Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Clinical Trial
. 2009 Feb;123(2):661-669.
doi: 10.1097/PRS.0b013e3181956633.

Correction of frontonasoethmoidal encephalocele: the HULA procedure

Affiliations
Clinical Trial

Correction of frontonasoethmoidal encephalocele: the HULA procedure

Anand Kumar et al. Plast Reconstr Surg. 2009 Feb.

Abstract

Background: The frontonasoethmoidal encephalomeningocele deformity involves central herniation of a glial mass that "pushes outward" and deforms the medial orbit, medial canthus, nasomaxillary process, and nasal structures without resulting in hypertelorbitism. The authors studied a modification of the "Chula" repair, called the HULA procedure (H = hard-tissue sealant, U = undermine and excise encephalocele, L = lower supraorbital bar, A = augment nasal dorsum), which provided complete correction of the midline hard and soft-tissue structures using an intracranial and extracranial approach.

Methods: Filipino patients with frontonasoethmoidal encephalomeningoceles were treated by a civilian/military humanitarian team at Tripler Army Hospital (n = 12). Operative technique followed the four steps of the HULA frontoethmoidal encephalocele procedure. Postoperative and follow-up assessments were based on examination, photographic images, computed tomography scans, parental surveys, Whitaker score, and developmental testing.

Results: Patient ages ranged from 5 to 12 years; 67 percent were female and 33 percent male. Sixty-seven percent required excisions of poor-quality, hyperpigmented skin along with the large glial mass; the other 33 percent had a "closed" resection of the smaller mass through a gingivobuccal sulcus incision. No patients manifested cerebrospinal fluid leaks, infection, or elevated intracranial pressures postoperatively. Skeletal correction showed improved medial orbit distance, with a mean correction of 14 mm (42 percent). Whitaker score was 1.3 (no or minor soft-tissue revision necessary). Parental survey showed a high degree of satisfaction with the aesthetic and functional outcomes. Follow-up developmental tests showed normal global evaluations for all but one child with normal memory and attention skills.

Conclusion: The authors' outcomes demonstrated that the HULA technique was a safe and effective approach for the complete correction of frontonasoethmoidal encephalomeningoceles.

PubMed Disclaimer

Comment in

References

    1. Stricker M, van der Meulen J, Mazzola R. Craniofacial Malformations. New York: Churchill Livingstone; 1990.
    1. Suwanwela C. Geographic distribution of fronto-ethmoidal encephalomeningocele. Br J Prev Soc Med. 1972;26:193–198.
    1. David DJ. Cephaloceles: Classification, pathology, and management–-A review. J Craniofac Surg. 1993;4:192–202.
    1. Yokota A, Matsukado Y, Fuwa I, Moroki K, Nagahiro S. Anterior basal encephalocele of the neonatal and infantile period. Neurosurgery 1986;19:468–478.
    1. Rojvachiranonda N, David DJ, Moore MH, Cole J. Frontoethmoidal encephalomeningocele: New morphological findings and a new classification. J Craniofac Surg. 2003;14:847–858.

Publication types

LinkOut - more resources