Extensive fibrous dysplasia into frontocalvarial and frontobasal region: Case report

Abstract

Fibrous dysplasia can involve the frontal and sphnoidal bones eventually leads to distortion of the facial features and skull shape as a result of the proliferation of the thick dense bones. Its etiology is unknown but the pathology involves a replacement of normal bone with a fibro-osseous matrix. Fibrous dysplasia causes cosmetic deformity, orbital displacement with resulting double vision and occasional blindness. The surgical principle involves removing dysplastic bone and replacing it with normal harvested bone. A 38 year-old man who presented with complaints of nasal obstruction, headache and asymmetric facial appearance was admitted to our hospital. His facial deformity progressively worsened and he experienced frequent: episodes of pneumonia and sinusitis. He had consulted an ENT physician thereafter he was referred to our department. His examination revealed hypertelorism, double vision at extreme lateral gaze and left frontal diffuse bony prominence. A cranial CT showed a mass lesion that fills left nasal concha, left medial wall of the maxillary sinus, left sphenoid sinus, and frontoparietal region. He underwent exposure osteotomies of the frontal bones to provide access for frontoethmoidal dysplastic bone removal with drilling to make thin. We have found that this procedure significantly lessens the operative risks, and allows more working space. Another advantage of using this drilling technique is the reduction in operative field and operative time.