Craniomaxillofacial Fibrous Dysplasia: Conservative Treatment or Radical Surgery? A Retrospective Study on 68 Patients

Abstract

In most cases of monostotic or monofocal fibrous dysplasia of the craniofacial region, modern surgical techniques allow an aggressive but definitive treatment with good functional and aesthetic results. The authors perform radical treatment even in cases involving the maxilla and mandible, and prefer a conservative approach only in polyostotic cases and McCune-Albright syndrome.

Prognosis for craniofacial fibrous dysplasia after incomplete resection: age and serum alkaline phosphatase

“…The optimum treatment for craniofacial FD has been controversial for a long time 18 . Recent advances in craniofacial surgical techniques have led to complete resection and autologous bone graft becoming an ideal treatment modality 12,15 .…”

“…In general, the pathological process of craniofacial FD begins in childhood and progresses through puberty and adolescence 15,18 . The progression usually stops after adolescence 1 .…”

“…The surgical treatment of craniofacial FD consists of conservative shaving (contouring), which may be repeated, or complete resection of the dysplastic bone followed by reconstruction using autologous bone 3,18 . In the fronto-orbital, zygomatic and upper maxillary areas, total excision and immediate reconstruction produce good functional and esthetic results 11 .…”

“…The surgical approach and complete resection in the base of the skull are limited and difficult due to sphenoid or ethmoid bone invasion 4 . The timing and extent of surgery is controversial, especially in children with craniofacial FD who have thriving bone metabolism 18 . It is important to observe the progress and regrowth of remnant FD in patients who undergo incomplete resection, but there is no objective and simple method to predict clinical results and progression or regrowth.…”

GNAS mutational analysis in differentiating fibrous dysplasia and ossifying fibroma of the jaw

“…5 No bone can be spared. 6 According to Hart et al's report, 7 90% of the total body disease skeletal burden is established by age 15 years, and most of the monostotic fibrous dysplasia tend to stop growing when skeletal maturity has been attained; 1 thus, it is best to perform bone contouring subsequent to growth arrest of the lesion. 8 Differential diagnosis of fibrous dysplasia and ossifying fibroma is of great importance for their treatment and prognosis.…”