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Encephaloceles, while a common entity affecting 1:4000 live births, typically occur in the occipital region. Encephaloceles involving the frontal region comprise only 15% of all cases. Naso-orbital encephaloceles are rarely seen. Our case profiles a child born at term with an atrial septal defect (ASD), micrognathia, cleft lip, and frontonasal as well as bilateral naso-orbital encephaloceles. At birth the encephaloceles were undetected. During the cleft palate pre-operative preparation, the bilateral naso-orbital encephaloceles were diagnosed as dacrocystoceles for which the child underwent surgical repair. Misdiagnosis and loss to follow up lead to delayed surgical treatment until the child was almost two years of age; the right eye was near complete closure due to the increasing size of the encephalocele. This case highlights the importance of meticulous radiologic interpretation of midline nasal masses, as a correct diagnosis impacts clinical management and directs surgical repair.

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Objectives: To evaluate the likelihood of abuse for various fractures, we aimed to compare the prevalence of concomitant suspicious injuries (CSIs) in subjects with fractures presumed to be low risk for abuse to those with non-low-risk fractures (aim 1) and to evaluate the prevalence of low-risk and non-low-risk fractures identified on skeletal survey (SS) (aim 2).Methods: Subjects included toddlers 9 to 23 months of age presenting to a children's hospital system with a fracture and having an SS completed (aim 1) as well as those who had an SS completed for any concern for abuse (aim 2). For aim 1, we performed a 5-year retrospective case-control study. Low-risk fractures were defined as extremity buckle, clavicle, supracondylar, or toddler's fractures. Controls included moderate-and high-risk fracture groups. Groups were compared for the prevalence of CSIs. For aim 2, we described the frequencies of all fracture types identified by SS completed for any concern for abuse over the same period.Results: For aim 1, there were 58 low-risk, 92 moderate-risk, and 8 high-risk fractures. The rates of CSIs were not significantly different between low-and moderate-risk fractures (odds ratio, 0.9; 95% confidence interval, 0.4-2.5), whereas half of high-risk fractures had CSIs. Forty-five subjects had an occult fracture on SS completed for any abuse concern. All low-risk fractures were identified by SS, most commonly buckle fractures (22.2% of cases). Conclusions:Fractures presumed to be low risk for abuse in young, mobile children require consideration of abuse as a cause.