Rare Craniofacial Clefts and Encephalomeningoceles—Clinical Findings and Surgical Management under Conditions of Charity Missions

Purpose: The wide variation of craniofacial clefts and their complexity as well as the rarity of these conditions make classification difficult and require adjusted surgical strategies. For surgical treatment among the different structures involved in the cleft formation, the orbit and the cranial base require special consideration. In general, surgical treatment of rare facial clefts is a multistep procedure in almost all cases. This session reviews our experience in surgical management of craniofacial clefts under Third-World conditions applied during 18 charity missions in Africa, Asia, and Central America.

Method: Thirty children (11 female, 19 male) of a total of 654 patients treated with a cleft lip and palate deformity suffered from rare complex facial clefts. Among these, in 6 patients the orbit (Tessier Nos. 4, 5, 11, and 12) and in 12 patients the neurocranium (Tessier Nos. 11, 12, and 14) were involved in the cleft formation, causing encephalomeningoceles at different locations. Due to the special situation, surgical treatment was always performed as a one-step procedure. Surgical treatment focused on closure of the bony gaps to avoid a relapse of the encephalomeningoceles after their removal. Autologous bone grafts from the hip region were used and a plaster splint was applied for 3 weeks to avoid development of a cerebrospinal fluid fistula. In order to deal with soft-tissue deficiency especially in the periorbital region, cheek rotation flaps were performed to improve the eyelid function.

Results: No severe complications occurred after surgery in these patients. Two out of 12 patients developed a local wound infection which was successfully treated using oral antibiotics. Because the plaster splint was removed earlier than 3 weeks, 1 patient developed a cerebrospinal fluid fistula and 1 a relapse of a minor meningocele. Both could be managed conservatively.

Conclusion: The session focuses on the clinical findings, preoperative diagnostics, and classification of rare craniofacial cleft cases. The one-step surgical procedures resulted in a distinct functional improvement even without major craniofacial surgery under conditions of charity missions. The special surgical management allowed final treatment of the encephalomeningoceles and an improvement of function and aesthetics.