do nevus piloso gigante que acomete o dorso? / Congenital giant nevocellular nevus of the back with worsening deep extension to the fat and fascia?

A presença de pigmentação profunda no nevus piloso gigante dificulta sua ressecção completa e deve ser levada em consideração no plano de tratamento. Um caso clínico no qual a pigmentação foi encontrada atingindo a fáscia muscular levou-nos a avaliar as possibilidades terapêuticas disponíveis. A lesão foi removida cirurgicamente, com comprovação patológica de remoção completa de toda sua extensão na profundidade, com resultado estético-funcional favorável através da utilização de expansores de tecido. Técnicas atuais para a reconstrução cirúrgica após a remoção dos nevos pilosos incluem excisão seriada, enxertia de pele parcial, enxertia de pele total e retalhos cutâneos pré-expandidos. Qualquer que seja o método, a remoção completa do nevus piloso gigante que acomete o dorso é muitas vezes impossível sem mutilação, casos em que a melhor opção é a ressecção parcial da lesão seguida de acompanhamento clínico rigoroso. O avanço nas indicações de alguns tipos de laser tem possibilitado novas perspectivas no tratamento dessas lesões, mas o laser não remove os melanócitos sob a camada dérmica profunda e podem dificultar o monitoramento de malignizações. Atualmente, a cirurgia ainda permanece a forma mais segura de tratamento para o nevus piloso gigante que acomete o dorso.

Giant congenital nevi are melanocytic lesions that cover large areas of the body and are associated with the development of malignant melanoma. Recent numbers showed that the risk of malignancy is lower than previously reported, making the treatment based merely on oncologic anticipation no longer suitable. The presence of deep pigmentation makes certain treatment options not as effective as surgical ablation. A clinical case is presented here to raise treatment options when the deeper location of the pigmentation may alter the surgeon’s approach. The presence of deep pigmentation in a Giant Congenital Nevus makes its complete removal very difficult and should be taken into consideration when planning for treatment. A clinical case in which the pigmented lesion was found to extend deep into the muscle fascia is described. The lesion was surgically removed with an acceptable functional and aesthetic result through the utilization of tissue expansion. Modern techniques for surgical reconstruction after removal of the giant nevus include serial excision, partial skin graft, full- thickness skin graft and the utilization of previously expanded skin flaps. Whatever the method of treatment employed, complete removal might de impossible without mutilation, situation in which it is preferable partial removal followed by close clinical follow-up. The indications for utilization of lasers have opened a horizon of possibilities; however, the laser treatment does not remove pigmented cells located at the level of the deep dermis, and they may difficult the follow- up. The presence of deep pigmentation makes certain treatment options not as effective as surgical ablation.