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Management of Aggressive Midface and Orbital Fibrous Dysplasia
John L. Frodel, MD;
Gerry Funk, MD;
Jay Boyle, MD;
Mark Richardson, MD
Arch Facial Plast Surg. 2000;2:187-195.
Objective To discuss cosmetic and functional implications in the evaluation and treatment planning of large, aggressive midfacial fibrous dysplasias.
Patients and Methods Eight patients (aged 2-38 years) with large fibrous dysplasias of the maxilla, zygomatic, and ethmoid bones requiring varying degrees of intervention and reconstruction were retrospectively reviewed. Patients with smaller lesions of these regions not requiring resection and reconstruction, as well those requiring sinus surgery alone were excluded from this review.
Results All fibrous dysplasias in this review were monostotic, 6 originating in the maxilla, 1 in the zygoma, and 1 in the ethmoid. Five lesions (4 maxillary, 1 zygomatic) caused cosmetic deformity without functional deficits and required resection and/or contouring only with minimal reconstruction. The remaining lesions were invasive such that function of the eye and/or dentition was affected. These lesions were treated by aggressive resection and various degrees of reconstruction to optimize function.
Conclusions While fibrous dyplasia is classified as a benign process, local expansion can cause significant functional and aesthetic deformities. Each lesion should be thoroughly evaluated and, when vital structures are involved or threatened, total or subtotal resection should be considered. A variety of options should be available to the surgeon for definitive primary reconstruction.
From the Division of Otolaryngology, Plastic and Reconstructive Surgery, Department of Surgery, University of New Mexico Health Sciences Center, Albuquerque (Dr Frodel); Department of Otolaryngology—Head and Neck Surgery, University of Iowa Hospitals and Clinics, Iowa City (Dr Funk); Head and Neck Surgery Service, Sloan-Kettering Memorial Cancer Center, New York, NY (Dr Boyle); and Department of Otolaryngology—Head and Neck Surgery, Johns Hopkins Medical Institutions, Baltimore, Md (Dr Richardson). The authors have no commercial, proprietary, or financial interests in the technique described in this article.
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