The article elucidates the management of a case of severe form of grade III hypertelorism with an intercanthal distance of 61 mm in a 4-year-old child. The management was especially challenging because of the patient's young age, degree of hypertelorism, wide cleft and simultaneous presence of 2 big (sincipital & basal) encephaloceles and a lipoma in the midline. This paper attempts to describe the attempted surgery, postoperative course and the learnings derived from its management to probably create a road-map for surgeons faced with such a challenge in future.
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