Inferior encephalocele: transpalatal repair using paired costal bone grafts with a 14-year follow-up.

A 2-year-old girl was referred to our hospital because of a pulsating mass in the roof of the mouth. On examination, a mass measuring 4 × 5 cm was found in the roof of the mouth and nose with a secondary palatal cleft. She had hypertelorism, a bifid nose, and a visible cleft over the dorsum and skin of the nose. In 1 stage, the mass was opened, reduced, and repositioned into the cranial cavity, and the defect was repaired with 2 parallel bridges of split costal bone grafts. The bone grafts were placed between 2 layers of soft tissue and the mucosa repaired over it. Palatal cleft was repaired with the Veau-Wardill-Kilner method 1 year later. Fourteen years later, the bifid nose was corrected using a flying-bird incision and a costal cartilage graft for the dorsum of the nose. On follow-up, minimal scar remained on the tip of the nose. There was neither obliteration nor reduction in the size of the bony defect. There were no operative complications, and the shape of the nose improved. The patient and her parents were highly satisfied with the result.