title: Strategies for the Optimal Individualized Surgical Management of Craniofacial Fibrous Dysplasia.
abstract: BACKGROUND
  The surgical management of craniofacial fibrous dysplasia is controversial. The purpose of this study was to report the surgical outcomes of individualized management of craniofacial fibrous dysplasia of a single institution.
  
  
  METHODS
  Data from patients (n = 20) with craniofacial fibrous dysplasia, who were surgically treated between 2007 and 2014, were analyzed. Surgical approach (radical or conservative surgery) was individualized according to age, craniofacial anatomical site (zones I to IV of Chen and Noordhoff), functional issues, aesthetic impairment, patients/parents' preferences, and surgical team experience. The surgical outcomes (radical surgery group versus conservative surgery group) were compared based on the age at the time of the procedure, the length of hospital stay, reoperation, recurrence and complication rates, and the Whitaker grading system.
  
  
  RESULTS
  Significant (all P < 0.05) differences were observed in patients with craniofacial fibrous dysplasia who were treated with radical excision (65%) compared with those treated with limited reduction burring (35%), according to age (19.22 years versus 12.57 years), the length of hospital stay (3.56 days versus 1.29 days), recurrence (15% versus 71%), and number of subsequent procedures (1 intervention versus 2.4 interventions), respectively. The radical surgery group presented a significantly (P < 0.05) lower initial Whitaker outcome score than the conservative surgery group (1.89 and 2.57, respectively). Similar (all P > 0.05) final Whitaker outcome scores (1.56 versus 1.71) and surgical complication rates (11% versus 14%) were recorded between the treatment groups.
  
  
  CONCLUSIONS
  Based on clinical experience and surgical outcomes presented in this study, the surgical approach of craniofacial fibrous dysplasia should be tailored to individual patient's needs.
authors.affiliation: From the *Institute of Plastic and Craniofacial Surgery, SOBRAPAR Hospital, Campinas; and †Division of Pediatric Neurosurgery, Department of Neurology, School of Medical Sciences, State University of Campinas (UNICAMP), Campinas, São Paulo, Brazil.
authors.forename: Rafael
authors.initials: R
authors.lastname: Denadai
authors.forename: Cesar Augusto
authors.initials: CA
authors.lastname: Raposo-Amaral
authors.forename: Frederico Figueiredo
authors.initials: FF
authors.lastname: Marques
authors.forename: Enrico
authors.initials: E
authors.lastname: Ghizoni
authors.forename: Celso Luiz
authors.initials: CL
authors.lastname: Buzzo
authors.forename: Cassio Eduardo
authors.initials: CE
authors.lastname: Raposo-Amaral
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D005147:Facial Bones / Q000601:surgery*; D005260:Female; D005359:Fibrous Dysplasia, Polyostotic / Q000601:surgery*; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D019637:Orthopedic Procedures / Q000379:methods*; D012189:Retrospective Studies; D012886:Skull / Q000601:surgery*; D016896:Treatment Outcome; D055815:Young Adult