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THE CRANIOFACIAL Center:
Advances in the Treatment of Facial Deformities...page 2
Larry A. Sargent, M.D.

eye was completely obscured. The distal half of the nose was flattened and the medial canthi widely separated. A CT scan confirmed the mass to be an encephalocele with a large defect located at the nasofrontal suture. The communicating nasofrontal encephalocele caused a marked widening of the medial orbital walls.

figure 1.

Figure 1. (Left) Photograph of the patient at 1 week of age showing large nasofrontal encephalocele. (Right) Postoperative photographs of the patient eight months after definitive one-stage reconstruction (case 1).

figure 2.

Figure 2. The nasofrontal encephalocele bone defect is shown with osteotomies for mobilization of the medial orbital walls illustrated. The orbital walls are centrally mobilized and then stabilized, and the remaining defects bone grafted (case 1).

An intracranial approach was used to excise the encephalocele and repair the defect in the dura; osteotomies were performed on the medial orbital walls with central mobilization to correct the orbital hypertelorism (Fig. 2). The nasal bones and defects were reconstructed with bone grafts. The postoperative course was uneventful. At one-year follow-up examination, the patient has maintained the anatomical correction (Fig. 1). Case 2. A 12 year old girl with facial features characteristic of Crouzon's disease (Fig. 3) had severe midface hypoplasia and retrusion with a class III malocclusion. The patient also had a moderate degree of orbital hypertelorism. A facial bipartition procedure was performed to correct the orbital hypertelorism and midface retrusion in one operation (Fig. 4). The improvement in profile is seen after orbital-maxillary advancement with forehead remodeling (Fig. 3).

figure 3.

figure 4.

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The Tennessee Craniofacial Center, part of the Erlanger Health System, is located in Chattanooga, Tennessee. The Center, led Larry A. Sargent, M.D., specializes in the evaluation and treatment of patients of all ages with craniofacial deformities. Location: 975 East Third Street. Chattanooga, Tennessee 37403
Phone: 423-778-9192 or 800-418-3223 Fax: 423-778-8172
Internet: www.craniofacialcenter.com Copyright ©1997, 2000, Erlanger Health Systems