Frontoethmoidal Meningoencephaloceles: Appraisal of a Craniofacial Surgical 12 Years Teaching Program in Cambodia

Object. Fronto-ethmoidal meningoencephaloceles (fMEC), a craniofacial disease affecting mainly poor children in Cambodia was not managed by local surgeons early in the 2000’s. We developed a teaching program to allow some local surgeons to manage by themselves this disease. The topic of this paper was to evaluate the results of the fMEC children operated on by Khmer surgeons alone and discuss many aspects of surgical teaching in a low-income country.
Methods. In the first years (2004-2009) of this teaching program organized in the “Children Surgical Center” in Phnom Penh, Khmer surgeons were taught how to manage this malformation always with a visiting surgical team. In the second part (2010-2016), they worked alone and results (cosmetic and social results through a questionnaire) were evaluated jointly during several visiting missions. During this last period, 100 patients (mean age: 12 years old) with fMEC were operated on exclusively by Khmer surgeons by a combined bicoronal and transfacial approach in most cases with limited surgical materials and equipment.
Results. Organizing the postoperative follow-up of these low-income patients was probably the most challenging part of this teaching program. Nine patients were lost from follow-up. In other cases, cosmetic results were judged by the surgeons as worse in 1 case, poor in 12, average in 27, and good in 51 cases. Patients and parents tended to have an overall better opinion about surgical results than surgeons. Questionnaire results confirmed that fMEC has important social and educational consequences for the affected children; unfortunately, these consequences could only be partially improved by fMEC correction. Postoperative complications arose in 20 patients, the most common postoperative issues being temporary CSF leaks. At the end of this program, the local team was able to operate patients affected with fMEC in their own country without foreign assistance and through years’ greater volumes were achieved.
Conclusions. We believe that better achievements in humanitarian teaching programs require to focus on a (or at least on very few) selected disease in patients with good life-expectancy once the disease treated. Program evaluation is also fundamental and necessitate the building of a database for patient follow up. Finally, both foreign and local surgeons should understand that they would be involved in protracted efforts over years to achieve the initial aims.