Frontal encephaloceles are common in Papua New Guinea (PNG). Seventeen cases collected over 7 years are reported. Eleven frontal (sincipital) encephaloceles were repaired successfully via an extracranial approach. One of these patients with a frontonasal encephalocele developed a recurrence following the extracranial approach, which was subsequently repaired intracranially. Three patients with small naso-ethmoidal encephaloceles were repaired intracranially via an extradural approach. The other three cases have not yet had surgical correction. Complex craniofacial surgery which corrects hypertelorism as well as the encephalocele is unavailable in the developing world. For the general surgeon in the developing world, the extracranial approach is recommended for the frontonasal encephaloceles, and the intracranial approach for the naso-ethmoidal and naso-orbital encephaloceles. Hydrocephalus and epilepsy have not developed in the patients.

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Fifty-five double paddled flaps and five single paddled flaps were used to reconstruct large surgical defects in the oral cavity. There were no complications in 38 cases. Two patients died, one from diabetic ketoacidosis and the other after discharge with a possible pulmonary embolus. One flap necrosed completely due to technical error and required a latissimus dorsi flap. The most frequent complication was intra-oral dehiscence in 12 patients, six of whom developed oral fistula. Following debridement the wounds healed spontaneously without further reconstructive surgery. In the developing world the double paddled pectoralis major flap allows a one stage operation that provides bulk for large defects in the cheek with two epithelial surfaces and the donor site can be concealed by clothes. Oral feeds can normally be started from the third day and this is particularly important where sophisticated nutritional support is not available.