Meningoencephalocele: a late complication of Le Fort III midfacial advancement in a patient with Crouzon syndrome

Case report

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  • 1 Departments of Plastic and Oral Surgery, and
  • 2 Neurosurgery, Children's Hospital Boston, Harvard Medical School, Boston, Massachusetts
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Complications of Le Fort III midfacial advancement include CSF rhinorrhea, meningitis, and ocular and cerebral injury. This report reviews the anatomy of the Le Fort III osteotomies and their relevance to the unusual complication of meningoencephalocele.

In this report, a young male patient with Crouzon syndrome underwent subcranial midfacial advancement at the age of 10 years for obstructive sleep apnea and ocular exposure. He presented 4 years later complaining of nasal obstruction. On physical examination, a mucous-covered mass was noted in the left upper nasal vault medial to the turbinates. Computed tomography scanning and MR imaging confirmed the diagnosis of frontoethmoidal meningoencephalocele. Repair of the meningoencephalocele was accomplished using a combined neurosurgery and plastic surgery approach.

Meningoencephalocele is a rare complication of subcranial midfacial advancement. The abnormal anatomy of the anterior cranial base in patients with syndromic craniosynostosis places them at greater risk for fracture of the cribriform plate and dural tears during this procedure. Unrecognized dural injury is the etiology of this complication in this young patient; however, elevated intracranial pressure may have been a confounding factor. Attention to the anatomy of the anterior cranial base, as seen on sagittal CT images, will aid in preventing this complication.

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Contributor Notes

Address correspondence to: Alexander E. Ropper, M.D., Department of Neurosurgery, Children's Hospital Boston, 300 Longwood Avenue, Hunnewell 2, Boston, Massachusetts 02115. email: aeropper@partners.org.
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