Surgical Treatment of Craniomaxillofacial Fibrous Dysplasia

Abstract

In most patients, a conservative surgery will achieve good functional and aesthetic results. For patients with mild symptoms, the aesthetic effect should be given priority while for the heavier patients the restoration of function and aesthetic effects should all be taken into account.

Strategies for the Optimal Individualized Surgical Management of Craniofacial Fibrous Dysplasia

“…However, as craniofacial fibrous dysplasia has a wide clinical spectrum (the anatomical site involved, the dysplastic bone lesion extension, and the functional issues), the choice of a particular surgical approach should be tailored to the individual clinical presentation. 1,6,7,17,24 We and others 1,6,7,11,24 have supported our therapeutic decisions based on key factors such as age, affected craniofacial bone site, extension of anatomical zone, functional and/or aesthetic issues, occurrence of orbital dystopia, preferences of patients/families, and surgical team experience.…”

“…We have only partially supported our therapeutic approach in Chen and Noordhoff's craniofacial zones. 17 Based on our results and previous data, [1][2][3][4][5][6][7][8][9][10][11][12][13][14][15][16][17]21,[23][24][25]27,28 we have applied the following guidelines while treating patients with craniofacial fibrous dysplasia. Dysplastic bone lesions of the fronto-orbital, zygomatic, maxillary, mandibular, and/or hair-bearing cranium regions (zones I, II, and IV) in adult patients have been radically treated, while skeletally immature patients (<7 years) with no visual impairment and/or other functional issues have been managed conservatively because major osteotomies may jeopardize the development of the dentition and craniofacial growth.…”

“…The conservative surgical intervention (no curative potential) has been recommended by some groups 11,12 who planned subsequent successive interventions until the end of facial growth, considering that repeated conservative procedures might constitute less morbidity than a single radical procedure. On the other hand, other groups 3,4,[8][9][10] have been in favor of the radical surgical intervention (the unique option for eliminating the illness 4,9 ), which permit complete removal of the dysplastic bone lesion with immediate functional and aesthetic recovery.…”

“…We and other groups 7,8,11 evaluated the surgical results with each particular therapeutic approach. The UCLA group 8 achieved similar initial and final (categories II and I, respectively) Whitaker outcome scores 20 with both radical and conservative approaches.…”

“…1,[3][4][5] However, there is no consensus regarding the ideal surgical approach, and distinct therapeutic algorithms have been previously described in the literature. 6,7 Although some craniofacial surgery centers 3,4,[8][9][10] are in favor of radical surgical approaches (radical excision with immediate bone reconstruction), others 11,12 prefer the more conservative surgical approaches (curettage, contouring, and/or remodeling). Additionally, controversies related to the need for prophylactic orbital decompression and the surgical management of skeletally immature patients have been previously reported.…”