involvements of orbit are extremely rare . in the most of reported orbital growing fracture , defect in such cases however , such fracture also extending through orbit and frontal region causing forehead swelling and proptosis is not reported previously . the pathophysiology of growing skull fracture is still debated . a dural tear underlying a skull fracture suri and mahapatra observed the presence of orbital fracture and associated dural tear was observed in both the cases . suri and mahapatra also concluded frontonasal brain injury play an important role in the growing skull fracture pathogenesis . a 4-year - old boy presented with progressive swelling over the right frontal region and right upper eyelid . he has a history of fall from bed at the age of 6 months . since then the swelling was noticed . the bony defect was palpable around the swelling which was irregular and extended down to the roof of the orbit . although there was ptosis in the right eye , the vision was intact in his right eye . all this was suggestive of a growing skull fracture of the right fonto - orbital region . computed tomography ( ct ) scan showed a large bony defect in the right frontal region extending to the roof of orbit [ figure 1a and b ] with underlying gliotic area without any evidence of hydrocephalus . the intraoperative findings revealed a large bony defect of 12 cm  8 cm with anteroposterior diameter being the longer . the exposed brain was gliosed and extending through the fracture to the right frontal sinus and adjoining right orbital roof . a large craniotomy was made , and the defect was closed with split thickness bone graft harvested from the skull adjacent craniotomy [ figure 2a and b ] after primary watertight dural closure . ( b ) computed tomography showing large defect of frontal bone causing forehead swelling ( a ) postoperative computed tomography showing large defect of orbital roof reconstructed using autologous bone graft . ( b ) postoperative computed tomography showing repair of frontal bone reconstructed using autologous bone graft the majority of these lesions occur in children , and the parietal skull is the most common location . however , delayed presentation of this with a traumatic encephalocele is uncommon . it is commonly found in adult patients following orbital roof fracture with underlying frontal contusion . pediatric patients with orbital roof fractures that exhibit more than 2 mm diastasis and associated frontal cerebral contusion may be at greater risk for developing intraorbital encephalocele . the defect in such cases in usually small and often limited to the orbital roof . repair of the orbital roof is the key step in the management of such cases , and the repair should be done in a rigid manner to avoid the transmission of intracranial pressure into the orbit . in the current case , there was a large defect which involved the right frontal region and also extended downward to the roof of the orbit and frontal sinus and posteriorly involved the optic canal with brain matter herniating through defect . moreover , in spite of this large defect , the patient had no visual acuity reduction . the children present with a tender , pulsatile mass , or can be incidental picked up while adult counterpart present with nonpulsatile and nontender swelling having history of the previous head injury . when the orbital roof manifestation include diplopia , proptosis , and restriction of extraocular movements . the type i being those containing herniation of arachnoid tissue only and type ii also additionally containing brain matter herniation and finally type iii is associated the presence of porencepahalic cyst of underlying brain . these stages correspond to leptomeningeal cyst represented by stage i and encephalocele as type ii respectively . for clinical diagnosis in addition to clinical history , examination , the ct provides excellent view bony defects in the orbital roof and three dimensional reconstruction . the magnetic resonance imaging shows the intraorbital extension and additional associated intracranial porencephalic cyst , gliosis and helpful in distinguishing the contents as herniated brain parenchyma or csf or rarely prolapsing venous sinuses . management of such cases is challenging , and surgical repair is considered as mainstay of treatment ; however , cases of spontaneous stabilization are reported in the literature . however , aim of the surgical repair to prevent the development of rupture , visual disturbance , cosmetic deformity . authors recommended child developing ocular symptoms , who sustained a head injury several months or years before should be suspected for possible development of the growing fractures of the orbital roof . in every child presenting with swelling of forehead and orbit with history of head injury even after many years after head injury , possibility of orbital growing skull fracture should always be considered and early surgical management can yield good cosmesis and visual outcome . there are no conflicts of interest .
fracture of the anterior skull base can occur following head injury . growing skull fracture is usually observed in children under age of 3-years . 
 it commonly involves frontal and parietal regions . however , orbit involvement is extremely uncommon . 
 authors report a case of giant orbital encephalocele with a forehead disfiguring swelling in a 4-years boy , who sustained head injury about 3 years back . 
 however , such delayed presentation of traumatic encephalocele is extremely uncommon and represents the first case in the western literature , who had a successful postoperative outcome .