title: Fibrous dysplasia: an overview of disease process, indications for surgical management, and a case report.
abstract: BACKGROUND
  First described by Von Recklinghausen in 1891, fibrous dysplasia is a developmental defect of osseous tissue such that bone is produced with an abnormally thin cortex and marrow is replaced with fibrous tissue that demonstrates characteristic ground-glass appearance on x-ray examination. The underlying defect in fibrous dysplasia is a mutation of the GNAS1 gene, which leads to constitutive activation of gene products that preclude the maturation of osteoprogenitor cells and lead to development of abnormal bone matrix, trabeculae, and collagen, produced by undifferentiated mesenchymal cells. There exists a mainly self-limiting form of fibrous dysplasia classified as monostotic, which is characterized by dysplastic bone in a single location that remains relatively stable throughout life and a polyostotic form, which can exhibit aggressive growth placing adjacent structures at risk for compressive sequelae.
  
  
  METHODS
  We present the surgical management of an unusual case of monostotic fibrous dysplasia, which exhibited aggressive growth with mass effect, and late presentation, both uncharacteristic features for the monostotic form. The authors also performed a comprehensive review of the literature and discuss the disease process, management options, and indications for surgical treatment.
  
  
  RESULTS
  An overview of the disease process and management options is presented. The authors also present details of reconstruction in an unusual form of symptomatic monostotic fibrous dysplasia.
  
  
  CONCLUSIONS
  Conservative management is usually the mainstay of therapy in asymptomatic cases of fibrous dysplasia. In patients fulfilling criteria for surgical management, craniofacial reconstruction offers a viable option in the surgeon's armamentarium, providing good functional and cosmetic outcomes.
authors.affiliation: Division of Plastic Surgery, Albany Medical Center, Albany, NY.
authors.forename: Oluwaseun A
authors.initials: OA
authors.lastname: Adetayo
authors.affiliation: Department of Plastic Surgery, Loma Linda University Medical Center, Loma Linda, CA.
authors.forename: Samuel E
authors.initials: SE
authors.lastname: Salcedo
authors.affiliation: Albany Medical College, Albany, NY.
authors.forename: Vedant
authors.initials: V
authors.lastname: Borad
authors.affiliation: Department of Plastic Surgery, Loma Linda University Medical Center, Loma Linda, CA.
authors.forename: Sara S
authors.initials: SS
authors.lastname: Richards
authors.affiliation: Department of Plastic Surgery, Loma Linda University Medical Center, Loma Linda, CA.
authors.forename: Adrienne D
authors.initials: AD
authors.lastname: Workman
authors.affiliation: Department of Plastic Surgery, Loma Linda University Medical Center, Loma Linda, CA.
authors.forename: Andrea O
authors.initials: AO
authors.lastname: Ray
keywords: PEEK implant; craniofacial fibrous dysplasia; craniofacial reconstruction; fibrous dysplasia; von Recklinghausen
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