Frontoethmoidal meningoencephalocele: challenges and the Tawanchai center's long-term integrated management

The challenges for the management of patients with fronto-ethmoidal meningoencephalocele (FEEM) include: classification, assessment and analysis of the deformities, craniofacial reconstruction and long-term management.

To present experience of the Tawanchai Craniofacial Center of long-term integrated management and outcome of patients with FEEM.

Medical records were reviewed of 32 patients with FEEM treated by the authors between 1993 and 2011 at the Tawanchai Center, Srinagarind Hospital; the referral center for Northeast Thailand.

Geographic Information System (GIS) analysis was used to examine the incidence and pattern of referrals to our Center. Most of the patients had the nasoethmoidal type (12 patients) followed by the combined naso-ethmoidal/-orbital type (8 patients). The surgical procedures included craniofacial reconstruction with medial canthopexy, orbital translocation, external repair and nasal reconstruction. Ultimately, most patients were satisfied with their remedied facial appearance. The Center's interdisciplinary protocol for the care of patients with FEEM was established.

Experience demonstrated that a craniofacial center with interdisciplinary management was necessary to provide proper, early and longitudinal care and to achieve optimum outcomes for the patients with FEEM. In each case, the surgical outcome depended on the severity and classification of the deformities and the extent of associated brain anomalies. Nevertheless, in every case the final measurement should be done at the age of complete skeletal maturity. Funding from a number of sources, including the Foundation, is needed to ensure patients' access to treatment and follow-up and for the Craniofacial Cleft Center to improve the quality of treatment and programing.