Three-year-old Ton Nu Hoang Dung was born in Quang Binh province, Vietnam, with a rare naso-frontal encephalocele. Part of her brain herniated through a gap at the front of the skull into the region between her eyes, pushing the orbits apart (hypertelorism), displacing the eyeballs, and distorting her entire mid-face. Neighbors called her “monster face.” She could see mainly with one eye. Left untreated, the exposed brain tissue and dural defect carried a constant risk of meningitis, further orbital deformity, and irreversible vision loss. Vietnamese hospitals performed earlier operations to reduce some of the mass but could not complete the complex skull-base and facial reconstruction.

Her parents, including mother Hoang Thi Thuy Linh, brought her to Mount Elizabeth Hospital in Singapore. Neurosurgeon Dr. Keith Goh—already known for leading the 2001 separation of Nepalese craniopagus twins Ganga and Jamuna Shrestha—accepted the case. A multidisciplinary team of neurosurgeons, plastic surgeons, ophthalmologists, and neuro-anesthetists planned an 11-hour procedure.

On the morning of the operation the little girl remained lively and talkative in the ward while her parents waited in silence. Surgeons first reduced the herniated brain tissue back into the cranial cavity, sealed the basal skull defect to prevent cerebrospinal-fluid leak and infection, then remodeled the orbital and facial skeleton to restore more normal spacing of the eyes and a harmonious mid-face contour. The operation lasted from late morning until nearly midnight.

The immediate goals were achieved: the brain was protected inside the skull, the risk of meningitis was reduced, and the most severe facial distortion was corrected. Dr. Goh noted that additional staged operations would still be needed to refine the orbits, nose, and remaining skull contour toward roughly 80 percent of a typical appearance, along with ongoing checks of vision, facial growth, and brain development. Later Vietnamese reports described further reconstructive procedures, including replacement of earlier implants with autologous bone. By 2020 Hoang Dung was able to start school.

Fronto-ethmoidal encephaloceles are more common in parts of Southeast Asia than in Western countries. Successful repair requires both watertight dural closure and three-dimensional craniofacial reconstruction—work that few centers can offer. Hoang Dung’s case illustrates how a single marathon operation can convert a life-threatening, socially isolating malformation into a foundation for childhood development, even when several more surgeries still lie ahead.

Sources

• Contemporary reports of the Mount Elizabeth Hospital operation (Straits Times / Reddit archive of the original article, November 2018)
• Vietnamese coverage: VietnamNet, Gia đình & Sức khỏe, Nữ Doanh Nhân (2018–2020 follow-up on subsequent surgeries and school enrollment)
• Background on naso-frontal / fronto-ethmoidal encephalocele and Dr. Keith Goh’s earlier craniofacial work