Posttraumatic Encephalocele as a Rare but Relevant Complication of Frontobasal Fractures

Background: Frontobasal fractures are often complicated injuries that require an interdisciplinary treatment. Due to the complex anatomy in this area, it can cause multiple problems, such as damage to the visual and olfactory functions, vascular lesions, cerebrospinal fluid fistulas, and encephaloceles, followed by meningitis.

Case Report: We report a 9-year-old boy with a frontobasal fracture after a fall from a jungle gym. The CT scan showed a nondislocated fracture of the orbita roof and the frontal sinus with hematosinus and intracranial air. Furthermore, there was involvement of the right orbita wall and a bleeding in the ethmoidal cells on the right side. The fracture was treated conservatively. After 5 years, the patient went to the doctor because of intermittent rhinorrhea from the right nostril. The MRI scan showed a huge encephalocele of the sinus rectus into the ethmoidal cells and the right side of nose. The injury was treated by a neurosurgical operation without complications. The further course of the procedure was without any complications like meningitis or epilepsy.

Discussion: Often the late complications of the frontobasal fractures are underestimated, especially cerebrospinal fluid fistulas and encephaloceles which can occur with a latency of several years. So it seems to be very important to get a detailed diagnostic including a CT and a MRI scan and to discuss the indication for an operation carefully and interdisciplinary. Furthermore, a follow-up is important to prevent late complications.