The Ophthalmology Department,  Universiti Malaysia Sarawak (UNIMAS), Kuching, Sarawak.
The Ophthalmology Department, Sarawak General Hospital, Kuching, Sarawak, East Malaysia.

Case 24

by Dr.Chua

This 4-month-old boy was seen by the ENT team of the Sarawak General Hospital, Kuching during a camp trip to a border village near Indonesia. The swelling has been present since birth and has a flatulent feel. The swelling showed transillumination. Examination of the eye appears normal except for a slight restriction of right adduction.


Figure 1. A large cystic swelling arising from the right medial canthus causing distortion

of the right medial canthus and right nostril.


Figure 2. Transillumination of the swelling shown with a torchlight.



The CT scan and bony reconstruction are as shown below.


Figure 3. CT bony reconstruction showing a defect in the floor at the right side of the anterior

cranial fossa at the junction of the frontal, ethmoid, lacrimal, maxillary and nasal bone.


Figure 4. CT scan shows herniation of part of the frontal lobe and CSF through the defect

into a subcutaneous pouch There is right subdural collection at the fronto-temporal-parietal

region. There is a smal midline shift.


a. What is the diagnosis?


b. How can the medial canthus be reconstructed after the neurosurgeon and ENT surgeons have replaced the brain and close the defects?


Case of the week