Fibrous Dysplasia is a nonneoplastic developmental bone disease characterized by a progressive replacement of normal bone with fibro-osseus connective tissue. Up to 80–85 percent of cases correspond to the monostotic type, with craniofacial involvement in 10–27 percent of them (50–100 percent in the polyostotic). Facial swelling and asymmetry are the most common clinical signs. Other manifestations such as nasal obstruction, sinusitis, hearing loss, headache, dystopia, diplopia, dysesthesia, proptosis and loss of vision might be present. Its onset usually occurs during puberty and growth tends to stop in adolescence, but there are some cases of later onset and continuous growth reported.
If treatment is necessary, principal therapy for Fibrous Dysplasia is surgical. Primary treatments include complete resection followed by immediate reconstruction with autogenous bone graft or three-dimensional models, or conservative therapy (curettage, contouring or remodelling) in mildly deformed patients. Radiation therapy is ineffective and increases the incidence of malignant degeneration. No medical treatment arrests the progression of the illness.
We present the case of a 47-year-old male who consulted for progressive malar swelling and facial asymmetry with previous history of ipsilateral hemifacial trauma seven years before. We performed a malar osteotomy through an extended hemicoronal and subcilliary approach, intramedullar curettage and surface three-dimensional modelling of the explanted bone and posterior osteosynthesis to its original location. Aesthetic result was deemed adequate and patient was satisfied with its outcome.
We discuss current surgical techniques and outcomes for craniofacial fibrous dysplasia and describe current controversia among conservative versus radical treatment.
Conflict of interest: None declared.