A new technique for the repair and reconstruction of frontoethmoidal encephalomeningoceles by medial orbital composite-unit translocation

A frontoethmoidal encephalomeningocele is a hemiation of brain and meninges through a congenital bone defect in the skull at the junction of the front al and ethmoidal bones. Between 1992 and 1999, we treated 145 cases of fron toethmoidal encephalomeningocele. Before 1993, the operation was performed in two stages. An intracranial repair by neurosurgeons preceded the externa l extirpation of the mass. In 70 cases that were operated on after 1993, a one-stage closure of the skull defect with a medial orbital composite-unit translocation technique was used. The medial orbital rim on each side, with intact periosteum, medial canthal ligament and lacrimal apparatus, was tra nslocated as a unit to the midline. The advantages of this technique are th at it allows convenient access to resect the herniation mass and close the defect, it restores normal interorbital and intercanthal distances and it e liminates thr need for a transnasal medial canthopexy. Augmentation rhinopl asty can be avoided in most cases by tilting the composite unit with its pr eserved blood supply. (C) 2001 The British Association of Plastic Surgeons.