Correction of large facial encephalocele with bilateral rare craniofacial clefts

Treatment of Tessier number 3, 11 craniofacial clefts represent a surgical challenge with complex bone and soft tissue deficits of the lip, cheek, medial orbit, and forehead. The severity of the presenting defect will ultimately determine the number of reconstructive stages required as well as the timing of each stage. Initial surgery in infancy is aimed at functional correction. We present the case of a patient with an expanding fronto-orbital encephalocele, a right number 3, 11 cleft and a left number 3, 10 cleft. The initial procedure repaired the encephalocele and reconstructed the supraorbital and forehead regions. Subsequent surgeries corrected the bilateral facial clefts with cleft lip repair, rotation of the forehead and nasal unit, cheek advancement, and a lower eyelid transposition flap.