Case 24 Answers
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?
1. Suwanwela C, Suwanwela N. A morphological classification of sincipital encephalomeningoceles. J Neurosurg 1972;36:201–211.
2. David DJ, Sheffield L, Simpson D, White J. Fronto-ethmoidal meningo-encephaloceles: morphology and treatment. Br J Plast Surg 1984;37:271–284.
3. Surgery of the Eyelid, Orbit, and Lacrimal System : Volume 1 - 3 (American Academy of Ophthalmology Monograph Series) (Paperback).