Management of aggressive midface and orbital fibrous dysplasia.
OBJECTIVE
To discuss cosmetic and functional implications in the evaluation and treatment planning of large, aggressive midfacial fibrous dysplasias.


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.
Division of Otolaryngology, Plastic and Reconstructive Surgery, Department of Surgery, 2211 Lomas Blvd NE, ACC Second Floor, University of New Mexico Health Sciences Center, Albuquerque, NM 87131-5341, USA.
J L
JL
Frodel
G
G
Funk
J
J
Boyle
M
M
Richardson
D000293:Adolescent; D000328:Adult; D000465:Algorithms; D002648:Child; D002675:Child, Preschool; D005260:Female; D005357:Fibrous Dysplasia of Bone / Q000601:surgery*; D006801:Humans; D007223:Infant; D008297:Male; D008437:Maxilla / Q000601:surgery; D009915:Orbit / Q000601:surgery; D019651:Plastic Surgery Procedures