Neurofibromatosis type 1 of the head and neck: dilemmas in management

Neurofibromatosis type 1 (NF 1) or Von Recklinghausen's disease is an autos omal dominant condition characterized by multiple skin cafe-au-lait lesions and multiple neurofibromas. In the head and neck neurofibromas have a pred ilection to arise in th deep planes of the neck. Surgical management is nea rly always required for functional or cosmetic reasons or to exclude the po ssibility of malignant transformation. We present four cases of neurofibrom a of the head and neck and illustrate the difficulties inherent in managing this condition, particularly the age range in which it may occur, the risk of malignant transformation, the possibility of abnormal bleeding and the morbidity that may be associated with the surgical resection. The role of m agnetic resonance (MR) scan in the assessment and monitoring of these lesio ns is highlighted. We also report a unique association of a pharyngeal pouc h with NF 1 in a young (25-year-old) patient.