Nasopharyngeal encephalocele: report of transcranial and transpalatal repair with a 25-year follow-up.

BACKGROUND: : Encephaloceles are an extension or protrusion of any intracranial matter through a cranial bone defect. The sphenoethmoidal encephalocele is often fatal. For those who survive long enough, expeditious repair is critical. We report a case that was repaired successfully via a combined transcranial and transpalatal approach, and because of successful repair, the patient underwent multiple secondary reconstructions resulting in a 25-year follow-up. CLINICAL REPORT: : A 3960-g, term male infant from a normal gestation was delivered via cesarean delivery for breech position. Initial examination revealed a 2 x 3-cm gray intraoral nasopharyngeal mass with smooth mucosal covering extruding through a midline palatal cleft. At 4 weeks of life, extradural and intradural exploration of the encephalocele was performed via a bifrontal craniotomy. At 15 months of age, the patient underwent median cleft lip repair. At 6 years of age, hypertelorism was corrected by wedge resection of the frontal and nasal bones and medial mobilization of the orbits. Follow-up was continued until 25 years of age, which revealed excellent maintenance of correction. CONCLUSION: : Sphenoethmoidal encephalocele is a rare sporadic congenital cranial floor defect associated with typical facial and cerebral anomalies. Encephaloceles extending into the nasopharynx may cause airway obstruction and feeding difficulty and present a potential pathway for central nervous system infection. Repair of the encephalocele should then be performed as soon as possible. Care of patients with nasopharyngeal encephaloceles requires a lifetime of reconstructive surgery. Care of these patients can be rewarding to both families and surgeons.

Correction of involutional entropion by horizontal tangential wedge excision of the tarsus.

Involutional entropion, a condition in which the lower eyelid margin is rotated inward, occurs often in elderly people. It can result in corneal and conjunctival irritation by the inverted eyelashes. The pathophysiology has been attributed to multiple factors, including attenuation of the tarsal plate with age, enophthalmus occurring with aging, decreased action of the inferior palpebral muscle, and the overridge of the preseptal orbicularis oculi. Many surgical options have been described for the treatment of involutional entropion. We present an innovative surgical procedure for correction of involutional entropion by a horizontal tangential wedge excision of the tarsal plate.